Outbreaks of Acute Hepatitis C Among HIV+ Homosexual Men in Europe

Outbreaks of hepatitis C among homosexual menhave recently been reported in several large Europeancities (Berlin, London, Paris, Amsterdam). Thisobservation is striking since HCV was not believedto be efficiently transmitted by sexual contact, as iswell established for HBV or HIV. At the last CROI,held in Denver in February 2006, British investigators(Danta, et al. abstract 86) described the maincharacteristics of a series of 111 cases of acutehepatitis C among HIV-infected individuals in London.All occurred in male homosexuals, and HCVgenotype-1 accounted for 88% of cases. Phylogenetic analyses of HCV sequences derived fromthese individuals identified multiple clusters. Oneinvolved 43 cases infected by the same HCV genotype-1a virus. In order to investigate which factorswere associated with the acquisition of acute hepatitisC, the authors did a case-control study. Notsurprisingly, cases had more sexual partners thancontrols (median number of 30 vs. 10) in the preceding12 months. Unprotected, receptive and insertiveanal intercourse, fisting, and sexual activity underthe influence of drugs such as ketamine and ecstasy(generally taken nasally or orally) were all independentlyassociated with the acquisition of acute hepatitisC. The authors concluded that better educationand prevention programs are urgently needed formale homosexuals.