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Epidemic of Sexually Transmitted Hepatitis C Virus Infection Among HIV-Infected Men. Curr Infect Dis Rep 2011; 12:118-25. [PMID: 21308508 DOI: 10.1007/s11908-010-0088-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Sexual contact is thought to be an inefficient mode of hepatitis C virus (HCV) transmission. However, reports of sexually transmitted HCV infection among HIV-infected men who have sex with men (MSM) began to appear in 2004. The patients were of early middle age with well-controlled HIV infection, participated in unprotected receptive sex, and frequently used noninjection recreational drugs. Molecular studies showed evidence of clusters of transmission between patients in different countries in Europe. Spontaneous clearance was relatively rare, but treatment with pegylated interferon and ribavirin resulted in cure in about two thirds of patients. Of concern was the finding of moderately advanced fibrosis during the early stages of HCV infection. HIV-infected MSM are a new risk group for HCV infection and so should be screened regularly for HCV infection.
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Gamage DG, Read TRH, Bradshaw CS, Hocking JS, Howley K, Chen MY, Fairley CK. Incidence of hepatitis-C among HIV infected men who have sex with men (MSM) attending a sexual health service: a cohort study. BMC Infect Dis 2011; 11:39. [PMID: 21291565 PMCID: PMC3040713 DOI: 10.1186/1471-2334-11-39] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Accepted: 02/03/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We aimed to determine the incidence of Hepatitis C (HCV) infection among HIV-infected men who have sex with men (MSM) attending a Sexual Health Centre. METHODS A retrospective cohort study was carried out among HIV-infected MSM seen at least once between February 2002 and March 2010. The analysis was restricted to MSM who had had a negative HCV antibody test at least 6 months after their diagnosis for HIV. Duration of follow up was taken from the date of HIV diagnosis to the first positive or last negative HCV antibody test. RESULTS During the time 1445 HIV-infected men attended the clinic of whom 1065 (74%) were MSM. Of these, 869 (82%) were tested for HCV at any time after HIV diagnosis. Of these 869, 69% (620) tested HCV negative at least 6 months after their HIV diagnosis. These 620 men had a mean age of 34 years (range 17-72) at HIV diagnosis and a total of 4,359 person years (PY) of follow up. There were 40 incident cases of HCV, of which 16 were in injecting drug users (IDU) and 24 in non-IDU. The overall incidence of HCV among HIV-infected MSM was 0.9/100 PY (95% CI 0.6-1.2). The incidence among HIV-infected IDU was 4.7/100 PY (95% CI 2.7-7.5) while the incidence among HIV-infected non-IDU was 0.6/100 PY (95% CI 0.4-0.8) (hazard ratio of 8.7 and 95% CI 4.6-16.6, P < 0.001).The majority (78%) were tested for HCV because they developed abnormal liver transaminases (n = 31) or hepatitis symptoms (n = 2), while others (n = 7) were identified through routine HCV testing. CONCLUSION A considerable proportion of HIV-positive MSM who did not inject drugs contracted HCV, presumably via sexual transmission and the main trigger for investigation was abnormal liver transaminases.
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Affiliation(s)
- Deepa G Gamage
- Melbourne Sexual Health Centre, Alfred Hospital, Melbourne, Australia
- Epidemiology Unit, Ministry of Health, Colombo, Sri Lanka
| | - Tim RH Read
- Melbourne Sexual Health Centre, Alfred Hospital, Melbourne, Australia
- School of Population Health, University of Melbourne, Australia
| | - Catriona S Bradshaw
- Melbourne Sexual Health Centre, Alfred Hospital, Melbourne, Australia
- School of Population Health, University of Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Australia
| | - Jane S Hocking
- School of Population Health, University of Melbourne, Australia
| | - Kerry Howley
- Melbourne Sexual Health Centre, Alfred Hospital, Melbourne, Australia
| | - Marcus Y Chen
- Melbourne Sexual Health Centre, Alfred Hospital, Melbourne, Australia
- School of Population Health, University of Melbourne, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Hospital, Melbourne, Australia
- School of Population Health, University of Melbourne, Australia
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Buxton JA, Yu A, Kim PH, Spinelli JJ, Kuo M, Alvarez M, Gilbert M, Krajden M. HCV co-infection in HIV positive population in British Columbia, Canada. BMC Public Health 2010; 10:225. [PMID: 20429917 PMCID: PMC2868820 DOI: 10.1186/1471-2458-10-225] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2009] [Accepted: 04/29/2010] [Indexed: 01/28/2023] Open
Abstract
Background As HIV and hepatitis C (HCV) share some modes of transmission co-infection is not uncommon. This study used a population-based sample of HIV and HCV tested individuals to determine the prevalence of HIV/HCV co-infection, the sequence of virus diagnoses, and demographic and associated risk factors. Methods Positive cases of HIV were linked to the combined laboratory database (of negative and positive HCV antibody results) and HCV reported cases in British Columbia (BC). Results Of 4,598 HIV cases with personal identifiers, 3,219 (70%) were linked to the combined HCV database, 1,700 (53%) of these were anti-HCV positive. HCV was diagnosed first in 52% of co-infected cases (median time to HIV identification 3 1/2 years). HIV and HCV was diagnosed within a two week window in 26% of cases. Among individuals who were diagnosed with HIV infection at baseline, subsequent diagnoses of HCV infection was independently associated with: i) intravenous drug use (IDU) in males and females, Hazard Ratio (HR) = 6.64 (95% CI: 4.86-9.07) and 9.76 (95% CI: 5.76-16.54) respectively; ii) reported Aboriginal ethnicity in females HR = 2.09 (95% CI: 1.34-3.27) and iii) males not identified as men-who-have-sex-with-men (MSM), HR = 2.99 (95% CI: 2.09-4.27). Identification of HCV first compared to HIV first was independently associated with IDU in males and females OR = 2.83 (95% CI: 1.84-4.37) and 2.25 (95% CI: 1.15-4.39) respectively, but not Aboriginal ethnicity or MSM. HIV was identified first in 22%, with median time to HCV identification of 15 months; Conclusion The ability to link BC public health and laboratory HIV and HCV information provided a unique opportunity to explore demographic and risk factors associated with HIV/HCV co-infection. Over half of persons with HIV infection who were tested for HCV were anti-HCV positive; half of these had HCV diagnosed first with HIV identification a median 3.5 years later. This highlights the importance of public health follow-up and harm reduction measures for people identified with HCV to prevent subsequent HIV infection.
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Affiliation(s)
- Jane A Buxton
- BC Centre for Disease Control, Vancouver, British Columbia.
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Russell M, Chen MJ, Nochajski TH, Testa M, Zimmerman SJ, Hughes PS. Risky sexual behavior, bleeding caused by intimate partner violence, and hepatitis C virus infection in patients of a sexually transmitted disease clinic. Am J Public Health 2009; 99 Suppl 1:S173-9. [PMID: 19218181 PMCID: PMC2724935 DOI: 10.2105/ajph.2007.126383] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2008] [Indexed: 01/08/2023]
Abstract
OBJECTIVES We sought to investigate independent contributions of risky sexual behaviors and bleeding caused by intimate partner violence to prediction of HCV infection. METHODS We conducted a case-control study of risk factors among patients of a sexually transmitted disease clinic with and without HCV antibodies, group-matched by age. RESULTS Multivariate analyses indicated that Black race (odds ratio [OR] = 2.4; 95% confidence interval [CI] = 1.3, 4.4), injection drug use (OR = 20.3; 95% CI = 10.8, 37.8), sharing straws to snort drugs (OR = 1.8; 95% CI = 1.01, 3.0), sharing razors (OR = 7.8; 95% CI = 2.0, 31.0), and exposure to bleeding caused by intimate partner violence (OR = 5.5; 95% CI = 1.4, 22.8) contributed significantly to the prediction of HCV infection; risky sexual behavior and exposure to blood or sores during sexual intercourse did not. CONCLUSIONS HCV risk among patients of a sexually transmitted disease clinic can be explained by direct blood exposure, primarily through injection drug use. Exposure to bleeding caused by intimate partner violence may be a previously unrecognized mechanism for HCV transmission associated with risky sexual behavior.
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Affiliation(s)
- Marcia Russell
- Pacific Institute for Research & Evaluation, Prevention Research Center, Berkeley, CA, USA
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Affiliation(s)
- R Gilson
- Centre for Sexual Health And HIV Research, Royal Free and University College Medical School, The Mortimer Market Centre, London WC1E 6AU, UK.
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Ghosn J, Deveau C, Goujard C, Garrigue I, Saïchi N, Galimand J, Nagy Z, Rouzioux C, Meyer L, Chaix ML. Increase in hepatitis C virus incidence in HIV-1-infected patients followed up since primary infection. Sex Transm Infect 2006; 82:458-60. [PMID: 16923739 PMCID: PMC2563871 DOI: 10.1136/sti.2006.021493] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND An increase in the incidence of sexually transmitted infections and hepatitis C virus (HCV) infections in HIV-infected men who have sex with men (MSM) has recently been reported. OBJECTIVE To estimate HCV incidence and risk factors among HIV-1-infected patients followed up since primary HIV infection in the French PRIMO Cohort between 1996 and 2005. PATIENTS AND METHODS All patients with at least 18 months of follow-up were studied. HCV antibody tests were performed on baseline plasma samples and repeated on the latest available sample when negative at baseline. RESULTS In total, 402 patients with a median follow-up of 36 (range 18-104) months were eligible. HCV seroconversion was observed in 6 patients (4 men and 2 women), corresponding to an HCV incidence rate of 4.3 per 1000 person-years. Incidence rates in men and women were 3.5 and 7.8 per 1000 person-years, respectively. The incidence rate was 1.2 per 1000 person-years before January 2003 and 8.3 per 1000 person-years after January 2003 (p = 0.06). The classic risk factors for HCV infection were found in women (intravenous drug use, and body piercing), whereas the only identified risk factor for HCV acquisition was unsafe sex in the four men. CONCLUSIONS Increase in the incidence of acute HCV infection in recently HIV-infected patients confirms the shift in sexual behaviour in the recent years, especially in HIV-infected MSM. Repeated testing for HCV antibodies should be carried out in HCV-negative HIV-infected patients and specific recommendations about protected sex should be clearly provided.
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Affiliation(s)
- J Ghosn
- Laboratoire de Virologie, EA MRT 3620, Université René Descartes Paris5, CHU Necker-Enfants Malades, 149 Rue de Sèvres, 75015 Paris, France.
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Luetkemeyer A, Hare CB, Stansell J, Tien PC, Charlesbois E, Lum P, Havlir D, Peters M. Clinical presentation and course of acute hepatitis C infection in HIV-infected patients. J Acquir Immune Defic Syndr 2006; 41:31-6. [PMID: 16340470 PMCID: PMC4050666 DOI: 10.1097/01.qai.0000191281.77954.27] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Hepatitis C virus (HCV) has become a significant source of morbidity and mortality in HIV-infected patients. However, little is known about the clinical presentation and course of acute HCV infection in this population. This study reports the outcomes of acute HCV infection in 9 HIV-infected men. Sex with men was the only reported risk factor for HCV infection in 6 of the subjects. Clinical presentation of acute HCV ranged from incidentally discovered elevated transaminases to severe liver dysfunction requiring hospitalization. At the time of HCV diagnosis, 8 of 9 patients had CD4+ counts >250 cells/mm(3), and 6 had HIV viral loads of < or =5000 copies/mL. Eight patients were receiving antiretroviral therapy. Outcome of these acute HCV infections varied. Five patients experienced virologic clearance, 2 in whom virus cleared spontaneously and 3 who were treated with pegylated interferon and ribavirin. Four patients developed chronic infection, one of whom had a relapse during HCV treatment and 3 of whom were untreated. All 4 patients to whom HCV therapy was administered experienced significant anemia or neutropenia, necessitating dose reduction or support with growth factors. Prompt recognition of acute HCV infection may minimize antiretroviral treatment interruption and will allow early treatment, which may improve virologic clearance. Unexplained transaminase elevations in HIV-infected patients, including men who have sex with men, should trigger an evaluation for acute HCV infection.
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Affiliation(s)
- Annie Luetkemeyer
- HIV/AIDS Division, San Francisco General Hospital, University of California at San Francisco, CA 94110, USA.
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Yildirim B, Tahan V, Ozaras R, Aytekin H, Mert A, Tabak F, Senturk H. Hepatitis C virus risk factors in the Turkish community. Dig Dis Sci 2005; 50:2352-2355. [PMID: 16416188 DOI: 10.1007/s10620-005-3061-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2004] [Accepted: 01/18/2005] [Indexed: 12/09/2022]
Abstract
Hepatitis C virus (HCV) is the most common chronic blood-borne infection in the worldwide. This infection is often insidious and one-half of infected patients are asymptomatic. Determination of risk factors for HCV transmission is very important. The aim of this study was to assess the risk factors, transmission to spouses and children for HCV infection in Turkish population. One hundred and fifty-one patients with chronic hepatitis C and 151 control cases were investigated for the probable risk factors of HCV infection. Complete blood count, ALT, AST, albumin, prothrombin time, upper abdomen ultrasonography assessment and percutaneous liver biopsy (not for cirrhotics) were performed in all patients with chronic hepatitis C. Anti-HCV testing was done by using second-generation ELISA in 302 cases. Minor surgical operation (p < 0.001), major surgical operation (p = 0.001), blood transfusion (p < 0.001), multi-partner sex (p < 0.05), frequent dental therapy (p < 0.05), and dental extraction (p < 0.001) in patients with a chronic HCV infection were found to be higher than the control group. No significant difference was found in other risk factors. The rate of hepatitis C virus in index cases was found to be 1.8% in their spouses and 1.2% in their children. Our study showed that surgical operation, frequent dental therapy, dental extraction, multi-partner sex, and blood transmission are the main risk factors for HCV infection in Turkish community.
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Affiliation(s)
- Beytullah Yildirim
- Department of Gastroenterology, Marmara University School of Medicine, Istanbul, Turkey
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Hoover DR, Sambamoorthi U, Walkup JT, Crystal S. Mental illness and length of inpatient stay for medicaid recipients with AIDS. Health Serv Res 2004; 39:1319-39. [PMID: 15333111 PMCID: PMC1361072 DOI: 10.1111/j.1475-6773.2004.00292.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE To examine the associations between comorbid mental illness and length of hospital stays (LOS) among Medicaid beneficiaries with AIDS. DATA SOURCE AND COLLECTION/STUDY SETTING: Merged 1992-1998 Medicaid claims and AIDS surveillance data obtained from the State of New Jersey for adults with >or=1 inpatient stay after an AIDS diagnosis from 1992 to 1996. STUDY DESIGN Observational study of 6,247 AIDS patients with 24,975 inpatient visits. Severe mental illness (SMI) and other less severe mental illness (OMI) diagnoses at visits were ascertained from ICD-9 Codes. About 4 percent of visits had an SMI diagnosis; 5 percent had an OMI diagnosis; 43 percent did not have a mental illness diagnosis, but were patients who had been identified as having an SMI or OMI history; and 48 percent were from patients with no identified history of mental illness. PRINCIPAL FINDINGS The overall mean hospital LOS was 12.7 days. After adjusting for measures of HIV disease severity and health care access in multivariate models, patients presenting with primary and secondary severe mental illness (SMI) diagnoses had approximately 32 percent and approximately 11 percent longer LOS, respectively, than did similar patients without a mental illness history (p<0.001 for each). But in these adjusted models of length of stay: (1) diagnosis of OMI was not related to LOS, and (2) in the absence of a mental illness diagnosed at the visit, an identified history of either SMI or OMI was also not related to LOS. In adjusted models of time to readmission for a new visit, current diagnosis of SMI or OMI and in the absences of a current diagnosis, history of SMI or OMI all tended to be associated with quicker readmission. CONCLUSIONS This study finds greater (adjusted) LOS for AIDS patients diagnosed with severe mental illness (but not for those diagnosed with less severe mental comorbidity) at a visit. The effect of acute severe mental illness on hospitalization time may be comparable to that of an acute AIDS opportunistic illness. While previous research raises concerns that mental illness increases LOS by interfering with treatment of HIV conditions, the associations here may simply indicate that extra time is needed to treat severe mental illnesses or arrange for discharge of afflicted patients.
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Affiliation(s)
- Donald R Hoover
- Institute for Health, Health Care Policy, and Aging Research, Rutgers University, 30 College Avenue, New Brunswick, NJ 08901, USA
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Abstract
Co-infection with hepatitis C virus and human immunodeficiency virus is common in certain populations. Among HCV (+) persons, 10% are also HIV (+), and among HIV (+) persons, 25% are also HCV (+). Many studies have shown that in intravenous drug users, co-infection prevalence can be as high as 90%-95%. There is increasing evidence supporting the concept that people infected with HIV have a much more rapid course of their hepatitis C infection. Treatment of co-infection is often challenging because highly active anti-retroviral therapy (HAART) therapy is frequently hepatotoxic, especially in the presence of HCV. The purpose of this review is to describe the effects that HIV has on hepatitis C, the effects that hepatitis C has on HIV, and the treatment options in this challenging population.
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Affiliation(s)
- Irena Maier
- Department of Medicine Division of Gastroenterology-Hepatology, University of Connecticut Health Center, Rm. AM-045,263 Farmington Avenue, Farmington, CT 06030-1845,USA
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Roy E, Haley N, Leclerc P, Boivin JF, Cédras L, Vincelette J. Risk factors for hepatitis C virus infection among street youths. CMAJ 2001; 165:557-60. [PMID: 11563207 PMCID: PMC81413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023] Open
Abstract
BACKGROUND The relative contributions to risk of hepatitis C virus (HCV) infection resulting from unsafe sexual behaviours and exposures to blood (e.g., tattooing, body piercing and injection drug use) among youths at risk are not well known. We interviewed street youths about risk factors for HCV infection and documented their HCV antibody status. METHODS From December 1995 to September 1996 we recruited 437 youths aged 14 to 25 years who met specific criteria for itinerancy. Data on sociodemographic characteristics and lifetime risk factors were obtained during a structured interview, and a venous blood sample was taken for HCV antibody testing. RESULTS Many of the subjects reported behaviours that put them at risk for blood-borne diseases: 45.8% had injected drugs, 56.5% had at least 1 tattoo, and 78.3% had body piercing. The overall prevalence of HCV infection was 12.6% (95% confidence interval [CI] 9.7%-15.9%). In a multivariate logistic regression analysis, injecting drugs (adjusted odds ratio [OR] 28.4 [95% CI 6.6-121.4]), being over 18 years of age (adjusted OR 3.3 [95% CI 1.6-7.0]) and using crack cocaine (adjusted OR 2.3 [95% CI 1.0-5.3]) were independent risk factors for HCV infection. Having more than 1 tattoo (adjusted OR 1.8 [95% CI 0.95-3.6]) was marginally associated with HCV infection, and body piercing was not. INTERPRETATION Drug injection was the factor most strongly associated with HCV infection among street youths. Given that injection drug users are the driving force of the HCV infection epidemic in Canada, increased intervention efforts to prevent initiation of drug injection are urgently needed to curb the epidemic.
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Affiliation(s)
- E Roy
- Montreal Regional Public Health Department, McGill University, Montreal, Que.
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Fondation canadienne du foie, Programme d’éducation nationale sur l’hépatite C. Hepatitis C: medical information update. Canadian Liver Foundation. National Hepatitis C Education Program. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2000; 91 Suppl 1:S4-9. [PMID: 11059122 PMCID: PMC6979663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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