Hepatitis C Co-infection in People Living With HIV-Epidemiologic Differences Between Men Who Have Sex With Men MSM and Non-MSM

Abstract

People living with human immunodeficiency virus (PLHIV) constitute a unique group at higher risk of hepatitis C virus (HCV) co-infection. In light of the diverse profiles of PLHIV, we differentiated between men who have sex with men (MSM) and non-MSM in the characterization of the epidemiologic features of HIV/HCV co-infection. Clinical data of HCV co-infection patients from the HIV specialist clinic in Hong Kong were retrospectively collected in conjunction with their HIV subtypes and HCV genotypes. Logistic regression models were used to identify factors associated with HIV/HCV co-infection in MSM. Survival analysis was performed to compare the time lag between HIV and HCV diagnoses between two groups. Latent class analysis was conducted to describe the features of different classes of co-infections. Four classes of HIV/HCV co-infections were identified: local MSM acquiring HCV after HIV diagnosis, local MSM with HIV/HCV co-diagnoses, local non-MSM, and non-local non-MSM. Accounting for over half of the co-infections, MSM were more likely to be younger, local residents, and associated with HCV genotype 3, compared to genotypes 1 and 6 in non-MSM. Overall, MSM had higher odds of achieving HIV viral suppression and co-diagnosing with a sexually transmitted infection at HCV diagnosis, and having a longer time lag between HIV and HCV diagnoses. Drug injection accounted for a majority of non-MSM HCV infection. There were distinctive epidemiologic differences between MSM and non-MSM co-infected with HIV and HCV, the characteristics of which could inform intervention strategies for achieving HCV micro-elimination.

Keywords: HIV/HCV co-infection; men who have sex with men; molecular epidemiology; people living with HIV; people who inject drugs.

Figure 1

Temporal trend of HCV infections by route of transmission.

Figure 2

Duration between HIV and HCV diagnoses among co-infected patients (N = 413). Each horizontal line represents a patient's time to HCV serconversion since HIV diagnosis. Blue lines are MSM; green lines are non-MSM. The color band on the left denotes HIV subtype of the corresponding patient: blue: subtype B; red: subtype CRF01_AE; other subtypes: brown; unknown: gray. The color band on the right denotes their HCV genotype: green: 1; brown: 2; blue: 3; red: 6.

Figure 3

Kaplan-Meier estimates by HIV viral suppression status at HCV diagnosis within strata of route of transmission. Green and red lines are non-MSM with and without HIV viral suppression at HCV diagnosis, respectively; whereas purple and blue lines are MSM with and without HIV viral suppression at HCV diagnosis, respectively.