Urbanus Anouk T, Van De Laar Thijs J W, Geskus Ronald, Vanhommerig Joost W, Van Rooijen Martijn S, Schinkel Janke, Heijman Titia, Coutinho Roel A, Prins Maria
aAmsterdam Public Health Service, Cluster of Infectious Diseases bSanquin Blood Supply Foundation, Department of Blood-borne Infections cAcademic Medical Center (AMC), Department of Clinical Epidemiology, Biostatistics and Bioinformatics dAMC, Department of Clinical Virology, Amsterdam eNational Institute for Public Health and the Environment, Center for Infectious Disease Control, Bilthoven fAMC, Department of Internal Medicine, Division of Infectious Diseases, Tropical Medicine and AIDS (CINIMA), Amsterdam gJulius Center for Health Science and Primary Care, University Medical Center, Utrecht, The Netherlands.
AIDS. 2014 Mar 13;28(5):781-90. doi: 10.1097/QAD.0000000000000126.
Since 2000, there is growing evidence that hepatitis C virus (HCV) infection has emerged as a sexually transmitted infection (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.
During biannual cross-sectional anonymous surveys (1995-2010), participants were interviewed and tested for HIV and HCV-antibodies. Additional HCV RNA tests were performed in all HIV-positives. Determinants of HCV infection were analysed using logistic regression. Phylogenetic analysis provided evidence for sexual transmission.
HCV prevalence among HIV-positive MSM increased from 1995 onwards (5.6%) and peaked in 2008 (20.9%). Prevalent HCV infection was more strongly associated with fisting in 2007-2008 [adjusted odds ratio (aOR) 2.85, 95% confidence interval (CI) 1.19-6.82] than in 2009-2010 (aOR 0.92, 95% CI0.42-2.02). In addition, HCV infection was independently associated with Chlamydia, injecting drug use, unprotected anal intercourse and older age. Phylogenetic analysis revealed a high degree of MSM-specific clustering from 2000 onwards. Identification of a new MSM-specific HCV lineage and the finding of recent HCV infections (0-4%) in established HCV clusters during recent years argue for ongoing transmission of HCV among HIV-positive MSM. HCV prevalence among HIV-negative MSM remained low (2007-2010: 0.5%).
HCV prevalence among HIV-positive MSM significantly increased over calendar time but appears to level off in recent years, possibly due to increased awareness, saturation in the population, decreased risk behaviour and earlier HCV screening and treatment. The association with fisting became less strong over time, but our analyses continue to support sexual transmission. Monitoring HIV-positive and HIV-negative MSM for HCV infection remains needed to guide prevention efforts.
自2000年以来，越来越多的证据表明丙型肝炎病毒（HCV）感染已成为HIV阳性男男性行为者（MSM）中的一种性传播感染（STI）。在此，我们呈现了在荷兰一家大型性传播感染诊所就诊的男男性行为者中HCV流行情况的15年概述。
在1995年至2010年每半年进行一次的横断面匿名调查中，对参与者进行访谈并检测HIV和HCV抗体。对所有HIV阳性者进行额外的HCV RNA检测。使用逻辑回归分析HCV感染的决定因素。系统发育分析为性传播提供了证据。
HIV阳性男男性行为者中的HCV流行率自1995年起开始上升（5.6%），并在2008年达到峰值（20.9%）。2007 - 2008年，现患HCV感染与拳交的关联更强[调整优势比（aOR）2.85，95%置信区间（CI）1.19 - 6.82]，而在2009 - 2010年则较弱（aOR 0.92，95% CI 0.42 - 2.02）。此外，HCV感染与衣原体感染、注射吸毒、无保护肛交以及年龄较大独立相关。系统发育分析显示自2000年起存在高度的男男性行为者特异性聚类。鉴定出一种新的男男性行为者特异性HCV谱系，以及近年来在已建立的HCV聚类中发现近期HCV感染（0 - 4%），这表明HIV阳性男男性行为者中HCV正在持续传播。HIV阴性男男性行为者中的HCV流行率仍然较低（2007 - 2010年：0.5%）。
HIV阳性男男性行为者中的HCV流行率随时间显著上升，但近年来似乎趋于平稳，这可能是由于意识提高、人群饱和、危险行为减少以及HCV筛查和治疗更早所致。随着时间推移，与拳交的关联变得不那么强，但我们的分析继续支持性传播。仍需要对HIV阳性和HIV阴性男男性行为者进行HCV感染监测，以指导预防工作。
