Study Shows Increase in Hepatitis C Rate Among Some HIV-Positive Men

Researchers conducted an analysis of studies that spanned more than two decades and found that outbreaks of sexually transmitted hepatitis C is increasing among men who are HIV positive and have sex with other men.

The systematic review and meta-analysis of studies was funded by the NIH and conducted by NYU’s Center for Drug Use and HIV Research (CDUHR) at the College of Nursing (NYUCN), according to a university news release. The results of the review that aimed to characterize the incidence of sexual transmission of hepatitis C among HIV-positive men who have sex with men was published in AIDS, the official journal of the International AIDS Society.

Hepatitis C is a bloodborne virus that if left unchecked can cause serious liver damage over time. Infections of the virus are more likely to lead to progressive liver disease in people who also have HIV, even if they are being treated for HIV, note the authors.

Currently the predominant way that hepatitis C is transmitted is via injection drug use among people who inject drugs (PWID) but there have been several reports of outbreaks of sexual transmission of the virus among HIV-positive men who have sex with men, the researchers note. The authors excluded any study involving men with a history of drug injection in order to limit their review to the sexual transmission of hepatitis c among men who have sex with other men, their target cohort.

“The purpose of our study was to explain why these outbreaks are occurring and understand whether the increase in reporting indicates a real trend,” Holly Hagan, PhD, a professor at NYUCN and Co-Director of CDUHR who leads the HCV Synthesis Project, states in the release. “Understanding the causes and the magnitude of the problem will help identify subgroups for targeted intervention,” said Hagan, the study’s principal author.

Researchers combed through medical literature, including unpublished reports and followed more than 13,000 people in 15 unique studies to observe 497 cases of hepatitis C virus seroconversion over 93,100 person-years using incidence density estimation, according to the release. They found that approximately 0.53 men who had sex with other men and were HIV-positive acquired the hepatitis C virus in 100-person-years of observation.

“Putting this another way, if one thousand HIV-positive MSM (men who have sex with men) were followed for one year each, approximately five would acquire HCV,” Hagan stated in the release. “This is far lower than the rates among PWID. However, when we pooled the data across studies and looked at incidence in relation to calendar time, we saw an increase.”

The researchers found that the hepatitis C incidence rate among HIV-positive men who have sex with men had increased three-fold from 1991 to 2010. By 2012 the estimate was 1.34 new infections per 100 person-years, showing that the rate of increase ticked higher again, according to the release. In addition, reinfection of the hepatitis C virus following successful treatment was also found to be much higher than initial infection.

Researchers concluded that data indicates an existence of a subset of HIV-positive men who have sex with men with recurring sexual exposure to the hepatitis C virus that could begin to approach the risk of hepatitis C infection among PWID. They called for further investigation to gain greater understanding of causal pathways that could inform prevention and treatment strategies.