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Behavioural predictors of subsequent hepatitis C diagnosis in a UK clinic sample of HIV positive men who have sex with men
  1. J M Turner1,
  2. A T Rider1,
  3. J Imrie1,
  4. A J Copas1,
  5. S G Edwards2,
  6. J P Dodds1,
  7. J M Stephenson1,
  8. on behalf of the SHARP Study Group
  1. 1Centre for Sexual Health and HIV Research, Royal Free & University College Medical School, University College London, London, UK
  2. 2Camden NHS Primary Care Trust, London, UK
  1. Correspondence to:
 Dr Joanna Turner
 Centre for Sexual Health and HIV Research, Mortimer Market Centre, Capper Street, London WC1E 6AU, UK; jturner{at}


Objective: To explore the associations between self reported high risk sexual behaviours and subsequent diagnosis with hepatitis C virus (HCV) infection.

Methods: The Sex, Health and Anti-Retrovirals Project (SHARP) was a cross sectional study of sexual behaviour in HIV positive, men who have sex with men (MSM) attending a London outpatient clinic. From July 1999 to August 2000 participants completed a computer assisted self interview questionnaire (CASI) on recent sexual behaviour, recreational drug use, and detailed reporting of the last two sexual episodes involving different partners. Results were combined with routine clinic data and subsequent testing for HCV up to 21 April 2005. A new HCV diagnosis was defined as anti-HCV antibody seroconversion or positive HCV RNA following a previous negative. Incident rate ratios (IRR) were calculated using Poisson regression in Stata (version 9). Men contributed time at risk from interview until either their diagnosis or their last negative test result.

Results: Of the 422 men who completed questionnaires, 308 (73%) had sufficient clinical and HCV testing data available for analysis. Incident HCV infection was identified in 11 men. Unprotected anal intercourse, more than 30 sex partners in the past year, higher numbers of new anal sex partners, rimming (oro-anal sex), fisting, use of sex toys, and intranasal recreational drug use were associated with HCV. In multivariate analysis only fisting remained associated with HCV (adjusted IRR 6.27, p = 0.005).

Conclusions: In this study of HIV positive MSM, fisting is strongly associated with HCV infection. Where individuals report high risk sexual behaviours, clinicians should offer appropriate testing for HCV infection.

  • CASI, computer assisted self interview
  • HCV, hepatitis C virus
  • IRR, incident rate ratios
  • MSM, men who have sex with men
  • SHARP, Sex, Health and Anti-Retrovirals Project
  • UAI, unprotected anal intercourse
  • hepatitis C virus infection
  • sexual behaviour
  • MSM
  • HIV positive

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  • Funding: Medical Research Council.

  • Conflict of interest: none.

    Competing interests: none.

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