Department of Infectious Diseases, Hospital Carlos III, Madrid, Spain.
Liver Int. 2013 Oct;33(9):1357-62. doi: 10.1111/liv.12212. Epub 2013 Jun 3.
Outbreaks of acute hepatitis C in HIV-positive men who have sex with men (MSM) are being reported in large cities in western countries along with increasing rates of sexually transmitted diseases.
All HIV individuals attended at a large outclinic in Madrid within the last 5 years were examined. Incident syphilis was diagnosed based on rapid plasma reagin (RPR) reactivity, being negative previously or showing >4-fold increase. Acute hepatitis C was diagnosed based on HCV antibody seroconversion and/or positive serum HCV-RNA after being negative within the last year.
A total of 859 episodes of syphilis and 19 of acute hepatitis C were diagnosed during the study period. Syphilis was recognized in 65/2,094 (3.1%) individuals attended in 2008 and rose up to 261/2,512 (10.4%) in 2012 (P < 0.001). Acute hepatitis C was diagnosed in only one subject in 2008 but rose up to 7 in 2012 (P = 0.12). All 19 HIV patients with acute hepatitis C were MSM. Syphilis was diagnosed concomitantly in seven. All eight individuals who were treated with peginterferon/ribavirin were cured, whereas only one untreated experienced spontaneous clearance (P = 0.004). Two clusters of infections by HCV genotypes 4 and 1a were identified by phylogenetic analyses.
The incidence of acute hepatitis C is low but steadily increasing in HIV-positive MSM in Madrid (<1% yearly), despite the very high rates of syphilis (currently 20% yearly in HIV-positive MSM). Preventive measures for sexually transmitted infections and periodic HCV screening are warranted in this population as treatment of acute hepatitis C is very effective.
在西方国家的大城市中，越来越多的性传播疾病伴随着 HIV 阳性男男性行为者（MSM）中丙型肝炎急性爆发的报道。
在过去 5 年内，对在马德里一家大型诊所就诊的所有 HIV 感染者进行了检查。根据快速血浆反应素（RPR）反应性诊断新发梅毒，之前为阴性或滴度增加 4 倍以上。丙型肝炎急性发作基于 HCV 抗体血清转换和/或过去 1 年内阴性后血清 HCV-RNA 阳性来诊断。
在研究期间共诊断出 859 例梅毒和 19 例丙型肝炎急性发作。2008 年就诊的 2094 人中，有 65 例（3.1%）被诊断为梅毒，而 2012 年就诊的 2512 人中，有 261 例（10.4%）（P<0.001）。2008 年仅诊断出 1 例丙型肝炎急性发作，而 2012 年增加至 7 例（P=0.12）。所有 19 例 HIV 合并急性丙型肝炎的患者均为 MSM。其中 7 例并发梅毒。接受聚乙二醇干扰素/利巴韦林治疗的 8 例患者均治愈，而未接受治疗的 1 例患者自发清除（P=0.004）。通过系统进化分析，鉴定出由 HCV 基因型 4 和 1a 引起的两个感染群。
尽管 HIV 阳性 MSM 中的梅毒发病率很高（目前 HIV 阳性 MSM 中每年发病率为 20%），但马德里 HIV 阳性 MSM 中丙型肝炎急性发作的发病率较低，但呈稳步上升趋势（每年约 1%）。应在该人群中采取预防性行为感染的措施并定期进行 HCV 筛查，因为急性丙型肝炎的治疗效果非常有效。
