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Advances in dermatology and venereology Acta Dermato-Venereologica
An HIV-negative Same-sex Male Couple Both Infected with Hepatitis C Virus
Roeland C. A. ACHTERBERGH 1, Sylvia M. BRUISTEN 1, 2, Thijs J. W. V. D. LAAR 3, Charlie P. VAN DER WEIJDEN 4, Maarten SCHOLING 1, 5, Marion CORNELISSEN 2, 6 and Henry J. C. DE VRIES 1, 2, 7
1
Department of Infectious Diseases, Public Health Service Amsterdam, Nieuwe Achtergracht 100, NL-1018 WT Amsterdam, 2 Amsterdam Infection and Immunity Institute( AI & II), Academic Medical Center, University of Amsterdam, 3 Department of Blood-borne Infections, Sanquin Blood Supply, Amsterdam, 4 Public Health Service Flevoland, Lelystad, 5 Department of Medical Microbiology, OLGV General Hospital,
6
Laboratory of Experimental Virology, Department of Medical Microbiology, and 7 Department of Dermatology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. E-mail: h. j. devries @ amc. uva. nl Accepted Aug 9, 2017; Epub ahead of print Aug 10, 2017
Hepatitis C virus( HCV) has emerged as a sexually transmitted infection( STI) in human immunodeficiency virus( HIV)-positive men who have sex with men( MSM), whereas HIV-negative MSM remain largely unaffected. This case report describes 2 HIV-negative MSM in a long-term relationship who sequentially acquired a highly similar HCV strain based on NS5B sequencing( 340 nt). Screening of high-risk MSM for HCV, irrespective of HIV status, should be considered.
CASE REPORT
After the introduction of combination antiretroviral therapy( cART) in 1996, hepatitis C virus( HCV) has rapidly emerged as a STI among( HIV)-positive MSM( 1). Although HIV is no prerequisite for sexual transmission of HCV, HIV-negative MSM have remained largely unaffected( 2). In recent years, however, the number of case reports of sexually acquired HCV among HIV-negative MSM is increasing steadily( 2 – 5). We previously described 4 HIV-negative MSM who were infected with HCV strains that specifically circulated among HIV-positive MSM( 2). All 4 HIVnegative MSM reported HIV-positive sexual partners, which suggested incidental sexual transmission of HCV from HIV-positive MSM to HIV-negative MSM. The current case report describes 2 HIV-negative MSM in a long-term relationship, who sequentially acquired HCV strains with nearly identical NS5B gene fragments. Both strains are part of a cluster of equally similar HCV strains that have been circulating among HIV-positive MSM. This case report underlines once again that HCV sexual transmission occurs in HIV-negative MSM and emphasizes the potential threat of HCV spreading to, and within, the HIV-negative population.
In February 2015, 2 HIV-negative men in a long-term open relationship, tested positive for HCV antibodies after being warned about an HCV infection by a third partner with symptoms of acute HCV with whom both had had sexual contact. The presence of HCV infection was confirmed by HCV RNA testing. Patient A( 45 years) and B( 41 years) both reported serosorting, by jointly engaging in sex parties for presumed HIV-negative men only. Both men had receptive and insertive anal sex with approximately 20 partners in the last 6 months. They reported practicing negotiated safety( i. e. they always used condoms with third partners, but not when having sex with each other). Both men participated in group sex, and reported performing anal fisting but never without using nitrile gloves. Sex toys were shared but always cleaned with anti-bacterial soap before changing partners. Both men reported recreational oral and intranasal drugs during sex, e. g. gammahydroxybutrate( GHB), ketamine and cocaine, but they had never injected drugs. Despite their attempts to reduce the risk of STI, both men had been diagnosed with multiple STIs at the Amsterdam STI clinic; patient A with anorectal chlamydia( 2011) and anorectal gonorrhoea( 2014), patient B with gonorrhoea( 2008, 2010 and 2013) and urogenital chlamydia( 2010)( Fig. 1). At the time of HCV diagnosis they had no other STIs. Both men were seronegative for HIV and syphilis 3 months after their HCV diagnosis. Contact tracing was initiated to detect additional HCV cases among the sexual partners of patients A and B. Of the 20 sexual partners during the 6 months prior to HCV diagnosis, 11 were reached. All tested HCV-negative. Unfortunately the person who initially warned the couple could not be reached, and another sexual partner who was allegedly HIV-negative and HCV-positive refused testing.
To determine the time of HCV seroconversion, we retrospectively tested stored serum samples from previous STI clinic visits. Patient A seroconverted between October 2008 and January 2011, and patient B between October 2012 and January 2013( Fig. 1). Both men were infected with HCV genotype 1a. A 436-bp fragment of the NS5B gene was amplified, sequenced and compared with 73 HCV strains obtained from HIV-positive MSM diagnosed with HCV-1a during the period 2000 to 2010( 1, 6). A phylogenetic tree was constructed using the maximum-likelihood approach using a general time-reversed substitution model with g distribution assuming a certain fraction of evolutionary invariable sites( GTR + G + I)( Fig. S1 1). Both patients A and B were part of a large MSM-specific HCV cluster( MSM-1) along with 34 HIV-positive MSM.
1 https:// www. medicaljournals. se / acta / content / abstract / 10.2340 / 00015555-2764
Fig. 1. Timeline of 2 human immunodeficiency virus( HIV)-negative men who have sex with men( MSM) who seroconverted for hepatitis C virus( HCV) antibodies. Tests were performed respectedly since 2008. Ng: Neisseria gonorrhoea; Ct: Chlamydia trachomatis; –: negative sexual transmitted infection( STI) test. § Warned by a third partner with symptoms of acute HCV.
This is an open access article under the CC BY-NC license. www. medicaljournals. se / acta Journal Compilation © 2017 Acta Dermato-Venereologica. doi: 10.2340 / 00015555-2764 Acta Derm Venereol 2017; 97: 1255 – 1257