TUAC0503 - Oral Abstract
Prevalence, incidence and determinants of HCV infections among HIV-positive MSM attending a STI clinic, 1995-2010
Presented by Anouk Titia Urbanus (Netherlands).
A.T. Urbanus1, T. van de Laar2, R. Geskus3, J. Vanhommerig4, M. van Rooijen4, J. Schinkel5, T. Heijman4, R. Coutinho6,7, M. Prins4,8
1Public Health Service, Cluster of Infectious Diseases, Amsterdam, Netherlands, 2VUmc, Amsterdam, Netherlands, 3Academic Medical Center (AMC), Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam, Netherlands, 4Public Health Service Amsterdam, Amsterdam, Netherlands, 5Academic Medical Center (AMC), Department of Clinical Virology, Amsterdam, Netherlands, 6National Institute for Public Health and the Environment (RIVM), Center for Infectious Disease Control, Bilthoven, Netherlands, 7Julius Center for Health Science and Primary Care, Utrecht, Netherlands, 8Academic Medical Center (AMC), Division of Infectious Diseases, Tropical Medicine and AIDS (CINIMA), Amstedam, Netherlands
Background: Since 2000 there is growing evidence that HCV has emerged as an STI among HIV positive MSM. Here we present a 15 year overview of the HCV epidemic among MSM visiting a large STI clinic in the Netherlands.
Methods: During waves of the bi-annual cross-sectional anonymous survey (1995-2010), participants were interviewed and tested for HIV and HCV antibodies. Additional HCV RNA tests were performed in all HIV-positive MSM. Determinants of HCV infection were analysed using logistic regression. HCV incidence was estimated using the window period from HCV RNA detection until HCV-antibody development. Phylogenetic analysis of obtained HCV NS5B sequences was performed to determine HCV genotype and to characterise HCV transmission networks among HIV-positive MSM.
Results: Anti-HCV prevalence among HIV-positive MSM gradually increased from 2.8% in 1995 to 3.8% in 2003 and reached its peak in 2008 (17.3%). The HCV incidence was highest in 2006 (14.0/100 PY; 95% CI: 5.02-37.69) and decreased thereafter, although not significantly. Fisting in 2007/2008 was more strongly associated (aOR 2.62, 95%CI: 1.20-5.71) with HCV infection than fisting in 2009/2010 (aOR 0.98, 95% CI 0.47-2.03). In addition, Chlamydia, IDU, UAI and age were independently associated with HCV. Phylogenetic analysis revealed a high degree of MSM-specific clustering from 2000 onwards. HCV prevalence among HIV-negative MSM remained stable (around 0.5%, 2007-2010).
Conclusions: HCV prevalence among HIV-positive MSM significantly increased untill 2007, but appears to be levelling off in recent years. This levelling off might partly be explained by increased testing and HCV treatment uptake. The effect of fisting became less strong over time, but both risk factor analysis and phylogenetic analysis continue to support ongoing sexual transmission of HCV among HIV-positive MSM. Monitoring of HCV in both HIV-positive and HIV-negative MSM remains needed to guide prevention in order to halt this epidemic.
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