HIV Medicine 2024; (doi: 10.1111/hiv.13657)
Authors: Axel Jeremias Schmidt, Peter Weatherburn, Haoyi Wang, Thomas Lutz, Knud Schewe, Stefan Mauss, Ivanka Krznaric, Axel Baumgarten, Christoph Boesecke, Jürgen K. Rockstroh, Stefan Christensen, Patrick Ingiliz
Abstract
Objectives
To identify sexual/sex-associated risk factors for hepatitis C transmission among men who have sex with men (MSM) and visualise behavioural trajectories from 2019 to 2021.
Methods
We linked a behavioural survey to a hepatitis C cohort study (NoCo), established in 2019 across six German HIV/hepatitis C virus (HCV) treatment centres, and performed a case–control analysis. Cases were MSM with recent HCV infection, and controls were matched for HIV status (model 1) or proportions of sexual partners with HIV (model 2). We conducted conditional univariable and multivariable regression analyses.
Results
In all, 197 cases and 314 controls completed the baseline questionnaire and could be matched with clinical data. For regression models, we restricted cases to those with HCV diagnosed since 2018 (N = 100). Factors independently associated with case status included sex-associated rectal bleeding, shared fisting lubricant, anal douching, chemsex, intravenous and intracavernosal injections, with population-attributable fractions of 88% (model 1) and 85% (model 2). These factors remained stable over time among cases, while sexual partner numbers and group sex decreased during COVID-19 measures.
Conclusions
Sexual/sex-associated practices leading to blood exposure are key factors in HCV transmission in MSM. Public health interventions should emphasize the importance of blood safety in sexual encounters. Micro-elimination efforts were temporarily aided by reduced opportunities for sexual encounters during the COVID-19 pandemic.
Note: The questionnaire underlying this case-control study based many questions on EMIS-2010 and EMIS-2017.