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Sexually transmitted hepatitis C infection

the evolving epidemic in HIV-positive and HIV-negative MSM

Lockart, Iana,c; Matthews, Gail V.b; Danta, Marka,c

Current Opinion in Infectious Diseases: February 2019 - Volume 32 - Issue 1 - p 31–37
doi: 10.1097/QCO.0000000000000515
STD I: Edited by Thomas F. Patterson and Robert C. Read

Purpose of review The scale-up of direct-acting antiviral (DAA) therapy and introduction of preexposure prophylaxis (PrEP) has changed the epidemiology of sexually acquired hepatitis C virus (HCV) amongst HIV-positive and HIV-negative MSM.

Recent findings Sexually acquired HCV continues to occur predominantly amongst HIV-positive MSM. Despite an increased uptake of DAA therapy the incidence of acute HCV has not declined consistently amongst HIV-positive MSM, likely a result of high infection and reinfection rates. Increasing cases of sexually acquired HCV have been reported amongst HIV-negative MSM accessing PrEP. Despite a lower prevalence of HCV at baseline, HIV-negative MSM accessing PrEP have an equally high overall incidence of HCV compared with HIV-positive MSM during follow-up. Behavioural factors (high-risk sexual behaviours and sexualized drug use) appear to be driving this HCV epidemic amongst MSM and effective behavioural interventions and early identification of reinfections are essential to control the HCV epidemic amongst MSM.

Summary An improved understanding of the epidemiology of sexually acquired HCV will allow implementation of more effective public health interventions to control the transmission of HCV amongst HIV-positive and HIV-negative MSM.

aSt Vincent's Clinical School, Faculty of Medicine

bViral Hepatitis Clinical Research Program, Kirby Institute, UNSW

cDepartment of Gastroenterology, St Vincent's Hospital, Sydney, New South Wales, Australia

Correspondence to Mark Danta, St Vincent's Clinical School, Faculty of Medicine, UNSW, St Vincent's Hospital, Sydney, NSW, Australia. E-mail:

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