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to Section One | to Arts & Entertainment
posted Friday, February 22, 2013 - Volume 41 Issue 8
The new epidemic? Hep C infection at all-time high among HIV+ men, study finds
Section One
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The new epidemic? Hep C infection at all-time high among HIV+ men, study finds

by Mike Andrew - SGN Staff Writer

Hepatitis C infections are at an all-time high among HIV-positive men, a new study by the Fenway Institute in Boston says.

According to the study, published in Clinical Infectious Diseases, the rate of infection among HIV-positive men was 1.6%, the highest ever seen among men who have sex with men (MSM) in the United States.

'This is the highest HCV [Hepatitis C Virus] incidence reported in the United States among HIV-infected MSM to date and suggests that incident HCV is common in this population,' the authors of the study said.

SEX, DRUGS BLAMED
The study's findings also showed that infections were most likely due to high-risk sexual behavior and/or non-injecting drug use.

Hepatitis C is a blood-borne infection, and injecting drug use is a major risk factor for infection.

However, there is growing evidence that Hep C transmissions are not always linked to injecting drug use among HIV-positive Gay men. Instead, Hep C infections appear to be due to 'traumatic sexual practices' (such as fisting) and non-injecting drug use, especially in the context of group sex.

'Our findings support the growing body of evidence that the epidemiology of HCV infection may be changing among HIV-infected MSM in the United States,' the authors said.

'In the absence of [injecting drug use], high-risk sexual behaviors and non-injecting drug use appear to play an important role in transmission.'

To date, much of the data on HCV/HIV co-infection comes from Europe. However, Hep C infections in the absence of injecting drug use have also been reported among HIV-positive Gay men in New York and other U.S. cities.

A LARGE-SCALE STUDY
The importance of the Fenway study is that it represents the largest study to date of patients in the U.S.

Doctors from the Institute designed a retrospective study involving all HIV-infected men who had at least two appointments at their clinic between June 2008 and June 2009. The authors then extracted data from patient records to determine prevalence and incidence of Hep C infection between 1997 and 2009.

A total of 1,160 HIV-positive Gay men were included in the study, and 1,059 (91%) of those had had at least one hepatitis C antibody test.

Men who reported sex with men as their only risk factor for infection with HIV were more likely to be screened for hepatitis C than men who reported both sex with another man and injecting drug use. Men with a detectable HIV viral load were also more likely to have a hepatitis C antibody test than patients with an undetectable viral load.

Initial screening showed that 64 (6%) of the HIV-positive men were co-infected with the Hep C virus.

The Fenway Institute in Boston provides care to a large number of HIV-positive Gay men. The prevalence of self-reported injecting drug use among these patients is low at below 3%. Researchers at the Institute therefore believed their patients offered 'a unique opportunity to explore the epidemiology of HCV among a population of patients previously perceived to be at low risk.'

TEST FOR HEP C YEARLY
The authors conclude that HIV-positive Gay men should be tested annually for Hepatitis C.

They also recommend that 'HIV-infected MSM who use recreational drugs and/or engage in unprotected sex should receive education and services related to sexual risk reduction ... preventative interventions are crucial to stemming the ongoing spread of HCV.'

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