Epidemics of HCV infection have emerged in HIV-positive men-who-have-sex-with-men (MSM) in many countries over the past decade. Knowledge of sexual and drug use behaviour in these populations may help target health strategies and interventions.
The Control and Elimination of HCV from HIV-infected individuals within Australia (CEASE-D) cohort study aims to characterise socio-demographic, clinical and behavioural features of individuals with HIV/HCV co-infection. This analysis included individuals enrolled between July 2014 and August 2015 who had completed the screening behavioural questionnaire regarding sexual behaviour, drug use and HCV knowledge. Logistic regression analysis assessed factors associated with recently acquired (<2 years) HCV.
175 HIV/HCV infected individuals (mean age 47 years [SD 9], MSM 89%, cART 97%) were included. Median time since HCV infection was 7 years (IQR 2-15) in MSM and 16 years (IQR 10-24) in the remainder (p<0.001), with 25% and 0% having recently acquired HCV (p=0.014). Injecting drug use (IDU, 53%) and sexual exposure with a partner of the same sex (33%) were the predominant modes of HCV acquisition. IDU ever and within 6 months were reported by 81% and 37%, respectively, with amphetamines the most commonly injected drug (ever 72%). Age at first injecting was older in MSM (27 years [IQR 20-35] vs 17 years [IQR 16-21], p=0.001). Knowledge regarding behaviours associated with HCV transmission was variable; 83% and 73% correctly identified needle sharing and sharing other drug paraphernalia as high risk, whereas fisting, sex toys and group sex were identified as risk factors by 51%, 46% and 52%. Only 69% were aware of the potential for HCV reinfection. In the MSM population (n=155), 34% had a regular male partner (RMP) (HIV-positive 65%) and 66% casual male partners (CMP). Current high-risk sexual behaviour was reported by the majority (condom-less anal intercourse 74%, group sex 35%). While 74% ‘always’ or ‘sometimes’ disclosed their HIV status, only 41% disclosed their HCV status. Recently acquired HCV in MSM was associated with younger age (AOR 0.9, 95% CI 0.9, 1.0; p=0.002), full or part time employment (AOR 3.0, 95% CI 1.1, 8.0; p=0.028), sexual acquisition (AOR 13.6, 95% CI 4.5, 41.2; p<0.001) and CMPs (AOR 4.0, 95% CI 1.2, 13.4; p=0.023).
Sexual behaviour was associated with recently acquired HCV in HIV/HCV co-infected MSM. Limited knowledge around sexual transmission risk and HCV status disclosure is concerning.