Johns Hopkins University, Baltimore, Maryland, USA.
HPTN Leadership and Operations Center, FHI 360, Durham, North Carolina, USA.
Clin Infect Dis. 2021 Oct 5;73(7):e2205-e2210. doi: 10.1093/cid/ciaa1869.
Sexual transmission of hepatitis C virus (HCV) is uncommon, yet documented among men who have sex with men (MSM), primarily among those with human immunodeficiency virus (HIV).
In the HIV Prevention Trials Network 078 study (HPTN 078), which assessed an integrated strategy to achieve HIV viral suppression, 1305 MSM were screened across 4 geographically diverse US cities. At screening, demographic/behavioral/psychosocial questionnaires were completed, along with HIV and HCV testing. Multivariable logistic regression was used to evaluate associations with HCV antibody positivity.
Among the 1287 (99%) of the MSM with HCV antibody results, the median age was 41, 69% were black, 85% had a high school education or more, 35% were employed, 70% had HIV, and 21% had undergone substance use counseling. The median lifetime number of male sexual partners was 17 (interquartile range, 6-50), and 246 (19%) were HCV antibody positive. HCV antibody positivity was high in MSM with HIV (20%) and MSM without HIV (17%) (P = .12) and was higher in those receiving substance use counseling (36%) than in those who had not (15%) (P ≤ .01). Substance use counseling (odds ratio, 2.51; 95% confidence interval, 1.80-3.51) and unstable housing (2.16; 1.40-3.33) were associated with HCV antibody positivity.
Nearly 1 in 5 MSM screened for HPTN 078 have been infected with HCV. The prevalence is high regardless of HIV status and is high even in those who did not undergo substance use counseling. In HIV burden networks, high HCV infection prevalence may occur in MSM without HIV. As implementation of preexposure prophylaxis expands and condom use declines, routine HCV counseling and screening among MSM are important.
丙型肝炎病毒（HCV）通过性传播的情况并不常见，但在男男性行为者（MSM）中已有记录，主要发生在 HIV 感染者中。
在评估实现 HIV 病毒抑制的综合策略的 HIV 预防试验网络 078 研究（HPTN 078）中，在 4 个地理位置不同的美国城市对 1305 名 MSM 进行了筛查。在筛查时，完成了人口统计学/行为/心理社会问卷调查，以及 HIV 和 HCV 检测。多变量逻辑回归用于评估与 HCV 抗体阳性的相关性。
在 1287 名（99%）有 HCV 抗体结果的 MSM 中，中位年龄为 41 岁，69%为黑人，85%具有高中及以上学历，35%有工作，70%感染 HIV，21%接受过药物使用咨询。终身男性性伴侣数中位数为 17（四分位距，6-50），246 名（19%）为 HCV 抗体阳性。HIV 阳性 MSM（20%）和 HIV 阴性 MSM（17%）的 HCV 抗体阳性率较高（P =.12），接受药物使用咨询者（36%）高于未接受者（15%）（P ≤.01）。药物使用咨询（比值比，2.51；95%置信区间，1.80-3.51）和不稳定的住房状况（2.16；1.40-3.33）与 HCV 抗体阳性相关。
在 HPTN 078 中筛查的 MSM 中，近 1/5 已感染 HCV。无论 HIV 状态如何，其流行率都很高，甚至在未接受药物使用咨询者中也很高。在 HIV 负担网络中，无 HIV 的 MSM 可能会发生高 HCV 感染率。随着暴露前预防的实施扩大和避孕套使用率下降，对 MSM 进行常规 HCV 咨询和筛查非常重要。
