Possible sexual transmission of Hep. C among HIV+ MSM: CDC MMWR

[MarcoPoz]

See the following CDC MMWR:

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6028a2.htm?s_cid=mm6028a2_e&source=govdelivery

[mecch]

Univariable results. Univariable analyses indicated that the HIV-infected MSM newly infected with HCV (case-patients) were significantly more likely than the HIV-infected MSM without HCV infection (matched controls) to have had receptive (matched odds ratio [mOR] = 24.87) or insertive (mOR = 2.62) anal intercourse with no condom and with ejaculation, practiced receptive (mOR = 10.08) or insertive (mOR = 7.90) fisting, used sex toys (mOR = 4.38), engaged in group sex (mOR = 19.28), engaged in sex while high on drugs (mOR = 11.37), previously had syphilis (mOR = 8.80) or gonorrhea (mOR = 5.02), and had sex while high on methamphetamine (mOR = 26.80) (Table 2). Because three variables (receptive anal intercourse, no condom, no ejaculation; sex while high on gamma hydroxybutyrate [GHB]; and sex while high on ketamine) yielded undefined ORs, the data were analyzed further using exact conditional logistic regression. Results showed that case-patients were significantly more likely than controls to report receptive anal intercourse with no condom and no ejaculation (mOR = 24.26) and sex while high on GHB (mOR = 16.34).

Multivariable results. Results from the multivariable analyses showed that receptive anal intercourse with no condom and with ejaculation of the partner (adjusted odds ratio [AOR] = 23.00) and sex while high on methamphetamine (AOR = 28.56) were both significantly related to acquiring HCV infection. Of all the practices and behaviors, having sex while using methamphetamine was most strongly associated with HCV infection

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Does this surprise anyone? Not me.

[Miss Philicia]

Maybe I missed it, but like other studies of urban gay men it fails to take into account the rampant sharing of nasal contraptions used for recreational drugs. Why is this?

[LM]

I didn't get it very well. If a guy has unprotected sex with another with no drugs, fisting, toys and whatever, is there a risk for HCV?

[mecch]

Maybe I missed it, but like other studies of urban gay men it fails to take into account the rampant sharing of nasal contraptions used for recreational drugs. Why is this?

That's a great point (and one i wasn't aware of --  until a HIV+ friend of mine who battles HCV was describing his close party friends from the 80's who have HCV and he said it must have been coke spoons because these men and women weren't fucking each other nor injecting). 

Why don't they REALLY go into the gritty details?   Another good question.  I dunno.  Why don't you write to them and explain, and ask?

When I seroconverted I got this milk-toast stupid survey from the state hospital on sexual practices.  I called the researchers and explained how unperceptive, imprecise, mistargeted, and just dumb their questions and possible answers were and they just couldn't handle the TMI (too-much-information) I was suggesting they consider.

[mecch]

I didn't get it very well. If a guy has unprotected sex with another with no drugs, fisting, toys and whatever, is there a risk for HCV?

Well that's the big question.  What one would extrapolate is that where there is drug use and "hard" sex, there is tearing and therefore blood-blood transmission, or sperm and receptive cells.   I don't know why they can't come out with the logical hypothesis, rather seem to lay it on meth -- when obviously the meth isn't infected. 

The "no ejaculation" seems like an iffy self-report prone to error, by the way.

By blood or by sperm, the transmission is done.  (HIV+ men with HCV are more like to have HCV in their sperm than HIV- men.)

[freaky_dream]

Seriously though I am surprised how many homos are injecting meth (and who knows what else) these days. You did not see this a few years ago now it is pretty common to come across online profiles making references to "slamming", "administration", and the color orange.

[LM]

I thought there wasn't HCV in sperm, at least that's what I read. That you got it sexually because of more hardcore sexual practices and group sex, because of any residual blood.

[mecch]

http://www.eatg.org/eatg/Global-HIV-News/Hepatitis/Hepatitis-C-virus-in-semen-unlikely-to-explain-transmission

I have read different extrapolations of different studies.  The studies show small quantities of HCV in the sperm of some men and the different extrapolations are that it could transmit, or alternatively it is not the likely way.

Here is a group of fisting dildoing barebacking drug taking HIV+ men so it would be a challenge to discover a finding indicating transmission by sperm rather than by blood.  And here the claim is there is no ejaculation.  Which is bizarre to me -- because if someone goes to the trouble of arranging this kind of sex, why wouldn't there also be "breeding" ....   Mysteries....