Hepatitis C virus infection among non-IDU HIV-infected and uninfected men who have sex with men.

Letters to the Editor

Hepatitis C Virus Infection Among non-IDU HIV-Infected and Uninfected Men who Have Sex with Men

M. Giuliani1,4,  L. Nosotti2, A. Latini1, C. Mirisola2, F. Pimpinelli3, S. Volpi3,  F. Ensoli3, G. Impara1 and G. Palamara1

1 U.O.C. di Dermatologia Infettiva, San Gallicano Dermatological Institute (IRCCS), Rome.
2 National Institute for Health, Migration and Poverty (NIHMP), Rome.
3 Laboratorio di Patologia Clinica e Microbiologia, San Gallicano Dermatological Institute (IRCCS), Rome, Italy.
4 Dipartimento di Malattie Infettive, Parassitarie e Immunomediate (MIPI), Istituto Superiore di Sanità, Rome, Italy.

Correspondence to: Dr. Lorenzo Nosotti and Dr. Massimo Giuliani. UOC Dermatologia Infettiva, St Gallicano Dermatological Institute (IRCCS), Via Elio Chianesi, 53, 00144 Rome, Italy. Tel+ 39 0652662806 Fax +39 0652662804.
E-mail : l.nosotti@virgilio.it  giuliani@ifo.it

Published: November 28, 2011
Received: October 24, 2011
Accepted: November 17, 2011
Mediterr J Hematol  Infect Dis 2011, 3(1): e2011058, DOI 10.4084/MJHID.2011.058
This article is available from: http://www.mjhid.org/article/view/9418
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

Dear Editor,

Approximately one third of the estimated 40 million people infected with HIV-1 worldwide, suffers from chronic hepatitis C virus (HCV) infection.[1] In the Mediterranean countries, hepatitis C virus infection affect nearly 45% of HIV-1 infected individuals, consistently to the high proportion of patients with a history of intravenous drug use and exposed to the two viruses by parenteral route.[2]
Even in association with HIV-infection, HCV infection is rarely transmitted through sexual intercourse due to the lower efficiency of mucosal exposure to virus than that blood-borne. Thus, the incidence and prevalence of HCV infection are far lower among the non-intravenous drug users  (IDU) at risk of sexually transmitted infections (STI).
However, after 2000, several outbreaks of Hepatitis C virus infections have been observed among non-IDU men who have sex with men (MSM) in northern Europe and in the U.S.A., most of them HIV-infected.[3-5] Epidemiologic investigations of clusters have showed that HCV infection was associated with at-high-risk sexual practices such as having a high number of partners, engaging in group sex, having a traumatic intercourse, use of rectal enema and co-infection with ulcerative STI.
In 1997, our group has already reported a higher incidence of HCV infection among HIV co-infected MSM and suggested an increased risk of HCV among non-IDU immunosupressed MSM.6 Recently a study seem to suggest that HCV-RNA can be found in seminal plasma of HIV infected individuals.[7]
Thus, we report the preliminary results from a HCV seroprevalence study conducted on consecutive HIV-infected and uninfected MSM attending the Sexually Transmitted Infections (STI) Centre of the San Gallicano Dermatological Institute of Rome, who did not have a history of intravenous drug use.
From January 2008 to December 2009, 203 non-IDU HIV-infected and 260 non IDU HIV-uninfected MSM were screened for antibodies against HCV. Median age was respectively, 32 years (IQR=28-56) and 29 years (IQR=24-55) in the HIV-infected and the HIV-uninfected individuals. Fifty tree (26.1%) of the HIV-infected and forty four (16.9%) of the HIV-uninfected were non-national males.
The prevalence of HCV infection was 2.46% (95% CI:0.80-5.65) and 1.54 (95% CI:0.42-3.89) among the HIV-infected and the HIV-uninfected, respectively. All HCV infected individuals were Italian MSM. Not significant statistical difference was evaluated between the two HCV prevalence rates (COR=1.62, 95% CI: 0.34-8.25).
Our data showed that the prevalence of HCV infection among MSM is higher than that observed in unselected MSM in England,[8] but much far lower than that reported in HIV-infected MSM in the U.S.A, Australia and Holland.[9-12]
Two hypotheses may be taken in account to explain the lower prevalence rates observed in our seroprevalence study. The MSMs participating to our study could have less sexual contacts with IDU-MSMs than other gay community residents in other western countries. The non-IDU MSMs recruited in this study could have a lower frequency of at-risk sexual practices for HCV then the non-IDU MSMs enrolled in other studies.
Additional behavioral and phylogenetic investigations are needed to confirm these hypotheses. In particular, accurate behavioral investigation should be conducted in all MSM HCV patients, who deny any parental exposure, to better define the role of sexual exposure in the acquisition of infection. Moreover, phylogenetic approach to study HCV infections among population at risk for STI, could to reveal specific transmission networks and the comparison with genotyping profiles from IDU-MSM could to confirm different characteristics of the transmission pathways.
Correspondence to: Dr. Lorenzo Nosotti and Dr. Massimo Giuliani. UOC Dermatologia Infettiva, St Gallicano Dermatological Institute (IRCCS), Via Elio Chianesi, 53, 00144 Rome, Italy. Tel+ 39 0652662806 Fax +39 0652662804. E-mail:
l.nosotti@virgilio.it giuliani@ifo.it


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