The Hepatitis C epidemic among HIV-positive men who have sex with men: incidence estimates from 1990 to 2007.

Published: April 18, 2011

BACKGROUND: Outbreaks of acute hepatitis C virus (HCV) infection among HIV-infected men having sex with men (MSM) have been described since 2000. However, phylogenetic analysis suggests that the spread of HCV started around 1996. We estimated the incidence of HCV in HIV-infected MSM with well estimated dates of HIV seroconversion from 1990 to 2007.

METHODS: Data from 12 cohorts within the CASCADE Collaboration were used. HCV incidence was estimated using standard incidence methods and methods for interval censored data. We accounted for the fact that routine HCV data collection in each cohort started in different calendar years.

RESULTS: Of 4,724 MSM, 3,014 had an HCV test result and were included. Of these, 124 (4%) had only positive HCV test results, 2,798 (93%) had only negative results and, 92 (3%) had both. In 1990, HCV incidence ranged from 0.9 to 2.2/1000 person-years (PY), depending on the analysis strategy used. HCV incidence increased up to 1995 when it was estimated to range between 5.5 and 8.1/1000 PY. From 2002 onwards it increased substantially to values between 16.8 and 30.0/1000 PY in 2005 and between 23.4 and 51.1/1000 PY in 2007.

CONCLUSIONS: Our data support phylodynamic findings that HCV incidence had already increased among HIV-infected MSM from the mid-1990 s. However, the main expansion of the HCV epidemic started after 2002. Incidence estimates obtained from cohort studies may help identify changes in the spread of important infections earlier and should guide routine testing policies to minimize further disease burden

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