Boerekamps A, Wouters K, Ammerlaan H S M, Götz H M, Laga M, Rijnders B J A
Department of Internal Medicine and Infectious Diseases, Erasmus MC, Rotterdam, the Netherlands.
Neth J Med. 2018 Oct;76(8):374-378.
The evidence that HIV treatment as prevention (TasP) and HIV pre-exposure prophylaxis (PrEP) reduces the risk of HIV transmission is overwhelming. But as PrEP and TasP can lead to increased sexual mixing between HIV positive and negative men who have sex with men (MSM), sexually transmitted infections such as acute hepatitis C (HCV), which were thought to be limited to HIV-infected MSM, could become more frequent in HIV uninfected MSM as well. The objective of this study was to describe a series of cases of sexually transmitted HCV infections in HIV-uninfected MSM in the Netherlands and Belgium.
Through the Dutch Acute HCV in HIV Study (a Dutch-Belgian prospective multicentre study on the treatment of acute HCV infection, NCT02600325) and the Be-PrEP-ared study (a PrEP project in Antwerp, EudraCT2015-000054-37) several acute HCV infections were detected in HIV-negative men.
A newly acquired HCV infection was diagnosed in ten HIV-negative MSM. HCV was diagnosed at a sexually transmitted infection (STI) clinic (n = 2), by their general practitioner (n = 2), by their HIV physician (n = 1) or at a PrEP clinic (n = 5). Ten patients reported unprotected anal intercourse and four had a concomitant STI at the time of HCV diagnosis. Six patients reported using drugs during sex.
Our observation calls for a larger nationwide epidemiological study on the prevalence, incidence and risk factors of HCV infection in HIV-uninfected MSM. In the changing landscape of TasP and PrEP, reliable and up-to-date epidemiological data on HCV among HIV-uninfected MSM are needed and will help in developing evidence-based testing policies.
有压倒性证据表明，艾滋病治疗即预防（TasP）和艾滋病暴露前预防（PrEP）可降低艾滋病病毒传播风险。但由于PrEP和TasP可能导致男男性行为者（MSM）中艾滋病病毒阳性和阴性者之间的性接触增加，原本认为仅限于感染艾滋病病毒的男男性行为者中的性传播感染，如急性丙型肝炎（HCV），在未感染艾滋病病毒的男男性行为者中也可能变得更加常见。本研究的目的是描述荷兰和比利时未感染艾滋病病毒的男男性行为者中一系列性传播HCV感染病例。
通过荷兰艾滋病合并急性HCV研究（一项荷兰 - 比利时关于急性HCV感染治疗的前瞻性多中心研究，NCT02600325）和Be-PrEP-ared研究（安特卫普的一项PrEP项目，EudraCT2015-000054-37），在HIV阴性男性中检测到几例急性HCV感染。
在10名HIV阴性男男性行为者中诊断出了新获得的HCV感染。HCV在性传播感染（STI）诊所（n = 2）、全科医生处（n = 2）、HIV医生处（n = 1）或PrEP诊所（n = 5）被诊断出来。10名患者报告有未保护的肛交行为，4名患者在HCV诊断时伴有其他性传播感染。6名患者报告在性行为期间使用了毒品。
我们的观察结果呼吁在全国范围内对未感染艾滋病病毒的男男性行为者中HCV感染的患病率、发病率和危险因素进行更大规模的流行病学研究。在TasP和PrEP不断变化的形势下，需要关于未感染艾滋病病毒的男男性行为者中HCV的可靠和最新的流行病学数据，这将有助于制定基于证据的检测政策。
