Epidemic of Hepatitis C among Gay and Bisexual Men in Amsterdam
31, 2009 issue of AIDS, researchers described an ongoing epidemic of
hepatitis C virus (HCV) infection among men who have sex with men (MSM) in Amsterdam,
finding that the rate of HCV infection was nearly 18% among HIV positive men compared
with less than 1% among HIV negative men.|
2000, clinicians in several large European cities have reported outbreaks of apparently
sexually transmitted acute hepatitis C, primarily
among HIV positive gay and bisexual men. Similar
outbreaks have since been reported in Australia and the U.S.
research has revealed that these outbreaks are connected through an international
network of transmission among MSM.
Urbanus from the Amsterdam Public Health service and colleagues sought to learn
more about the prevalence and risk factors associated with the ongoing hepatitis
C epidemic in that city.
analysis included 689 MSM (out of a total 3125 clients) at a large sexually transmitted
disease clinic in Amsterdam who participated in an anonymous bi-annual cross-sectional
survey during 2007-2008.
were screened for HIV and HCV antibodies and interviewed about sexual activities,
drug use, and other risk factors. The investigators performed a genetic analysis
to compare HCV strains from the clinic patients to strains previously collected
from MSM diagnosed with acute HCV from 2000 through 2007.
2 of 532 HIV negative MSM (0.4%) were found to have HCV, compared with 28 of 157
HIV positive MSM (17.8%).|
HIV positive MSM, HCV prevalence increased from 14.6% to 20.9% over the study
of the 28 HIV-HCV coinfected men (25.0%) had acute HCV infection (estimated to
have been contracted within the past 6 months).|
one-third of the HCV positive men were not previously aware that they were infected.|
of 28 coinfected men (17.9%) reported ever injecting drugs. |
a univariate analysis, risk factors associated with HCV infection were:|
number of life-time sexual partners;|
of sexually transmitted diseases;|
of the club drug gamma hydroxy butyrate (GHB).|
an adjusted analysis restricted to HIV positive men, the only significant predictors
of HCV infection were:|
drug use (adjusted OR 13.4).|
(adjusted OR 10.6); |
use (adjusted odds ratio [OR] 4.6).|
analysis revealed a high degree of clustering of HCV strains specifically among
found a high and increasing HCV prevalence in HIV-infected MSM," the study
authors concluded. "Though not statistically significant, this trend, and
the relatively large proportion of acute infections suggest ongoing transmission
of HCV in HIV positive MSM."
their discussion, they noted that "the relatively large proportion of acute
infections strongly indicate a rapid and recent spread" of HCV among high-risk
HIV positive gay and bisexual men.
of [injection drug use], rough sexual techniques and use of recreational drugs
were associated with HCV infection," they continued. "Targeted prevention,
like raising awareness and routine testing, is needed to stop the further spread
among HIV infected MSM, and to prevent possible spillover to HIV negative MSM."
of Infectious Diseases, Amsterdam Public Health Service, Amsterdam, Netherlands.
Urbanus, TJ van de Laar, IG Stolte, and others. Hepatitis C virus infections among
HIV-infected men who have sex with men: an expanding epidemic. AIDS 23(12): F1-F7.
July 31, 2009. (Abstract).