Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, New York.
Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
Clin Infect Dis. 2017 Feb 1;64(3):284-288. doi: 10.1093/cid/ciw740. Epub 2016 Nov 9.
For over a decade we have known of an epidemic of sexually transmitted hepatitis C virus (HCV) infection among human immunodeficiency virus (HIV)-infected men who have sex with men (MSM), but there still remains significant controversy over which bodily fluid(s) are responsible for HCV transmission in these men.
We enrolled HIV-infected MSM with recent and chronic HCV infection and quantified HCV from rectal fluid obtained by blind swab. We compared the rectal HCV viral load (VL) with paired blood HCV VL.
We found rectal HCV shedding in 20 (47%) of 43 men, only one (2%) of whom had visible bleeding. Detection of rectal HCV shedding was associated with blood VL > 5 log IU/mL (p = .01), and 85% with blood VL > 5 log IU/mL had rectal shedding. The HCV VL of the rectal fluid ranged from 2.6 to 5.5 log IU/mL. Based on the median rectal fluid VL, the surface of an average human penis would be exposed to at least 2,300 IU of HCV for the duration of anal intercourse.
This study provides the first direct evidence to our knowledge that a sufficient quantity of HCV is shed into the rectum in HIV-infected men with HCV infection to directly infect an inserted penis or be passed indirectly through fomite-like transmission to the rectum of sex partner. We must develop an appropriate public health campaign to educate MSM about these routes of HCV infection to reverse the HCV epidemic among HIV-infected MSM.
十多年来，我们已经了解到，在感染艾滋病毒（HIV）的男男性行为者（MSM）中，存在丙型肝炎病毒（HCV）性传播的流行，但对于哪种体液导致这些男性感染 HCV 仍存在很大争议。
我们招募了近期和慢性 HCV 感染的 HIV 感染 MSM，并通过盲拭子定量检测直肠液中的 HCV。我们比较了直肠液和配对血 HCVVL。
我们发现 43 名男性中有 20 名（47%）存在直肠 HCV 脱落，其中只有 1 名（2%）有明显出血。直肠 HCV 脱落的检测与血液 VL>5logIU/mL 相关（p=0.01），85%的血液 VL>5logIU/mL 有直肠脱落。直肠液中的 HCVVL 范围为 2.6 至 5.5logIU/mL。根据直肠液中位 VL，在肛交过程中，一个普通男性的阴茎表面会暴露于至少 2300IU 的 HCV。
这项研究首次直接提供了证据，表明在 HIV 感染的 HCV 感染男性中，有足够数量的 HCV 脱落到直肠中，足以直接感染插入的阴茎，或通过类似污染物的间接传播途径感染性伴侣的直肠。我们必须开展适当的公共卫生运动，教育 MSM 了解这些 HCV 感染途径，以扭转 HIV 感染 MSM 中的 HCV 流行。
