At
several HIV and hepatitis conferences over the past few years, researchers have
been reporting on outbreaks of acute, apparently sexually transmitted hepatitis
C virus (HCV) infection among men who have sex with men (MSM) in various cities
in the U.K. and Europe. Most reported cases have been in HIV positive men, but
a recent study showed that acute
HCV infection also occurs in HIV negative men.
Researchers
with the U.K. Health Protection Agency presented further data on the outbreak
in London at the recent British HIV Association annual meeting in April (also
published in the May 2007 supplemental issue of HIV Medicine).
The
objective of their study was to ascertain the burden and geographic extent of diagnosed
recently acquired HCV infection among in MSM in London in order to inform public
health interventions.
The
investigators used a questionnaire-based survey of HIV and genitourinary medicine
(GUM) clinics to assess recently acquired HCV in MSM attendees between 2002 and
June 2006. Diagnosed recently acquired HCV was defined as a positive PCR HCV RNA
or antibody test in patients who had a negative HCV test in the previous 3 years.
Results
•
13 HIV centers
in London responded to the survey, covering 85% of MSM who received HIV care in
the city.
•
By
2006, all clinics reported routine screening for HCV, but only 5 reported routine
screening over the entire period.
•
A
total of 352 cases of diagnosed recently acquired HCV were reported (arising from
39,306 person years of observation), for an overall incidence rate of 9.0 cases
per 1000 person years.
•
The
range across different clinics was 0 to 15.4 cases per 1000 person years.
•
The
estimated annual increase in incidence of diagnosed recently acquired HCV was
20%.
•
There
was no evidence that this was affected by routine HCV screening.
•
Little
information was available for HIV negative MSM, since most GUM clinics did not
routinely screen all MSM for HCV.
Conclusion
In conclusion,
the researchers wrote, "This study provides some evidence of increasing incidence
in [diagnosed recently acquired HCV] in HIV positive MSM attending HIV centres
across London since 2002. Yet there still are many gaps in our understanding,
especially related to the burden of disease in HIV [negative] MSM. Close collaboration
between clinicians and public health specialists will be key to inform public
health interventions and potentially required surveillance."
05/15/07
Reference M
Ruf, I Giraudon, H Maguire, and others. Evidence of increase in recently acquired
hepatitis C in HIV-positive men who have sex with men across London, 2002-2006.
HIV Medicine 8(s1): 1-8. May 2007.
