• Hellard, Margaret E.
• Traeger, Michael
• Stoové, Mark A.
• Cornelisse, Vincent J.
• Wright, Edwina J.
• Doyle, Joseph S.
• Santen, Daniela K. Van
• Harney, Brendan L.
• Sacks-Davis, Rachel

Abstract

<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Gay and bisexual men using HIV pre-exposure prophylaxis (PrEP) are at increased risk for sexually transmissible infections. Hepatitis C virus (HCV) risk among PrEP users is less clear. We explored HCV prevalence and incidence among cohorts of gay and bisexual men using PrEP and sources of heterogeneity across studies.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>This was a systematic review and meta-analysis of open-label PrEP studies to April 2022 reporting HCV prevalence at baseline or incidence during follow-up among gay and bisexual men using PrEP. Pooled prevalence and incidence estimates were calculated using random-effects meta-analysis, and subgroup analyses were performed by study- and country-level characteristics, including availability of HCV direct-acting antiviral (DAA) therapy at time of study.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Twenty-four studies from 9 countries were included, with a total sample of 24 733 gay and bisexual men. Pooled HCV antibody baseline prevalence was 0.97% (95% CI, 0.63%–1.31%), and pooled HCV RNA baseline prevalence was 0.38% (95% CI, 0.19%–0.56%). Among 19 studies reporting HCV incidence, incidence ranged from 0.0 to 2.93/100 person-years (py); the pooled estimate was 0.83/100py (95% CI, 0.55–1.11). HCV incidence was higher in 12 studies that began follow-up before broad DAA availability (1.27/100py) than in 8 studies that began follow-up after broad DAA availability (0.34/100py) and higher in studies in Europe compared with North America and Australia.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Early reports of high HCV incidence among PrEP-using cohorts likely reflect enrollment of individuals based on specific risk-based eligibility criteria for smaller studies and enrollment before DAA scale-up. In contexts where both DAAs and PrEP have been implemented at scale, studies report lower HCV incidence. PrEP-specific HCV testing guidelines should be guided by local epidemiology.</jats:p></jats:sec>

Topics

• impedance spectroscopy
• laser emission spectroscopy
• random
• size-exclusion chromatography
• chemical ionisation