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Hepatitis C infection and reinfection among men who have sex with men need higher priority, US and European studies show
Liz Highleyman, 2016-09-30 07:30:00

Public health officials in Michigan have identified a cluster of more than 20 cases of apparently sexually transmitted hepatitis C virus (HCV) infection among HIV-positive gay and bisexual men, according to a report at the 2016 STD Conference last week in Atlanta. A recently published related study saw a high rate of HCV reinfection among gay men and concluded that prevention measures are needed to address the risk of HCV recurrence after spontaneous clearance or a cure.

Starting in the early 2000s, researchers in the UK and elsewhere in Europe began reporting clusters of apparently sexually transmitted acute HCV infection among HIV-positive men who have sex with men (MSM); similar outbreaks followed in Australia and the US.

The US Centers for Disease Control and Prevention (CDC) has held that sexual transmission of HCV is rare – at least among monogamous HIV-negative heterosexuals. HCV sexual transmission among gay and bi men is not fully understood. It has traditionally been assumed that HCV is transmitted through sexual activities that involve blood, but the virus has also been detected in semen and in rectal secretions and faeces. A number of risk factors have been implicated – including condomless anal sex, fisting, group sex, use of sex toys, having other sexually transmitted infections (STIs) and non-injected recreational drug use – but these have not been consistent across studies.

Sexually transmitted HCV infection has mostly been seen among HIV-positive gay and bi men, though some cases have also been reported among HIV-negative men – including a few among men on PrEP. It is unclear why HCV sexual transmission is more common among men with HIV, since it can occur in those with well-preserved immune function and high CD4 T-cell counts.