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Clin Infect Dis. 2019 Feb 27. pii: ciz160. doi: 10.1093/cid/ciz160. [Epub ahead of print]

Patterns of HCV transmission in HIV-infected and HIV-negative men having sex with men.

Author information

1
Virology Laboratory, Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Lyon, France.
2
Centre International de Recherche en Infectiologie (CIRI), INSERM U1111, CNRS UMR 5308), Lyon, France.
3
University of Lyon, Université Claude Bernard Lyon, Villeurbanne, France.
4
Infectious Diseases Department, Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Lyon, France.
5
Hepatology Department, Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Lyon, France.
6
Pharmacy, Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Lyon, France.
7
Clinical Research Centre, Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Lyon, France.
8
INSERM U1052, Lyon, France.

Abstract

BACKGROUND:

Sexually transmitted acute HCV infections (AHI) have been mainly described in HIV-infected men having sex with men (MSM). Cases in HIV-negative MSM are scarce. We describe the epidemic of AHI and the patterns of transmission in HIV-infected and in HIV-negative MSM in Lyon, France.

METHODS:

All cases of AHI diagnosed in MSM in Lyon University Hospital from 2014 to 2017 were included. AHI incidence was determined in HIV-infected and in PrEP-using MSM. Transmission clusters were identified by construction of phylogenetic trees based on HCV NS5B (genotype 1a/4d) or NS5A (genotype 3a) Sanger sequencing. Risk factors were analyzed per cluster.

RESULTS:

From 2014 to 2017, 108 AHI (80 first infections, 28 reinfections) were reported in 96 MSM (HIV-infected 72, HIV-negative 24). AHI incidence rose from 1.1/100PY (95%CI 0.7-1.7) in 2014 to 2.4/100PY (95%CI 1.1-2.6) in 2017 in HIV-infected MSM (p=0.05), and from 0.3/100PY (95%CI 0.06-1.0) in 2016 to 3.4/100PY (95%CI 2.0-5.5) in 2017 in PrEP-users (p<0.001). Eleven clusters from 2 to 27 cases were identified. All clusters included HIV-infected MSM, 6 also included HIV-negative MSM. All clusters started with ≥1 HIV-infected MSM. Risk factors distribution varied widely among clusters.

CONCLUSION:

AHI incidence increased in both HIV-infected and HIV-negative MSM. Cluster analysis suggests initial transmission from HIV-infected to HIV-negative MSM through chemsex and traumatic sexual practices, leading to mixed patterns of transmission regardless of HIV status and no overlap with the general population. Screening of at-risk patients, targeted harm reduction interventions and early HCV treatment are needed to control this epidemic.

KEYWORDS:

HCV; MSM; acute infection; cluster; transmission

PMID:
30810158
DOI:
10.1093/cid/ciz160

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