Can current national surveillance systems in England and Wales monitor sexual transmission of hepatitis C among HIV-infected men who have sex with men?

Abstract

BackgroundRecent reports suggest an increase in sexually-transmitted hepatitis C infection among HIV-infected men who have sex with men (MSM) in European cities. We investigated whether current national surveillance systems in England and Wales (E&W) are able to monitor sexual transmission of hepatitis C infection among HIV-infected MSM.MethodsRoutine laboratory reports of hepatitis C diagnoses and data from sentinel hepatitis C testing surveillance were matched to HIV diagnosis reports to determine: (i) the number of MSM diagnosed with HIV and hepatitis C (1996–2003); (ii) the number of HIV-diagnosed MSM tested for hepatitis C and found to be positive at sentinel sites (2003).Results(i) Between 1996–2003, 38,027 hepatitis C diagnoses were reported; 25,938 (68%) were eligible for matching with HIV diagnoses. Thirty-one men (four in London) had both a HIV and hepatitis C diagnosis where the only risk was sex with another man. Numbers of "co-diagnosed" MSM increased from 0 in 1996 to 14 in 2003. The majority of MSM (22/31) tested hepatitis C positive after HIV diagnosis. (ii) Of 78,058 test results from sentinel hepatitis C testing sites in 2003, 67,712 (87%) were eligible for matching with HIV diagnoses. We identified 242 HIV-diagnosed MSM who did not inject drugs who tested for hepatitis C in 2003; 11 (4.5%) tested hepatitis C positive (95%CI: 2.3%–8.0%). Applying this percentage to all MSM seen for HIV-related care in E&W in 2003, an estimated 680 MSM living with diagnosed HIV would have tested positive for sexually-transmitted hepatitis C (95%CI: 346–1208).ConclusionMatching routine laboratory reports of hepatitis C diagnoses with HIV diagnoses only identified 31 HIV infected MSM with sexually-transmitted hepatitis C infection. Clinical studies suggest that this is an underestimate. On the other hand, matching sentinel surveillance reports with HIV diagnoses revealed that in E&W in 2003 nearly 5% of HIV-diagnosed MSM tested hepatitis C positive where the only risk was sex with another man. Reports of sexually-transmitted hepatitis C infection were not confined to London. Enhanced surveillance is needed to monitor sexually-transmitted hepatitis C among HIV-infected MSM in E&W.

Incidence of acute hepatitis C virus infection among men who have sex with men with and without HIV infection: a systematic review

“…Following reports of emergence of acute HCV in HIV-positive MSM, many have called for routine screening and targeted prevention in this group 1 2 6–8 29 30 . w1 w2 Reports of increased HCV incidence among HIV-negative MSM have also prompted some to argue that acute HCV is an expanding epidemic among all MSM and that universal screening in the MSM population should be undertaken 29 30 .…”

“…w1 w2 Reports of increased HCV incidence among HIV-negative MSM have also prompted some to argue that acute HCV is an expanding epidemic among all MSM and that universal screening in the MSM population should be undertaken 29 30 . w1–w3 A number of these calls, however, were supported not by studies describing incidence of acute HCV, but by case studies wherein traumatic sexual behaviour was the only known or significant risk factor for infection 1 2 30 . w2 Furthermore, recent cross-sectional studies have found a low prevalence of HCV in HIV-positive MSM without a history of injection drug use.…”

Increase in diagnosed newly acquired hepatitis C in HIV-positive men who have sex with men across London and Brighton, 2002-2006: is this an outbreak?

“…In the United Kingdom there are several shortcomings in the current national surveillance systems for HCV 14 – 15. Risk factors are poorly recorded (less than a third of the laboratory reports contain this information) and reports are often incomplete, particularly in London 16.…”

Monitoring HIV testing in diverse healthcare settings: results from a sentinel surveillance pilot study

“…This would enable automated collection of large amounts of data without additional work by the person requesting the test or the need for labour-intensive local audits. It would also provide the opportunity to monitor testing for co-infection with hepatitis B and C in HIV-positive individuals, something which is not currently possible with existing surveillance systems 15. Such a scheme may also be of value in other countries, particularly those with national healthcare systems where data collection from a network of representative sentinel laboratories is feasible.…”