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Background: Recent studies demonstrate elevated risk of hepatitis C (HCV) acquisition among HIV+ men-who-have-sex-with-men (MSM).
Objectives: Determine HCV incidence among HIV+ MSM through chart review and testing stored specimens.
Methods: We obtained de-identified data from all MSM participating in the University of Washington HIV Repository. We tested the most recent stored specimen from men without a HCV diagnosis for HCV antibody and RNA. For RNA-positive subjects, the earliest available specimen was tested.
Results: Of 477 MSM without evidence of drug injection, mean age at most recent HCV test was 49 years; 72% were white, 14% African-American, 6% black African, and 4% Asian. Clinicians tested 96% for HCV at least once; 28 (5.9%) had evidence of HCV and 21 (4.4%) had chronic hepatitis C (CHC). Among 448 men with initial negative HCV tests, clinicians retested 222 (49.6%) in routine clinical care; repeated testing was associated with elevated alanine aminotransferase (OR 2.8;95%CI:1.7-4.7) and identified 23 cases of incident HCV. The study identified 7 additional HCV cases through stored specimens; 6 were confirmed incident. Overall HCV and CHC incidence was 10.4 (95%CI: 7.2-=15.0) and 9.7 (95%CI: 6.6-14.1) per 1000 person years, respectively. Incidence of clinically-undetected HCV and CHC was 2.2 (1.0-5.0) and 1.9 (95%CI: 0.7-4.5) per 1000 person years, respectively. On multivariate analysis, HCV incidence was associated with age (HR 0.7;95%CI:0.6-0.8), abuse of cocaine or opiates (HR 3.8;95%CI:1.7-8.8) and black African (HR 23.8;95%CI:9.0-62.8) or Asian (HR 5.2;95%CI:1.7-15.7) versus white race. There was no association with alanine aminotransferase, CD4 nadir, HIV viral load, amphetamine abuse, gonorrhea, chlamydial infection or syphilis.
Conclusions: Although HCV incidence among non-injecting HIV+ MSM in Seattle is relatively high and similar to that observed in Europe, most cases are detected without routine annual screening.
Implications for Programs, Policy, and Research: Results do not support routine annual HCV screening of HIV+MSM. Further research is required to elucidate factors associated with incident HCV.