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High incidence of HCV in HIV-negative men who have sex with men using pre-exposure prophylaxis

2019; Elsevier BV; Volume: 72; Issue: 5 Linguagem: Inglês

10.1016/j.jhep.2019.11.022

1600-0641

Elske Hoornenborg, Liza Coyer, Anders Boyd, Roel Achterbergh, Maarten Franciscus Schim van der Loeff, Sylvia M. Bruisten, Henry J.C. de Vries, Jelle Koopsen, Thijs van de Laar, Maria Prins, Jan van Bergen, Godelieve J. de Bree, P. Brokx, F. Deug, M. Heidenrijk, Maria Prins, Peter Reiss, Marc van der Valk, Jan van Bergen, Godelieve J. de Bree, P. Brokx, Udi Davidovich, Suzanne E. Geerlings, Elske Hoornenborg, A. Oomen, Ard van Sighem, Wim Zuilhof, M.L. Groot Bruinderink, Roel Achterbergh, Michiel A. van Agtmael, Jintanat Ananworanich, Diederik van de Beek, G.E.L. van den Berk, Daniela Bezemer, A. van Bijnen, W Blok, S Bogers, Marije K. Bomers, Charles A. Boucher, W. Brokking, David M. Burger, Kees Brinkman, N. Brinkman, Marijn de Bruin, Sylvia M. Bruisten, Liza Coyer, Reinout van Crevel, Ceranza G. Daans, L. Dellemann, Maartje Dijkstra, Y. T. van Duijnhoven, Arne van Eeden, L. Elsenburg, Mark A. M. van den Elshout, Carmen Ester, E. Ersan, P. E. V. Felipa, P. H. J. Frissen, Teunis B. H. Geijtenbeek, Mieke H. Godfried, J. van Gool, Abraham Goorhuis, Marco R. de Groot, Catherine Hankins, A. Heijnen, M Hillebregt, A.A. Hogewoning, M. Hommenga, Joppe W. Hovius, Y. J. H. Janssen, K. De Jong, Vita W. Jongen, Neeltje A. Kootstra, Richard A. Koup, Frank P. Kroon, Thijs van de Laar, Fanny N. Lauw, M.M. van Leeuwen, Kamilla D. Lettinga, Ineke Linde, Dominique Loomans, J. T. van der Meer, T. Mouhebati, Barbara J.M. Mulder, Jan Mulder, F.J.B. Nellen, A. Nijsters, H. Nobel, Paul M. Oostvogel, Eline Op de Coul, Edgar J.G. Peters, Inga Peters, T. van der Poll, Oliver Ratmann, Casper Rokx, Martijn S. van Rooijen, Maarten F. Schim van der Loeff, W.E.M. Schoute, Gerard J.B. Sonder, Jan A. Veenstra, Annelies Verbon, F. Verdult, J. de Vocht, Henry J.C. de Vries, S.M.E. Vrouenraets, Michèle van Vugt, W. Joost Wiersinga, Ferdinand W.N.M. Wit, L. R. Woittiez, S Zaheri, Paul Zantkuijl, Menno C. van Zelm, Anna Żakowicz, Hanne M. L. Zimmermann,

HIV/AIDS drug development and treatment

•HIV-negative men who have sex with men while on pre-exposure prophylaxis are at risk of incident HCV infection. •High incidence rates of both HCV primary and re-infection were observed. •Identified HCV risk-factors were similar to those in HIV-positive men who have sex with men. •Specific clusters of HCV strains were identified in men who have sex with men, with and without HIV. •HCV-testing for HIV-negative men who have sex with men while on pre-exposure prophylaxis is recommended. Background & Aims HCV has emerged as a sexually transmitted infection (STI) among HIV-positive men who have sex with men (MSM). We evaluated HCV incidence and its risk factors among HIV-negative MSM using HIV pre-exposure prophylaxis (PrEP). Methods Participants of the Amsterdam PrEP project were tested for HCV antibodies or HCV-RNA every 6 months. Participants used daily or event-driven PrEP and could switch regimens during follow-up. We calculated incidence rates (IRs) for overall HCV infection and separately for primary and re-infection. A univariable Bayesian exponential survival model was used to identify risk factors associated with incident HCV infection. The HCV NS5B gene fragment (709 bp) was sequenced and compared to HCV isolates from HIV-positive MSM and other risk groups (n = 419) using phylogenetic analysis. Results Among 350 participants contributing 653.6 person-years (PYs), we detected 15 HCV infections in 14 participants (IR = 2.30/100PY). There were 8 primary infections (IR = 1.27/100PY) and 7 re-infections (IR = 27.8/100PY). IR was 2.71/100PY in daily and 1.15/100PY in event-driven PrEP users. Factors associated with incident HCV infection were higher number of receptive condomless anal sex acts with casual partners (posterior hazard ratio [HR] 1.57 per ln increase; 95% credibility interval [CrI] 1.09–2.20), anal STI (posterior HR 2.93; 95% CrI 1.24–7.13), injecting drug use (posterior HR 4.69; 95% CrI 1.61–12.09) and sharing straws when snorting drugs (posterior HR 2.62; 95% CrI 1.09–6.02). We identified robust MSM-specific HCV clusters of subtypes 1a, 4d, 2b and 3a, which included MSM with and without HIV. Conclusions HIV-negative MSM using PrEP are at risk of incident HCV infection, while identified risk factors are similar to those in HIV-positive MSM. Regular HCV testing is needed, especially for those with a previous HCV infection and those reporting risk factors. Lay summary We report that hepatitis C virus infections are frequently acquired among HIV-negative men who have sex with men (MSM) using pre-exposure prophylaxis to prevent HIV infection. New infections occurred more frequently in those reporting receptive anal sex without using condoms, having an anal sexually transmitted infection, injecting drugs, and sharing straws when snorting drugs. The viruses found in HIV-negative men using pre-exposure prophylaxis are genetically similar to those in HIV-positive men, but not in other hepatitis C risk groups, suggesting that (sexual) transmission is occurring between HIV-positive MSM and HIV-negative MSM using pre-exposure prophylaxis. Clinical Trial number Dutch trial registration number NTR5411. HCV has emerged as a sexually transmitted infection (STI) among HIV-positive men who have sex with men (MSM). We evaluated HCV incidence and its risk factors among HIV-negative MSM using HIV pre-exposure prophylaxis (PrEP). Participants of the Amsterdam PrEP project were tested for HCV antibodies or HCV-RNA every 6 months. Participants used daily or event-driven PrEP and could switch regimens during follow-up. We calculated incidence rates (IRs) for overall HCV infection and separately for primary and re-infection. A univariable Bayesian exponential survival model was used to identify risk factors associated with incident HCV infection. The HCV NS5B gene fragment (709 bp) was sequenced and compared to HCV isolates from HIV-positive MSM and other risk groups (n = 419) using phylogenetic analysis. Among 350 participants contributing 653.6 person-years (PYs), we detected 15 HCV infections in 14 participants (IR = 2.30/100PY). There were 8 primary infections (IR = 1.27/100PY) and 7 re-infections (IR = 27.8/100PY). IR was 2.71/100PY in daily and 1.15/100PY in event-driven PrEP users. Factors associated with incident HCV infection were higher number of receptive condomless anal sex acts with casual partners (posterior hazard ratio [HR] 1.57 per ln increase; 95% credibility interval [CrI] 1.09–2.20), anal STI (posterior HR 2.93; 95% CrI 1.24–7.13), injecting drug use (posterior HR 4.69; 95% CrI 1.61–12.09) and sharing straws when snorting drugs (posterior HR 2.62; 95% CrI 1.09–6.02). We identified robust MSM-specific HCV clusters of subtypes 1a, 4d, 2b and 3a, which included MSM with and without HIV. HIV-negative MSM using PrEP are at risk of incident HCV infection, while identified risk factors are similar to those in HIV-positive MSM. Regular HCV testing is needed, especially for those with a previous HCV infection and those reporting risk factors.