A study published in Clinical Infectious Diseases has concluded that the incidence of acute infection with hepatitis C virus (HCV) among gay men, bisexuals and other men who have sex with men who use pre-exposure prophylaxis (PrEP) for HIV is it has increased ten times in the last two years. Lately, these outbreaks have also been observed in gay men, bisexuals and other MSM without HIV, as was the case of Lion (France).

The study included all cases of acute Hepatitis C infection in gay men, bisexuals and other MSM documented in Lion between 2014 and 2017. HCV samples were analyzed genetically to see how they were related to each other and whether there were various transmission networks During this time, a total of 108 cases of acute infection due to HCV affected 96 gay, bisexual and other MSM men, of whom 80 were first infections and 28 were reinfections. The main risk factors were injecting drug use (in 33% of cases), use of intranasal drugs (in 34%), group sex (in 69%) and fisting, which is the total or partial introduction of the hand in the anus of the couple (in 24%).

The participants without HIV were younger than those with HIV (median age of 37 and 47 years, respectively) and had a higher probability of drug use (96% and 40%, respectively) and of practicing fisting (50 % and 15%, respectively). Two thirds of the participants without HIV took PrEP at the time of diagnosis of HCV infection.

The number of diagnoses of acute HCV infection doubled, since in 2014 there were 20 cases and in 2017 there were 40. Gay men, bisexuals and other MSM without HIV accounted for 45% of cases of acute infection diagnosis.

The incidence of acute HCV infection in MSM with HIV doubled, from 1.1 cases per 100 person per year in 2014 to 2.4 cases per 100 person per year in 2017. However, this increase only reached statistically significant levels in the case of reinfections, since the first infections remained relatively stable.

In 8% of cases, spontaneous remission of HCV infection was observed. A total of 94 participants carried out treatments with direct-acting antivirals a median of 5 months after diagnosis. The cure rates among those treated were 96%.

A subsequent analysis of the same study presented at the Conference on Retroviruses and Opportunistic Infections (CROI 2019) -recently held in the US city of Seattle- evidenced the importance of early diagnosis and treatment and the implementation of strategies to reduce risks and damages, since it was calculated that each MSM with acute infection had transmitted the virus to an average of 2.35 men in five months.

The results of the present study highlight two main aspects. On the one hand, acute HCV infections are also spreading to gay men, bisexuals and other MSM without the HIV users of PrEP through risky practices such as chemsex or traumatic sexual practices. And on the other hand, in order to control this type of outbreaks, early diagnoses and treatments are essential, as well as interventions with a risk and damage reduction approach.

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