Objectives The epidemiology of the incidence of sexually-transmitted hepatitis C virus (HCV) infection in HIV-positive men who have sex with men (HIV+MSM) is only partially understood. In the presence of HIV, HCV infection is more likely to become chronic and liver fibrosis progression is accelerated. Design A systematic review and meta-analysis was used to synthesize data characterizing sexually transmitted HCV in HIV+MSM. Methods Electronic and other searches of medical literature (including unpublished reports) were conducted. Eligible studies reported on HCV seroconversion or on reinfection post-successful HCV treatment in HIV+MSM who were not injecting drugs. Pooled incidence rates were calculated using random-effects meta-analysis, and meta-regression was used to assess study-level moderators. Attributable risk measures were calculated from statistically significant associations between exposures and HCV seroconversion. Results More than 13,000 HIV+MSM in 17 studies were followed >91,000 person-years (PY) between 1984–2012; the pooled seroconversion rate was 0.53/100PY. Calendar time was a significant moderator of HCV seroconversion, increasing from an estimated rate of 0.42/100PY in 1991 to 1.09/100PY in 2010, and 1.34/100PY in 2012. Reinfection post-successful HCV treatment (n=2 studies) was 20 times higher than initial seroconversion rates. Among the seroconverters, a large proportion of infections were attributable to high risk behaviors including mucosally-traumatic sex and sex while high on methamphetamine. Conclusions The high reinfection rates and the attributable risk analysis suggest the existence of a subset of HIV+MSM with recurring sexual exposure to HCV. Approaches to HCV control in this population will need to consider the changing epidemiology of HCV infection in MSM.

Since 2000, an increase in hepatitis C virus infection among HIV-infected (HIV+) men who have sex with men has been observed. Evidence points to blood exposure during sex as the medium of hepatitis C virus transmission. Hepatitis C virus prevalence among HIV+MSM overall and in relation to injection drug use is poorly characterized. In this study, a systematic review and meta-analysis examining global hepatitis C virus antibody prevalence and estimating active hepatitis C virus prevalence among HIV+MSM were conducted; 42 reports provided anti-hepatitis C virus prevalence data among HIV+MSM. Pooled prevalence produced an overall anti-hepatitis C virus prevalence among HIV+MSM of 8.1%; active HCV prevalence estimate was 5.3%–7.3%. Anti-hepatitis C virus prevalence among injection drug use and non-injection drug use HIV+MSM was 40.0% and 6.7%, respectively. Among HIV+MSM, hepatitis C virus prevalence increased significantly over time among the overall and non-injection drug use groups, and decreased significantly among injection drug use HIV+MSM. We identified a moderate prevalence of hepatitis C virus among all HIV+MSM and among non-injection drug use HIV+MSM; for both, prevalence was observed to be increasing slightly. Pooled prevalence of hepatitis C virus among HIV+MSM was higher than that observed in the 1945–1965 US birth cohort. The modest but rising hepatitis C virus prevalence among HIV+MSM suggests an opportunity to control HCV among HIV+MSM; this combined with data demonstrating a rising hepatitis C virus incidence highlights the temporal urgency to do so.

BackgroundOutbreaks of hepatitis C virus (HCV) infection have been reported in HIV-positive men who have sex with men (MSM) in North America, Europe and Asia. Transmission is believed to be the result of exposure to blood during sexual contact. In those infected with HIV, acute HCV infection is more likely to become chronic, treatment for both HIV and HCV is more complicated and HCV disease progression may be accelerated. There is a need for systematic reviews and meta-analyses to synthesize the epidemiology, prevention and methods to control HCV infection in this population.Methods/designEligible studies will include quantitative empirical data related to sexual transmission of HCV in HIV-positive MSM, including data describing incidence or prevalence, and associations between risk factors or interventions and the occurrence or progression of HCV disease. Care will be taken to ensure that HCV transmission related to injection drug use is excluded from the incidence estimates. Scientific databases will be searched using a comprehensive search strategy. Proceedings of scientific conferences, reference lists and personal files will also be searched. Quality ratings will be assigned to each eligible report using the Newcastle–Ottawa scale. Pooled estimates of incidence rates and measures of association will be calculated using random effects models. Heterogeneity will be assessed at each stage of data synthesis.DiscussionHIV-positive MSM are a key HCV-affected population in the US and other high-income countries. This review seeks to identify modifiable risk factors and settings that will be the target of interventions, and will consider how to constitute a portfolio of interventions to deliver the greatest health benefit. This question must be considered in relation to the magnitude of HCV infection and its consequences in other key affected populations, namely, young prescription opioid users who have transitioned to illicit opiate injection, and older injection drug users among whom HCV prevalence and incidence are extremely high. This review is part of a series of systematic reviews and meta-analyses that will synthesize the evidence across all these population groups and develop recommendations and decision tools to guide public health resource allocation.Trial registrationPROSPERO registration number: CRD42013006462

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