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Shabil M, Yadav A, Shamim MA, Ahmed M, Satapathy P, Zaidan AA, Khatib MN, Gaidhane S, Zahiruddin QS, Rabaan AA, Al Kaabi NA, Almosa FAM, AlSihati J, Sah R. Prevalence of hepatitis B and C infections among HIV-positive men who have sex with men: A systematic review and meta-analysis. Health Sci Rep 2024; 7:e2206. [PMID: 38933421 PMCID: PMC11199987 DOI: 10.1002/hsr2.2206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 05/10/2024] [Accepted: 06/06/2024] [Indexed: 06/28/2024] Open
Abstract
Background Human immunodeficiency virus (HIV) infection is highly prevalent and often coexists with other infectious diseases, especially Hepatitis B virus (HBV) and Hepatitis C virus (HCV). Men who have sex with men (MSM) represent a vulnerable population in terms of HIV infection. We aimed to determine the prevalence of HCV, HBV among HIV-infected MSM. Methods This systematic review and meta-analysis searched PubMed, Cochrane, Scopus, Web of Science, and ProQuest up-to 2023/04/22. All studies reporting the prevalence of HBV or HCV infection in MSM PLHIV were included. Meta-analysis used random effect model for synthesis and I 2 along with prediction interval for heterogeneity. Subgroup analysis based on continent and meta-regression for study size, average age and year of publication were used to explore heterogeneity. Modified Newcastle-Ottawa Scale was used to evaluate the quality of studies according to the protocol (PROSPERO: CRD42023428764). Results Fifty-six of 5948 studies are included. In 53 studies with 3,07,589 participants, a pooled prevalence of 7% (95% confidence interval [CI]: 5-10) was found for HCV among MSM PLHIV, while a 9% (95% CI: 4-18) prevalence was found for HBV infection from five studies which included 5641 MSM PLHIV. Asia reported the lowest pooled prevalence at 5.84% (95% CI: 2.98-11.13) for HCV while Europe reported the highest pooled prevalence at 7.76% (95% CI: 4.35-13.45). Baujat plot and influence diagnostic identified contributors to influence and between-study heterogeneity. Sensitivity analyses omitting these studies result in considerably more precise estimates. Another sensitivity analysis as leave-one-out meta-analysis did not change any pooled estimate significantly. Conclusion There is a significant burden of HCV and HBV among MSM PLHIV worldwide, with varying prevalence rates. Future studies should focus on these multimorbidity clusters and investigate factors influencing disease burden, long-term outcomes, optimal testing strategies, and tailored interventions.
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Affiliation(s)
- Muhammed Shabil
- Evidence of Policy and LearningGlobal Center for Evidence SynthesisChandigarhIndia
| | - Aarti Yadav
- Evidence of Policy and LearningGlobal Center for Evidence SynthesisChandigarhIndia
| | - Muhammed A. Shamim
- Department of PharmacologyAll India Institute of Medical SciencesJodhpurIndia
| | - Mohammed Ahmed
- School of Medical SciencesUniversity of HyderabadHyderabadIndia
| | - Prakasini Satapathy
- Center for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical SciencesSaveetha UniversityChennaiIndia
- Medical Laboratories Techniques DepartmentAL‐Mustaqbal UniversityHillahBabilIraq
| | - Ali A. Zaidan
- Gastroenterology DepartmentKing Fahad Armed Forces HospitalJeddahSaudi Arabia
| | - Mahalaqua N. Khatib
- Division of Evidence Synthesis, Global Consortium of Public Health and ResearchDatta Meghe Institute of Higher EducationWardhaIndia
| | - Shilpa Gaidhane
- One Health Centre (COHERD), Jawaharlal Nehru Medical CollegeDatta Meghe Institute of Higher EducationWardhaIndia
| | - Quazi S. Zahiruddin
- Global Health Academy, Division of Evidence Synthesis, School of Epidemiology and Public Health and Research, Jawaharlal Nehru Medical CollegeInstitute of Higher education and ResearchWardhaIndia
| | - Ali A. Rabaan
- Molecular Diagnostic LaboratoryJohns Hopkins Aramco HealthcareDhahranSaudi Arabia
- College of MedicineAlfaisal UniversityRiyadhSaudi Arabia
- Department of Public Health and NutritionThe University of HaripurHaripurPakistan
| | - Nawal A. Al Kaabi
- College of Medicine and Health ScienceKhalifa UniversityAbu DhabiUnited Arab Emirates
- Sheikh Khalifa Medical CityAbu Dhabi Health Services Company (SEHA)Abu DhabiUnited Arab Emirates
| | - Fadel A. M. Almosa
- Gastroenterology Unit, Department of Internal Medicine, Qatif Central HospitalMinistry of HealthQatifSaudi Arabia
| | - Jehad AlSihati
- Internal Medicine Department, Gastroenterology SectionKing Fahad Specialist HospitalDammamSaudi Arabia
| | - Ranjit Sah
- Department of MicrobiologyTribhuvan University Teaching HospitalKathmanduNepal
- Department of Clinical Microbiology, DY Patil Medical College, Hospital and Research CentreDY Patil VidyapeethPuneMaharashtraIndia
- Department of Public Health Dentistry, Dr. D.Y. Patil Dental College and HospitalDr. D.Y. Patil VidyapeethPuneMaharashtraIndia
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2
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Salazar-Vizcaya L, Kusejko K, Günthard HF, Böni J, Metzner KJ, Braun DL, Nicca D, Bernasconi E, Calmy A, Darling KEA, Wandeler G, Kouyos RD, Rauch A. An Approach to Quantifying the Interaction between Behavioral and Transmission Clusters. Viruses 2022; 14:v14040784. [PMID: 35458514 PMCID: PMC9032082 DOI: 10.3390/v14040784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 02/04/2023] Open
Abstract
We hypothesize that patterns of sexual behavior play a role in the conformation of transmission networks, i.e., the way you behave might influence whom you have sex with. If that was the case, behavioral grouping might in turn correlate with, and potentially predict transmission networking, e.g., proximity in a viral phylogeny. We rigorously present an intuitive approach to address this hypothesis by quantifying mapped interactions between groups defined by similarities in sexual behavior along a virus phylogeny while discussing power and sample size considerations. Data from the Swiss HIV Cohort Study on condom use and hepatitis C virus (HCV) sequences served as proof-of-concept. In this case, a strict inclusion criteria contrasting with low HCV prevalence hindered our possibilities to identify significant relationships. This manuscript serves as guide for studies aimed at characterizing interactions between behavioral patterns and transmission networks. Large transmission networks such as those of HIV or COVID-19 are prime candidates for applying this methodological approach.
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Affiliation(s)
- Luisa Salazar-Vizcaya
- Department of Infectious Diseases, Bern University Hospital Inselspital, University of Bern, 3010 Bern, Switzerland; (G.W.); (A.R.)
- Correspondence:
| | - Katharina Kusejko
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, 8091 Zurich, Switzerland; (K.K.); (H.F.G.); (K.J.M.); (D.L.B.); (R.D.K.)
- Institute of Medical Virology, University of Zurich, 8057 Zurich, Switzerland;
| | - Huldrych F. Günthard
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, 8091 Zurich, Switzerland; (K.K.); (H.F.G.); (K.J.M.); (D.L.B.); (R.D.K.)
- Institute of Medical Virology, University of Zurich, 8057 Zurich, Switzerland;
| | - Jürg Böni
- Institute of Medical Virology, University of Zurich, 8057 Zurich, Switzerland;
| | - Karin J. Metzner
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, 8091 Zurich, Switzerland; (K.K.); (H.F.G.); (K.J.M.); (D.L.B.); (R.D.K.)
- Institute of Medical Virology, University of Zurich, 8057 Zurich, Switzerland;
| | - Dominique L. Braun
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, 8091 Zurich, Switzerland; (K.K.); (H.F.G.); (K.J.M.); (D.L.B.); (R.D.K.)
- Institute of Medical Virology, University of Zurich, 8057 Zurich, Switzerland;
| | - Dunja Nicca
- Institute of Nursing Science, University of Basel, 4056 Basel, Switzerland;
- Department of Public Health, Epidemiology, Biostatistics and Public Health Institute, University of Zurich, 8001 Zurich, Switzerland
| | - Enos Bernasconi
- Division of Infectious Diseases, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland;
- University of Southern Switzerland, 6928 Manno, Switzerland
- Division of Infectious Diseases, Geneva University Hospitals, 1205 Geneva, Switzerland;
| | - Alexandra Calmy
- Division of Infectious Diseases, Geneva University Hospitals, 1205 Geneva, Switzerland;
| | - Katharine E. A. Darling
- Infectious Diseases Service, Lausanne University Hospital (CHUV), 1011 Lausanne, Switzerland;
- University of Lausanne, 1015 Lausanne, Switzerland
| | - Gilles Wandeler
- Department of Infectious Diseases, Bern University Hospital Inselspital, University of Bern, 3010 Bern, Switzerland; (G.W.); (A.R.)
| | - Roger D. Kouyos
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, 8091 Zurich, Switzerland; (K.K.); (H.F.G.); (K.J.M.); (D.L.B.); (R.D.K.)
- Institute of Medical Virology, University of Zurich, 8057 Zurich, Switzerland;
| | - Andri Rauch
- Department of Infectious Diseases, Bern University Hospital Inselspital, University of Bern, 3010 Bern, Switzerland; (G.W.); (A.R.)
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3
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Thitipatarakorn S, Chinbunchorn T, Peelay J, Seekaew P, Amatavete S, Sangsai M, Pankam T, Avihingsanon A, Avery M, Phanuphak P, Ramautarsing R, Phanuphak N. Prevalence and the associated factors of hepatitis B and hepatitis C viral infections among HIV-positive individuals in same-day antiretroviral therapy initiation program in Bangkok, Thailand. BMC Public Health 2022; 22:144. [PMID: 35057784 PMCID: PMC8772186 DOI: 10.1186/s12889-021-12429-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 12/03/2021] [Indexed: 11/26/2022] Open
Abstract
Background Viral hepatitis is highly prevalent among people with HIV (PWH) and can lead to chronic liver complications. Thailand started universal hepatitis B vaccination at birth in 1992 and achieved over 95% coverage in 1999. We explored the prevalence of hepatitis B and C viral infections and the associated factors among PWH from same-day antiretroviral therapy (SDART) service at the Thai Red Cross Anonymous Clinic, Bangkok, Thailand. Methods We collected baseline characteristics from PWH enrolled in the SDART service between July 2017 and November 2019. Multivariable logistic regression was performed to determine factors associated with positive hepatitis B surface antigen (HBsAg) and hepatitis C antibody (anti-HCV). Results A total of 4011 newly diagnosed PWH who had HBsAg or anti-HCV results at baseline: 2941 men who have sex with men (MSM; 73.3%), 851 heterosexuals (21.2%), 215 transgender women (TGW; 5.4%), and 4 transgender men (0.1%). Median age was 27 years. Overall seroprevalence of HBsAg and anti-HCV were 6.0 and 4.1%, respectively. Subgroup prevalence were 6.2 and 4.7% among MSM, 4.6 and 2.4% among heterosexuals, and 9.3 and 3.7% among TGW, respectively. Factors associated with HBsAg positivity were being MSM, TGW, born before 1992, CD4 count < 200 cells/mm3, and alanine aminotransferase ≥ 62.5 U/L. Factors associated with anti-HCV positivity were being MSM, age > 30 years, alanine aminotransferase ≥ 62.5 U/L, creatinine clearance < 60 ml/min, and syphilis infection. Conclusions Around 5–10% of newly diagnosed PWH in Bangkok had hepatitis B viral infection after 25 years of universal vaccination. Anti-HCV positivity was found in 4–5% of PWH who were MSM and TGW. As World Health Organization and Thailand national guidelines already support routine screening of hepatitis B and C viral infections in PWH and populations at increased risk of HIV including MSM and TGW, healthcare providers should reinforce this strategy and provide linkage to appropriate prevention and treatment interventions. Catch-up hepatitis B vaccination should be made available under national health coverage.
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Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I, Reno H, Zenilman JM, Bolan GA. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep 2021; 70:1-187. [PMID: 34292926 PMCID: PMC8344968 DOI: 10.15585/mmwr.rr7004a1] [Citation(s) in RCA: 772] [Impact Index Per Article: 257.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
These guidelines for the treatment of persons who have or are at risk for
sexually transmitted infections (STIs) were updated by CDC after consultation
with professionals knowledgeable in the field of STIs who met in Atlanta,
Georgia, June 11–14, 2019. The information in this report updates the
2015 guidelines. These guidelines discuss 1) updated recommendations for
treatment of Neisseria gonorrhoeae, Chlamydia trachomatis,
and Trichomonas vaginalis; 2) addition of
metronidazole to the recommended treatment regimen for pelvic inflammatory
disease; 3) alternative treatment options for bacterial vaginosis; 4) management
of Mycoplasma genitalium; 5) human papillomavirus vaccine
recommendations and counseling messages; 6) expanded risk factors for syphilis
testing among pregnant women; 7) one-time testing for hepatitis C infection; 8)
evaluation of men who have sex with men after sexual assault; and 9) two-step
testing for serologic diagnosis of genital herpes simplex virus. Physicians and
other health care providers can use these guidelines to assist in prevention and
treatment of STIs.
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5
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Salazar-Vizcaya L, Kusejko K, Schmidt AJ, Carrillo-Montoya G, Nicca D, Wandeler G, Braun DL, Fehr J, Darling KEA, Bernasconi E, Schmid P, Günthard HF, Kouyos RD, Rauch A. Clusters of Sexual Behavior in Human Immunodeficiency Virus-positive Men Who Have Sex With Men Reveal Highly Dissimilar Time Trends. Clin Infect Dis 2021; 70:416-424. [PMID: 30874293 DOI: 10.1093/cid/ciz208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 03/08/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Separately addressing specific groups of people who share patterns of behavioral change might increase the impact of behavioral interventions to prevent transmission of sexually transmitted infections. We propose a method based on machine learning to assist the identification of such groups among men who have sex with men (MSM). METHODS By means of unsupervised learning, we inferred "behavioral clusters" based on the recognition of similarities and differences in longitudinal patterns of condomless anal intercourse with nonsteady partners (nsCAI) in the HIV Cohort Study over the last 18 years. We then used supervised learning to investigate whether sociodemographic variables could predict cluster membership. RESULTS We identified 4 behavioral clusters. The largest behavioral cluster (cluster 1) contained 53% of the study population and displayed the most stable behavior. Cluster 3 (17% of the study population) displayed consistently increasing nsCAI. Sociodemographic variables were predictive for both of these clusters. The other 2 clusters displayed more drastic changes: nsCAI frequency in cluster 2 (20% of the study population) was initially similar to that in cluster 3 but accelerated in 2010. Cluster 4 (10% of the study population) had significantly lower estimates of nsCAI than all other clusters until 2017, when it increased drastically, reaching 85% by the end of the study period. CONCLUSIONS We identified highly dissimilar behavioral patterns across behavioral clusters, including drastic, atypical changes. The patterns suggest that the overall increase in the frequency of nsCAI is largely attributable to 2 clusters, accounting for a third of the population.
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Affiliation(s)
- Luisa Salazar-Vizcaya
- Department of Infectious Diseases, Bern University Hospital Inselspital, University of Bern, Switzerland
| | - Katharina Kusejko
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Switzerland
| | - Axel J Schmidt
- Division of Infectious Diseases and Infection Control, Cantonal Hospital St. Gallen, Switzerland.,Sigma Research, London School of Hygiene and Tropical Medicine, United Kingdom
| | | | - Dunja Nicca
- Institute of Nursing Science, University of Basel, Switzerland
| | - Gilles Wandeler
- Department of Infectious Diseases, Bern University Hospital Inselspital, University of Bern, Switzerland
| | - Dominique L Braun
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Switzerland
| | - Jan Fehr
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Switzerland
| | - Katharine E A Darling
- Infectious Diseases Service, Department of Medicine, University Hospital of Lausanne (CHUV), Switzerland
| | - Enos Bernasconi
- Division of Infectious Diseases, Lugano Regional Hospital, Switzerland
| | - Patrick Schmid
- Division of Infectious Diseases and Infection Control, Cantonal Hospital St. Gallen, Switzerland
| | - Huldrych F Günthard
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Switzerland
| | - Roger D Kouyos
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Switzerland
| | - Andri Rauch
- Department of Infectious Diseases, Bern University Hospital Inselspital, University of Bern, Switzerland
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6
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Ang LW, Choy CY, Ng OT, Leo YS, Wong CS. Hepatitis C virus infection in HIV-infected men in Singapore, 2006-2018: incidence and associated factors. Sex Health 2021; 18:221-231. [PMID: 34148565 DOI: 10.1071/sh20197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 02/23/2021] [Indexed: 11/23/2022]
Abstract
Background The epidemiology of hepatitis C virus (HCV) infection in people living with HIV has been evolving, with increasing evidence of permucosal (sexual) transmission identified predominantly in HIV-positive men who have sex with men (MSM). The aim of this study was to estimate the incidence rate and elucidate epidemiological factors associated with HCV infection among HIV-infected men in Singapore from 2006 to 2018. METHODS A retrospective cohort study was conducted using a clinical database maintained by the Clinical HIV Program at the National Centre for Infectious Diseases, Singapore. Factors associated with incident HCV infections were identified using Cox proportional hazards regression analyses. RESULTS Among 1348 HIV-infected male patients who were HCV seronegative at baseline, 64 (4.7%) subsequently tested positive for HCV, giving an incidence of 0.88 per 100 person-years of follow-up (PYFU) (95% confidence interval (CI) 0.69-1.13). The incidence rate of HCV seroconversion increased from 0.33 (95% CI 0.12-0.71) per 100 PYFU in 2010-2012 to 1.93 (95% CI 1.36-2.67) in 2016-2018. Independent factors associated with incident HCV infection were younger age groups at HIV diagnosis versus ≥45 years, HIV acquisition via MSM or via both sexual contact and intravenous drug use versus heterosexual transmission, HIV diagnosis in later periods versus 2006-2009, and recent syphilis acquisition. CONCLUSIONS An increasing trend of incident HCV infection was seen in HIV-infected men, particularly for MSM. Preventive and behavioural interventions should be targeted at HIV-infected individuals engaged in high-risk sexual behaviour.
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Affiliation(s)
- Li Wei Ang
- National Public Health and Epidemiology Unit, National Centre for Infectious Diseases, 16 Jalan Tan Tock Seng, 308442, Singapore; and Corresponding author.
| | - Chiaw Yee Choy
- Department of Infectious Diseases, National Centre for Infectious Diseases, 16 Jalan Tan Tock Seng, 308442, Singapore
| | - Oon Tek Ng
- Department of Infectious Diseases, National Centre for Infectious Diseases, 16 Jalan Tan Tock Seng, 308442, Singapore; and Department of Infectious Diseases, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, 308433, Singapore; and Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, 308232, Singapore
| | - Yee Sin Leo
- Department of Infectious Diseases, National Centre for Infectious Diseases, 16 Jalan Tan Tock Seng, 308442, Singapore; and Department of Infectious Diseases, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, 308433, Singapore; and Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, 308232, Singapore; and Saw Swee Hock School of Public Health, National University of Singapore, 16 Medical Drive, 117597, Singapore; and Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, 117597, Singapore
| | - Chen Seong Wong
- Department of Infectious Diseases, National Centre for Infectious Diseases, 16 Jalan Tan Tock Seng, 308442, Singapore; and Department of Infectious Diseases, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, 308433, Singapore; and Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, 308232, Singapore
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7
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HCV Genetic Diversity Can Be Used to Infer Infection Recency and Time since Infection. Viruses 2020; 12:v12111241. [PMID: 33142675 PMCID: PMC7692400 DOI: 10.3390/v12111241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/19/2020] [Accepted: 10/27/2020] [Indexed: 11/25/2022] Open
Abstract
HIV-1 genetic diversity can be used to infer time since infection (TSI) and infection recency. We adapted this approach for HCV and identified genomic regions with informative diversity. We included 72 HCV/HIV-1 coinfected participants of the Swiss HIV Cohort Study, for whom reliable estimates of infection date and viral sequences were available. Average pairwise diversity (APD) was calculated over each codon position for the entire open reading frame of HCV. Utilizing cross validation, we evaluated the correlation of APD with TSI, and its ability to infer TSI via a linear model. We additionally studied the ability of diversity to classify infections as recent (infected for <1 year) or chronic, using receiver-operator-characteristic area under the curve (ROC-AUC) in 50 patients whose infection could be unambiguously classified as either recent or chronic. Measuring HCV diversity over third or all codon positions gave similar performances, and notable improvement over first or second codon positions. APD calculated over the entire genome enabled classification of infection recency (ROC-AUC = 0.76). Additionally, APD correlated with TSI (R2 = 0.33) and could predict TSI (mean absolute error = 1.67 years). Restricting the region over which APD was calculated to E2-NS2 further improved accuracy (ROC-AUC = 0.85, R2 = 0.54, mean absolute error = 1.38 years). Genetic diversity in HCV correlates with TSI and is a proxy for infection recency and TSI, even several years post-infection.
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8
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Somi MH, Sepehri B, Nikniaz Z, Sedghi R. Efficacy of Sovodak in the Management of Patients Co-infected with HIV/HCV. Adv Pharm Bull 2020; 10:662-665. [PMID: 33072543 PMCID: PMC7539312 DOI: 10.34172/apb.2020.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 01/07/2020] [Accepted: 01/27/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose: Sofosbuvir (SOF) and daclatasvir (DOC) are suggested for the treatment of hepatitis C virus (HCV) in patients with concomitant HCV and human immunodeficiency virus (HIV). In 2016, Sovodak tablet a combination of SOF and DOC was introduced. In the present study we assessed the effectiveness of SOF in the treatment of HCV in patients co-infected with HIV. Methods: A total of 26 HCV patients co-infected with HIV received SOF for 3 months. One patient did not adhere to the drug protocol and was removed from the final analysis. The blood sample for qualitative polymerase chain reaction (PCR) was obtained after treatment and sustained virological response (SVR) was calculated. Results: Twenty five patients finished the study. The mean patients’ age was 44.16±6.21 years. About 72% of participants had HCV genotype 1a, 8% genotype 1b, and 20% genotype 3a. After 3 months of intervention with Sovodak, the SVR12 was about 96%. None of the patients reported any adverse events. Conclusion: For the first time, the results of the present study showed that Sovodak had high SVR12 in HCV patients co-infected with HIV. However, for a precise conclusion, there is a need for larger studies and an equal number of patients with different virus genotypes.
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Affiliation(s)
- Mohammad Hossein Somi
- Liver and gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Bita Sepehri
- Liver and gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zeinab Nikniaz
- Liver and gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Roya Sedghi
- Liver and gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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9
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Doyle JS, van Santen DK, Iser D, Sasadeusz J, O'Reilly M, Harney B, Traeger MW, Roney J, Cutts JC, Bowring AL, Winter R, Medland N, Fairley CK, Moore R, Tee B, Asselin J, El-Hayek C, Hoy JF, Matthews GV, Prins M, Stoové MA, Hellard ME. Micro-elimination of hepatitis C among people with HIV coinfection: declining incidence and prevalence accompanying a multi-center treatment scale-up trial. Clin Infect Dis 2020; 73:e2164-e2172. [PMID: 33010149 DOI: 10.1093/cid/ciaa1500] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Gay and bisexual men (GBM) are a key population affected by HIV and hepatitis C (HCV) co-infection. Providing HCV treatment scale-up across specialist and non-hepatitis specialist settings may eliminate HCV in this population. We aimed to (1) deliver and measure HCV treatment effectiveness, and (2) determine the population impact of treatment on HCV prevalence and incidence longitudinally. METHODS The co-EC Study (Enhancing care and treatment among HCV/HIV co-infected individuals to Eliminate Hepatitis C transmission) was an implementation trial providing HCV direct-acting antiviral treatment in Melbourne, Australia, from 2016-2018. Individuals with HCV/HIV co-infection were prospectively enrolled from primary and tertiary-care services providing care for 85% of GBM with HIV in our jurisdiction. HCV-viraemic prevalence and HCV-antibody/viraemic incidence were measured using a state-wide, individually-linked, electronic surveillance system. RESULTS Among 200 participants recruited, 186 initiated treatment during the study period. Sustained virological response among primary care participants (98%, 95%CI:93-100%) was not different to tertiary care (98%, 95%CI:86-100%). From 2012-2019, between 2434 and 3476 GBM with HIV-infection attended our primary-care sites annually providing 13,801 person-years of follow-up; 50-60% received an HCV test annually, 10-14% were anti-HCV positive. Among those anti-HCV positive, viraemic prevalence declined 83% during the study (54% to 9%; 2016 to 2019). HCV incidence decreased 25% annually from 1.7/100 person-years in 2012 to 0.5/100 person-years in 2019 (incidence rate ratio 0.75; CI:0.68-0.83;p<0.001). CONCLUSION High treatment effectiveness by non-specialists demonstrates the feasibility of treatment scale-up in this population. Substantial declines in HCV incidence and prevalence among GBM with HIV-infection provides proof-of-concept for HCV micro-elimination. REGISTRATION ClinicalTrials.gov (Identifier: NCT02786758).
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Affiliation(s)
- J S Doyle
- Burnet Institute, Melbourne, VIC, Australia.,Department of Infectious Diseases, The Alfred and Monash University, Melbourne, VIC, Australia
| | - D K van Santen
- Burnet Institute, Melbourne, VIC, Australia.,School of Population Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - D Iser
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, VIC, Australia.,Department of Gastroenterology, St Vincent's Hospital, Melbourne, VIC, Australia
| | - J Sasadeusz
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, VIC, Australia.,Victorian Infectious Diseases Service at the Doherty Institute, Melbourne, VIC, Australia
| | - M O'Reilly
- Prahran Market Clinic, Melbourne, VIC, Australia
| | - B Harney
- Burnet Institute, Melbourne, VIC, Australia
| | | | - J Roney
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, VIC, Australia
| | - J C Cutts
- Burnet Institute, Melbourne, VIC, Australia
| | | | - R Winter
- Burnet Institute, Melbourne, VIC, Australia
| | - N Medland
- Melbourne Sexual Health Centre, Alfred Health, Carlton, VIC, Australia
| | - C K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Carlton, VIC, Australia
| | - R Moore
- Northside Clinic, Fitzroy North, VIC, Australia
| | - B Tee
- Centre Clinic, Melbourne, VIC, Australia
| | - J Asselin
- Burnet Institute, Melbourne, VIC, Australia
| | - C El-Hayek
- Burnet Institute, Melbourne, VIC, Australia
| | - J F Hoy
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, VIC, Australia
| | - G V Matthews
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - M Prins
- Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Infection and Immunity Institute Amsterdam, the Netherlands.,Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - M A Stoové
- Burnet Institute, Melbourne, VIC, Australia.,School of Population Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - M E Hellard
- Burnet Institute, Melbourne, VIC, Australia.,Department of Infectious Diseases, The Alfred and Monash University, Melbourne, VIC, Australia.,School of Population Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Doherty Institute and Melbourne School of Population and Global Health, University of Melbourne
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10
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Salazar-Vizcaya L, Kouyos RD, Metzner KJ, Caraballo Cortes K, Böni J, Shah C, Fehr J, Braun DL, Bernasconi E, Mbunkah HA, Hoffmann M, Labhardt N, Cavassini M, Rougemont M, Günthard HF, Keiser O, Rauch A. Changing Trends in International Versus Domestic HCV Transmission in HIV-Positive Men Who Have Sex With Men: A Perspective for the Direct-Acting Antiviral Scale-Up Era. J Infect Dis 2020; 220:91-99. [PMID: 30759225 PMCID: PMC6548898 DOI: 10.1093/infdis/jiz069] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 02/11/2019] [Indexed: 12/29/2022] Open
Abstract
Background Scale-up of direct-acting antiviral therapy is expected to abate hepatitis C virus (HCV) incidence among human immunodeficiency virus (HIV)-positive men who have sex with men (MSM). International transmission could influence this process. We classified HCV infections in HIV-positive MSM as either domestically or internationally acquired, and estimated how this classification changed over time. Methods HCV subtype 1a (the most frequent subtype among MSM) genomes from 99 persons enrolled in the Swiss HIV Cohort Study and diagnosed with replicating HCV infections, were sequenced. Sixty-six of these sequences were from MSM. We inferred maximum-likelihood phylogenetic trees and time trees containing a fragment of the NS5B region of these and 374 circulating strains. We inferred transmission clusters from these trees and used the country composition of such clusters to attribute infections to domestic or international transmission. Results Of HCV transmissions, 50% to 80% were classified as domestic depending on the classification criterion. Between 2000 and 2007, the fraction attributable to domestic transmission was 54% (range 0–75%). It increased to 85% (range 67%–100%) between 2008 and 2016. Conclusions International and domestic transmission have played major roles in this epidemic. While international transmission persists, local transmission has established as the main source of infections.
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Affiliation(s)
- Luisa Salazar-Vizcaya
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Roger D Kouyos
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Switzerland
| | - Karin J Metzner
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Switzerland
| | - Kamila Caraballo Cortes
- Department of Immunopathology of Infectious and Parasitic Diseases, Medical University of Warsaw, Poland
| | - Jürg Böni
- Institute of Medical Virology, University of Zurich, Switzerland
| | - Cyril Shah
- Institute of Medical Virology, University of Zurich, Switzerland
| | - Jan Fehr
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Switzerland
| | - Dominique L Braun
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Switzerland
| | - Enos Bernasconi
- Division of Infectious Diseases, Lugano Regional Hospital, Switzerland
| | - Herbert A Mbunkah
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Switzerland
| | - Matthias Hoffmann
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, Switzerland
| | - Niklaus Labhardt
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Switzerland
| | - Matthias Cavassini
- Infectious Diseases Service, Department of Medicine, University Hospital of Lausanne, Switzerland
| | - Mathieu Rougemont
- Division of Infectious Diseases, University Hospital Geneva, Switzerland
| | - Huldrych F Günthard
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Switzerland
| | - Olivia Keiser
- Institute of Global Health, University of Geneva, Switzerland
| | - Andri Rauch
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Switzerland
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11
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Exploring Awareness of HCV Among Sexual-Minority Black Generation Millennials and Gen Z: a Qualitative Study. J Racial Ethn Health Disparities 2020; 7:555-562. [PMID: 32006242 DOI: 10.1007/s40615-019-00684-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/10/2019] [Accepted: 12/12/2019] [Indexed: 10/25/2022]
Abstract
Hepatitis C (HCV) is a significant public health burden globally. While HIV-positive men who have sex with men (MSM) have traditionally comprised the majority of sexually acquired HCV cases in the USA, recent studies indicate that HIV-negative MSM and MSM who use pre-exposure prophylaxis (PrEP) in particular are at increasing risk for incident HCV. Further, in the USA, African Americans are disproportionately burdened by chronic HCV compared with other ethnic groups. We sought to better understand awareness and knowledge about HCV and the perceived barriers to HCV testing, among young Black MSM (YBMSM) ages 18-24 in an urban southern California setting. This formative work was conducted in the context of a broader study designed to develop a brief, peer-led intervention to increase hepatitis awareness and testing among young men at risk. Our focus group findings suggest that YBMSM are lacking awareness and knowledge about HCV that are important for self-appraisal of their risk and need for testing. Additionally, YBMSM reported low social support for HCV testing; many indicated they do not discuss HCV with peers, community leaders, or family members. Using study participants' recommendations for engaging YBMSM in HCV prevention efforts, our study emphasizes the need for education and screening efforts targeted to YBMSM, and especially YBMSM who are engaging in high-risk sexual activity with HIV-positive and/or older MSM. We offer recommendations for public health strategies that may be helpful for increasing awareness of HCV risks and HCV screening among vulnerable YBMSM groups.
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12
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Rossotti R, Puoti M. Sexually Transmitted Hepatitis. Sex Transm Infect 2020. [DOI: 10.1007/978-3-030-02200-6_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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13
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Huang MH, Chang SY, Liu CH, Cheng A, Su LH, Liu WC, Su YC, Sun HY, Hung CC, Chang SC. HCV reinfections after viral clearance among HIV-positive patients with recent HCV infection in Taiwan. Liver Int 2019; 39:1860-1867. [PMID: 31343813 DOI: 10.1111/liv.14199] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 05/14/2019] [Accepted: 07/04/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Higher rates of hepatitis C virus (HCV) reinfection after viral clearance have been well described among HIV-positive men who have sex with men (MSM) in Europe. The epidemiology of HCV reinfection, however, has rarely been investigated among HIV-positive patients in Asia-Pacific region. METHODS We retrospectively identified HIV-positive patients with recent HCV infection who had cleared their primary infection, either spontaneously or via treatment, between January 2011 and May 2018. All included patients were observed until 31 March 2019. HCV reinfection was defined as recurrent HCV viraemia after achieving viral clearance with anti-HCV treatment or after spontaneous clearance. RESULTS During the study period, 219 HIV-positive patients (90.4% MSM) were diagnosed with recent HCV infection. Viral clearance with successful treatment was achieved in 108 patients (49.3%) and spontaneous clearance occurred in 20 (9.1%); of them, 18 (14.1%) acquired HCV reinfections, resulting in an incidence rate of 8.2 per 100 person-years of follow-up (95% CI 5.2-13.1). With the adjusted Cox proportional hazards model, we found a higher reinfection risk in patients with syphilis (adjusted hazard ratio 10.3, 95% CI 1.4-77.8, P = .023) compared to those without syphilis. HCV RNA testing, if performed only following syphilis and elevated aminotransferases, might miss 44.4% and 33.3% of HCV reinfections, respectively. CONCLUSIONS Similar to the findings in Europe, we observed a high incidence of HCV reinfection among HIV-positive Taiwanese with recent HCV infection, which was significantly associated with syphilis. To identify HCV reinfections, annual HCV RNA testing should be instituted instead of testing driven by symptoms, syphilis or elevated aminotransferases.
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Affiliation(s)
- Miao-Hui Huang
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Internal Medicine, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | - Sui-Yuan Chang
- Department of Laboratory Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Clinical Laboratory Sciences and Medical Biotechnology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chen-Hua Liu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Aristine Cheng
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Li-Hsin Su
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wen-Chun Liu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yi-Ching Su
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsin-Yun Sun
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chien-Ching Hung
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Tropical Medicine and Parasitology, National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.,China Medical University, Taichung, Taiwan
| | - Shan-Chwen Chang
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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14
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Sadeghimehr M, Bertisch B, Schaetti C, Wandeler G, Richard JL, Scheidegger C, Keiser O, Estill J. Modelling the impact of different testing strategies for HCV infection in Switzerland. J Virus Erad 2019. [DOI: 10.1016/s2055-6640(20)30036-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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15
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Nguyen LH, Tran BX, Rocha LEC, Nguyen HLT, Yang C, Latkin CA, Thorson A, Strömdahl S. A Systematic Review of eHealth Interventions Addressing HIV/STI Prevention Among Men Who Have Sex With Men. AIDS Behav 2019; 23:2253-2272. [PMID: 31401741 DOI: 10.1007/s10461-019-02626-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A systematic review was conducted to summarize and appraise the eHealth interventions addressing HIV/STI prevention among men who have sex with men (MSM), and characterize features of successful eHealth interventions. Fifty-five articles (17 pilots and 38 full efficacy trials) were included with the predominance of web-based interventions in the United States-based settings. Intervention modalities include web-based, short message service (SMS)/text messges/email reminder, online video-based, computer-assisted, multimedia-based, social network, live chat and chat room, virtual simulation intervention, and smartphone applications. Forty-nine eHealth interventions achieved a short-term behaviour change among participants. Four studies were conducted with 12-month follow-ups; and only one of them could maintain the behaviour change over this longer time period which could be due to the lack of booster interventions. Our study suggests that eHealth interventions can achieve short term behaviour change among MSM, however limited interventions could maintain behaviour change over 12 months. Further eHealth intervention strategies to promote HIV prevention among MSM should be conducted and rigorously evaluated.
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16
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Nijmeijer BM, Koopsen J, Schinkel J, Prins M, Geijtenbeek TBH. Sexually transmitted hepatitis C virus infections: current trends, and recent advances in understanding the spread in men who have sex with men. J Int AIDS Soc 2019; 22 Suppl 6:e25348. [PMID: 31468692 PMCID: PMC6715947 DOI: 10.1002/jia2.25348] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 06/21/2019] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Hepatitis C virus (HCV) is a major public health threat. Although the recent availability of highly effective directly acting antivirals created optimism towards HCV elimination, there is ongoing transmission of HCV in men who have sex with men (MSM). We here report current epidemiological trends and synthesise evidence on behavioural, network, cellular and molecular host factors associated with sexual transmission of HCV, in particular the role of HIV-1 co-infection. We discuss prevention opportunities focusing on the potential of HCV treatment. METHODS We searched MEDLINE, fact sheets from health professional bodies and conference abstracts using appropriate keywords to identify and select relevant reports. RESULTS AND DISCUSSION Recent studies strongly suggest that HCV is transmitted via sexual contact in HIV-positive MSM and more recently in HIV-negative MSM eligible for or on pre-exposure prophylaxis. The reinfection risk following clearance is about 10 times the risk of primary infection. International connectedness of MSM transmission networks might contribute to ongoing reinfection. Some of these networks might overlap with networks of people who inject drugs. Although, the precise mechanisms facilitating sexual transmission remain unclear, damage to the mucosal barrier in the rectum could increase susceptibility. Mucosal dendritic cell subsets could increase HCV susceptibility by retaining HCV and transmitting the virus to other cells, allowing egress into blood and liver. Early identification of new HCV infections is important to prevent onward transmission, but early diagnosis of acute HCV infection and prompt treatment is hampered by the slow rate of HCV antibody seroconversion, which in rare cases may take more than a year. Novel tests such as testing for HCV core antigen might facilitate early diagnosis. CONCLUSIONS High-risk sexual behaviour, network characteristics, co-infection with sexually transmitted infections like HIV-1 and other concomitant bacterial and viral sexually transmitted infections are important factors that lead to HCV spread. Targeted and combined prevention efforts including effective behavioural interventions and scale-up of HCV testing and treatment are required to halt HCV transmission in MSM.
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Affiliation(s)
- Bernadien M Nijmeijer
- Department of Experimental ImmunologyAmsterdam Infection and Immunity InstituteAmsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands
| | - Jelle Koopsen
- Department of Medical MicrobiologyLaboratory of Clinical VirologyAmsterdam Infection and Immunity InstituteAmsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands
| | - Janke Schinkel
- Department of Medical MicrobiologyLaboratory of Clinical VirologyAmsterdam Infection and Immunity InstituteAmsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands
| | - Maria Prins
- Department of Infectious Diseases, Research and PreventionPublic Health Service of AmsterdamAmsterdamThe Netherlands
| | - Teunis BH Geijtenbeek
- Department of Experimental ImmunologyAmsterdam Infection and Immunity InstituteAmsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands
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17
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Jin F, Matthews GV, Grulich AE. Sexual transmission of hepatitis C virus among gay and bisexual men: a systematic review. Sex Health 2019; 14:28-41. [PMID: 27712618 DOI: 10.1071/sh16141] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 08/14/2016] [Indexed: 12/21/2022]
Abstract
A systematic review was performed on the evidence of sexual transmission of hepatitis C virus (HCV) in gay and bisexual men (GBM). Studies conducted in industrialised countries and published in English from 2000 to 2015 with data on HCV in GBM were included. Pooled estimates of prevalence and incidence of HCV infection were stratified by study settings and participants' HIV status using random effect models. Case-series reports were summarised descriptively. Of the 38 cross-sectional studies, the pooled HCV prevalence was substantially higher in HIV-positive men (8.3%, 95% CI: 6.7-9.9) than in HIV-negative men (1.5%, 95% CI 0.8-2.1), and higher in those who reported injecting drug use (34.8%, 95% CI 26.9-42.7) than in those who did not (3.5%, 95% CI 2.4-4.5). Of the 16 longitudinal studies, the pooled HCV incidence was markedly higher in clinic-based (7.0 per 1000 person-years, 95% CI 4.6-9.5) than in community-based (1.4 per 1000 person-years, 95% CI 0.7-2.1) studies, and in HIV-positive men (6.4 per 1000 person-years, 95% CI 4.6-8.1) than in HIV-negative men (0.4 per 1000 person-years, 95% CI 0-0.9). Since the early 2000s, 15 case-series reports increasingly pointed to the importance of sexual transmission of HCV in mainly HIV-positive men. Injecting drug use remained the major transmission route of HCV in GBM. Receptive condomless intercourse and concurrent ulcerative sexually transmissible infections are likely drivers that facilitated HCV sexual transmission in HIV-positive men. HCV incidence remains very low in HIV-negative GBM.
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Affiliation(s)
- Fengyi Jin
- The Kirby Institute, Wallace Wurth Building, University of New South Wales, Sydney, NSW 2052, Australia
| | - Gail V Matthews
- The Kirby Institute, Wallace Wurth Building, University of New South Wales, Sydney, NSW 2052, Australia
| | - Andrew E Grulich
- The Kirby Institute, Wallace Wurth Building, University of New South Wales, Sydney, NSW 2052, Australia
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18
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Scott N, Stoové M, Wilson DP, Keiser O, El-Hayek C, Doyle J, Hellard M. Eliminating hepatitis C virus as a public health threat among HIV-positive men who have sex with men: a multi-modelling approach to understand differences in sexual risk behaviour. J Int AIDS Soc 2019; 21. [PMID: 29314670 PMCID: PMC5810343 DOI: 10.1002/jia2.25059] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 12/18/2017] [Indexed: 12/12/2022] Open
Abstract
Introduction Outbreaks of hepatitis C virus (HCV) infections among HIV‐positive men who have sex with men (MSM) have been observed globally. Using a multi‐modelling approach we estimate the time and number of direct‐acting antiviral treatment courses required to achieve an 80% reduction in HCV prevalence among HIV‐positive MSM in the state of Victoria, Australia. Methods Three models of HCV transmission, testing and treatment among MSM were compared: a dynamic compartmental model; an agent‐based model (ABM) parametrized to local surveillance and behavioural data (“ABM1”); and an ABM with a more heterogeneous population (“ABM2”) to determine the influence of extreme variations in sexual risk behaviour. Results Among approximately 5000 diagnosed HIV‐positive MSM in Victoria, 10% are co‐infected with HCV. ABM1 estimated that an 80% reduction in HCV prevalence could be achieved in 122 (inter‐quartile range (IQR) 112 to 133) weeks with 523 (IQR 479 to 553) treatments if the average time from HCV diagnosis to treatment was six months. This was reduced to 77 (IQR 69 to 81) weeks if the average time between HCV diagnosis and treatment commencement was decreased to 16 weeks. Estimates were consistent across modelling approaches; however ABM2 produced fewer incident HCV cases, suggesting that treatment‐as‐prevention may be more effective in behaviourally heterogeneous populations. Conclusions Major reductions in HCV prevalence can be achieved among HIV‐positive MSM within two years through routine HCV monitoring and prompt treatment as a part of HIV care. Compartmental models constructed with limited behavioural data are likely to produce conservative estimates compared to models of the same setting with more complex parametrizations.
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Affiliation(s)
- Nick Scott
- Disease Elimination Program, Burnet Institute, Melbourne, Vic., Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Vic., Australia
| | - Mark Stoové
- Disease Elimination Program, Burnet Institute, Melbourne, Vic., Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Vic., Australia
| | - David P Wilson
- Disease Elimination Program, Burnet Institute, Melbourne, Vic., Australia
| | - Olivia Keiser
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Carol El-Hayek
- Disease Elimination Program, Burnet Institute, Melbourne, Vic., Australia
| | - Joseph Doyle
- Disease Elimination Program, Burnet Institute, Melbourne, Vic., Australia.,Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Vic., Australia
| | - Margaret Hellard
- Disease Elimination Program, Burnet Institute, Melbourne, Vic., Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Vic., Australia.,Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Vic., Australia
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19
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Martin TCS, Rauch A, Salazar-Vizcaya L, Martin NK. Understanding and Addressing Hepatitis C Virus Reinfection Among Men Who Have Sex with Men. Infect Dis Clin North Am 2019; 32:395-405. [PMID: 29778262 DOI: 10.1016/j.idc.2018.02.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Hepatitis C virus reinfection rates among men who have sex with men are high. Factors associated with infection point to varied sexual and drug-related risks that could be targeted for interventions to prevent infection/reinfection. Modeling indicates that tackling increasing incidence and high reinfection rates requires high levels of hepatitis C virus treatment combined with behavioral interventions. Enhanced testing strategies and prompt retreating of reinfection may be required to promptly diagnosed reinfections. Behavioral interventions studies addressing reinfection are required. Other interventions include traditional harm reduction interventions, adapted behavioral interventions, and interventions to prevent harms related to ChemSex and other risk factors.
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Affiliation(s)
- Thomas C S Martin
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, 9500 Gilman Drive La Jolla, CA 92093-0507, USA
| | - Andri Rauch
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland, Friedbühlstrasse 53, Personalhaus 6, 3010 Bern, Switzerland
| | - Luisa Salazar-Vizcaya
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland, Friedbühlstrasse 53, Personalhaus 6, 3010 Bern, Switzerland
| | - Natasha K Martin
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, 9500 Gilman Drive La Jolla, CA 92093-0507, USA; School of Social and Community Medicine, University of Bristol, Senate House, Tyndall Avenue, Bristol BS8 1TH, UK.
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20
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Butt ZA, Shrestha N, Gesink D, Murti M, Buxton JA, Gilbert M, Balshaw RF, Wong S, Kuo M, Wong J, Yu A, Alvarez M, Samji H, Roth D, Consolacion T, Hull MW, Ogilvie G, Tyndall MW, Krajden M, Janjua NZ. Effect of opioid-substitution therapy and mental health counseling on HIV risk among hepatitis C-infected individuals. Clin Epidemiol 2018; 10:1127-1145. [PMID: 30214316 PMCID: PMC6124790 DOI: 10.2147/clep.s173449] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Background Understanding differences in HIV incidence among people living with hepatitis C virus (HCV) can help inform strategies to prevent HIV infection. We estimated the time to HIV diagnosis among HCV-positive individuals and evaluated factors that could affect HIV-infection risk in this population. Patients and methods The British Columbia Hepatitis Testers Cohort includes all BC residents (~1.5 million: about a third of all residents) tested for HCV and HIV from 1990 to 2013 and is linked to administrative health care and mortality data. All HCV-positive and HIV-negative individuals were followed to measure time to HIV acquisition (positive test) and identify factors associated with HIV acquisition. Adjusted HRs (aHRs) were estimated using Cox proportional-hazard regression. Results Of 36,077 HCV-positive individuals, 2,169 (6%) acquired HIV over 266,883 years of follow-up (overall incidence of 8.1 per 1,000 person years). Overall median (IQR) time to HIV infection was 3.87 (6.06) years. In Cox regression, injection-drug use (aHR 1.47, 95% CI 1.33–1.63), HBV infection (aHR 1.34, 95% CI 1.16–1.55), and being a man who has sex with men (aHR 2.78, 95% CI 2.14–3.61) were associated with higher risk of HIV infection. Opioid-substitution therapy (OST) (aHR 0.59, 95% CI 0.52–0.67) and mental health counseling (aHR 0.48, 95% CI 0.43–0.53) were associated with lower risk of HIV infection. Conclusion Injection-drug use, HBV coinfection, and being a man who has sex with men were associated with increased HIV risk and engagement in OST and mental health counseling were associated with reduced HIV risk among HCV-positive individuals. Improving access to OST and mental health services could prevent transmission of HIV and other blood-borne infections, especially in settings where access is limited.
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Affiliation(s)
- Zahid A Butt
- School of Population and Public Health, University of British Columbia, Vancouver, BC,
| | - Nabin Shrestha
- School of Population and Public Health, University of British Columbia, Vancouver, BC,
| | - Dionne Gesink
- Dalla Lana School of Public Health, University of Toronto
| | - Michelle Murti
- Dalla Lana School of Public Health, University of Toronto.,Public Health Ontario, Toronto, ON
| | - Jane A Buxton
- School of Population and Public Health, University of British Columbia, Vancouver, BC, .,Clinical Prevention Services, British Columbia Centre for Disease Control
| | - Mark Gilbert
- Clinical Prevention Services, British Columbia Centre for Disease Control
| | - Robert F Balshaw
- Clinical Prevention Services, British Columbia Centre for Disease Control
| | - Stanley Wong
- Clinical Prevention Services, British Columbia Centre for Disease Control
| | - Margot Kuo
- Clinical Prevention Services, British Columbia Centre for Disease Control
| | - Jason Wong
- School of Population and Public Health, University of British Columbia, Vancouver, BC, .,Clinical Prevention Services, British Columbia Centre for Disease Control
| | - Amanda Yu
- Clinical Prevention Services, British Columbia Centre for Disease Control
| | - Maria Alvarez
- Clinical Prevention Services, British Columbia Centre for Disease Control
| | - Hasina Samji
- Clinical Prevention Services, British Columbia Centre for Disease Control
| | - David Roth
- Clinical Prevention Services, British Columbia Centre for Disease Control
| | | | - Mark W Hull
- Division of AIDS, Faculty of Medicine, University of British Columbia.,AIDS Research Program, British Columbia Centre for Excellence in HIV/AIDS
| | - Gina Ogilvie
- School of Population and Public Health, University of British Columbia, Vancouver, BC, .,Clinical Prevention Services, British Columbia Centre for Disease Control
| | - Mark W Tyndall
- School of Population and Public Health, University of British Columbia, Vancouver, BC, .,Clinical Prevention Services, British Columbia Centre for Disease Control
| | - Mel Krajden
- School of Population and Public Health, University of British Columbia, Vancouver, BC, .,Clinical Prevention Services, British Columbia Centre for Disease Control.,BCCDC Public Health Laboratory, Vancouver, BC, Canada
| | - Naveed Z Janjua
- School of Population and Public Health, University of British Columbia, Vancouver, BC, .,Clinical Prevention Services, British Columbia Centre for Disease Control
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21
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Tieu HV, Laeyendecker O, Nandi V, Rose R, Fernandez R, Lynch B, Hoover DR, Frye V, Koblin BA. Prevalence and mapping of hepatitis C infections among men who have sex with men in New York City. PLoS One 2018; 13:e0200269. [PMID: 30020960 PMCID: PMC6051624 DOI: 10.1371/journal.pone.0200269] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 06/23/2018] [Indexed: 12/13/2022] Open
Abstract
Emerging sexually transmitted hepatitis C virus (HCV) epidemics among men who have sex with men (MSM) have been reported worldwide, with higher HCV infection rates among those who are HIV-infected. This study aims to determine prevalence of recent and chronic HCV infections among community-recruited MSM in New York City (NYC), map HCV infections by home, social, and sexual neighborhoods, and identify clusters of genetically linked HCV variants using phylogenetic analysis. The NYC M2M study recruited MSM via modified time-space, venue-based sampling and internet/mobile app-based recruitment during 2010–13. Participants completed a Google Earth map on neighborhoods of where they lived, socialized, and had sex in the last 3 months, an ACASI questionnaire, and a sexual network inventory about their sex partners. The men received HIV testing and provided serum samples. Testing on stored serum samples included HCV antibody and RNA viral load, HCV antibody avidity assay (avidity index <30% with positive viral load is considered recently infected), and HCV RNA extraction and amplification to generate a 432 base-pair region of Core/E1 for sequencing and phylogenetic analysis. Historic local controls were included in the phylogenetic analysis. Of 1,028 MSM, 79.7% were HIV-negative and 20.3% HIV-positive. Twenty nine MSM (2.8%) were HCV antibody-positive. MSM who were HCV antibody-positive reported a median of 2 male sex partners in last 3 months, with 6.9% aged 18–24, 17.2% 25–29, 13.8% 30–39, and 62.1% 40 and over. 8.1% of HIV-positive MSM were HCV antibody-positive vs. 1.5% of HIV-negative men (p<0.0001). Of 29 HCV-antibody positive MSM, 12 (41%) were HCV RNA-positive (11 subtype 1a and 1 subtype 1b). Two of 12 HCV RNA-positive participants had low antibody avidity values, suggesting recent HCV infection. HCV antibody seropositivity was significantly associated with older age >40 years, adjusted odds ratio (aOR) 3.56 (95% CI 1.57, 8.08), HIV-positive serostatus, aOR 3.18 (95% CI 1.40, 7.22), any sexually transmitted infection (STI) in the last 3 months, aOR 2.81 (95% CI 1.11, 7.13), and injection drug use (IDU) ever, aOR 4.34 (95% CI 1.69, 11.17). Mapping of HCV infections differed slightly by home, social, and sexual neighborhoods. Based on phylogenetic analysis from 12 HCV RNA-positive samples, no evidence of a clustered HCV epidemic was found. Overall HCV seroprevalence was 2.8% among community-recruited MSM in NYC, with higher prevalence among HIV-positive MSM compared to HIV-negative MSM. Only two participants were found to have recent HCV infection, with no evidence of a clustered HCV epidemic based on phylogenetic analysis. Our results support testing of HCV infection among HIV-negative MSM if they report having a recent STI and IDU in the past rather than universal HCV testing in all HIV-negative MSM.
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Affiliation(s)
- Hong-Van Tieu
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York, United States of America
- Columbia University Medical Center, Division of Infectious Diseases, Department of Medicine, New York, United States of America
- * E-mail:
| | - Oliver Laeyendecker
- National Institute of Allergy and Infectious Diseases, Baltimore, United States of America
- School of Medicine, Johns Hopkins University, Baltimore, United States of America
| | - Vijay Nandi
- Laboratory of Data Analytics, New York Blood Center, New York, United States of America
| | - Rebecca Rose
- BioInfoExperts, LLC, Thibodaux, United States of America
| | - Reinaldo Fernandez
- School of Medicine, Johns Hopkins University, Baltimore, United States of America
| | - Briana Lynch
- National Institute of Allergy and Infectious Diseases, Baltimore, United States of America
| | - Donald R. Hoover
- Rutgers the State University of New Jersey, Department of Statistics, Piscataway, United States of America
| | - Victoria Frye
- City University of New York School of Medicine, New York, United States of America
| | - Beryl A. Koblin
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York, United States of America
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Wright E, Grulich A, Roy K, Boyd M, Cornelisse V, Russell D, O'Donnell D, Whittaker B, Crooks L, Zablotska I. Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine HIV pre-exposure prophylaxis: clinical guidelines. Update April 2018. J Virus Erad 2018. [DOI: 10.1016/s2055-6640(20)30260-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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23
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Steininger K, Boyd A, Dupke S, Krznaric I, Carganico A, Munteanu M, Neifer S, Schuetze M, Obermeier M, Arasteh K, Baumgarten A, Ingiliz P. HIV-positive men who have sex with men are at high risk of development of significant liver fibrosis after an episode of acute hepatitis C. J Viral Hepat 2017; 24:832-839. [PMID: 28439936 DOI: 10.1111/jvh.12707] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 02/01/2017] [Indexed: 12/17/2022]
Abstract
Acute hepatitis C virus infection remains a major health concern in human immunodeficiency virus(HIV)-infected men who have sex with men (MSM). New direct-acting antiviral agent (DAA) combination therapy has not yet been approved for the treatment for acute hepatitis C virus(HCV), thereby potentially causing deferral of HCV treatment. Therefore, we aimed to study the course of liver disease after an episode of acute HCV. This study is a retrospective single-centre cohort of HIV-positive MSM with acute HCV infection. Liver fibrosis was estimated by Fibroscan® and Fibrotest® . Liver-related and non-liver-related outcomes were documented. Overall 213 episodes of acute HCV infection in 178 men were documented. Median follow-up for all included patients was 38.7 months. Spontaneous HCV clearance was found in 10.8% of patients, which was significantly associated with older age, lower HCV RNA levels, and higher ALT levels upon initial acute HCV diagnosis. Treatment with interferon-based therapy was initiated in 86.3% of cases, resulting in a sustained virological response(SVR) rate of 70.7%. After 3 years' follow-up, significant liver fibrosis of METAVIR F2 stage or higher was found in 39.4% of patients after first acute HCV diagnosis. Higher age, physician-declared alcoholism, and nonresponse to acute HCV therapy were independently associated with higher fibrosis stages. Ten patients died during the observation period (IR 1.4/100 patient-years) and four during interferon treatment. Significant liver fibrosis is a common finding in HIV-positive MSM following acute HCV infection despite high treatment uptake and cure rates, suggesting the need for close liver disease monitoring particularly if HCV treatment is deferred.
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Affiliation(s)
- K Steininger
- Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - A Boyd
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM UMR_S 1136, Paris, France
| | - S Dupke
- Center for Infectiology, Berlin, Germany
| | - I Krznaric
- Center for Infectiology, Berlin, Germany
| | | | | | - S Neifer
- Center for Microbiology Dr. Neifer, Berlin, Germany
| | | | | | - K Arasteh
- Department of Infectiology, Vivantes Auguste-Viktoria-Hospital, Berlin, Germany
| | | | - P Ingiliz
- Center for Infectiology, Berlin, Germany
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Wright E, Grulich A, Roy K, Boyd M, Cornelisse V, Russell D, O'Donnell D, Whittaker B, Crooks L, Zablotska I. Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine HIV pre-exposure prophylaxis: clinical guidelines. J Virus Erad 2017. [DOI: 10.1016/s2055-6640(20)30338-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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25
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Wurcel AG, Chen DD, Chui KKH, Knox TA. "Tweak Your Order Set!" Implementation of Modified Laboratory Order Set Improves Hepatitis C Virus Screening Rates in People Living With Human Immunodeficiency Virus. Open Forum Infect Dis 2017; 4:ofx098. [PMID: 28852673 PMCID: PMC5569929 DOI: 10.1093/ofid/ofx098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 05/10/2017] [Indexed: 11/25/2022] Open
Abstract
There are several barriers to annual hepatitis C virus antibody (HCVAb) testing, including lack of provider knowledge of the changing HCV epidemic and provider underestimation of a patient’s risk. We identified low rates of testing for HCVAb in people living with human immunodeficiency virus (HIV) in our outpatient HIV Infectious Diseases clinic, and we developed a quality improvement project to increase rates of HCVAb screening.
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Affiliation(s)
- Alysse G Wurcel
- Department of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston,Massachusetts; and.,Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston,Massachusetts
| | - Daniel D Chen
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston,Massachusetts
| | - Kenneth K H Chui
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston,Massachusetts
| | - Tamsin A Knox
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston,Massachusetts
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26
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Medland NA, Chow EPF, Bradshaw CS, Read THR, Sasadeusz JJ, Fairley CK. Predictors and incidence of sexually transmitted Hepatitis C virus infection in HIV positive men who have sex with men. BMC Infect Dis 2017; 17:185. [PMID: 28253838 PMCID: PMC5335771 DOI: 10.1186/s12879-017-2288-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 02/23/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sexual transmission of Hepatitis C virus (HCV) in men who have sex with men (MSM) and its interaction with HIV status, sexually transmitted infections and sexual behaviour is poorly understood. We assessed the incidence and predictors of HCV infection in HIV positive MSM. METHODS The electronic medical record and laboratory results from HIV positive MSM in care at a large urban public specialist HIV clinic embedded in a sexual health centre in Melbourne Australia were collected. Patients with two or more HCV antibody tests between January 2008 and March 2016 and with no record of injecting drug use were included. The HCV exposure intervals were the periods between a negative HCV test and the next HCV test. We compared HCV exposure intervals temporally associated with and without newly acquired syphilis or anorectal chlamydia. HCV exposure intervals were also categorised as being before or after HIV virological suppression and by most recent and nadir CD4 cell count. RESULTS Thirty seven new HCV infections were diagnosed in 822 HIV positive MSM with no history of injecting drug use over 3114 person years (PY) of follow-up. Mean age was 43.1 years (±12.5) and mean CD4 cell count nadir was 362 cells/uL (±186). The incidence of HCV infection in the study population was 1.19/100PY (0.99-1.38). The incidence in exposure periods temporally close to new syphilis infection was 4.72/100PY (3.35-6.08) and to new anorectal chlamydia infection was 1.37/100PY (0.81-1.93). The incidence in men without supressed viral load was 3.19/100PY (1.89-4.49). In the multivariate Cox regression analysis only younger age (aHR 0.67 (0.48-0.92)), exposure periods temporally associated to new syphilis infection (aHR 4.96 (2.46-9.99)) and higher CD4 cell count nadir (aHR 1.26 per 100 cells/uL (1.01-1.58)) were associated with increased risk of HCV infection. During the study period the incidence of syphilis increased dramatically but the incidence of HCV infection remained the same. CONCLUSIONS Incidence of HCV infection is associated with syphilis but not anorectal chlamydia which suggests a biological rather than behavioural risk modification. Rising syphilis incidence may offset declines in HCV transmission through HCV treatment as prevention.
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Affiliation(s)
- Nicholas A Medland
- Melbourne Sexual Health Centre, Alfred Health, Melbourne Australia and Central Clinical School, Monash University, Melbourne, Australia. .,, 580 Swanston Street, Carlton, VIC, 3053, Australia.
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne Australia and Central Clinical School, Monash University, Melbourne, Australia
| | - Catriona S Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, Melbourne Australia and Central Clinical School, Monash University, Melbourne, Australia
| | - Timothy H R Read
- Melbourne Sexual Health Centre, Alfred Health, Melbourne Australia and Central Clinical School, Monash University, Melbourne, Australia
| | | | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne Australia and Central Clinical School, Monash University, Melbourne, Australia
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27
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Jordan AE, Perlman DC, Neurer J, Smith DJ, Des Jarlais DC, Hagan H. Prevalence of hepatitis C virus infection among HIV+ men who have sex with men: a systematic review and meta-analysis. Int J STD AIDS 2017; 28:145-159. [PMID: 26826159 PMCID: PMC4965334 DOI: 10.1177/0956462416630910] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Since 2000, an increase in hepatitis C virus infection among HIV-infected (HIV+) men who have sex with men has been observed. Evidence points to blood exposure during sex as the medium of hepatitis C virus transmission. Hepatitis C virus prevalence among HIV + MSM overall and in relation to injection drug use is poorly characterized. In this study, a systematic review and meta-analysis examining global hepatitis C virus antibody prevalence and estimating active hepatitis C virus prevalence among HIV + MSM were conducted; 42 reports provided anti-hepatitis C virus prevalence data among HIV + MSM. Pooled prevalence produced an overall anti-hepatitis C virus prevalence among HIV + MSM of 8.1%; active HCV prevalence estimate was 5.3%-7.3%. Anti-hepatitis C virus prevalence among injection drug use and non-injection drug use HIV + MSM was 40.0% and 6.7%, respectively. Among HIV + MSM, hepatitis C virus prevalence increased significantly over time among the overall and non-injection drug use groups, and decreased significantly among injection drug use HIV + MSM. We identified a moderate prevalence of hepatitis C virus among all HIV + MSM and among non-injection drug use HIV + MSM; for both, prevalence was observed to be increasing slightly. Pooled prevalence of hepatitis C virus among HIV + MSM was higher than that observed in the 1945-1965 US birth cohort. The modest but rising hepatitis C virus prevalence among HIV + MSM suggests an opportunity to control HCV among HIV + MSM; this combined with data demonstrating a rising hepatitis C virus incidence highlights the temporal urgency to do so.
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Affiliation(s)
- Ashly E Jordan
- 1 New York University, New York, NY, USA
- 2 Center for Drug Use and HIV Research, New York, NY, USA
| | - David C Perlman
- 2 Center for Drug Use and HIV Research, New York, NY, USA
- 3 Icahn School of Medicine, Mount Sinai Beth Israel, New York, NY, USA
| | | | | | - Don C Des Jarlais
- 2 Center for Drug Use and HIV Research, New York, NY, USA
- 3 Icahn School of Medicine, Mount Sinai Beth Israel, New York, NY, USA
| | - Holly Hagan
- 1 New York University, New York, NY, USA
- 2 Center for Drug Use and HIV Research, New York, NY, USA
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28
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Incidence of hepatitis C in HIV positive and negative men who have sex with men 2000-2016: a systematic review and meta-analysis. Infection 2016; 45:309-321. [PMID: 28005195 DOI: 10.1007/s15010-016-0975-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 12/08/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND There is a need for systematic reviews and meta-analyses to synthesize the epidemiology, and the riskfactors for hepatitis C virus (HCV) among HIV-coinfected and HIV negative men who have sex with men (MSM). METHODS A meta-analysis of 28 studies was carried out by pooling HCV incidence data of HIV-coinfected and HIV negative MSM. Differences in incidence outcome depending on the prospective or retrospective nature of the individual studies were investigated. RESULTS The pooled incidence of HCV in MSM was 6.3 per 1000 person-years (95% CI 5.0-7.5). The overall estimated incidence was 19-fold higher in HIV positive compared to HIV negative MSM living in resource-rich countries. This result was confirmed when the analysis was restricted to high-quality studies. Factors associated with an increased risk for incident HCV included behavioural factors (sexual risk behaviour and recreational drug use) as well as biological characteristics (HIV coinfection and a recent history of syphilis). CONCLUSION In conclusion, incident HCV predominantly affects HIV positive MSM. The incidence rate varied largely between studies, factors such as study design might play an important role.
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29
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Sollima S, Antinori S, Torre A, Binda F, Giacomelli A, Milazzo L. Successful treatment of sexually acquired acute HCV reinfection with ledipasvir/sofosbuvir in a HIV-infected patient. Int J STD AIDS 2016. [PMID: 28632109 DOI: 10.1177/0956462416684462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Here we describe the case of a HIV-positive patient with acute hepatitis C virus reinfection, who was successfully treated with an interferon-free regimen of ledipasvir/sofosbuvir.
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Affiliation(s)
- Salvatore Sollima
- 1 III Division of Infectious Diseases, L. Sacco University Hospital, Milan, Italy
| | - Spinello Antinori
- 1 III Division of Infectious Diseases, L. Sacco University Hospital, Milan, Italy.,2 Department of Clinical and Biomedical Sciences L. Sacco, University of Milan, Milan, Italy
| | - Alessandro Torre
- 1 III Division of Infectious Diseases, L. Sacco University Hospital, Milan, Italy
| | - Francesca Binda
- 1 III Division of Infectious Diseases, L. Sacco University Hospital, Milan, Italy
| | - Andrea Giacomelli
- 1 III Division of Infectious Diseases, L. Sacco University Hospital, Milan, Italy
| | - Laura Milazzo
- 1 III Division of Infectious Diseases, L. Sacco University Hospital, Milan, Italy
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30
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Salazar‐Vizcaya L, Kouyos RD, Zahnd C, Wandeler G, Battegay M, Darling KEA, Bernasconi E, Calmy A, Vernazza P, Furrer H, Egger M, Keiser O, Rauch A. Hepatitis C virus transmission among human immunodeficiency virus-infected men who have sex with men: Modeling the effect of behavioral and treatment interventions. Hepatology 2016; 64:1856-1869. [PMID: 27531615 PMCID: PMC5132019 DOI: 10.1002/hep.28769] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 07/04/2016] [Accepted: 07/25/2016] [Indexed: 12/12/2022]
Abstract
UNLABELLED The incidence of hepatitis C virus (HCV) infections among human immunodeficiency virus (HIV)-infected men who have sex with men has increased in recent years and is associated with high-risk sexual behavior. Behavioral interventions that target high-risk behavior associated with HCV transmission and treatment with direct-acting antivirals may prevent further HCV infections. We predicted the effect of behavioral and treatment interventions on HCV incidence and prevalence among HIV-infected men who have sex with men up to 2030 using a HCV transmission model parameterized with data from the Swiss HIV Cohort Study. We assessed behavioral interventions associated with further increase, stabilization, and decrease in the size of the population with high-risk behavior. Treatment interventions included increase in treatment uptake and use of direct-acting antivirals. If we assumed that without behavioral interventions high-risk behavior spread further according to the trends observed over the last decade and that the treatment practice did not change, HCV incidence converged to 10.7/100 person-years. All assessed behavioral interventions alone resulted in reduced HCV transmissions. Stabilization of high-risk behavior combined with increased treatment uptake and the use of direct-acting antivirals reduced incidence by 77% (from 2.2 in 2015 to 0.5/100 person-years) and prevalence by 81% (from 4.8% in 2015 to 0.9%) over the next 15 years. Increasing treatment uptake was more effective than increasing treatment efficacy to reduce HCV incidence and prevalence. A decrease in high-risk behavior led to a rapid decline in HCV incidence, independent of treatment interventions. CONCLUSION Treatment interventions to curb the HCV epidemic among HIV-infected men who have sex with men are effective if high-risk behavior does not increase as it has during the last decade; reducing high-risk behavior associated with HCV transmission would be the most effective intervention for controlling the HCV epidemic, even if this was not accompanied by an increase in treatment uptake or efficacy. (Hepatology 2016;64:1856-1869).
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Affiliation(s)
- Luisa Salazar‐Vizcaya
- Institute of Social and Preventive MedicineUniversity of BernBernSwitzerland,Department of Infectious DiseasesInselspital, Bern University Hospital, University of BernBernSwitzerland
| | - Roger D. Kouyos
- Division of Infectious Diseases and Hospital EpidemiologyUniversity Hospital ZurichZurichSwitzerland,Institute of Medical VirologyUniversity of ZurichZurichSwitzerland
| | - Cindy Zahnd
- Institute of Social and Preventive MedicineUniversity of BernBernSwitzerland
| | - Gilles Wandeler
- Institute of Social and Preventive MedicineUniversity of BernBernSwitzerland,Department of Infectious DiseasesInselspital, Bern University Hospital, University of BernBernSwitzerland
| | - Manuel Battegay
- Division of Infectious Diseases and Hospital EpidemiologyUniversity Hospital BaselBaselSwitzerland
| | | | - Enos Bernasconi
- Division of Infectious DiseasesLugano Regional HospitalLuganoSwitzerland
| | - Alexandra Calmy
- Division of Infectious DiseasesUniversity Hospital GenevaGenevaSwitzerland
| | - Pietro Vernazza
- Division of Infectious Diseases and Hospital EpidemiologyCantonal Hospital St. GallenSt. GallenSwitzerland
| | - Hansjakob Furrer
- Department of Infectious DiseasesInselspital, Bern University Hospital, University of BernBernSwitzerland
| | - Matthias Egger
- Institute of Social and Preventive MedicineUniversity of BernBernSwitzerland,Centre for Infectious Disease Epidemiology & ResearchUniversity of Cape TownCape TownSouth Africa
| | - Olivia Keiser
- Institute of Social and Preventive MedicineUniversity of BernBernSwitzerland
| | - Andri Rauch
- Department of Infectious DiseasesInselspital, Bern University Hospital, University of BernBernSwitzerland
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Oliver NT, Hartman CM, Kramer JR, Chiao EY. Statin drugs decrease progression to cirrhosis in HIV/hepatitis C virus coinfected individuals. AIDS 2016; 30:2469-2476. [PMID: 27753678 PMCID: PMC5290260 DOI: 10.1097/qad.0000000000001219] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Chronic HIV/hepatitis C virus (HCV) coinfection carries increased risk of cirrhosis, hepatocellular carcinoma, and death. Due to anti-inflammatory properties, 3-hydroxy-3methylglutaryl coenzyme A (HMG-CoA) inhibitors (statins) may be useful adjunctive therapy to reduce liver disease progression. METHODS Clinical information was extracted from the Veterans Affairs HIV and HCV Clinical Case Registries (1999-2010). HIV-related variables included combination antiretroviral therapy era of diagnosis, CD4 cell count, and percentage time with undetectable HIV viral load. Metabolic variables included diabetes, low high-density lipoprotein (HDL), and hypertension. Statin use was measured as percentage time with active prescription (time-updated throughout the follow-up period). Cox proportional hazards analysis was used to determine risk factors for cirrhosis (International Classification of Diseases-9 or aminotransferase-to-platelet ratio index >2) overall and in groups stratified by alanine aminotransferase (ALT) level above and below 40 IU/l. RESULTS The cohort included 5985 HIV/HCV coinfected veterans. The majority was black race, and the mean age at index date was 45 years. Statin use was significantly protective of cirrhosis for patients with ALT 40 IU/l or less; for every 30% increase in time on statin, there was a 32% decreased risk of developing cirrhosis (hazard ratio 0.68, 95% confidence interval 0.47-0.98). Diabetes and low HDL were significantly associated with cirrhosis in patients with ALT greater than 40 IU/l (hazard ratio 1.15, P < 0.04 and hazard ratio 1.3, P < 0.0001). CONCLUSION Statin drug use is beneficial in mitigating the risk of liver disease progression for HIV/HCV coinfected patients without advanced liver disease. Low HDL and diabetes in coinfected patients with abnormal ALT have greater risk of cirrhosis development.
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Affiliation(s)
- Nora T Oliver
- aDepartment of Medicine, Section of Infectious Diseases and Health Services Research, Baylor College of Medicine bCenter for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
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32
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Midgard H, Weir A, Palmateer N, Lo Re V, Pineda JA, Macías J, Dalgard O. HCV epidemiology in high-risk groups and the risk of reinfection. J Hepatol 2016; 65:S33-S45. [PMID: 27641987 DOI: 10.1016/j.jhep.2016.07.012] [Citation(s) in RCA: 122] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 07/08/2016] [Accepted: 07/12/2016] [Indexed: 12/18/2022]
Abstract
Injecting risk behaviours among people who inject drugs (PWID) and high-risk sexual practices among men who have sex with men (MSM) are important routes of hepatitis C virus (HCV) transmission. Current direct-acting antiviral treatment offers unique opportunities for reductions in HCV-related liver disease burden and epidemic control in high-risk groups, but these prospects could be counteracted by HCV reinfection due to on-going risk behaviours after successful treatment. Based on existing data from small and heterogeneous studies of interferon-based treatment, the incidence of reinfection after sustained virological response range from 2-6/100 person years among PWID to 10-15/100 person years among human immunodeficiency virus-infected MSM. These differences mainly reflect heterogeneity in study populations with regards to risk behaviours, but also reflect variations in study designs and applied virological methods. Increasing levels of reinfection are to be expected as we enter the interferon-free treatment era. Individual- and population-level efforts to address and prevent reinfection should therefore be undertaken when providing HCV care for people with on-going risk behaviour. Constructive strategies include acknowledgement, education and counselling, harm reduction optimization, scaled-up treatment including treatment of injecting networks, post-treatment screening, and rapid retreatment of reinfections.
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Affiliation(s)
- Håvard Midgard
- Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway; Institute for Clinical Medicine, University of Oslo, Norway; Department of Gastroenterology, Oslo University Hospital, Norway.
| | - Amanda Weir
- School of Health and Life Sciences, Glasgow Caledonian University, United Kingdom; NHS National Services Scotland, Health Protection Scotland, Glasgow, United Kingdom
| | - Norah Palmateer
- School of Health and Life Sciences, Glasgow Caledonian University, United Kingdom; NHS National Services Scotland, Health Protection Scotland, Glasgow, United Kingdom
| | - Vincent Lo Re
- Division of Infectious Diseases, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, United States
| | - Juan A Pineda
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Sevilla, Spain
| | - Juan Macías
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Sevilla, Spain
| | - Olav Dalgard
- Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway; Institute for Clinical Medicine, University of Oslo, Norway
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33
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Entre pulsion et raison : dimensions psychodynamiques et sociologiques de la sexualité d’hommes gais séropositifs. Étude Hepaig, 2007–2008, France. EVOLUTION PSYCHIATRIQUE 2016. [DOI: 10.1016/j.evopsy.2016.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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The Health, Enlightenment, Awareness, and Living (HEAL) Intervention: Outcome of an HIV and Hepatitis B and C Risk Reduction Intervention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13100948. [PMID: 27669284 PMCID: PMC5086687 DOI: 10.3390/ijerph13100948] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Revised: 09/05/2016] [Accepted: 09/12/2016] [Indexed: 11/16/2022]
Abstract
African American women have among the highest HIV/AIDS and hepatitis B and C incidence rates in the United States, especially among those homeless or incarcerated. The objective of this study was to evaluate the Health Enlightenment, Awareness and Living Intervention, designed to decrease HIV/AIDS, hepatitis and related risky behaviors. The thirteen-session intervention was implemented among homeless and formerly incarcerated low-income African American women, ages 18 to 55, in Atlanta, Georgia from 2006 to 2010. A single group repeated measures study design was employed and consisted of a pre-test (n = 355) group, an immediate post-test (n = 228) group with a response rate of 64%, and a six-month follow up (n = 110) group with response rate of 48%, completing a 135-item survey. Paired-sample t-tests, McNemar tests, and repeated measures ANOVA were applied to compare survey results. Participants demonstrated statistically significant increases in hepatitis B and C knowledge over time (p < 0.001). Statistically significant decreases were also reported for unprotected sex in exchange for money, drugs or shelter (p = 0.008), and sex under the influence of drugs or alcohol (p < 0.001). Reported substance use decreased with statistical significance for alcohol (p = 0.011), marijuana (p = 0.011), illegal drugs (p = 0.002), and crack/cocaine (p = 0.003). Findings broaden the evidence base related to the effectiveness of HIV/AIDS and hepatitis risk reduction interventions designed for homeless and previously incarcerated African American women.
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Omata M, Kanda T, Wei L, Yu ML, Chuang WL, Ibrahim A, Lesmana CRA, Sollano J, Kumar M, Jindal A, Sharma BC, Hamid SS, Dokmeci AK, Al-Mahtab M, McCaughan GW, Wasim J, Crawford DHG, Kao JH, Yokosuka O, Lau GKK, Sarin SK. APASL consensus statements and recommendations for hepatitis C prevention, epidemiology, and laboratory testing. Hepatol Int 2016; 10:681-701. [PMID: 27229718 PMCID: PMC5003900 DOI: 10.1007/s12072-016-9736-3] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 04/20/2016] [Indexed: 02/06/2023]
Abstract
The Asian Pacific Association for the Study of the Liver (APASL) convened an international working party on "APASL consensus statements and recommendations for management of hepatitis C" in March 2015 to revise the "APASL consensus statements and management algorithms for hepatitis C virus infection" (Hepatol Int 6:409-435, 2012). The working party consisted of expert hepatologists from the Asian-Pacific region gathered at the Istanbul Congress Center, Istanbul, Turkey on 13 March 2015. New data were presented, discussed, and debated during the course of drafting a revision. Participants of the consensus meeting assessed the quality of the cited studies. The finalized recommendations for hepatitis C prevention, epidemiology, and laboratory testing are presented in this review.
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Affiliation(s)
- Masao Omata
- Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu-shi, Yamanashi, 400-8506, Japan.
- The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Tatsuo Kanda
- Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Lai Wei
- Peking University People's Hospital, Peking University Hepatology Institute, Beijing, China
| | - Ming-Lung Yu
- Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Wang-Long Chuang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Alaaeldin Ibrahim
- GI/Liver Division, Department of Internal Medicine, University of Benha, Banha, Egypt
| | | | - Jose Sollano
- University Santo Tomas Hospital, Manila, Philippines
| | - Manoj Kumar
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Ankur Jindal
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | | | - Saeed S Hamid
- Department of Medicine, Aga Khan University and Hospital, Stadium Road, Karachi, 74800, Pakistan
| | - A Kadir Dokmeci
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Mamun Al-Mahtab
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, 1000, Bangladesh
| | - Geofferey W McCaughan
- Royal Prince Alfred Hospital, Centenary Institute, University of Sydney, Sydney, Australia
| | - Jafri Wasim
- Department of Medicine, Aga Khan University and Hospital, Stadium Road, Karachi, 74800, Pakistan
| | - Darrell H G Crawford
- University of Queensland, School of Medicine, Woolloongabba, QLD, 4102, Australia
| | - Jia-Horng Kao
- National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan
| | - Osamu Yokosuka
- Graduate School of Medicine, Chiba University, Chiba, Japan
| | - George K K Lau
- The Institute of Translational Hepatology, Beijing 302 Hospital, Beijing, China
| | - Shiv Kumar Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
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Armstrong AR, Herrmann SE, Chassany O, Lalanne C, Da Silva MH, Galano E, Carrieri PM, Estellon V, Sogni P, Duracinsky M. The International development of PROQOL-HCV: An instrument to assess the health-related quality of life of patients treated for Hepatitis C virus. BMC Infect Dis 2016; 16:443. [PMID: 27553866 PMCID: PMC4994204 DOI: 10.1186/s12879-016-1771-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 08/10/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) compromises Health-related Quality of Life (HRQL) with detriments to Physical, Mental and Social health domains. Treatment with interferon and ribavirin is associated with side effects which further impair HRQL. New treatments appear potent, effective and tolerable. However, Patient Reported Outcomes instruments that capture the impact on HRQL for people with hepatitis C are largely non-specific and will be needed in the new treatment era. Therefore, we developed a conceptually valid multidimensional model of HCV-specific quality of life and pilot survey instrument, the Patient Reported Outcome Quality of Life survey for HCV (PROQOL-HCV). METHODS HCV patients from France (n = 30), Brazil (n = 20) and Australia (n = 20) were interviewed to investigate HCV-HRQL issues raised in the scientific literature and by treatment specialists. Interviews were recorded, transcribed and translated into English and French. RESULTS Fifteen content dimensions were derived from the qualitative analysis, refined and fitted to four domains: (1) Physical Health included: fatigue, pain, sleep, sexual impairment and physical activity; (2) Mental Health: psychological distress, psychosocial impact, and cognition; (3) Social Health: support, stigma, social activity, substance use; (4) TREATMENT: management, side effects, and fear of treatment failure. The impact of some dimensions extended beyond their primary domain including: physical activity, cognition, sleep, sexual impairment, and the three treatment dimensions. A bank of 300 items was constructed to reflect patient reports and, following expert review, reduced to a 72-item pilot questionnaire. CONCLUSION We present a conceptually valid multidimensional model of HCV-specific quality of life and the pilot survey instrument, PROQOL-HCV. The model is widely inclusive of the experience of hepatitis C and the first to include the treatment dimension.
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Affiliation(s)
- Andrew Richard Armstrong
- EA 7334 REMES, Patient-Centered Outcomes Research, University Paris-Diderot, Sorbonne Paris Cité, Paris, France
- Australian Institute of Family Studies, Melbourne, Australia
| | - Susan Elizabeth Herrmann
- Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Western Australia Australia
| | - Olivier Chassany
- EA 7334 REMES, Patient-Centered Outcomes Research, University Paris-Diderot, Sorbonne Paris Cité, Paris, France
- URC-ECO, Hopital Hotel-Dieu, AP-HP, Paris, France
| | - Christophe Lalanne
- EA 7334 REMES, Patient-Centered Outcomes Research, University Paris-Diderot, Sorbonne Paris Cité, Paris, France
| | | | - Eliana Galano
- Centro de Referência e Treinamento DST/Aids, Rue santa Cruz, Sao Paulo, Brazil
| | | | | | - Philippe Sogni
- Service d’Hépatologie, Hopital Cochin, AP-HP, Paris, France
| | - Martin Duracinsky
- EA 7334 REMES, Patient-Centered Outcomes Research, University Paris-Diderot, Sorbonne Paris Cité, Paris, France
- URC-ECO, Hopital Hotel-Dieu, AP-HP, Paris, France
- Service de Médecine Interne et d’Immunologie Clinique, Hopital Bicetre, AP-HP, Kremlin-Bicetre, France
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Chan DP, Sun HY, Wong HT, Lee SS, Hung CC. Sexually acquired hepatitis C virus infection: a review. Int J Infect Dis 2016; 49:47-58. [DOI: 10.1016/j.ijid.2016.05.030] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 05/26/2016] [Accepted: 05/28/2016] [Indexed: 12/19/2022] Open
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Remis RS, Liu J, Loutfy MR, Tharao W, Rebbapragada A, Huibner S, Kesler M, Halpenny R, Grennan T, Brunetta J, Smith G, Reko T, Kaul R. Prevalence of Sexually Transmitted Viral and Bacterial Infections in HIV-Positive and HIV-Negative Men Who Have Sex with Men in Toronto. PLoS One 2016; 11:e0158090. [PMID: 27391265 PMCID: PMC4938580 DOI: 10.1371/journal.pone.0158090] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 06/12/2016] [Indexed: 01/28/2023] Open
Abstract
Background Hepatitis B (HBV), hepatitis C (HCV) and other sexually transmitted infections (STIs) have been associated with HIV transmission risk and disease progression among gay men and other men who have sex with men (MSM), but the frequency and distribution of STIs in this community in Canada has not been extensively studied. Methods We recruited MSM living with and without HIV from a large primary care clinic in Toronto. Participants completed a detailed socio-behavioural questionnaire using ACASI and provided blood for syphilis, HIV, HBV and HCV, herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2), and human cytomegalovirus (CMV) serology, urine for chlamydia and gonorrhea, and a self-collected anal swab for human papillomavirus (HPV) molecular diagnostics. Prevalences were expressed as a proportion and compared using chi-square. Results 442 MSM were recruited, 294 living with HIV and 148 without. Active syphilis (11.0% vs. 3.4%), ever HBV (49.4% vs. 19.1%), HCV (10.4% vs. 3.4%), HSV-2 (55.9% vs. 38.2%), CMV (98.3% vs. 80.3%) and high-risk (HR) anal HPV (67.6% vs. 51.7%) infections were significantly more common in men living with HIV. Chlamydia and gonorrhea were infrequent in both groups. Regardless of HIV infection status, age and number of lifetime male sexual partners were associated with HBV infection and lifetime injection drug use with HCV infection. Conclusions Syphilis and viral infections, including HBV, HCV, HSV-2, CMV, and HR-HPV, were common in this clinic-based population of MSM in Toronto and more frequent among MSM living with HIV. This argues for the implementation of routine screening, vaccine-based prevention, and education programs in this high-risk population.
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Affiliation(s)
- Robert S. Remis
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Juan Liu
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Mona R. Loutfy
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, University of Toronto, Toronto, Ontario, Canada
- Maple Leaf Medical Clinic, Toronto, Ontario, Canada
| | - Wangari Tharao
- Women’s Health in Women’s Hands Community Health Centre, Toronto, Ontario, Canada
| | - Anuradha Rebbapragada
- Public Health Laboratory–Toronto Public Health Ontario, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Sanja Huibner
- Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Maya Kesler
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Troy Grennan
- Maple Leaf Medical Clinic, Toronto, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Graham Smith
- Maple Leaf Medical Clinic, Toronto, Ontario, Canada
| | - Tatjana Reko
- Maple Leaf Medical Clinic, Toronto, Ontario, Canada
| | - Rupert Kaul
- Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
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Lee S, Lee SH, Lee SJ, Kim KH, Lee JE, Cho H, Lee SG, Chung JS, Kwak IS. Incidence and risk factors of hepatitis C virus infection among human immunodeficiency virus (HIV) patients in a large HIV clinic in South Korea. Korean J Intern Med 2016; 31:772-8. [PMID: 27117318 PMCID: PMC4939506 DOI: 10.3904/kjim.2015.353] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 12/21/2015] [Accepted: 01/02/2016] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND/AIMS Increasing incidences of hepatitis C virus (HCV) infection in human immunodeficiency virus (HIV)-infected men who have sex were reported in the United States and Europe. However, few studies regarding the epidemiology of HCV infection in HIV-infected patients in Asian countries have been reported. METHODS To determine the prevalence and incidence of HCV infection in HIV-infected patients, a retrospective cohort study was conducted. All HIV-infected patients who visited a tertiary care hospital in Korea from 2000 to 2013 were identified. Patients with ≥ 1 HCV antibody (Ab) test were included and observed until December 2014. RESULTS Among 996 HIV-infected patients, 790 patients (79%) had baseline HCV Ab tests and 41 (5.2%) were positive at baseline and four at follow-up. Experience of injecting drug use (IDU; adjusted odds ratio, 16.20; 95% confidence interval [CI], 1.56 to 167.89; p < 0.01) was significantly associated with prevalent HCV infection. Conversion to HCV Ab positivity was observed in four of 384 included patients, with an incidence rate of 2.22 (95% CI, 0.60 to 5.80)/1,000 person-years (PYs); 164.89 (95% CI, 34.00 to 481.88)/1,000 PYs in patients with IDU, and 1.40 (95% CI, 0.35 to 7.79)/1,000 PYs in men who have sex with men who denied IDU. There was no significant increase in incidence rate of HCV in HIV-infected patients from 2009 to 2014 (p = 0.119). Among 19 patients who were positive for HCV RNA, genotype 1b (73%) was the most common following 2a/2c (20%). CONCLUSIONS IDU was an independent risk factor for prevalent HCV infection. Prevalence of HCV infection was low and incidence of HCV infection was not significantly increased in HIV-infected patients in South Korea.
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Affiliation(s)
- Shinwon Lee
- Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Sun Hee Lee
- Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan, Korea
- Correspondence to Sun Hee Lee, M.D. Division of Infectious Diseases, Department of Internal Medicine, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan 49241, Korea Tel: +82-51-240-7673 Fax: +82-51-247-3213 E-mail:
| | - Su Jin Lee
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Kye-Hyung Kim
- Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Jeong Eun Lee
- Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Heerim Cho
- Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Seung Geun Lee
- Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Joo Seop Chung
- Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Ihm Soo Kwak
- Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan, Korea
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Abstract
PURPOSE OF REVIEW Modern interferon (IFN)-free, and potentially also ribavirin-free, combinations consisting of two or three direct-acting antivirals (DAAs) are highly efficacious in treating chronic hepatitis C virus (HCV) infection with treatment durations being much shorter and with much more favorable toxicity profiles. With the acute HCV (AHC) epidemic among men who have sex with men (MSM) still ongoing, the question remains should we be using DAAs in the acute phase of the infection? RECENT FINDINGS To date, none of the currently available DAAs has been licensed for use in the setting of AHC infection. Thus, the current gold standard of treatment still is a combination of pegylated interferon (pegIFN) and weight-adapted ribavirin (RBV). However, with less patients being treated in the acute phase, the current epidemic of AHC in HIV-positive MSM will continue. SUMMARY A decision to treat AHC with pegIFN and RBV can currently only be made on an individual basis in an open discussion between patient and physician which will need to weigh up the risk and benefits of a rather toxic and lengthy treatment now versus the likely available options in the chronic phase. Therefore, studies with IFN-free DAA combinations remain of great urgency to further evaluate the role of DAAs in the treatment of AHC.
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Wurcel AG, Chen DD, Fitzpatrick RE, Grasberger PE, Kirshner CH, Anderson JE, Chui KKH, Knox TA. Hepatitis C Screening in People With Human Immunodeficiency Virus: Lessons Learned From Syphilis Screening. Open Forum Infect Dis 2016; 3:ofv215. [PMID: 26885544 PMCID: PMC4751919 DOI: 10.1093/ofid/ofv215] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 12/24/2015] [Indexed: 12/16/2022] Open
Abstract
Background. The incidence of hepatitis C virus (HCV) infection is increasing in human immunodeficiency virus (HIV)-positive men who have sex with men (MSM). New guidelines recommend annual screening for HCV, similar to recommendations for syphilis screening with rapid plasma reagin (RPR). Methods. This study compares the frequency of repeat HCV antibody (Ab) testing to repeat RPR testing in a retrospective chart review of 359 HCVAb-negative people living with HIV (PLWH) observed in an Infectious Diseases clinic. Patients were classified into risk groups based on sexual risk factors. Results. Although 85% of PLWH had repeat syphilis screening, less than two thirds had repeat HCVAb screening. The MSM status was associated with increased HCVAb and RPR testing (adjusted odds ratio, 2.6 and 5.9, respectively). Seven persons had incident HCV infection: 3 were MSM, and 4 had symptoms or abnormal laboratory results to prompt testing. Conclusions. Failure to find incident HCV infection in PLWH represents missed opportunities to cure HCV infection and prevent progressive liver disease. Further quality improvement studies are necessary to develop physician-focused interventions to increase HCV screening rates in PLWH.
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Affiliation(s)
- Alysse G Wurcel
- Department of Geographic Medicine and Infectious Diseases, Tufts Medical Center; Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | - Daniel D Chen
- Department of Public Health and Community Medicine , Tufts University School of Medicine , Boston, Massachusetts
| | - Rosemary E Fitzpatrick
- Department of Public Health and Community Medicine , Tufts University School of Medicine , Boston, Massachusetts
| | - Paula E Grasberger
- Department of Public Health and Community Medicine , Tufts University School of Medicine , Boston, Massachusetts
| | - Caleb H Kirshner
- Department of Public Health and Community Medicine , Tufts University School of Medicine , Boston, Massachusetts
| | - Jordan E Anderson
- Department of Public Health and Community Medicine , Tufts University School of Medicine , Boston, Massachusetts
| | - Kenneth K H Chui
- Department of Public Health and Community Medicine , Tufts University School of Medicine , Boston, Massachusetts
| | - Tamsin A Knox
- Department of Public Health and Community Medicine , Tufts University School of Medicine , Boston, Massachusetts
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Giuliani M, Vescio MF, Donà MG, Latini A, Frasca M, Colafigli M, Farinella M, Rezza G, Cristaudo A. Perceptions of Human Papillomavirus (HPV) infection and acceptability of HPV vaccine among men attending a sexual health clinic differ according to sexual orientation. Hum Vaccin Immunother 2016; 12:1542-50. [PMID: 26752151 DOI: 10.1080/21645515.2015.1115935] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Our aim was to gain a better understanding of the knowledge about Human Papillomavirus (HPV) infection and attitudes toward the HPV vaccine among men at risk for sexually transmitted infections (STI). A self-administered questionnaire was completed by attendees of the largest STI Center in Rome, Italy, from April to June 2013. Determinants of vaccine acceptability were investigated using a Structured Equation Model. A total of 423 males participated in the survey: 296 (70.0%) men who have sex with men (MSM) and 127 (30.0%) men who have sex with women (MSW). Only one half of the participants knew that HPV is the cause of genital warts (56.9% of MSM vs. 49.5% of MSW, p=0.28). Even less were aware that HPV causes cancer in men (37.2% vs. 27.3%, p=0.08). MSW were more likely to indicate HPV as a cause of cervical cancer (80.8% vs. 69.3%, p=0.03) and to have heard about the vaccine (58.3 vs. 43.6%, p=0.01). Moreover, 72.1% of MSM and 70.3% of MSW were willing to be vaccinated. A rise of one-unit in the HPV awareness score increased the OR of vaccine acceptability among MSM by 25% (OR 1.25, 95%CI: 1.05-1.49; p=0.013). Differently, only attitudes had a relevant effect on willingness to be vaccinated among MSW (OR 3.32, 95%CI: 1.53-7.17; p=0.002). Efforts should be made to maximize awareness of HPV, especially as a causative agent of genital warts and male cancers, and to reinforce positive attitudes toward vaccination among men visiting STI centers.
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Affiliation(s)
- Massimo Giuliani
- a STI/HIV Unit, UOC Dermatologia Infettiva e Allergologica, San Gallicano Dermatological Institute (IRCCS) , Rome , Italy
| | - Maria Fenicia Vescio
- b Infectious, Parasitic and Immunomediated Diseases Department , Istituto Superiore di Sanità , Rome , Italy
| | - Maria Gabriella Donà
- a STI/HIV Unit, UOC Dermatologia Infettiva e Allergologica, San Gallicano Dermatological Institute (IRCCS) , Rome , Italy
| | - Alessandra Latini
- a STI/HIV Unit, UOC Dermatologia Infettiva e Allergologica, San Gallicano Dermatological Institute (IRCCS) , Rome , Italy
| | - Mirko Frasca
- a STI/HIV Unit, UOC Dermatologia Infettiva e Allergologica, San Gallicano Dermatological Institute (IRCCS) , Rome , Italy
| | - Manuela Colafigli
- a STI/HIV Unit, UOC Dermatologia Infettiva e Allergologica, San Gallicano Dermatological Institute (IRCCS) , Rome , Italy
| | | | - Giovanni Rezza
- b Infectious, Parasitic and Immunomediated Diseases Department , Istituto Superiore di Sanità , Rome , Italy
| | - Antonio Cristaudo
- a STI/HIV Unit, UOC Dermatologia Infettiva e Allergologica, San Gallicano Dermatological Institute (IRCCS) , Rome , Italy
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Hepatitis C Virus Awareness Among Men Who Have Sex With Men in Southwest Switzerland. Sex Transm Dis 2016; 43:44-8. [DOI: 10.1097/olq.0000000000000378] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Bello DD, Ita-Nagy F, Hand J, Dieterich D. Treatment of hepatitis C in coinfected patients. Future Virol 2015. [DOI: 10.2217/fvl.15.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
HCV and liver disease have emerged as major causes of morbidity and mortality in HIV-positive patients. Treating HCV in patients with HIV has been challenging up until a few years ago due to poorer outcomes with interferon-based therapies in this population. The direct-acting antiviral (DAA) agents offer a new era in the treatment of HCV for all patients regardless of HIV status. This article reviews multiple aspects of the care of the coinfected patient with a focus on the modern DAA agents. HCV clinical treatment trials involving HIV-positive patients and antiretroviral therapy/DAA drug–drug interactions are reviewed in detail.
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Affiliation(s)
- David Del Bello
- Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, PO Box 1123, Annenberg 21–42, New York, NY 10029, USA
| | - Fanny Ita-Nagy
- Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, PO Box 1123, Annenberg 21–42, New York, NY 10029, USA
| | - Jonathan Hand
- Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, PO Box 1123, Annenberg 21–42, New York, NY 10029, USA
| | - Douglas Dieterich
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, PO Box 1123, Annenberg 21–42, New York, NY 10029, USA
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Low prevalence of hepatitis C co-infection in recently HIV-infected minority men who have sex with men in Los Angeles: a cross-sectional study. BMC Infect Dis 2015; 15:538. [PMID: 26590028 PMCID: PMC4654841 DOI: 10.1186/s12879-015-1279-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 11/12/2015] [Indexed: 12/04/2022] Open
Abstract
Background Geographic and sociodemographic characterization of hepatitis C virus (HCV) transmission amongst men who have sex with men (MSM) has been limited. Our aim was to characterize HCV prevalence, risk factors for HCV co-infection, and patterns of HIV and HCV co-transmission and transmitted drug resistance mutations (DRMs) in newly HIV-diagnosed Los Angeles MSM. Methods Viral RNA was extracted from stored plasma samples from a Los Angeles cohort of newly diagnosed HIV-infected MSM with well-characterized substance use and sexual behavioral characteristics via computer-assisted self-interviewing surveys. Samples were screened for HCV by qPCR. HCV E1, E2, core, NS3 protease and NS5B polymerase and HIV-1 protease and reverse transcriptase regions were amplified and sequenced. Phylogenetic analysis was used to determine relatedness of HCV and HIV-1 isolates within the cohort and viral sequences were examined for DRMs. Results Of 185 newly HIV-diagnosed MSM, the majority (65 %) were of minority race/ethnicity and recently infected (57.8 %), with median age of 28.3 years. A minority (6.6 %) reported injection drug use (IDU), whereas 96 (52.8 %) reported recent substance use, primarily cannabis or stimulant use. High risk sexual behaviors included 132 (74.6 %) with unprotected receptive anal intercourse, 60 (33.3 %) with group sex, and 10 (5.7 %) with fisting. Forty-five (24.3 %) had acute gonorrhea or chlamydia infection. Only 3 (1.6 %) subjects had detectable HCV RNA. Amongst these subjects, HIV and HCV isolates were unrelated by phylogenetic analysis and none possessed clinically relevant NS3 or NS5B HCV DRMs. Conclusions Prevalence of HCV co-infection was low and there was no evidence of HIV-HCV co-transmission in this cohort of relatively young, predominantly minority, newly HIV-diagnosed MSM, most with early HIV infection, with high rates of high risk sexual behaviors, STI, and non-IDU. The low HCV prevalence in a group with high-risk behaviors for non-IDU HCV acquisition suggests an opportune time for targeted HCV prevention measures.
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High Prevalence and High Incidence of Coinfection with Hepatitis B, Hepatitis C, and Syphilis and Low Rate of Effective Vaccination against Hepatitis B in HIV-Positive Men Who Have Sex with Men with Known Date of HIV Seroconversion in Germany. PLoS One 2015; 10:e0142515. [PMID: 26555244 PMCID: PMC4640863 DOI: 10.1371/journal.pone.0142515] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 10/22/2015] [Indexed: 12/14/2022] Open
Abstract
Objectives Men who have sex with men (MSM) are at higher risk for coinfection with hepatitis B virus (HBV), hepatitis C virus (HCV), and syphilis than the general population. HIV infection and these coinfections accelerate disease progression reciprocally. This study evaluated the prevalence and incidence of these coinfections in HIV1-positive MSM in Germany. Materials and Methods As part of a nationwide, multicenter, prospective cohort study of HIV-infected MSM, plasma samples collected yearly were screened for HBsAg and antibodies to HBc, HBs, HCV, and syphilis. Samples with indications of active HBV or HCV infection were confirmed by polymerase chain reaction. Prevalence and incidence of each infection and incidence rates per study participant were calculated, and incidences over 4-year time intervals compared. Results This study screened 5,445 samples from 1,843 MSM. Median age at HIV seroconversion was 33 years. Prevalences of active, cleared, and occult HBV, and of active/cleared HCV were 1.7%, 27.1%, 0.2%, and 8.2%, respectively, and 47.5% had been effectively vaccinated against HBV. Prevalence of antibodies to Treponema pallidum and of triple or quadruple sexually transmitted infections (STIs) were 39.6% and 18.9%, respectively. Prevalence of STI, cleared HBV, HBV vaccination, and history of syphilis differed significantly among age groups. Incidences of HBV, HCV, and syphilis were 2.51, 1.54, and 4.06 per 100 person-years, respectively. Incidences of HCV and syphilis increased over time. HCV incidence was significantly higher in MSM coinfected with syphilis and living in Berlin, and syphilis incidence was significantly higher for MSM living in Berlin. Discussion Despite extensive HBV vaccination campaigns, fewer than 50% of screened MSM were effectively vaccinated, with a high proportion of HIV-positive MSM coinfected with HBV. High rates of STI coinfections in HIV-positive MSM and increasing incidences emphasize the need for better tailored campaigns for HBV vaccination and STI prevention.
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Incidence of sexually transmitted hepatitis C virus infection in HIV-positive men who have sex with men. AIDS 2015; 29:2335-45. [PMID: 26258525 DOI: 10.1097/qad.0000000000000834] [Citation(s) in RCA: 169] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The epidemiology of the incidence of sexually transmitted hepatitis C virus (HCV) infection in HIV-positive men who have sex with men (MSM) is only partially understood. In the presence of HIV, HCV infection is more likely to become chronic and liver fibrosis progression is accelerated. DESIGN A systematic review and meta-analysis was used to synthesize data characterizing sexually transmitted HCV in HIV-positive MSM. METHODS Electronic and other searches of medical literature (including unpublished reports) were conducted. Eligible studies reported on HCV seroconversion or on reinfection postsuccessful HCV treatment in HIV-positive MSM who were not injecting drugs. Pooled incidence rates were calculated using random-effects meta-analysis, and meta-regression was used to assess study-level moderators. Attributable risk measures were calculated from statistically significant associations between exposures and HCV seroconversion. RESULTS More than 13 000 HIV-positive MSM in 17 studies were followed for more than 91 000 person-years between 1984 and 2012; the pooled seroconversion rate was 0.53/100 person-years. Calendar time was a significant moderator of HCV seroconversion, increasing from an estimated rate of 0.42/100 person-years in 1991 to 1.09/100 person-years in 2010, and 1.34/100 person-years in 2012. Reinfection postsuccessful HCV treatment (n = 2 studies) was 20 times higher than initial seroconversion rates. Among the seroconverters, a large proportion of infections were attributable to high-risk behaviours including mucosally traumatic sex and sex while high on methamphetamine. CONCLUSION The high reinfection rates and the attributable risk analysis suggest the existence of a subset of HIV-positive MSM with recurring sexual exposure to HCV. Approaches to HCV control in this population will need to consider the changing epidemiology of HCV infection in MSM.
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Boesecke C, Grint D, Soriano V, Lundgren JD, d'Arminio Monforte A, Mitsura VM, Chentsova N, Hadziosmanovic V, Kirk O, Mocroft A, Peters L, Rockstroh JK. Hepatitis C seroconversions in HIV infection across Europe: which regions and patient groups are affected? Liver Int 2015; 35:2384-91. [PMID: 25875966 DOI: 10.1111/liv.12848] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 04/09/2015] [Indexed: 02/13/2023]
Abstract
BACKGROUND & AIMS In the last decade, several outbreaks of sexually acquired acute hepatitis C (HCV) infection have been described in HIV-positive men who have sex with men (MSM). The aims of this study were to determine whether there has been an increase in the number of acute HCV infections in different parts of Europe. METHODS HCV seroconversion was defined as an HCV-antibody test change from negative to positive within the observation period in EuroSIDA. Binomial regression was performed to determine factors associated with being tested for HCV and HCV seroconversion. RESULTS A total of 223 HCV seroconversions were observed from 16,188 tests [1.38% (95%CI 1.20-1.56)] among 5736 patients between 2002 and 2013. Overall the odds of acquiring HCV infection increased by 4% per year (OR 1.04 [95%CI 0.99-1.09]; P = 0.10). Overall 63.2% (141/223) of all seroconversions were seen among MSM. Similar patterns were observed across all European regions (P = 0.69, test for interaction) and HIV transmission risks groups (P = 0.69, test for interaction). In multivariate analysis, North, South and East Europe had higher odds of HCV seroconversion compared with Western Europe [OR 1.90 (1.28-2.81), 1.55 (0.99-2.45) and 1.86 (1.21-2.84); P = 0.0014, P = 0.058 and P = 0.0044 respectively]. CONCLUSIONS Within EuroSIDA a significant increase in HCV seroconversions can be observed after accounting for increased levels of testing for HCV in recent years. This highlights the need for increased HCV prevention efforts among HIV-positive persons in Europe.
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Affiliation(s)
- Christoph Boesecke
- Department of Internal Medicine I, Bonn University Hospital, Bonn, Germany
| | | | | | - Jens D Lundgren
- Department of Infectious Diseases and Rheumatology, CHIP, Rigshospitalet, Copenhagen, Denmark
| | | | | | | | | | - Ole Kirk
- Department of Infectious Diseases and Rheumatology, CHIP, Rigshospitalet, Copenhagen, Denmark
| | | | - Lars Peters
- Department of Infectious Diseases and Rheumatology, CHIP, Rigshospitalet, Copenhagen, Denmark
| | - Jürgen K Rockstroh
- Department of Internal Medicine I, Bonn University Hospital, Bonn, Germany
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Tsai JC, Hung CC, Chang SY, Liu WC, Wu CH, Su YC, Wu PY, Luo YZ, Chang LH, Sun HY, Chang SC. Increasing incidence of recent hepatitis C virus infection among persons seeking voluntary counselling and testing for HIV and sexually transmitted infections in Taiwan. BMJ Open 2015; 5:e008406. [PMID: 26463221 PMCID: PMC4606383 DOI: 10.1136/bmjopen-2015-008406] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Revised: 08/05/2015] [Accepted: 09/17/2015] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES The incidence of hepatitis C virus (HCV) infection among HIV-negative men who have sex with men (MSM) is rarely investigated in the Asia-Pacific region. We aimed to estimate the incidence rate of and factors associated with recent HCV infection among the clients seeking voluntary counselling and testing (VCT) services for HIV in Taiwan. METHODS During 2006-2013, 12 143 clients sought VCT services for HIV. Clients with subsequent follow-up tests at an interval of 6 months or longer were included to estimate the incidence rate of HCV seroconversion. Phylogenetic analysis of HCV sequences from VCT clients and HIV-positive patients was performed. RESULTS The overall HCV seroprevalence at baseline was 0.3%. Of 2150 clients testing negative for anti-HCV antibody at baseline with a total of 5074.99 person-years of follow-up (PYFU), 17 (0.8%) developed HCV seroconversion, leading to an overall incidence rate of 3.35 per 1000 PYFU (95% CI 1.76 to 4.94), which increased from 2.28 (95% CI 0.05 to 4.51) in 2006-2009, to 3.33 (95% CI 0.86 to 5.80) in 2010 to 2011 and 4.94 per 1000 PYFU (95% CI 0.99 to 8.99) in 2012-2013; the incidence of early syphilis increased from 11.91 to 13.28 and 31.78 per 1000 PYFU in the three corresponding periods. In multivariate analysis, having HIV-positive partners (adjusted HR (AHR) =3.756; 95%CI 1.180 to 11.955) and developing a rapid plasma reagin titre of 4 or greater (AHR=9.978; 95% CI 1.550 to 64.233) were significantly associated with HCV seroconversion. CONCLUSIONS An increasing trend of recent HCV infection occurs among individuals seeking VCT services in Taiwan. Having HIV-positive partners and having syphilis are independently associated with recent HCV seroconversion.
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Affiliation(s)
- Jen-Chih Tsai
- Department of Internal Medicine, Tzu-Chi Hospital and Tzu-Chi University College of Medicine, Hualien, Taiwan
| | - Chien-Ching Hung
- Departments of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Sui-Yuan Chang
- Departments of Laboratory Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Clinical Laboratory Sciences and Medical Biotechnology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wen-Chun Liu
- Departments of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Cheng-Hsin Wu
- Departments of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yi-Ching Su
- Departments of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Pei-Ying Wu
- Center of Infection Control, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Zhen Luo
- Center of Infection Control, National Taiwan University Hospital, Taipei, Taiwan
| | - Lan-Hsin Chang
- Departments of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsin-Yun Sun
- Departments of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Shan-Chwen Chang
- Departments of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Lo YC, Tsai MS, Sun HY, Hung CC, Chuang JH. National Trend and Characteristics of Acute Hepatitis C among HIV-Infected Individuals: A Matched Case-Control Study-Taiwan, 2001-2014. PLoS One 2015; 10:e0139687. [PMID: 26439381 PMCID: PMC4595084 DOI: 10.1371/journal.pone.0139687] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 09/16/2015] [Indexed: 12/11/2022] Open
Abstract
Background Hepatitis C virus (HCV) infection has been increasingly recognized among HIV-infected men who have sex with men (MSM) worldwide. We investigated the trend of and factors associated with acute hepatitis C (AHC) among HIV-infected individuals in Taiwan. Methods The National Disease Surveillance System collects characteristics of AHC, HIV, syphilis, and gonorrhea cases through mandatory reports and patient interviews. Reported AHC patients in 2014 were interviewed additionally on sexual and parenteral exposures. Information on HCV genotypes were collected from the largest medical center serving HIV-infected Taiwanese. We defined an HIV/AHC case as a documented negative HCV antibody test result followed within 12 months by a positive test in a previously reported HIV-infected individual. Each case was matched to two HIV-infected, non-AHC controls for age, age of HIV diagnosis, sex, transmission route, HIV diagnosis date, and county/city. Conditional logistic regression was used to identify associated characteristics. Results During 2001–2014, 93 of 6,624 AHC reports were HIV/AHC cases; the annual case count increased from one in 2009 to 34 in 2014. All were males (81 [87%] MSM) aged 21–49 years with AHC diagnosed 2–5,923 days after HIV diagnoses. Sixty-eight (73%) lived in the Taipei metropolitan area. Detected HCV genotypes were 2a (n = 6), 1b (n = 5), 1b + 2a (n = 1) and 2b (n = 1). Among 28 HIV/AHC patients interviewed in 2014, 13 (46%) reported engaging in unprotected sex ≤3 months before AHC diagnosis. Seventy-nine HIV/AHC cases were matched to 158 controls. HIV/AHC was associated with recent syphilis (adjusted odds ratio [aOR], 10.9; 95% confidence interval [CI], 4.2–28.6) and last syphilis >6 months (aOR, 2.9; 95% CI, 1.2–6.9). Conclusions HIV/AHC cases continued to increase particularly among sexually active HIV-infected MSM with a syphilis diagnosis in northern Taiwan. We recommend surveillance of associated behavioral and virologic characteristics and HCV counseling and testing for HIV-infected men in Taiwan.
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Affiliation(s)
- Yi-Chun Lo
- Taiwan Centers for Disease Control, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- * E-mail: (JHC); (YCL)
| | - Mao-Song Tsai
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Hsin-Yun Sun
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chien-Ching Hung
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jen-Hsiang Chuang
- Taiwan Centers for Disease Control, Taipei, Taiwan
- * E-mail: (JHC); (YCL)
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