Daniela Katinka van Santen1, Jannie Johanna van der Helm2, Julia Del Amo3, Laurence Meyer4, Antonella D'Arminio Monforte5, Matt Price6, Charles Antoine Béguelin7, Robert Zangerle8, Mette Sannes9, Kholoud Porter10, Ronald Bertus Geskus2, Maria Prins11. 1. Department of Infectious Disease Research and Prevention, Public Health Service of Amsterdam, Amsterdam, The Netherlands. Electronic address: dvsanten@ggd.amsterdam.nl. 2. Department of Infectious Disease Research and Prevention, Public Health Service of Amsterdam, Amsterdam, The Netherlands. 3. National Centre of Epidemiology, Instituto de Salud Carlos III (Madrid) and CIBERESP, Spain. 4. INSERM CESP U1018, Centre de recherche en Epidemiologie et Sante des Populations, Universite Paris Sud, Le Kremlin Bicetre, France. 5. Department of Health Sciences, Clinic of Infectious and Tropical Diseases, S Paolo Hospital, University of Milan, Milan, Italy. 6. International AIDS Vaccine Initiative, New York City, NY, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA. 7. Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland. 8. Department of Dermatology and Venereology, Medical University of Innsbruck, Innsbruck, Austria. 9. Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway. 10. Research Department of Infection and Population Health, University College London, London, United Kingdom. 11. Department of Infectious Disease Research and Prevention, Public Health Service of Amsterdam, Amsterdam, The Netherlands; Department of Infectious Diseases, Center for Infection and Immunology Amsterdam (CINIMA), Academic Medical Center (AMC), Amsterdam, the Netherlands.
Abstract
BACKGROUND & AIMS: Hepatitis C virus (HCV) incidence among HIV-positive men who have sex with men (MSM) has increased since 2000, although there are regional differences. We aimed to 1) estimate trends in HCV incidence among HIV-positive MSM, 2) assess the association between incidence and geographical region, age and HIV-related measurements and, 3) assess temporal changes from HIV seroconversion to HCV infection. METHODS: Data was used from MSM with well-estimated dates of HIV seroconversion from the CASCADE Collaboration (1990-2014). Smoothly varying trends in HCV incidence over time were allowed, using restricted cubic splines. The association of calendar year, age, CD4 count (lagged), HIV RNA (lagged), geographical region and HIV infection stage (recent vs. chronic) with HCV incidence were assessed using Poisson regression. RESULTS: Of 5,941 MSM, 337 acquired HCV during follow-up. HCV incidence significantly increased from 0.7/1,000 person-years in 1990 to 18/1,000 person-years in 2014. Recent calendar years, younger age, recent HIV infection and higher HIV RNA levels were significantly associated with HCV incidence, while CD4 count was not. Trends differed by geographical region; while incidence appeared to have stabilized in Western Europe and remained stable in Southern Europe, it continued to increase in Northern Europe in recent years. Time from HIV to HCV infection significantly decreased over time (p<0.001). CONCLUSIONS: HCV has continued to spread among HIV-positive MSM in recent years, but trends differ by geographical region. Interventions to decrease the risk of HCV acquisition and increase early diagnosis are warranted. LAY SUMMARY: Hepatitis C virus infection continues to spread among HIV-positive men who have sex with men, especially among younger individuals. However, trends seem to differ by European region in recent years. Furthermore, men who have sex with men with a higher HIV RNA load were more likely to get infected with the hepatitis C virus. During recent HIV infection, MSM appear to be at higher risk of acquiring hepatitis C.
BACKGROUND & AIMS: Hepatitis C virus (HCV) incidence among HIV-positive men who have sex with men (MSM) has increased since 2000, although there are regional differences. We aimed to 1) estimate trends in HCV incidence among HIV-positive MSM, 2) assess the association between incidence and geographical region, age and HIV-related measurements and, 3) assess temporal changes from HIV seroconversion to HCV infection. METHODS: Data was used from MSM with well-estimated dates of HIV seroconversion from the CASCADE Collaboration (1990-2014). Smoothly varying trends in HCV incidence over time were allowed, using restricted cubic splines. The association of calendar year, age, CD4 count (lagged), HIV RNA (lagged), geographical region and HIV infection stage (recent vs. chronic) with HCV incidence were assessed using Poisson regression. RESULTS: Of 5,941 MSM, 337 acquired HCV during follow-up. HCV incidence significantly increased from 0.7/1,000 person-years in 1990 to 18/1,000 person-years in 2014. Recent calendar years, younger age, recent HIV infection and higher HIV RNA levels were significantly associated with HCV incidence, while CD4 count was not. Trends differed by geographical region; while incidence appeared to have stabilized in Western Europe and remained stable in Southern Europe, it continued to increase in Northern Europe in recent years. Time from HIV to HCV infection significantly decreased over time (p<0.001). CONCLUSIONS: HCV has continued to spread among HIV-positive MSM in recent years, but trends differ by geographical region. Interventions to decrease the risk of HCV acquisition and increase early diagnosis are warranted. LAY SUMMARY: Hepatitis C virus infection continues to spread among HIV-positive men who have sex with men, especially among younger individuals. However, trends seem to differ by European region in recent years. Furthermore, men who have sex with men with a higher HIV RNA load were more likely to get infected with the hepatitis C virus. During recent HIV infection, MSM appear to be at higher risk of acquiring hepatitis C.
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