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. 2013 Oct;33(9):1357-62.
doi: 10.1111/liv.12212. Epub 2013 Jun 3.

Scaling up epidemics of acute hepatitis C and syphilis in HIV-infected men who have sex with men in Spain

Clara Sánchez  1 , Zulema Plaza, Eugenia Vispo, Carmen de Mendoza, Pablo Barreiro, José V Fernández-Montero, Pablo Labarga, Eva Poveda, Vincent Soriano
Affiliations

Scaling up epidemics of acute hepatitis C and syphilis in HIV-infected men who have sex with men in Spain

Clara Sánchez et al. Liver Int. 2013 Oct.

Abstract

Background: Outbreaks of acute hepatitis C in HIV-positive men who have sex with men (MSM) are being reported in large cities in western countries along with increasing rates of sexually transmitted diseases.

Methods: All HIV individuals attended at a large outclinic in Madrid within the last 5 years were examined. Incident syphilis was diagnosed based on rapid plasma reagin (RPR) reactivity, being negative previously or showing >4-fold increase. Acute hepatitis C was diagnosed based on HCV antibody seroconversion and/or positive serum HCV-RNA after being negative within the last year.

Results: A total of 859 episodes of syphilis and 19 of acute hepatitis C were diagnosed during the study period. Syphilis was recognized in 65/2,094 (3.1%) individuals attended in 2008 and rose up to 261/2,512 (10.4%) in 2012 (P < 0.001). Acute hepatitis C was diagnosed in only one subject in 2008 but rose up to 7 in 2012 (P = 0.12). All 19 HIV patients with acute hepatitis C were MSM. Syphilis was diagnosed concomitantly in seven. All eight individuals who were treated with peginterferon/ribavirin were cured, whereas only one untreated experienced spontaneous clearance (P = 0.004). Two clusters of infections by HCV genotypes 4 and 1a were identified by phylogenetic analyses.

Conclusions: The incidence of acute hepatitis C is low but steadily increasing in HIV-positive MSM in Madrid (<1% yearly), despite the very high rates of syphilis (currently 20% yearly in HIV-positive MSM). Preventive measures for sexually transmitted infections and periodic HCV screening are warranted in this population as treatment of acute hepatitis C is very effective.

Keywords: HIV; acute hepatitis C; interferon; men who have sex with men; ribavirin; syphilis.

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