1. Hepatitis C in MSMs; a review of testing practices in the GUIDe clinic & a description of recent cases
N. Lynn*, J Dean**, e quinn**, G Farrell*, C Murray* , F Lyons*,
C Bannan*. C. DeGascun**, C. Bergin*
* Department of Genitourinary Medicine and Infectious Disease, St. James’s Hospital
** National Virus Reference Lab

2. Background Hepatitis C emerging as an STI in MSM¹
Epidemiology of Hep C transmission changing²
Since 2000 , longitudinal cohort studies confirm ↑ HCV incidence in HIV+ MSM, but not HIV- MSM
Reported incidence of HCV infection in HIV+ MSM /100 person years³
The odds ratio of sexual transmission of HCV ↑ in HIV+ MSM (adjusted ratio ) 1. 2.
3. Lauer GM, Walker BD. Hepatitis C virus infection. New Engl J Med 2001;345(1):41-52.
4. Tohme RA, Holmberg SD. Is sexual contact a major mode of hepatitis C virus transmission? Hepatology 2010;52(4):

3. Hx chemsex/drug use
HIV+ve patients
sex associated with trauma
rectal LGV +ve

4. Audit Methods HIV+ MSMs attending a HIV clinic in January 2016
Electronic Patient Record (EPR) reviewed
Descriptive column statistics used for data analysis

5. Audit Results 198 HIV+ MSM - 8 clinics – Jan 2016
Median age 38 (IQR 31,50)
14% (n=13) detectable HIV VL ( )
96% (n=191) HCV Ab/PCR on EPR
Median time to last Ab/PCR: 107 days ( days)
28% (n=57) Ab/PCR OPD
68% (n=135) Hepatitis C Ab/PCR test <365 days*
* As per BASHH Guidelines

6. MSM STI testing in HIV OPD
84% (n=167) STI screen on EPR
27% (n=54) MSM STI clinic
71% (n= 141) MSM STI screen in the past year*
Median time since last screen 115 days (range 0 – 2083)
82% (n=138) last screen negative
*as per BASHH Guidelines

7. Conclusion
Good compliance with HCV & NAATs BASHH testing Guidelines (66% & 71%)
Poor documentation of sexual practices, chemsex & drug use
Strategies to improve testing:
Add full MSM STI screen to annual HIV bloods
Include hepatitis C Ab in routine MSM STI testing
Improve access to results from other services (e.g GMHS)
Universal patient number to limit duplication of testing
Audit findings will be presented at departmental level
Cycle 2 of Audit - after implementation of the above strategies

8. Hepatitis C outbreak in MSM
CDC Definition¹
Confirmed: Negative Ab/PCR < 12/12
Probable: meets clinical criteria, no testing in past 12/12 1.
Clinical Criteria:
Lab Criteria:
T◦/ HA/Malaise/Anorexia/Vomiting/Diarrhoea/Abdo Pain
Anti HCV +
AND
PCR+
Jaundice OR
ALT Peak >200
Antigen+

9. Results 19 MSM 1 Aug 2015 – 21 Oct 2016 Average age 36 (range 23-56)
89% (n=17) previously tested for HCV
Median days since last test 239 (range )
63% (n=12) previous test within 1 year
37% (n=7) test >1 year ago
Hep B immune 74% (n = 14)
All transaminitis, 2 new HIV, 3 new STI.

10. HIV & STI Results HIV STI testing (n=18) 78% (n=15) Detectable VL
Average CD4 571 VL
UD VL 73% (n=11)
Detectable 27% (n=4)
Detectable VL
Median 60,096
Range ,831

11. STI screen +ve (66%, n=12)

12. Acute Hepatitis C Genotype Transaminases 90% Genotype 1 (n = 17)
5% PCR -ve prior to genotyping (n = 1)
Median
Range Dx
119 Dx
264
Peak AST
211
Peak ALT
475

13. NS3 Sequencing 1 PCR –ve 1 HCV viral load; log 2 IU/ml
1 Did not amplify
1 G3
G1a n = 15

14. GT Clade NS3 Result 1a II N174G I Q80K V55A 3
89% Clade I: Q80K mutation

15. GT 1a H77 Ref
GT 1a Clade I
GT 1a Clade II
GT 1a H77 Ref
GT 1a Clade I
GT 1a Clade II

16. Where are they now and how are they doing?
n = 19; n=18 managed in GUIDe
“Chronic” HCV (n=2)
Spontaneous clearance (n=3)
PCR last visit (Aug-Nov ‘16) (n=11)*
DAAs in GUIDe (n=1)**
Travelled for treatment/meds (n=3):
HCVL UD Post Rx (n = 2)
HCVL <12 W2 Rx (n = 1)
*1 due DAAs, Fibroscan score 9
**Fibroscan score 8.7

17. STI screens in HCV
33% positive STI screens

18. Conclusion: Anecdotal cases noted at clinic visits – differing sites
No strong association with LGV
Viral sequencing to support epi and PN data in managing outbreak
Concern re: transmitted resistance - treatment implications
Preclusion to rx based on criteria
Staging of liver disease
High rates of new STIs
Attempt to describe the cohort in context of new cases. Threshold for access to treatment. No other STI where this applies.

19. Thanks; GUIDe Clinic: C Bannan, C Bergin, G Farrell, C Murray, F Lyons
NVRL: C De Gascun, J Dean, E Quinn
SJH Lab: B Crowley, M Kelleher
GMHP: S O’Dea, G Courtney