Prevalence of hepatitis C in a Swiss sample of men who have sex with men: whom to screen for HCV infection?

Abstract

Background: While the numbers of hepatitis-C-virus (HCV) infections among men who have sex with men (MSM) who are co-infected with the human immunodeficiency virus (HIV) are on the rise, with vast evidence for sexual transmission of HCV in this population, concerns have also been raised regarding sexual HCV-transmission among MSM without HIV infection. Therefore, the aim of this study was to estimate the prevalence of hepatitis C among MSM without HIV diagnosis in Zurich (Switzerland).

Methods: Participants were recruited from a gay health centre and various locations such as dark rooms, saunas and cruising areas in Zurich. Participants self-completed a questionnaire assessing known and suspected risk factors for HCV-infection, and provided a blood sample for detection of past (antibodies) and present (core antigen, RNA) infections with HCV.

Results: In total, 840 MSM aged 17-79 (median: 33 years) underwent HCV-testing and completed the questionnaire, among whom 19 reported living with HIV. Overall, seven tested positive for HCV-antibodies, and two were also positive for HCV core antigen and HCV-RNA-these two were immigrants, one from a country where HCV is endemic. None of the seven were aware of their infection. The seroprevalence of hepatitis C among the 821 non-HIV-diagnosed MSM was 0.37% (95%-CI: 0.12-1.69%), and one man harboured replicating virus (0.12%; 0.02-0.69%), resulting in a number needed to test of 821 to detect one active infection. Significant univariable associations of lifetime HCV-infection were found with known HIV-diagnosis (OR=72.7), being tattooed (OR=10.4), non-injection use of cocaine/amphetamines (OR=8.8), and non-Swiss origin (OR=8.5). For MSM without HIV-diagnosis, the only variable marginally associated with positive HCV-serostatus was being tattooed (OR=8.3). No significant associations were observed with reported injection drug use, unprotected anal intercourse, sexual practices that may lead to mucosal trauma, or proxy measures for group sex and lesion-prone STIs.

Conclusions: Our findings suggest that in Switzerland, hepatitis C among MSM without diagnosed HIV is not more prevalent than in the general population. We found no evidence of elevated rates of sexual transmission of HCV among MSM without HIV-infection. Therefore, we currently see no reason for promoting HCV-testing among all MSM in Switzerland.

Figure 1

Number needed to test (NNT) to detect one active HCV infection Number needed to test (on a logarithmic scale) to detect one active HCV infection, in different scenarios for targeted HCV-testing. The two intervals at the top are based prevalence estimates for the Swiss general population, assuming that 75% of those ever infected develop chronic infection, and each reflecting the respective lower and upper limit. The remaining eleven point estimates with 95% confidence intervals represent MSM recruited at Checkpoint Zurich, reflecting the whole sample (n = 840; thus including 19 men with diagnosed HIV) or sub-samples based on individual characteristics. (1) Estimate based on blood donors and pregnant women [2]; (2) Estimate based on mathematical modelling [3]; (3) High anti-HCV prevalence (>3.5%) countries were defined according to Modh Hanafiah et al. 2012 [36]; (4) Non-injection drug use (NIDU) of cocaine/amphetamines; (5) Any of the following: NIDU of cocaine/amphetamines, being tattooed, being pierced, receptive fisting, group sex (proxy measure), or a history of lesion-prone STIs (proxy measure); (6-7) Birth cohort screening (1955-1974/1955-1984) as discussed as add-on strategies by Bruggmann et al. 2013[39].