There is some evidence that hepatitis C virus (HCV) may be sexually transmitted among HIV-positive men who have sex with men (MSM). There have been recent reports of elevated HCV prevalence among HIV- negative MSM initiating HIV pre-exposure prophylaxis (PrEP). The aim of this analysis was to determine HCV prevalence among HIV-negative MSM initiating HIV post-exposure prophylaxis (PEP) or PrEP at New York City (NYC) Sexual Health Clinics (SHC). The HCV prevalence among MSM attending sexual health clinics in the United States has not been recently reported.
NYC SHC began providing PEP and PrEP to patients at increased risk of HIV infection in September 2016. At the time of medication initiation, HCV serology (HCV Ab) with reflex HCV RNA PCR is obtained per New York State PrEP/PEP Guidelines. Using electronic medical record data from the PrEP/PEP initiation visit, we examined HCV testing, demographics, incident sexually transmitted infections, and reported sexual behavior and recent recreational drug use. Patients who tested positive for HCV antibody were matched against the NYC HCV surveillance registry to determine if they were newly diagnosed.
From September 2016-August 2017, 1142 HIV-negative MSM initiated PEP (N=760) or PrEP (N=382) in NYCSHCs; HCV Ab testing was performed for 99.7% (1139/1142). Among patients tested for HCV Ab, median age was 28 years (IQR 25-33); 26% (290/1139) were black non-Hispanic and 30% (345/1139) were Hispanic. Patients reported a median of 3 sex partners in past three months (IQR 2- 6); 25% were diagnosed with chlamydia, gonorrhea, and /or early syphilis at the time of PrEP/PEP initiation. In the three months prior to the visit, 4% (45/1139) of patients reported methamphetamine, gamma-hydroxybutyrate (GHB), or injection drug use (IDU). Three patients (0.26%, 95% CI: 0.1-0.8 %) tested positive for HCV Ab; one reported IDU. The patient with an IDU history was a previously diagnosed chronically infected HCV case with no prior treatment. A second patient had a new diagnosis of HCV which had spontaneously cleared. The third patient had been previously diagnosed with HCV, and successfully treated.
At NYCSHC’s, HCV prevalence among HIV-negative MSM initiating PrEP and PEP is 0.26%. This prevalence is lower than the prevalence estimated in the general population of NYC and the U.S. The PrEP/PEP programs at sexual health clinics provide a good opportunity for monitoring trends in sexually transmitted HCV.