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Hepatitis C Remains Uncommon Among HIV Negative Gay Men

Hepatitis C virus (HCV) infection was uncommon, with a prevalence less than 1%, among more than 2000 gay and bisexual men screened at sexual health clinics in the U.K., according to a study reported in the May 2010 Journal of Infection. This is close to the rate of the general population in England, suggesting that recent outbreaks of acute hepatitis C among men who have sex with men is limited to those with HIV.

Clinicians began reporting outbreaks of apparently sexually transmitted HCV infection among HIV positive men who have sex with men (MSM) in the U.K. around 2000. But few such cases have been identified among HIV negative gay men.

HIV positive people routinely undergo liver function monitoring to detect antiretroviral drug toxicity, which also may reveal viral hepatitis. HIV negative people generally do not receive liver monitoring, leading some experts to suggest that HCV among HIV negative men was not being detected because no one was looking for it.

Although local guidelines recommended HCV testing only for those MSM being screened for sexual transmitted diseases (STDs) who disclosed known risk factors, some urban sexual health clinics started to incorporate unselected HCV screening into their routine practice starting in 2007. Christopher Scott and colleagues reviewed the results of this change.

Results

  • Over 6 months, a total of 3365 MSM attended the included clinics for STD screening, and 2309 (69%) agreed to also be screened for HCV.
  • Among the men who underwent screening, the prevalence of HCV was 0.65% -- similar to the prevalence in the general population within England.

Based on these findings, the study authors wrote, "We conclude that unselected screening of MSM for HCV within our sexual health services is not currently justified."

Researchers in other cities in the UK, Europe, Australia, and U.S. have also not seen unusually high rates of hepatitis C among gay and bisexual men who are not also infected with HIV, even though HIV/HCV coinfection rates are quite high in some areas and appear to be rising. The reasons HIV positive men are so much more susceptible to HCV are not fully understood and require further study.

St. Stephen's Centre, Chelsea & Westminster Hospital, London, UK; Imperial College Healthcare NHS Trust, London, UK.

6/11/10

Reference

C Scott, S Day, E Low, and others. Unselected hepatitis C screening of men who have sex with men attending sexual health clinics. Journal of Infection 60(5): 351-353. May 2010.