High number of potential transmitters revealed in a population-based systematic hepatitis C virus RNA screening among human immunodeficiency virus infected men who have sex with men. Clinical Infectious Diseases
Braun et al. aimed to perform a systematic hepatitis C virus (HCV) RNA–based screening among HIV-infected men who have sex with men (MSM) participating in the Swiss HIV Cohort Study (SHCS). HCV antibodies were measured from all HCV RNA–positive samples.
Of 4’257 MSM recorded in the SHCS database, the investigators screened 3722 (87%) by HCV polymerase chain reaction and identified 177 (4.8%) with replicating HCV infection. Of those, 24 individuals (14%) had an incident HCV infection. Notably, one-third of individuals with incident HCV infection had a negative HCV antibody result at the time of HCV RNA positivity. The investigators calculated a median delay of 197 days (range, 53–366 days) in the diagnosis of incident HCV infection when following the SHCS standard-of-care annual HCV antibody testing. In a multivariable model, elevated liver enzyme values (odds ratio, 14.52; 95% confidence interval, 9.92–21.26), unprotected sex with occasional partners (2.01; 1.36–2.98), intravenous drug use (7.13; 4.36–11.64), noninjectable drug use (1.94; 1.3 2.88), and previous syphilis diagnosis (2.56; 1.74–3.76) were associated with HCV RNA positivity.
In conclusion, the systematic HCV RNA–based screening among HIV-infected MSM revealed a high number of potential transmitters. A substantial subpopulation of MSM had incident infection, one-third of whom had a negative HCV antibody test result at the time of the HCV RNA positivity. These data reveal that one-time RNA testing of a high-risk population for HCV RNA might identify more infected persons than routine testing for HCV antibodies and liver enzymes. Hence, HCV RNA–based screening should be considered in sexually active MSM, particularly when they indulge in highrisk behavior.