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Risk factors for hepatitis C in HIV positive MSM. A preliminary evaluation of a case control study
Presented by Axel J. Schmidt, Germany.
Schmidt A.J.1, Vogel M.2, Rockstroh J.K.2, Radun D.3, Study Group on Sexual Risk Factors for Hepatitis C
1WZB (Social Science Research Center Berlin), Public Health Unit, Berlin, Germany, 2University of Bonn, Medical Department I, Bonn, Germany, 3Robert Koch Institute, Department for Infectious Disease Epidemiology, Berlin, Germany
Objectives: Since 2001, clinicians in Europe have been reporting increasing numbers of infections with the hepatitis C virus (HCV) in HIV positive men who have sex with men (MSM). The role of sexual HCV transmission are controversial. Despite biological plausibility, longitudinal studies among HIV negative MSM showed no evidence for an epidemiologically relevant sexual transmission. Therefore, the aim of this study is to explore social, behavioural/sexual, or nosocomial risk factors for hepatitis C in HIV positive MSM.
Methods: In 2006, we conducted a case control study embedded in a survey on knowledge, attitudes and behaviour in German MSM as to STIs. Cases consisted of HIV/HCV-coinfected MSM without history of injecting drug use (IDU), as related sharing of equipment is the leading risk factor for HCV infection in industrialised countries. HIV positive MSM without HCV infection, matched for age group, served as controls. Their serostatus was confirmed by antibody tests from dried blood specimen.
Results: 22 cases and 44 controls were included for preliminary evaluation. In the bivariate analysis, significant risk factors were (1) consumption of nasally applicable drugs like cocaine (OR=10.5), (2) history of major surgery (OR=9.1), (3) “gangbanging”/group sex (OR=7.7), (4) a history of >5 episodes of unprotected anal intercourse within the past year (OR=7.5), (5) bleeding anal injuries from any sort of sexual intercourse (OR=7.1), (6) “fisting” (OR=5.9), or (7) use of sildenafil (OR=4.1). In logistic regression, (1) and (5) remained in the model.
Conclusions: There is evidence that in HIV positive MSM, a complex interaction between sexual practices and associated behaviour like consumption of cocaine are relevant risk factors for HCV transmission. However, it is notable that despite high standards of hygiene in German hospitals, cases were more likely to report nosocomial risks than controls. More cases and controls are needed to fit adequate power and precision.
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