Sex, Rather Than Drug Use, Is Driving HCV Reinfection in MSM With HIV

Semen in the rectum leads to higher hepatitis C virus (HCV) reinfection rates among men who have sex with men (MSM) with HIV, according to new research presented at CROI 2020.

To conduct their study, the researchers performed a prospective cohort study in New York City to examine the behavioral risk factors for HCV reinfection after primary HCV infection among MSM with HIV.

At clinical visits held between January 2006 and December 2018, patients (N=305) were asked about their engagement in previously identified risk factors for primary HCV infection: semen in the rectum, sex with use of crystal methamphetamine, and injection use of crystal methamphetamine.

The median age of the cohort was 44 years, and 21% were black, 78% were white, and 20% were Latino. Over 647 person years, there were 1286 clinical visits.

Analysis showed that 37 of 305 participants had first reinfections, which was a rate of 4.4 per 100 person years.

Findings from univariable Cox proportional hazards models showed that semen in the rectum, sex with use of crystal methamphetamine, and injection use of crystal methamphetamine were all significantly associated with first HCV reinfection. However, in a multivariable Cox proportional hazards model, only semen in rectum was significantly associated with first HCV reinfection.

“Sex, with receipt of semen into the rectum, rather than drug (methamphetamine) use, was the behavior driving HCV reinfection in HIV-infected MSM. Taken together with previous research demonstrating HCV in semen, and as condom use has not been successful as an HCV prevention strategy, our results suggest the need for novel interventions to prevent seminal HCV from causing trans-rectal HCV infection.”

—Amanda Balbi

Reference:

Factor SH, Carollo JR, Rodriguez-Caprio G, et al; the New York Acute Hepatitis C Surveillance Network. Sex, Not Drug Use, Is Driving HCV Reinfection Among HIV-Infected MSM In New York City. Paper presented at: Conference on Retroviruses and Opportunistic Infections 2020; March 8-11, 2020; Boston, MA. http://www.croiconference.org/sessions/sex-not-drug-use-driving-hcv-reinfection-among-hiv-infected-msm-new-york-city.