Background The transmission of HCV happens mostly across percutaneous exposure to blood. The role of the sexual transmission has not been well defined. In the last years HCVcases due to sexual transmission in HIV-infected MSM have been described. METHODS: Descriptive study of HIV-infected patients seen in our clinic, who showed HCV antibodies simultaneously with HCV-RNA-positive test and that previously had a negative test for antibody, without reporting injection drug use. Period of study: August 2011 to February 2013. RESULTS: We have diagnosed six cases. Age: 40.2 ± 6.22; length of HIV infection: 9.83 ± 6.17 yr. All the patients reported unsafe sex in the six previous months and all were on ART with HIV viral load ≤ 50 copies/ml. HBV-coinfection:1/6 (16.6%); Anti-HBs Ab ≤ 10 UI: 2/6 (33.3%). Previous sexual transmitted infections (STI): 5/6 (83.3%). Baseline CD4 count: 686.2 ± 198.3 cells/µL. Median ASAT: 200.6 ± 163 IU/L; median ALAT: 491.8 ± 334.4 IU/l. Median HCV-RNA at presentation: 2.133.293 ± 1.703.605 IU/mL. HCV genotype: G4 3/5 (60%), G1 2/5 (40%) (result of 1 patient, pending). Polymorphism of IL28B not favourable in 4/6: rs12979860 CT and rs8099917 TG (2 patients pending genetic analysis). Fibroscan^® at diagnosis: F2 3/6 (50%), F0 (1), F1 (1), F3 (1). No patient showed jaundice as a clinical presentation. During the evolution nobody presented decline ≥ 2 log of HCV-PCR at 1^st month of the diagnosis, neither on the 3^rdmonth spontaneous viral clearance. A patient has received treatment withpegIFN+ribavirine six months after the diagnosis, with rapid virological response (negative HCV-PCR at 4 wk).

Conclusion This report suggests that hepatitis C is an emergent STI in MSM population HIV-infected. The evolution towards chronicity is common. It should also be considered in case of sudden increase of transaminases, even without symptoms and therefore should be a part of the annual serology screening.