Predictors
of Sexual Transmission of HCV in Gay Men Sexual
transmission of hepatitis C virus (HCV) is rare between monogamous heterosexual
couples, but recent reports from the United Kingdom and Europe suggest that
it is more common among men who have sex with men, especially
those coinfected with HIV. Previous
studies have shown that sexual transmission is associated with various sexual
practices, a higher number of sexual partners, recreational
drug use, and concurrent sexually transmitted infections. In
the August 2006 issue of Sexually Transmitted Infections, researchers with
the Centre for Sexual Health and HIV Research in London shed further light on
risk factors that predict HCV transmission among gay and bisexual men.  The
Sex, Health and Antiretrovirals Project (SHARP) was a cross-sectional study
of sexual behavior in HIV positive men who have sex with men attending a London
outpatient clinic. Between July 1999 and August 2000, participants completed a
self-administered computer-assisted questionnaire about recent sexual behavior,
recreational drug use, and their last two sexual episodes involving different
partners. Results were combined with routine clinical data and testing for HCV
through April 2005. Among the 422 men who completed the questionnaire, 308 had
sufficient clinical and HCV testing data available for analysis.
Results 
Of the 308 men with adequate data, incident HCV infection -- defined as HCV antibody
seroconversion or detectable HCV RNA following a previous negative test -- was
identified in 11 men.
Factors associated with recent HCV infection were: -
unprotected anal intercourse;
- more than 30 sexual partners in the past year
(P = 0.023);
- higher number of new anal sex partners in the past month;
- fisting (P < 0.001; adjusted relative risk 9.39);
- use of
sex toys (P = 0.016);
- rimming (oral-anal sex) (P = 0.047);
-
intranasal recreational drug use (P = 0.042).
In a multivariate analysis controlling for other factors, only fisting remained
significantly associated with HCV (adjusted relative risk 6.27; P = 0.005).
In contrast with some previous studies, there was no observed association between
HCV diagnosis and frequenting public sex venues such as saunas, sex clubs, or
cruising grounds. There was also no apparent association with injection drug use
during the past five years.
Conclusion In
conclusion, the authors wrote, "In this study of HIV positive [men who have
sex with men], fisting is strongly associated with HCV infection. Where individuals
report high-risk sexual behaviors, clinicians should offer appropriate testing
for HCV infection." HIV
positive men who practiced anal fisting were about six times more likely to
be infected with HCV. Fisting may promote infection by damaging the rectal lining,
facilitating entry of the virus. However, most men who practiced fisting also
engaged in other potentially high-risk sexual practices (making it difficult to
determine which activities were responsible for transmission), and five of the
men who contracted HCV did not report fisting. "Fisting
is not an isolated sexual practice, but one component of a larger sexual episode
that probably includes several different sexual practices," the researchers
wrote. "HCV infection may occur when mucosal disruption as a consequence
of receptive fisting occurs and is followed by receptive unprotected anal intercourse
either within the same sexual episode or another one." Since
interferon-based hepatitis C therapy is highly effective when starting during
acute infection, they recommended that, "consideration should be given to
HCV RNA screening in individuals
identified as being at high sexual risk, detecting acute infection before anti-HCV
antibody seroconversion." 8/18/06 Reference
J
M Turner, A T Rider, J Imrie, and others. Behavioral predictors of subsequent
hepatitis C diagnosis in a UK clinic sample of HIV-positive men who have sex with
men. Sexually Transmitted Infections 82(4): 298-300. August 2006. | 
