Amsterdam 2015
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| Abstract #2034 - Comorbidity - double jeopardy | ||||
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Session: 23.1: Comorbidity - double jeopardy (Parallel) on Wednesday @ 16.30-18.00 in 202 Chaired by Margalit Lorber, Simon Rackstraw Authors: Presenting Author: Mr Joost Vanhommerig - GGD Amsterdam, Netherlands |
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| Additional Authors: | ||||
| Aim: Since 2000, incidence of sexually acquired hepatitis C virus (HCV) infection has increased among HIV-infected men who have sex with men (MSM). Only few case-control and cohort studies evaluating transmission risk factors were conducted, and most of these studies were initially set up to study HIV-related behavior and characteristics, but lack HCV-specific ones. The MOSAIC study is an observational cohort study initiated specifically to study determinants and sequelae of acute HCV infection in HIV-infected MSM. As such, it provides a unique opportunity to study risk factors for acute HCV infection. | ||||
| Method / Issue: From February 2009 onwards, HIV-infected MSM with an acute HCV infection (cases) were prospectively included and followed at five hospitals in Amsterdam, Rotterdam and Utrecht, the Netherlands. For each case, one to two unmatched controls were ed from the population of HIV-infected MSM without HCV. At study visits anonymous, written questionnaires were administered by cases and controls, covering socio-demographics, risk factors for HCV infection, sexual risk behavior, sex-related variables, and drug use before/during sex. Clinical data on HIVrelated variables were acquired through linkage with databases from the Dutch HIV Monitoring Foundation. Determinants of HCV infection were analyzed using logistic regression. | ||||
| Results / Comments: Among 213 MSM (82 MSM with and 131 MSM without HCV infection), the median age was 45.7 years (IQR: 41.0-52.2). Many sex-related variables and drug use were associated with HCV in univariable analyses. In multivariable regression, unprotected anal intercourse (UAI) with =1 sex partner with HCV unknown or positive status (OR: 7.15, 95% CI: 2.43-21.0), having had =1 ulcerative STI (OR: 4.98, 95% CI: 1.80-13.8), sharing sex toys (OR: 3.55, 95% CI: 1.20-10.5), unprotected fisting (OR: 3.36, 95% CI: 1.31-8.66), and lower CD4 cell count at the last HCV-negative visit before study entry (OR: 1.82 per cubic root lower, 95% CI: 1.25-2.64), were significantly associated with acute HCV acquisition. Of interest, (injecting) drug use, anal rinsing, rectal bleeding, number of sex partners, and group sex participation were not significantly associated in multivariable analysis. No interactions between sexual risk behavior and CD4 cell count, anal rinsing, or rectal bleeding were found. | ||||
| Discussion: Unprotected anal intercourse, ulcerative STI, fisting, and sharing sex toys wereindependently associated with acute HCV infection. In addition, lower CD4 cell count was associated with an increased risk of acquiring HCV. Although this association has been frequently suggested, studies addressing this topic are scarce and results are conflicting. Further studies are needed as it is still unclear whether a lower CD4 cell count facilitates HCV infection, or is a result of acute HCV infection itself (or both). Our results may inform future HCV prevention programs for MSM. | ||||
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