Hepatitis C Virus Reinfection Among Men Who Have Sex With Men With HIV in New York City
Author:
Fierer Daniel S1ORCID, Carollo Jesse R1, Rodriguez-Caprio Gabriela1ORCID, Radix Asa2ORCID, Vail Rona2ORCID, Chavez Robert3, Bungay Krisczar J4, Dillon Stephen M4, Akil Bisher, Bailey Juan, Bellman Paul, Bowers Daniel, Burger Susanne, Cantor Aviva, Chasan Rachel, Chow Rita, Cohen Robert, Dalton Patrick, Dellosso John, Donlon Eileen, Farrow Terry, Fefer Jose, Gaisa Michael, Guadron Rodolfo, Haber Stuart, Hefron Susan, Higgins Lawrence, Hitzeman Lawrence, Hsu Ricky, Inada Victor, Jacob Sneha, Johnson Livette, Johnston Barbara, Kaminsky Donald, Klein Oscar, Kwong Jeffrey, Lares-Guia Jose, Leach Eric, Levine Randy, Linetskaya Irina, Litvinova Larisa, Malhotra Amisha, Mandell William, Markowitz Martin, Mayer Gal, Meraz Eddie, Mortensen Erik, Olivieri Joseph, Paolino Charles, Photangtham Punyadech, Psevdos George, Rapaport Steven, Ray Roona, Rodriguez-Caprio Gabriela, Shay William, Somasundaram Nirupama, Sorra Lembitu, Tran Richie, Urbina Antonio, Wallach Francis, Wang Wen, Weiss Susan, Wiener Melissa,
Affiliation:
1. Icahn School of Medicine at Mount Sinai, Department of Medicine, Division of Infectious Diseases , New York, New York , USA 2. Callen–Lorde Community Health Center , Department of Medicine, New York, New York , USA 3. NYU Grossman School of Medicine, Department of Medicine , New York, New York , USA 4. Gotham Medical Group , New York, New York , USA
Abstract
Abstract
Background
Hepatitis C virus (HCV) reinfection rates are substantially higher than primary infection rates among men who have sex with men (MSM) with human immunodeficiency virus (HIV) in European cohorts. The behaviors mediating this high rate of transmission among MSM are poorly characterized.
Methods
We performed a prospective cohort study in New York City (NYC) of MSM with HIV who cleared HCV to determine the incidence of and risk factors for HCV reinfection. We assessed the risk behaviors for primary HCV in NYC: receipt of semen in the rectum, and sexualized methamphetamine use, along with route of use. Multivariable analysis was performed with Andersen-Gill extension of the Cox proportional hazards model.
Results
From 2000 through 2018, among 304 MSM with HIV who cleared HCV, 42 reinfections occurred over 898 person-years, for an incidence rate of 4.7 per 100 person-years. Assessing 1245 postclearance visits, only receipt of semen into the rectum was associated with reinfection (hazard ratio, 9.7 [95% confidence interval: 3.3–28.3], P < .001); methamphetamine use was not.
Conclusions
The high HCV reinfection rate over almost 2 decades demonstrates that sexual transmission of HCV is not inefficient or unusual and that direct-acting antiviral treatment is not sufficient for HCV elimination among MSM in NYC. The contrasts between both the rates of and risk factors for primary and HCV reinfection suggest that HCV prevalence is highly heterogenous among sexual networks and that sexualized methamphetamine use, rather than mediating transmission, is instead a surrogate marker for the highest HCV prevalence networks. As neither condoms nor treatment have been successful strategies for HCV prevention in NYC, novel interventions are needed to stem this sexually transmitted HCV epidemic.
Publisher
Oxford University Press (OUP)
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