Researchers from the Dutch pre-exposure prophylaxis (PrEP) demonstration study, AmPrEP, have found an unexpectedly high rate of hepatitis C virus (HCV) infection in participants tested for it at baseline.
The HCV prevalence seen was more typical of that seen in HIV-positive gay men rather than the much lower rates seen in HIV-negative men.
Presenter Maria Prins said that phylogenetic mapping suggested that the explanation might lie in study participants being more likely to have condomless sex with men of HIV-positive or unknown status, amongst whom HCV prevalence was higher than other HIV-negative men.
One unanswered question is whether this might in future lead to a general increase in HCV prevalence among the HIV-negative gay population, or whether PrEP users were a specific population that were untypical of other HIV-negative gay men.
Prins said her data did suggest that hepatitis C screening and regular testing should become the norm among gay men seeking and taking PrEP. She added that if at-risk men were screened regularly and provided with early HCV treatment, the highly effective and swift-acting new HCV direct-acting antiviral drugs would have a chance to bring about a rapid reduction in overall HCV prevalence within the gay community, by acting as hepatitis C ‘treatment as prevention’.