Limits...
Trouble with bleeding: risk factors for acute hepatitis C among HIV-positive gay men from Germany--a case-control study.

Schmidt AJ, Rockstroh JK, Vogel M, An der Heiden M, Baillot A, Krznaric I, Radun D - PLoS ONE (2011)

Bottom Line: Sex-associated rectal bleeding, receptive fisting and snorting cocaine/amphetamines, combined with group sex, were independently associated with case status.Among cases, surgical interventions overlapped with sex-associated rectal bleeding.Further research is needed into the interplay of proctosurgery and sex-associated rectal bleeding.

View Article: PubMed Central - PubMed

Affiliation: Department for Infectious Diseases Epidemiology, Robert Koch Institute, Berlin, Germany. a.j.schmidt@rki.de

ABSTRACT

Objectives: To identify risk factors for hepatitis C among HIV-positive men who have sex with men (MSM), focusing on potential sexual, nosocomial, and other non-sexual determinants.

Background: Outbreaks of hepatitis C virus (HCV) infections among HIV-positive MSM have been reported by clinicians in post-industrialized countries since 2000. The sexual acquisition of HCV by gay men who are HIV positive is not, however, fully understood.

Methods: Between 2006 and 2008, a case-control study was embedded into a behavioural survey of MSM in Germany. Cases were HIV-positive and acutely HCV-co-infected, with no history of injection drug use. HIV-positive MSM without known HCV infection, matched for age group, served as controls. The HCV-serostatus of controls was assessed by serological testing of dried blood specimens. Univariable and multivariable regression analyses were used to identify factors independently associated with HCV-co-infection.

Results: 34 cases and 67 controls were included. Sex-associated rectal bleeding, receptive fisting and snorting cocaine/amphetamines, combined with group sex, were independently associated with case status. Among cases, surgical interventions overlapped with sex-associated rectal bleeding.

Conclusions: Sexual practices leading to rectal bleeding, and snorting drugs in settings of increased HCV-prevalence are risk factors for acute hepatitis C. We suggest that sharing snorting equipment as well as sharing sexual partners might be modes of sexual transmission. Condoms and gloves may not provide adequate protection if they are contaminated with blood. Public health interventions for HIV-positive gay men should address the role of blood in sexual risk behaviour. Further research is needed into the interplay of proctosurgery and sex-associated rectal bleeding.

Show MeSH

Related in: MedlinePlus

Venn diagram for overlap of exposures (frequent receptive fisting without gloves, frequent anal bleeding, group sex & consumption of NADs).*Unexposed: Respondents who neither had been frequently fisted without gloves (or with gloves that were shared), nor frequently experienced anal bleeding when having sex, nor reported group sex activities plus consumption of NADs. The circular areas correspond with the respective presence of exposures; intersecting areas reflect only roughly the given percentages.
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC3050932&req=5

pone-0017781-g001: Venn diagram for overlap of exposures (frequent receptive fisting without gloves, frequent anal bleeding, group sex & consumption of NADs).*Unexposed: Respondents who neither had been frequently fisted without gloves (or with gloves that were shared), nor frequently experienced anal bleeding when having sex, nor reported group sex activities plus consumption of NADs. The circular areas correspond with the respective presence of exposures; intersecting areas reflect only roughly the given percentages.

Mentions: There was an overlap between frequent receptive fisting without gloves and frequent rectal trauma with bleeding among cases (9% reported both exposures), whereas among controls, no such overlap was present (figure 1). All risk factors independently associated with HCV infection showed a higher degree of overlap among cases. Neither fisting nor rectal bleeding was associated with a recent history of bacterial STIs (p = 0.577; p = 0.512), a higher number of sex partners (p = 0.403; p = 1.000), or unprotected anal intercourse with a partner of unknown HIV serostatus (p = 0.278; P = 0.501). Among cases, but not among controls, there was substantial overlap between a history of multiple episodes of major surgery and rectal bleeding, or use of PDE-5-inhibitors (figure 2).


Trouble with bleeding: risk factors for acute hepatitis C among HIV-positive gay men from Germany--a case-control study.

Schmidt AJ, Rockstroh JK, Vogel M, An der Heiden M, Baillot A, Krznaric I, Radun D - PLoS ONE (2011)

Venn diagram for overlap of exposures (frequent receptive fisting without gloves, frequent anal bleeding, group sex & consumption of NADs).*Unexposed: Respondents who neither had been frequently fisted without gloves (or with gloves that were shared), nor frequently experienced anal bleeding when having sex, nor reported group sex activities plus consumption of NADs. The circular areas correspond with the respective presence of exposures; intersecting areas reflect only roughly the given percentages.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3050932&req=5

pone-0017781-g001: Venn diagram for overlap of exposures (frequent receptive fisting without gloves, frequent anal bleeding, group sex & consumption of NADs).*Unexposed: Respondents who neither had been frequently fisted without gloves (or with gloves that were shared), nor frequently experienced anal bleeding when having sex, nor reported group sex activities plus consumption of NADs. The circular areas correspond with the respective presence of exposures; intersecting areas reflect only roughly the given percentages.
Mentions: There was an overlap between frequent receptive fisting without gloves and frequent rectal trauma with bleeding among cases (9% reported both exposures), whereas among controls, no such overlap was present (figure 1). All risk factors independently associated with HCV infection showed a higher degree of overlap among cases. Neither fisting nor rectal bleeding was associated with a recent history of bacterial STIs (p = 0.577; p = 0.512), a higher number of sex partners (p = 0.403; p = 1.000), or unprotected anal intercourse with a partner of unknown HIV serostatus (p = 0.278; P = 0.501). Among cases, but not among controls, there was substantial overlap between a history of multiple episodes of major surgery and rectal bleeding, or use of PDE-5-inhibitors (figure 2).

Bottom Line: Sex-associated rectal bleeding, receptive fisting and snorting cocaine/amphetamines, combined with group sex, were independently associated with case status.Among cases, surgical interventions overlapped with sex-associated rectal bleeding.Further research is needed into the interplay of proctosurgery and sex-associated rectal bleeding.

View Article: PubMed Central - PubMed

Affiliation: Department for Infectious Diseases Epidemiology, Robert Koch Institute, Berlin, Germany. a.j.schmidt@rki.de

ABSTRACT

Objectives: To identify risk factors for hepatitis C among HIV-positive men who have sex with men (MSM), focusing on potential sexual, nosocomial, and other non-sexual determinants.

Background: Outbreaks of hepatitis C virus (HCV) infections among HIV-positive MSM have been reported by clinicians in post-industrialized countries since 2000. The sexual acquisition of HCV by gay men who are HIV positive is not, however, fully understood.

Methods: Between 2006 and 2008, a case-control study was embedded into a behavioural survey of MSM in Germany. Cases were HIV-positive and acutely HCV-co-infected, with no history of injection drug use. HIV-positive MSM without known HCV infection, matched for age group, served as controls. The HCV-serostatus of controls was assessed by serological testing of dried blood specimens. Univariable and multivariable regression analyses were used to identify factors independently associated with HCV-co-infection.

Results: 34 cases and 67 controls were included. Sex-associated rectal bleeding, receptive fisting and snorting cocaine/amphetamines, combined with group sex, were independently associated with case status. Among cases, surgical interventions overlapped with sex-associated rectal bleeding.

Conclusions: Sexual practices leading to rectal bleeding, and snorting drugs in settings of increased HCV-prevalence are risk factors for acute hepatitis C. We suggest that sharing snorting equipment as well as sharing sexual partners might be modes of sexual transmission. Condoms and gloves may not provide adequate protection if they are contaminated with blood. Public health interventions for HIV-positive gay men should address the role of blood in sexual risk behaviour. Further research is needed into the interplay of proctosurgery and sex-associated rectal bleeding.

Show MeSH
Related in: MedlinePlus