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While the numbers of hepatitis-C-virus (HCV) infections among men who
have sex with men (MSM) who are co-infected with the human immunodeficiency
virus (HIV) are on the rise, with vast evidence for sexual transmission of HCV
in this population, concerns have also been raised regarding sexual
HCV-transmission among MSM without HIV infection. Therefore, the aim of this
study was to estimate the prevalence of hepatitis C among MSM without HIV
diagnosis in Zurich (Switzerland).
Participants were recruited from a gay health centre and various
locations such as dark rooms, saunas and cruising areas in Zurich. Participants
self-completed a questionnaire assessing known and suspected risk factors for
HCV-infection, and provided a blood sample for detection of past (antibodies)
and present (core antigen, RNA) infections with HCV.
In total, 840 MSM aged 17-79 (median: 33 years) underwent HCV-testing
and completed the questionnaire, among whom 19 reported living with HIV.
Overall, seven tested positive for HCV-antibodies, and two were also positive
for HCV core antigen and HCV-RNA-these two were immigrants, one from a country
where HCV is endemic. None of the seven were aware of their infection. The
seroprevalence of hepatitis C among the 821 non-HIV-diagnosed MSM was 0.37%
(95%-CI: 0.12-1.69%), and one man harboured replicating virus (0.12%;
0.02-0.69%), resulting in a number needed to test of 821 to detect one active
infection. Significant univariable associations of lifetime HCV-infection were
found with known HIV-diagnosis (OR=72.7), being tattooed (OR=10.4),
non-injection use of cocaine/amphetamines (OR=8.8), and non-Swiss origin
(OR=8.5). For MSM without HIV-diagnosis, the only variable marginally
associated with positive HCV-serostatus was being tattooed (OR=8.3). No
significant associations were observed with reported injection drug use,
unprotected anal intercourse, sexual practices that may lead to mucosal trauma,
or proxy measures for group sex and lesion-prone STIs.
Our findings suggest that in Switzerland, hepatitis C among MSM without
diagnosed HIV is not more prevalent than in the general population. We found no
evidence of elevated rates of sexual transmission of HCV among MSM without
HIV-infection. Therefore, we currently see no reason for promoting HCV-testing
among all MSM in Switzerland.
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