In HIV-positive men who have sex with men (MSM), hepatitis C infections are mostly transmitted through high-risk sexual activities rather than injecting drug use, a Victorian study finds.
Reviewing data from all new hepatitis C virus (HCV) cases recorded in Victoria from April 2010 to June 2011, the authors identified a group of 31 HIV-positive MSM who also had HCV.
Injecting drug use accounted for only a third of HCV infections in this group even though it was a far more common transmission route in the general population, the authors found.
Patient interviews revealed most had participated in high-risk sexual activities which increased the risk of trauma and were likely the cause of their HCV infection, the researchers reported in this week’s MJA.
These high-risk sexual practices - group sex, fisting, sharing sex toys and not using condoms - had become the paradoxical reaction to the success story of antiretroviral therapy, the authors said.
There was a disproportionately high rate of HCV infection among Victorians living with HIV which was “concerning”, the authors said.
It was likely injecting drug use introduced HCV to a sexual network and the virus was then retransmitted sexually, the authors said. Serosorting, or selecting sexual partners on the basis of their HIV status, would then further concentrate HCV infection within the network.
There was a “pressing need” to raise awareness of HCV sexual transmission, which was all the more important since the consensus until recently had been that HCV was not effectively sexually transmitted, the authors said.
In related research, a US study published last week found the prevalence of liver cirrhosis or fibrosis without cirrhosis was much higher in patients coinfected with HIV and HCV than in those with HCV only.
Patients with HCV/HIV had similar liver fibrosis to those without HIV who were nearly a decade older, the authors said.
MJA 2013; Annals of Internal Medicine 2013