Epidemiology and Risk Factors for HCV Infection Among MSM With or at Risk of HIV in Madrid (2022-2024)

Area of Science:

• Hepatology
• Infectious Diseases
• Epidemiology

Background:

• Ongoing high-risk behaviors continue to drive Hepatitis C Virus (HCV) transmission among men who have sex with men (MSM), hindering elimination efforts.
• This study investigated HCV epidemiology in MSM with and without HIV in Madrid.

Purpose of the Study:

• To assess HCV prevalence and incidence in men who have sex with men (MSM) with HIV and those on PrEP.
• To identify risk factors associated with HCV infection and reinfection in this population.

Main Methods:

• Prospective study (2022-2024) enrolling 1372 MSM (733 with HIV, 639 on PrEP).
• Regular follow-up visits included HCV serology, RNA testing, liver enzymes, and STI screening.
• Data collected on sexual behaviors, including slamsex and condomless anal intercourse with multiple partners.

Main Results:

• Baseline HCV prevalence was 1.68%, significantly higher in those with prior HCV exposure (5.60%).
• Overall HCV incidence was 1.45/100 person-years (PY), with higher reinfection rates (4.32/100 PY) observed.
• Slamsex and condomless receptive anal intercourse with ≥4 partners were independently associated with HCV infection and reinfection.

Conclusions:

• Prior HCV exposure is a significant risk factor for higher HCV prevalence and incidence in MSM, irrespective of HIV status.
• Risky sexual behaviors remain primary drivers of HCV transmission.
• Behavior-informed prevention strategies are essential for sustaining HCV elimination efforts in MSM populations.