Lack of decline in hepatitis C virus incidence among HIV-positive men who have sex with men during 1990–2014

Background and Aims Hepatitis C virus (HCV) incidence among HIV-positive men who have sex with men (MSM) has increased since 2000, though regional differences have been documented in recent years. We aimed to 1) estimate trends in HCV incidence among HIV-positive MSM, 2) assess the association between incidence and geographical region, age and HIV-related measurements and, 3) assess temporal changes in time from HIV seroconversion to HCV infection. Methods We used data from MSM with well-estimated dates of HIV seroconversion from the CASCADE Collaboration (1990-2014). We allowed for smoothly varying trends in HCV incidence over calendar time using restricted cubic splines. We assessed the association of calendar year, age, CD4 count (lagged), HIV RNA (lagged), geographical region and HIV infection stage (recent vs. chronic) with HCV incidence using Poisson regression. Results Of 5,941 MSM, 337 acquired HCV during follow-up. HCV incidence significantly increased from 0.7/1000 person-years (py) in 1990 to 18/1000 py in 2014. Recent calendar years, younger age, recent HIV infection and higher HIV RNA levels were significantly associated with HCV incidence, while CD4 count was not. Trends differed by geographical region; while incidence appears to have stabilized in Western Europe and remained stable in Southern Europe, it continued to increase in Northern Europe in recent years. Time from HIV to HCV infection significantly decreased over calendar time (p<0.001). Conclusions HCV has con 1 tinued to spread among HIV-positive MSM in recent years, but trends differ by geographical region. Interventions to decrease the risk of HCV acquisition and increase early diagnosis are warranted.