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Crystal methamphetamine use and group sex fuel an explosive HCV epidemic among HIV+MSM in Bangkok, Thailand
Tanyaporn Wansom, MD
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3. Hepatitis C Virus among HIV+ MSM
Background
HCV is an important comorbidity for people living with HIV
Direct acting antivirals (DAA) provide opportunity for cure, but limited access in resource constrained settings
HCV outbreaks documented in resource-rich settings among HIV+ MSM who deny IDU
Limited data available on HCV prevalence and incidence among HIV+MSM in resource constrained settings
Study objectives
Measure HCV prevalence and incidence among a predominantly MSM cohort of Thai individuals diagnosed during acute HIV infection
Characterize risk factors that may be associated with HCV incidence

4. Hepatitis C Virus among HIV+ MSM
Methods
Participants enrolled in prospective cohort between
HCV Antibody (Anti-HCV), HbsAg, Anti-Hbs, RPR/TPHA measured at enrolment and then every 6 months or more often if clinically indicated
Incident HCV infection defined as seroconversion from Anti-HCV negative to Anti-HCV positive, or detectable HCV RNA in the setting of clinical hepatitis
HCV genotype conducted by linear array
Drug and alcohol use captured by computer assisted questionnaire and physician interview
Chi squared test used to compare incidence trend by year
Hazard ratios calculated in univariate and multivariate analysis to assess risk factors associated with incident HCV infection

5. Baseline Characteristics
All
(N=573)
Anti-HCV -
(N=525)
Anti-HCV +
 (N=48)
p-value
Age (years)*
26 (22 – 31)
25 (22 – 31)
0.599
Sex Assigned at Birth, n (%)
0.658
Female
15 (2.6)
15 (2.9)
0 (0)
Male
558 (97.4)
510 (97.1)
48 (100.0)
Behavior risk, n (%)
0.776
MSM
538 (93.9)
491 (93.5)
47 (97.9)
Heterosexual male
20 (3.5)
19 (3.6)
1 (2.1)
Heterosexual female
Number of sexual partners in the past month*
2 (1 – 3)
2 (1 – 4)
0.017
More than 1 sexual partner in the past month
327 (57.1)
293 (55.8)
34 (70.8)
0.048
Group sex, n(%)
111 (19.4)
90 (17.1)
21 (43.8)
<0.001
Alcohol use, n (%)
126 (22.0)
115 (21.9)
11 (2.9)
0.856
Drug use, n (%) 
122 (21.3)
101 (19.2)
Hepatitis B surface antigen positive
29 (5.1)
28 (5.3)
1 (2.1) 
0.499
History of syphilis (Positive TPHA/RPR)
82 (14.3)
73 (13.9)
9(18.8)
0.387
Fiebig stage, n (%)
0.870 I
81 (14.1)
75 (14.3)
6 (12.5) II
130 (22.7)
122 (23.2)
8 (16.7)
III
259 (45.2)
234 (44.6)
25 (52.1) IV
67 (11.7)
61 (11.6)
V-VI
36 (6.3)
33 (6.3)
3 (6.3)
CD4 T cells* (cells/µL), median (IQR)
361 (264 – 496)
361 (265 – 505)
360 (234 – 470)
HIV RNA at time of HIV diagnosis (log10copies/mL), median (IQR)
5.94 (5.24 – 6.75)
5.93 (5.23 – 6.73)
6.06 (5.39 – 6.89)

6. Epic Rise in HCV Incidence
No incident cases detected from
Incidence increased in between /1000 PY
Drastic rise in incidence in 2017 and 2018
Highest incidence documented to date 33.0/1000 PY in 2018

7. Risk Factors Associated with HCV Incidence
Incident Cases
Univariate
Multivariate
Risk Factors
Total
(N=563) No
(N=524)
Yes
(N=39)
Crude HR
(95%CI)
P-value
Adjusted HR (95%CI)
Group sex
456 (81.0)
434 (82.8)
22 (56.4)
Ref.
107 (19.0)
90 (17.2)
17 (43.6)
3.74 (1.99 – 7.08)
<0.001
2.54 (1.26 – 5.12)
0.009
Alcohol use 
367 (65.2)
341 (65.1)
26 (66.7)
196 (34.8)
183 (34.9)
13 (33.3)
0.87 (0.44 – 1.69)
0.677
Methamphetamine use 
465 (82.6)
441 (84.2)
24 (61.5)
98 (17.4)
83 (15.8)
15 (38.5)
4.05 (2.10 – 7.79)
2.33 (1.13 – 4.8)
0.02
Drug injection 
556 (98.8)
519 (99.1)
97 (94.9)
7 (1.2)
5 (0.9)
2 (5.1)
3.65 (0.84 – 15.78)
0.083
History of syphilis
343 (60.9)
331 (63.2)
12 (30.8)
220 (39.1)
193 (36.8)
27 (69.2)
3.02 ( )
0.001
2.43 ( )
0.01

8. Conclusions
Group sex, methamphetamine use, and history of syphilis all associated with incident HCV infection in this cohort of HIV+MSM
Clinicians should ask about these risk factors, educate HIV+MSM about potential for HCV transmission
Thai National Guidelines should consider including HIV+MSM in risk group to be screened for anti-HCV at regular intervals if at risk
Need for access to DAAs to decrease HCV-related morbidity and mortality as well as onward transmission