P1-S2.53 Hepatitis C Virus in men who have sex with men with no history of injection drug use - evidence for sexual transmission? A Canadian perspective
Authors: Totten S , McGuire M , Cox J , Lambert G , Fyfe M , Husbands W , Myers T , Remis R , Wylie J , Wong T 
Published: July 2011

Background

Sexual transmission of hepatitis C virus (HCV) is not common compared to other modes of transmission such as injection drug use (IDU). There have been recent reports of sexually transmitted HCV outbreaks among men who have sex with men (MSM) in Europe. The present analysis examines the Canadian HCV seroprevalence in MSM with no reported history of IDU. Methods Data from Phase 1 of M-Track (2005−2007), a national enhanced surveillance system of HIV and other sexually transmitted and blood-borne infections (STBBI) and associated risk behaviours among MSM in Canada, were analysed. HCV and HIV status were ascertained using serology tests on dried blood spot (DBS) specimens, and risk factors were assessed via self-administered questionnaire. Bivariate analyses using χ2 tests and ORs with 95% CIs were performed.

Results

Overall (regardless of IDU history), 5.3% of M-Track participants were seropositive for HCV. Among MSM who did not report any history of IDU (N=3250), HCV seropositivity was 2.1%, and was higher among HIV-infected MSM compared to those who were uninfected (5.1% vs 1.7% respectively, p<0.001). Factors associated with HCV seropositivity among non-IDU are presented in Abstract P1-S2.53 table 1. Being 30 yearss of age or older, having ever received money, drugs, or goods for sex, and use of any recreational drug in the 2  h preceding or during sex (specifically heroin/opioids, marijuana, tranquilisers, or cocaine) were all positively associated with being seropositive for HCV.

Asbtract P1-S2.53 Table 1

Self-reported factors associated with HCV seropositivity among MSM with no self-reported history of IDU, M-Track Phase 1 (2005−2007)

Risk factorHCV positive N (%)Univariate OR (95% CI)p valueAge (N=2167)29 or less (Ref)2 (0.4)5.5 (1.3 to 22.8)0.01530 and up38 (2.2)Number of male anal sex partners in past 6 months (N=1342)One (Ref)5 (1.1)1.5 (0.6 to 4.2)0.408Two or more15 (1.7)HIV seroconcordant unprotected anal intercourse (“serosorting”) (N=2136)No (Ref)30 (1.9)0.6 (0.3 to 1.5)0.266Yes6 (1.1)Ever received money, goods, or drugs for sex (N=2534)No (Ref)30 (1.3)8.2 (4.6 to 14.5)<0.001Yes21 (9.7)Ever used recreational drugs within 2 h of sex (N=2536)No (Ref)Yes32 (1.6)17 (3.4)2.2 (1.2 to 4.0)0.008Ever used heroin/opioids within 2 h of sex (N=2521)No (Ref)42 (1.7)8.5 (3.2 to 22.9)<0.001Yes5 (12.8)Ever used alcohol within 2 h of sex (N=2575)No (Ref)14 (2.1)0.9 (0.5 to 1.7)0.729Yes35 (1.8)Ever used marijuana within 2 h of sex (N=2539)No (Ref)19 (1.2)2.8 (1.6 to 5.1)<0.001Yes31(3.3)Ever used tranquilisers within 2 h of sex (N=2518)No (Ref)46 (1.9)5.5 (1.6 to 18.7)0.016Yes3 (9.4)Ever used cocaine within 2 h of sex (N=2520)No (Ref)29 (1.4)4.1 (2.3 to 7.3)<0.001Yes20 (5.3)Ever used sexual enhancers within 2 h of sex (N=2545)No (Ref)29 (1.8)1.1 (0.6 to 2.0)0.671Yes19 (2.0)

Conclusions

These findings do not confirm sexual transmission of HCV given the possibility of unreported IDU or other unknown parenteral transmission risk factors in this sample; however, they do support existing evidence of increased risk of HCV infection among HIV-infected MSM. Interpretation of results is limited by the self-reported nature of behaviours and the inability of laboratory tests used to distinguish between current infection from resolved/treated HCV or acute from chronic HCV status. Furthermore, behaviours reported in the past 6  months may not accurately reflect the risk profile of HCV-seropositive individuals at the time of infection. HCV testing for HIV-infected MSM, even in the absence of an IDU history, may be of benefit.