WHO-commissioned global systematic review finds high HCV prevalence and incidence among men who have sex with men

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In collaboration with the Kirby Institute at UNSW Sydney, Australia, WHO has printed nowadays a systematic review and meta-analysis of the prevalence and incidence of hepatitis C virus (HCV) an infection in men who have sex with men (MSM) in The Lancet Gastroenterology & Hepatology.

Globally an estimated 71 million other people have persistent HCV an infection and each and every yr, there are an estimated 1.75 million new infections.

WHO has set goals to get rid of hepatitis C virus by means of 2030. This formidable function is inside of achieve as healing direct-acting antivirals (DAA) for HCV are actually to be had along with efficient prevention measures. While HCV transmission happens essentially thru injecting drug use and unsafe injecting in healthcare settings, sexual transmission may additionally happen, in particular thru unprotected anal sex. 

WHO commissioned this systematic review and meta-analysis to summarise the global proof at the prevalence and incidence of HCV an infection among MSM and to inspect associations with HIV and injecting drug use. The effects are offered on this paper.

Of 1221 publications recognized, 194 have been assessed to be eligible and integrated within the meta-analysis.

“Findings from this review show that MSM populations globally have a high burden of HCV infection, with substantial variations across countries and regions,” states the lead writer, Jeff Jin, from the us Sydney. In this review, the total pooled HCV prevalence in MSM was once 3.4% (95% CI: 2.8-4.0).

The e-newsletter confirms the larger HCV chance in HIV-positive MSM.  The review discovered that globally, pooled HCV prevalence in HIV-positive MSM was once 6.3% (95% CI: 5.3-7.5) in comparison with 1.5% (95% CI: 1.0-2.1) in HIV-negative MSM. The distinction in pooled HCV prevalence between HIV-positive and HIV-negative MSM was once perfect within the WHO European Region, adopted by means of the WHO Western Pacific and the Americas areas. This increased HCV prevalence among HIV-positive MSM accounts for a lot of the extra HCV burden noticed among MSM relative to the overall inhabitants.

Injecting drug use is a big contributor to HCV transmission globally and could also be the most important chance issue for HCV transmission among MSM populations. MSM with a historical past of injecting drug use are considerably extra likley to be HCV-positive than MSM who have now not injected medication. The pooled HCV prevalence was once considerably upper in MSM who had ever (30.2%, 95% CI: 22.0-39.0) or these days (45.6%, 95% CI: 21.6 – 70.7) injected medication when in comparison to the ones who had by no means injected (2.7%, 95% CI: 2.0-3.6).

“Reaching and supporting MSM who also inject drugs with adapted and effective prevention, testing and treatment services is critical,” says Dr Niklas Luhmann, a Technical Officer within the WHO Global HIV, Hepatitis and Sexually Transmitted Infections Programmes.

Global information on HCV incidence among MSM was once additionally reviewed. A complete of 46 research that reported on HCV incidence in MSM have been integrated. The evaluation discovered that charges of latest infections are perfect among HIV-positive MSM with a pooled HCV incidence of 8.46 (95%CI: 6.78-10.32) in step with 1,000 person-years and in a couple of contemporary research of HIV-negative MSM who take pre-exposure prophylaxis (PrEP) (pooled HCV incidence of 14.80 (95% CI: 9.65-20.95) in step with 1,000 person-years).  

This upper HCV incidence observed among MSM taking PrEP could also be because of a number of components: MSM who selected PrEP most often accomplish that as a result of they have self-identified upper HIV chance and obstacles to constant condom use. They may additionally have larger sexual blending with HIV-positive MSM who, as famous above, have the next HCV prevalence than HIV-negative MSM. Furthermore, within the research reviewed, upper chance HIV-negative MSM who make a choice PrEP have been discovered to have a high prevalence of HCV viremia prior to PrEP initiation. This upper chance for HCV observed in HIV-negative men taking PrEP would possibly subsequently pre-date PrEP use reasonably than relate to adjustments in sexual behaviour and condom use after PrEP initiation.

“We know that we need to improve access to prevention, testing and treatment for highly affected and sometimes marginalized populations to reach our goals of hepatitis elimination,” mentioned Dr Meg Doherty, Director of the WHO Global HIV, Hepatitis and Sexually Transmitted Infections Programmes. “This first global systematic review of HCV prevalence and incidence in MSM populations highlights that extra efforts are had to reinforce get entry to to HIV and HCV prevention, checking out and remedy for MSM at upper chance. Existing HIV and PrEP programmes for MSM will have to come with HCV checking out and remedy and be offering tailored prevention interventions“.

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