Clinicians report two acute HCV infections in Kaiser San Francisco PrEP programme

Liz Highleyman
Original Article:

Two HIV-negative gay men receiving HIV pre-exposure prophylaxis (PrEP) through Kaiser Permanente in San Francisco were newly infected with hepatitis C virus (HCV), with sex being their only apparent risk factor, Kaiser clinicians reported in the February 18 issue of Clinical Infectious Diseases.

HCV was traditionally thought to be rarely transmitted through sex, but this was based on studies of monogamous heterosexual couples. Starting in the early 2000s clinicians began reporting clusters of apparently sexually transmitted acute HCV infection among HIV-positive men who have sex with men in cities in the UK, Europe, Australia and the US. Most studies to date have found that HCV sexual transmission among HIV-negative gay and bisexual men remains uncommon, but some experts think it is increasing.

In their Clinical Infectious Diseases letter, Jonathan Volk, Brad Hare and colleagues from Kaiser Permanente San Francisco – thought to be the largest PrEP provider in the US – reported that two gay men were newly infected with HCV out of 485 people who started Truvada (tenofovir/emtricitabine) PrEP between February 2011 and December 2014. With approximately 300 person-years of follow-up data, the incidence rate was 0.7 cases per 100 person-years, falling within the range of previous studies of acute hepatitis C among HIV-negative men.

Hare reported this past December that no new HIV infections have occurred among more than 500 Kaiser San Francisco members who started PrEP. But other sexually transmitted diseases (STDs) have been common, including syphilis, gonorrhoea and chlamydia, along with the two unusual acute HCV infections (in addition to two pre-existing but previously undiagnosed cases).

As described in the published report, both people with new HCV infection were gay men who reported multiple sex partners and had other STDs. Both had new gonorrhoea, syphilis, and rectal chlamydia. One man reported receptive anal sex with a partner who had a penis piercing and was a bottom during group sex. The men reported no injection drug use, no occupational exposure and had no tattoos.

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