Cluster of Sexually Transmitted Hepatits C Virus Among the MSM Population in Southeast Michigan

Background: Hepatitis C Virus (HCV) is a blood-borne pathogen that is rarely transmitted sexually among monogamous heterosexual couples.  However, risky behaviors among men who have sex with men (MSM) (e.g. fisting, use of sex toys, anal douching), particularly in the presence of HIV infection and/or ulcerative STDs, have been associated with increased risk of sexual transmission of HCV.  We report on a cluster investigation of sexually transmitted HCV in the MSM population in Southeast Michigan; a rare occurrence in the United States.   

Methods:In February 2016, an astute clinician notified the Michigan Department of Health and Human Services (MDHHS) about an increase in HCV diagnoses in their HIV-infected MSM population.  MDHHS began an investigation to determine the scope of the HCV infections, utilizing the Detroit Disease Intervention Specialists (DIS) to solicit cases and contacts and recommend testing for HCV antibody and RNA.  Demographic, clinical, and risk factor information were captured to inform the epidemiological investigation

Results: As of June 27, 2016 there were 19 cases in the cluster, with several dozen contacts still under investigation .  All nineteen of the cases were male and 18 were African American with one Hispanic.  All nineteen were infected with HIV, 18 reported never injecting drugs and 19 reported having sex with men.  A history of having an STD was common - syphilis (15), gonorrhea (12), chlamydia (11), and lymphogranuloma venereum (5).  Many HCV infections were acute or new seroconversions suggesting recent infection and of 9 isolates that underwent genotyping, all were HCV genotype 1a

Conclusions: The Detroit DIS have been crucial in enhancing the capacity of the State’s Viral Hepatitis Program in contact tracing cases and contacts and referral to HCV testing and treatment services.  Additional molecular characterization of the HCV specimens along with patient interviews will help further determine HCV transmission patterns in this community