Screening HIV-positive men who have sex with men for hepatitis C re-infection risk: is a single question on condom-use enough? A sensitivity analysis

Patrizia Künzler-Heule, Sandra Engberg, Manuel Battegay, Axel J Schmidt, Katharina Fierz, Huyen Nguyen, Agnes Kocher, Christiana Nöstlinger, Benjamin Hampel, Marcel Stöckle, Charles Béguelin, Julie Delaloye, Patrick Schmid, Markus Flepp, Mathieu Rougement, Dominique Laurent Braun, Jan Fehr, Dunja Nicca, Swiss HIV Cohort Study (SHCS), A Anagnostopoulos, M Battegay, E Bernasconi, J Böni, D L Braun, H C Bucher, A Calmy, M Cavassini, A Ciuffi, G Dollenmaier, M Egger, L Elzi, J Fehr, J Fellay, H Furrer, C A Fux, H F Günthard, D Haerry, B Hasse, H H Hirsch, M Hoffmann, I Hösli, M Huber, C R Kahlert, L Kaiser, O Keiser, T Klimkait, R D Kouyos, H Kovari, B Ledergerber, G Martinetti, B Martinez de Tejada, C Marzolini, K J Metzner, N Müller, D Nicca, P Paioni, G Pantaleo, M Perreau, A Rauch, C Rudin, A U Scherrer, P Schmit, R Speck, M Stöckle, P Tarr, A Trkola, P Vernazza, G Wandeler, R Weber, S Yerly, Patrizia Künzler-Heule, Sandra Engberg, Manuel Battegay, Axel J Schmidt, Katharina Fierz, Huyen Nguyen, Agnes Kocher, Christiana Nöstlinger, Benjamin Hampel, Marcel Stöckle, Charles Béguelin, Julie Delaloye, Patrick Schmid, Markus Flepp, Mathieu Rougement, Dominique Laurent Braun, Jan Fehr, Dunja Nicca, Swiss HIV Cohort Study (SHCS), A Anagnostopoulos, M Battegay, E Bernasconi, J Böni, D L Braun, H C Bucher, A Calmy, M Cavassini, A Ciuffi, G Dollenmaier, M Egger, L Elzi, J Fehr, J Fellay, H Furrer, C A Fux, H F Günthard, D Haerry, B Hasse, H H Hirsch, M Hoffmann, I Hösli, M Huber, C R Kahlert, L Kaiser, O Keiser, T Klimkait, R D Kouyos, H Kovari, B Ledergerber, G Martinetti, B Martinez de Tejada, C Marzolini, K J Metzner, N Müller, D Nicca, P Paioni, G Pantaleo, M Perreau, A Rauch, C Rudin, A U Scherrer, P Schmit, R Speck, M Stöckle, P Tarr, A Trkola, P Vernazza, G Wandeler, R Weber, S Yerly

Abstract

Background: Hepatitis C virus (HCV) is common in men who have sex with men (MSM) with HIV. The Swiss HCVree Trial targeted a micro-elimination by using a treat and counsel strategy. Self-reported condomless anal intercourse with non-steady partners was used as the selection criterion for participation in a counselling intervention designed to prevent HCV re-infection. The purpose of this study was to assess the ability of this criterion to identify men who engaged in other sexual risk behaviours associated with HCV re-infection.

Methods: Men who disclosed their sexual and drug- use behaviours during the prior 6 months, at study baseline, were included in the current study. Using a descriptive comparative study design, we explored self-reported sexual and drug-use risk behaviours, compared the odds of reporting each behaviour in men who reported and denied condomless anal intercourse with non-steady partners during the prior year and calculated the sensitivity/specificity (95% CI) of the screening question in relation to the other at-risk behaviours.

Results: Seventy-two (61%) of the 118 men meeting eligibity criteria reported condomless anal intercourse with non-steady partners during the prior year. Many also engaged in other potential HCV transmission risk behaviours, e.g., 52 (44%) had used drugs. In participants disclosing drug use, 44 (37%) reported sexualised drug use and 17 (14%) injected drugs. Unadjusted odds ratios (95% CI) for two well-known risk behaviours were 2.02 (0.80, 5.62) for fisting and 5.66 (1.49, 37.12) for injecting drug use. The odds ratio for sexualised drug use - a potential mediator for increased sexual risk taking - was 5.90 (2.44, 16.05). Condomless anal intercourse with non-steady partners showed varying sensitivity in relation to the other risk behaviours examined (66.7-88.2%).

Conclusions: Although condomless anal intercourse with non-steady partners was fairly sensitive in detecting other HCV relevant risk behaviours, using it as the only screening criterion could lead to missing a proportion of HIV-positive men at risk for HCV re-infection due to other behaviours. This work also points to the importance of providing access to behavioral interventions addressing other sexual and drug use practices as part of HCV treatment.

Trial registration: Clinical Trial Number: NCT02785666 , 30.05.2016.

Keywords: Condoms; HIV; Hepatitis C virus; Homosexuality; Male; Sexual behavior.

Conflict of interest statement

PKH received consultancy fees from Sigma-Tau, Norgine, AbbVie and grants from ViiV, Merck, and Janssen; all outside the submitted work.

SE has no conflict of interest.

MB has no conflict of interest.

KF has no conflict of interest.

NH has no conflict of interest.

AJS has no conflict of interest.

AK reports grant from Merck outside submitted work.

CN has no conflict of interest.

BH has no conflict of interest.

MSt reports board memberships with AbbVie, Gilead, and MSD.

CB reports fees from AbbVie, MSD, and Gilead, outside the submitted work.

JD has no conflict of interest.

PS received travel grants from Merck, outside submitted work.

MF has no conflict of interest.

MR reports grants from MSD and ViiV outside submitted work.

DLB received consultancy fees from Merck, Gilead, and ViiV.

JF is a member of the Federal Commission for Sexual Health. He received research, educational and travel grants from Janssen, Merck and ViiV Healthcare.

DN reports grants from Merck, Janssen, and ViiV outside submitted work.

Figures

Fig. 1
Fig. 1
Flowchart Swiss HCVree Trial and group building according to men’s response to the nsCAI screening question

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