High incidence of HCV in HIV-negative men who have sex with men using pre-exposure prophylaxis

JOURNAL OF HEPATOLOGY

卷:72

Article

Hoornenborg, Elske¹  Coyer, Liza¹  Boyd, Anders^1,5  Achterbergh, Roel Christiaan Alfons¹  van der Loeff, Maarten Franciscus Schim^1,2  Bruisten, Sylvia¹  de Vries, Henry John Christiaan^1,3  Koopsen, Jelle⁴  van de Laar, Thijs J. W.^6,7  Prins, Maria^1,2 

[1] Publ Hlth Serv Amsterdam, Dept Infect Dis, Nieuwe Achtergracht 100, NL-1018 WT Amsterdam, Netherlands

[2] Univ Amsterdam, Amsterdam Univ Med Ctr, UMC, Acad Med Ctr,Dept Infect Dis,AI&II, Amsterdam, Netherlands

[3] Univ Amsterdam, Amsterdam UMC, Acad Med Ctr, Dept Dermatol,Amsterdam Inst Infect & Immun AI&II, Amsterdam, Netherlands

[4] Univ Amsterdam, Amsterdam UMC, Acad Med Ctr, Clin Virol Lab, Amsterdam, Netherlands

[5] Stichting HIV Monitoring, Amsterdam, Netherlands

[6] Sanquin Res, Dept Donor Med Res, Lab Blood Borne Infect, Amsterdam, Netherlands

[7] Onze Lieve Vrouw Hosp, Lab Med Microbiol, Amsterdam, Netherlands

关键词: HIV;    Pre-exposure prophylaxis;    Hepatitis C virus;    Molecular epidemiology;    Risk factors;    Men who have sex with men;    Homosexuality;    Male;   

DOI  :  10.1016/j.jhep.2019.11.022

来源: Elsevier

【 摘 要 】

Background & Aims: HCV has emerged as a sexually transmitted infection (STI) among HIV-positive men who have sex with men (MSM). We evaluated HCV incidence and its risk factors among HIV-negative MSM using HIV pre-exposure prophylaxis (PrEP). Methods: Participants of the Amsterdam PrEP project were tested for HCV antibodies or HCV-RNA every 6 months. Participants used daily or event-driven PrEP and could switch regimens during follow-up. We calculated incidence rates (IRs) for overall HCV infection and separately for primary and re-infection. A univariable Bayesian exponential survival model was used to identify risk factors associated with incident HCV infection. The HCV NS5B gene fragment (709 bp) was sequenced and compared to HCV isolates from HIV-positive MSM and other risk groups (n = 419) using phylogenetic analysis. Results: Among 350 participants contributing 653.6 person-years (PYs), we detected 15 HCV infections in 14 participants (IR = 2.30/100PY). There were 8 primary infections (IR = 1.27/100PY) and 7 re-infections (IR = 27.8/100PY). IR was 2.71/100PY in daily and 1.15/100PY in event-driven PrEP users. Factors associated with incident HCV infection were higher number of receptive condomless anal sex acts with casual partners (posterior hazard ratio [HR] 1.57 per ln increase; 95% credibility interval [CrI] 1.09-2.20), anal STI (posterior HR 2.93; 95% CrI 1.24-7.13), injecting drug use (posterior HR 4.69; 95% CrI 1.61-12.09) and sharing straws when snorting drugs (posterior HR 2.62; 95% CrI 1.09-6.02). We identified robust MSM-specific HCV clusters of subtypes 1a, 4d, 2b and 3a, which included MSM with and without HIV. Conclusions: HIV-negative MSM using PrEP are at risk of incident HCV infection, while identified risk factors are similar to those in HIV-positive MSM. Regular HCV testing is needed, especially for those with a previous HCV infection and those reporting risk factors. Lay summary: We report that hepatitis C virus infections are frequently acquired among HIV-negative men who have sex with men (MSM) using pre-exposure prophylaxis to prevent HIV infection. New infections occurred more frequently in those reporting receptive anal sex without using condoms, having an anal sexually transmitted infection, injecting drugs, and sharing straws when snorting drugs. The viruses found in HIV-negative men using pre-exposure prophylaxis are genetically similar to those in HIV-positive men, but not in other hepatitis C risk groups, suggesting that (sexual) transmission is occurring between HIV-positive MSM and HIV-negative MSM using preexposure prophylaxis. Clinical Trial number: Dutch trial registration number NTR5411. (c) 2019 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

【 授权许可】

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