Men who have sex with men (MSM) are at risk of contracting hepatitis C virus (HCV) regardless of their HIV status, according to a study published in Clinical Infectious Diseases. High rates of sexually transmitted HCV among MSM without HIV has only recently been noted, while HCV has been well-documented among MSM with HIV since the early 2000s. Guidelines recommend that for MSM without HIV, HCV testing is necessary at pre-exposure prophylaxis (PrEP) initiation and annually thereafter while on PrEP.
Investigators analyzed data from the HIV Prevention Trials Network 078 for 1305 MSM who were tested for HIV and HCV infection and completed demographic, behavioral, and psychosocial questionnaires. Their objective was to determine the prevalence of HCV antibodies among MSM with and without HIV, as well as factors associated with HCV infection among MSM.
Of the 1287 MSM with HCV antibody results, the median age was 41 (interquartile range [IQR], 30-52), 69% were Black, 85% had a high school diploma or higher education, 35% were employed, 21% received substance use counseling in the past 6 months, and the median lifetime number of male sexual partners was 17 (IQR, 6-50). HIV was diagnosed in 70% (n=900) of participants, and 19% (n=246) of participants had HCV.
The prevalence of HCV antibody positivity was high in MSM with and without HIV (20% and 17%, respectively; P =.12), and was also higher in study participants who received substance use counseling vs those who had not (36% and 15%, respectively; P <.0001).
Factors associated with HCV infection among MSM included being older than the median age (odds ratio [OR], 1.07; 95% CI, 1.05-1.08), and having less than a high school diploma (OR, 1.67; 95% CI, 1.13-2.48), a history of substance use counseling or treatment (OR, 2.51; 95% CI, 1.80-3.51), and unstable housing (OR, 2.16; 95% CI, 1.40-3.33). Black MSM participating in the study were less likely to be HCV antibody positive (OR, 0.71; 95% CI, 0.51-0.98) than non-Black participants.
Investigators concluded that MSM without HIV need to be tested for HCV with higher frequency. Except for a standard, one-time test, current US recommendations for HCV testing from the Infectious Diseases Society of America do not have guidelines for testing MSM without HIV who are not on PrEP.
Investigators also noted that the strong association between HCV infection and MSM who received substance use counseling or treatment “suggest the need to co-locate HCV screening and treatment, alcohol, and other drug treatment in order to make care easily accessible.”
Irvin R, Gamble T, Malone J, et al. HPTN 078: high prevalence of HCV antibodies among urban U.S. men who have sex with men (MSM) independent of HIV status. Clin Infect Dis. Published online December 21, 2020. doi:10.1093/cid/ciaa1869