Department for Infectious Diseases Epidemiology, Robert Koch Institute, Berlin, Germany.
PLoS One. 2011 Mar 8;6(3):e17781. doi: 10.1371/journal.pone.0017781.
To identify risk factors for hepatitis C among HIV-positive men who have sex with men (MSM), focusing on potential sexual, nosocomial, and other non-sexual determinants.
Outbreaks of hepatitis C virus (HCV) infections among HIV-positive MSM have been reported by clinicians in post-industrialized countries since 2000. The sexual acquisition of HCV by gay men who are HIV positive is not, however, fully understood.
Between 2006 and 2008, a case-control study was embedded into a behavioural survey of MSM in Germany. Cases were HIV-positive and acutely HCV-co-infected, with no history of injection drug use. HIV-positive MSM without known HCV infection, matched for age group, served as controls. The HCV-serostatus of controls was assessed by serological testing of dried blood specimens. Univariable and multivariable regression analyses were used to identify factors independently associated with HCV-co-infection.
34 cases and 67 controls were included. Sex-associated rectal bleeding, receptive fisting and snorting cocaine/amphetamines, combined with group sex, were independently associated with case status. Among cases, surgical interventions overlapped with sex-associated rectal bleeding.
Sexual practices leading to rectal bleeding, and snorting drugs in settings of increased HCV-prevalence are risk factors for acute hepatitis C. We suggest that sharing snorting equipment as well as sharing sexual partners might be modes of sexual transmission. Condoms and gloves may not provide adequate protection if they are contaminated with blood. Public health interventions for HIV-positive gay men should address the role of blood in sexual risk behaviour. Further research is needed into the interplay of proctosurgery and sex-associated rectal bleeding.
确定男男性行为者（MSM）中 HIV 阳性者感染丙型肝炎的危险因素，重点关注潜在的性、医院内和其他非性决定因素。
自 2000 年以来，医生在工业化国家报告了 HIV 阳性 MSM 中丙型肝炎病毒（HCV）感染的爆发。然而，对于 HIV 阳性的男同性恋者通过性行为获得 HCV 的情况尚不完全清楚。
2006 年至 2008 年期间，一项病例对照研究嵌入了德国对 MSM 的行为调查。病例是 HIV 阳性且急性 HCV 合并感染的患者，没有注射吸毒史。HIV 阳性且无已知 HCV 感染的 MSM 与年龄组相匹配，作为对照。通过对干血标本进行血清学检测来评估对照的 HCV 血清状态。采用单变量和多变量回归分析来确定与 HCV 合并感染独立相关的因素。
共纳入 34 例病例和 67 例对照。与性相关的直肠出血、接受肛交和吸食可卡因/安非他命，以及群体性行为，与病例状态独立相关。在病例中，手术干预与与性相关的直肠出血重叠。
导致直肠出血的性行为，以及在 HCV 高流行环境中吸食毒品，是急性丙型肝炎的危险因素。我们建议，共享吸食工具以及共享性伴侣可能是性传播的模式。如果避孕套和手套被血液污染，可能无法提供充分的保护。针对 HIV 阳性男同性恋者的公共卫生干预措施应解决血液在性行为风险行为中的作用。需要进一步研究直肠手术与与性相关的直肠出血之间的相互作用。
