Incidence of acute hepatitis C virus infection among men who have sex with men with and without HIV infection: a systematic review
- 1Department of Medicine, Divisions of Infectious Diseases/Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- 2Department of Clinical Epidemiology, Royal Victoria Hospital, McGill University Health Centre, Montreal, Quebec, Canada
- Correspondence to Dr Marina Klein, Department of Medicine, Division of Infectious Diseases, McGill University Health Centre, Chronic Viral Illness Service, Montreal Chest Institute, 3650 Saint Urbain, Montreal, Quebec H2X 2P4 Canada;
Contributors All of the authors have seen and approved the final manuscript, and have participated sufficiently in the work to take public responsibility for its content. Sean Yaphe, Rachel Kyle and Nikki Bozinoff were responsible for the database and conference searches, as well as data abstraction and drafting the paper. Sushmita Shivkumar and Dr Nitika Pant Pai conducted the primary data analysis for the manuscript and prepared data reports for use in the manuscript. Marina Klein aided in drafting the paper, and has seen and approved all drafts of the manuscript.
- Accepted 8 July 2012
- Published Online First 2 August 2012
Background A recent increase in reports of acute hepatitis C virus infection (HCV) in HIV-infected and HIV-uninfected men who have sex with men (MSM), with the sole risk factor being sexual exposure, has led to routine screening and targeted prevention requests for this population; current evidence for this necessity is unclear.
Objective A systematic review was conducted to assess the incidence of HCV infection among studies conducted in HIV-positive and/or HIV-negative MSM to explore the implications for routine HCV screening.
Data sources The MEDLINE, EMBASE and BIOSYS databases were searched for the period January 2000 to May 2012, yielding 21 studies. Six conferences were hand-searched for the same period yielding four abstracts.
Study selection Only studies in English presenting incidence rates of HCV and specifying HIV status were included.
Data abstraction Data were abstracted by two authors using predefined data fields. The STROBE checklist was used to assess study quality.
Data synthesis Data were divided into HIV-negative MSM and HIV-positive MSM subgroups, and HCV incidence density measurements were pooled. Using a DerSimonian–Laird random effects model, pooled incidence was 1.48/1000 person-years (95% CI 0.75 to 2.21) for the HIV-negative MSM subgroup. The HIV-positive MSM subgroup was at 4.1 times higher risk of acquiring HCV at 6.08/1000 person-years (95% CI 5.18 to 6.99). Studies directly comparing subgroups estimated a pooled risk difference of 3.45/1000 person-years (95% CI 1.63 to 5.27).
Conclusion HIV-positive MSM were at higher risk for acute HCV infection than HIV-negative MSM, substantiating the need for routine screening initiatives. Insufficient evidence exists to warrant routine screening of HIV-negative MSM, except on a case-by-case basis, such as high-risk sexual behaviour.
Funding Dr Marina Klein is supported by a ‘Chercheur-boursiers cliniciens senior’ career award from the FRSQ. She has consulted and presented lectures for Glaxo-Smith-Kline/viv and consulted for Bristol Myers Squibb. Dr Nitika Pant Pai is supported by the CIHR New Investigator Award 2010 and by Grand Challenges Canada's 2011 Rising Star Award in Global Health Award.
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.