Screening HIV-positive men who have sex with men for hepatitis C re-infection risk: is a single question on condom-use enough? A sensitivity analysis. BMC Infectious Diseases
Künzler-Heule et al. aimed to (1) describe sexual and drug-using behaviours participants reported during Swiss HCVree study baseline assessment and to compare those behaviours in men who have sex with men (MSM) who did and did not report condomless anal intercourse with non-steady partners (nsCAI) during the prior year and to (2) examine the condom-use question’s sensitivity and specificity in identifying men who engaged in other hepatitis C virus (HCV) relevant risk behaviours.
Seventy-two (61%) of the 118 men meeting eligibity criteria reported nsCAI during the prior year. Many also engaged in other potential HCV transmission risk behaviours, e.g., 52 (44%) had used drugs. In participants disclosing drug use, 44 (37%) reported sexualised drug use and 17 (14%) injected drugs. Unadjusted odds ratios (95% CI) for two well-known risk behaviours were 2.02 (0.80, 5.62) for fisting and 5.66 (1.49, 37.12) for injecting drug use. The odds ratio for sexualised drug use – a potential mediator for increased sexual risk taking – was 5.90 (2.44, 16.05). nsCAI showed varying sensitivity in relation to the other risk behaviours examined (66.7–88.2%).
In conclusion, the study-findings support existing research that MSM coinfected with HIV/HCV engage in various sexual and drug-use behaviours, potentially increasing their risk of HCV re-infection. Men who reported nsCAI were more likely to report engaging in the other sexual and drug-use behaviors measured although the differences were only statistically significant for the drug-use behaviors. nsCAI was fairly sensitive in identifying men who also engaged in other risk behaviours, but relying only on it to identify men at risk for HCV infection would miss a proportion of MSM with HIV practicing other potentially modifiable behaviours. Based on the study-findings comprehensive screening of potential risk behaviours should be applied to identify men whose sexual and drug use behaviors increase their risk for HCV infection. This work also points to the importance of providing access to behavioral interventions addressing other sexual and drug use practices as part of HCV treatment.