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

Case-Control Study

To assess the role of sexual transmission of HCV, a matched case-control study was conducted beginning in July 2007. HIV-infected MSM examined at Mount Sinai during July 2007–December 2010 who were within 12 months of clinical onset of HCV infection and who reported no injection-drug use were recruited as case-patients. For each case-patient, 1–10 controls (i.e., HIV-infected MSM who did not have HCV infection, reported no injection-drug use, and matched by age [±5 years] and race/ethnicity) were recruited by Mount Sinai staff members from among the practices that referred case-patients during the enrollment period. In all, 22 case-patients and 53 control subjects were enrolled in the study.

All participants were asked to complete self-administered questionnaires regarding their sexual practices and drug-use behaviors during the 12 months preceding diagnosis (for case-patients) or preceding the questionnaire (for matched controls). To conduct a matched analysis, a conditional logistic regression of each variable (i.e., sexual practice or drug use behavior) was performed. Those variables that had a p value of ≤0.20 in the univariable analysis, as well as those previously associated with sexual transmission,[3] were entered into a model and analyzed using multivariable conditional logistic regression (i.e., forward, backward, and stepwise) to determine which variables were independently associated with HCV infection.

Univariable Results

Univariable analyses indicated that the HIV-infected MSM newly infected with HCV (case-patients) were significantly more likely than the HIV-infected MSM without HCV infection (matched controls) to have had receptive (matched odds ratio [mOR] = 24.87) or insertive (mOR = 2.62) anal intercourse with no condom and with ejaculation, practiced receptive (mOR = 10.08) or insertive (mOR = 7.90) fisting, used sex toys (mOR = 4.38), engaged in group sex (mOR = 19.28), engaged in sex while high on drugs (mOR = 11.37), previously had syphilis (mOR = 8.80) or gonorrhea (mOR = 5.02), and had sex while high on methamphetamine (mOR = 26.80) (Table 2). Because three variables (receptive anal intercourse, no condom, no ejaculation; sex while high on gamma hydroxybutyrate [GHB]; and sex while high on ketamine) yielded undefined ORs, the data were analyzed further using exact conditional logistic regression. Results showed that case-patients were significantly more likely than controls to report receptive anal intercourse with no condom and no ejaculation (mOR = 24.26) and sex while high on GHB (mOR = 16.34).

Multivariable results. Results from the multivariable analyses showed that receptive anal intercourse with no condom and with ejaculation of the partner (adjusted odds ratio [AOR] = 23.00) and sex while high on methamphetamine (AOR = 28.56) were both significantly related to acquiring HCV infection. Of all the practices and behaviors, having sex while using methamphetamine was most strongly associated with HCV infection (Table 2).

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