Incidence of sexually-transmitted hepatitis C virus infection in HIV-positive men who have sex with men: A systematic review and meta-analysis

Abstract

Objectives

The epidemiology of the incidence of sexually-transmitted hepatitis C virus (HCV) infection in HIV-positive men who have sex with men (HIV+MSM) is only partially understood. In the presence of HIV, HCV infection is more likely to become chronic and liver fibrosis progression is accelerated.

Design

A systematic review and meta-analysis was used to synthesize data characterizing sexually transmitted HCV in HIV+MSM.

Methods

Electronic and other searches of medical literature (including unpublished reports) were conducted. Eligible studies reported on HCV seroconversion or on reinfection post-successful HCV treatment in HIV+MSM who were not injecting drugs. Pooled incidence rates were calculated using random-effects meta-analysis, and meta-regression was used to assess study-level moderators. Attributable risk measures were calculated from statistically significant associations between exposures and HCV seroconversion.

Results

More than 13,000 HIV+MSM in 17 studies were followed >91,000 person-years (PY) between 1984–2012; the pooled seroconversion rate was 0.53/100PY. Calendar time was a significant moderator of HCV seroconversion, increasing from an estimated rate of 0.42/100PY in 1991 to 1.09/100PY in 2010, and 1.34/100PY in 2012. Reinfection post-successful HCV treatment (n=2 studies) was 20 times higher than initial seroconversion rates. Among the seroconverters, a large proportion of infections were attributable to high risk behaviors including mucosally-traumatic sex and sex while high on methamphetamine.

Conclusions

The high reinfection rates and the attributable risk analysis suggest the existence of a subset of HIV+MSM with recurring sexual exposure to HCV. Approaches to HCV control in this population will need to consider the changing epidemiology of HCV infection in MSM.