More safer sex intervention needed for HIV-positive MSM with higher education level for prevention of sexually transmitted hepatitis C.

Introduction: The epidemiology of hepatitis C virus (HCV) infections in Chinese HIV-infected men who have sex with men (MSM) remains obscure. More data is required to understand the epidemic and set up preventive strategy.

Materials And Methods: Baseline and annual testing of anti-HCV was in place for all HIV-infected MSM in the largest HIV clinic in Hong Kong. Logistic regression was used to compare those with HCV seroconversion (seroconverters) with those remained tested anti-HCV negative (non-seroconverters) to identify factors associated with incident HCV.

Results: From 1999 to 2013, 1311 patients were tested for anti-HCV seroconversion, contributing to 6295 patient-years of observation. Fourteen (1.1%) patients seroconverted, with genotype 3 being most commonly detected. The overall incidence rate of HCV infection was 0.22 per 100 patient-years (PY) in the cohort. The incidence rate increased from 0.13 per 100PY before 2002 to 0.19 per 100PY in 2002-2007 and 0.47 per 100PY in 2008-2013. All the seroconverters were Chinese, with median age of anti-HCV seroconversion at 38 years (range: 28-53 years). None of them were injecting drug users. As compared with the non-seroconverters, seroconverters were of higher education level (85.7% vs 50.7% tertiary education or above, OR 5.28, p=0.021) and had prior history of sexually transmitted infection (92.9% vs 60.9%, OR 8.34, p=0.041). More seroconverters were found to have history of syphilis infection (57.1% vs 37.2%, p=0.134) but the difference was not statistically significant. Baseline CD4 count and HIV viral load, proportion on antiretroviral therapy and duration of antiretroviral therapy were not different between two groups.

Conclusions: The incidence of HCV has been increasing among HIV-infected MSM non-injecting drug users in Hong Kong. More education and intervention on safer sex is required to be targeted on those with higher education level.