Sexual Transmission of Hepatitis C Virus Among HIV-Infected Men Who Have Sex With Men

New York City, 2005-2010

Daniel S. Fierer, MD; Stephanie H. Factor, MD; Alison J. Uriel, MBBS; Damaris C. Carriero, MS; Douglas T. Dieterich, MD; Michael P. Mullen, MD; Arielle Klepper, Wouter van Seggelen, MSc; Kathryn Childs, MBBS; Andrea D. Branch, PhD; Deborah Holtzman, PhD; John W. Ward, MD; Yury Khudyakov, PhD; Scott D. Holmberg, MD

Disclosures

Morbidity and Mortality Weekly Report. 2011;60(28):945-950. 

In This Article

Abstract and Introduction

Introduction

In the United States, an estimated 3.2 million persons are living with hepatitis C virus (HCV) infection.[1] HCV transmission occurs primarily through percutaneous exposure to blood, and persons who inject drugs are at greatest risk for infection. The role of sexual transmission of HCV has not been well defined. However, reports over the past decade, mainly from Europe, have implicated sexual transmission of HCV among human immunodeficiency virus (HIV)–infected men who have sex with men (MSM). In late 2005, two HIV-infected MSM, each with acute HCV infection that was suspected to have been acquired sexually, were evaluated at Mount Sinai Medical Center in New York City, prompting Mount Sinai to request referrals of similar patients.[2] During 2005–2010, a total of 74 HIV-infected MSM with recently acquired HCV infection and no reported history of injection-drug use were evaluated. To examine the role of sexual transmission, a matched case-control study and viral analysis were conducted. Results from the case-control study showed that high-risk sexual behavior was the most likely mode of transmission among these men. Phylogenetic analyses revealed five clusters of closely related HCV variants, suggesting networks of transmission among these men. The findings underscore the importance of screening HIV-infected MSM for HCV, particularly those engaged in high-risk sexual behavior.

For this study, a case-patient was defined as an HIV-infected MSM examined at Mount Sinai during October 2005–December 2010 who had 1) a newly elevated alanine transferase (ALT) level, 2) a newly positive HCV-antibody test result, and 3) no other evident cause of the newly elevated ALT level. To the extent possible, positive HCV-antibody results were confirmed by HCV RNA testing. If no record was found of a previous negative HCV-antibody test, a finding of jaundice or an ALT elevation of more than 15-fold above the upper limit of normal (i.e., >450 U/L) also was required. To assess whether patients might have had a previous positive HCV test result unknown to the referring physicians, the date of the first positive HCV-antibody test of a subset of patients (24 men) was confirmed by the New York City Department of Health and Mental Hygiene through review of the hepatitis registry of HCV surveillance data. Providers of primary care to HIV-infected MSM in New York City (who, as part of care, routinely obtain ALT levels on their patients during HIV monitoring visits) were contacted by the lead investigator and asked to refer patients with newly elevated ALT levels to Mount Sinai as soon as possible. Reminders were provided periodically throughout the study period. A total of 35 HIV-care providers contributed information on their patients to this study.

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