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Earlier Detection of Hepatitis C Virus Infection Through Routine Hepatitis C Virus Antibody Screening of Human Immunodeficiency Virus-Positive Men Who Have Sex With Men Attending A Sexually Transmitted Infection Outpatient Clinic: A Longitudinal Study

van Rooijen, Martijn MSc; Heijman, Titia MA; de Vrieze, Nynke MD; Urbanus, Anouk PhD; Speksnijder, Arjen MD, PhD; van Leeuwen, Petra MD; de Vries, Henry MD, PhD; Prins, Maria PhD

doi: 10.1097/OLQ.0000000000000497
Original Studies

Background: In 2007, routine hepatitis C virus (HCV) antibody testing was introduced for men who have sex with men (MSM) with a human immunodeficiency virus (HIV)-positive or unknown status attending a Dutch sexually transmitted infection (STI) outpatient clinic. We evaluated whether this screening resulted in additional and earlier HCV diagnoses among MSM who also attend HIV clinics.

Methods: At first STI consultation, HIV-positive MSM and MSM opting-out of HIV testing (HIV-status-unknown) were tested for HCV antibodies (anti-HCV). During follow-up consultations, only previously HCV-negative men were tested. Retrospectively, STI clinic and HIV clinic HCV diagnosis dates were compared.

Results: One hundred twelve (6.4%) of 1742 (95% confidence interval [CI], 5.3–7.6%) HIV-positive and 3 (0.7%) of 446 (95% CI, 0.2–2.0%) HIV-status-unknown MSM tested anti–HCV-positive at first consultation. During follow-up consultations, 32 HIV-positive (incidence HCV-positive: 2.35/100 person years (PY) (95% CI, 1.66–3.33)) and 0 (1-sided, 97.5% CI, 0.0–3.76) HIV-status-unknown MSM became anti–HCV-positive. Four (11.8%) of 34 HIV-positive MSM notified by their sexual partner of HCV tested anti–HCV-positive.

Of 163 HIV-positive MSM with HCV antibodies, 78 reported a history of HCV. HCV diagnosis data at the HIV clinic was requested for the remaining 85 MSM and available for 54 MSM. Of these 54 MSM, 28 (51.9%) had their first HCV diagnosis at the STI clinic, of whom 7 concurrently with HIV. At their next scheduled HIV clinic consultation, 3 HCV cases probably would have been missed.

Conclusions: The introduction of routine anti-HCV testing at the STI outpatient clinic resulted in additional and earlier HCV detection among HIV-positive MSM. Testing should be continued among HIV-positive MSM, at least for those not (yet) under the care of an HIV clinic and those notified of HCV by their sexual partner.

At the sexually transmitted infection clinic, 6.4% of human immunodeficiency virus-positive men who have sex with men tested baseline hepatitis C virus antibody positive, hepatitis C virus incidence was 2.35/100 person years and 51.9% were first detected at the sexually transmitted infection clinic (versus human immunodeficiency virus clinic).

From the *Department of Infectious Diseases, Public Health Service of Amsterdam; †Department of Dermatology, Academic Medical Center ‡Department of Internal Medicine, CINIMA, Academic Medical Center, Amsterdam, the Netherlands

Acknowledgements

The authors would like to thank all the nurses working on this project and Claire Buswell for editing the article. Special thanks go to all HIV specialists for providing HCV diagnosis data. The authors would also like to thank Joost Vanhommerig for his help with the incidence calculation and the discussion.

Conflicts of Interest and Source of Funding: None declared.

M.v.R., T.H., and M.P. designed the study protocol, supported by N.V. M.v.R. was responsible for data collection at the STI clinic and N.V. at the HIV treatment clinics. M.v.R. and M.P. completed the analyses. M.v.R., T.H., H.d.V., and M.P. drafted the article. All authors commented on draft versions, and all approved the final version.

Ethics approval: Because routinely collected anonymous data was used for this study, no ethical clearance was sought.

Previously presented: Preliminary result of the study have been presented as a poster at the NCHIV (27 November 2012, Amsterdam, the Netherlands abstract number 39) at the STI & AIDS World Congress (17 July 2013, Vienna, Austria abstract number P5.022).

Correspondence: Martijn van Rooijen, Public Health Service of Amsterdam, Department of Infectious Diseases, STI outpatient clinic, P.O. Box 2200, 1000 CE Amsterdam, the Netherlands. E-mail: mvrooijen@ggd.amsterdam.nl; Maria Prins, Public Health Service of Amsterdam, Department of Infectious Diseases, Research and Prevention, P.O. Box 2200, 1000 CE Amsterdam, the Netherlands. E-mail: mprins@ggd.amsterdam.nl.

Received for publication March 18, 2016, and accepted June 7, 2016.

© Copyright 2016 American Sexually Transmitted Diseases Association