Author: Harney B, Stoové M, Sacks-Davis R , van Santen DK, Fairley C, Medland N, O’Reilly M, Moore R , Tee BK, Sasadeusz J, Iser D, Roney J, Hoy J, Matthews G, Gane E, Prins M, Hellard M, Doyle J

Theme: Epidemiology & Public Health Research Year: 2019

Background: Hepatitis C virus (HCV) elimination among gay and bisexual men (GBM) living with HIV
is feasible in many high-income countries. There is concern that risk behaviours following treatment
may lead to reinfection and adversely impact HCV elimination goals. We examined risk behaviours
prior to and following HCV treatment commencement among sexually active GBM living with HIV.
Methods: Data were drawn from co-EC, a prospective study aiming to treat and eliminate HCV
among people living with HIV. Pre and post-HCV treatment commencement changes in self-reported
sexual and injecting drug-related behaviours among sexually active GBM attending primary and
tertiary care clinics in Melbourne were assessed using McNemar’s test. Modified Poisson regression
with robust variance was used to examine factors associated with risk behaviours following
treatment commencement.
Results: Of 173 males who started treatment, 120 completed a pre and post-treatment
commencement questionnaire of who 90 reported ≥1 male sex partner before and/or after
treatment commencement. Among these 90 sexually active GBM, there was no significant change
pre to post-treatment in condom-less anal intercourse with casual partners (52.5%/56.6%, p 0.513)
or injecting drug use (41.2%/45.9%, p 0.344), but a significant decrease in group sex (34.4%/21.1%, p
0.011). Post-treatment commencement, condom-less intercourse (adjusted prevalence ratio (aPR)
1.80, 95%CI 1.07-3.03, p 0.026) and group sex (aPR 4.53, 95%CI 1.76-11.67, p 0.002) was highest
amongst those who had reported these behaviours pre-treatment. Post-treatment commencement,
injecting drug use was associated with the use of crystal methamphetamine during follow-up (aPR
4.36, 95%CI 1.27-14.94, p 0.019).
Conclusion: HCV-related risk behaviours were common among sexually active GBM before and after
HCV treatment and primarily occurred among the same men. There was no significant increase in
risk behaviours. More frequent post-treatment HCV testing may be justified among GBM engaging in
these behaviours to identify potential HCV reinfection and provide prompt re-treatment to prevent
further transmission.
Disclosure of Interest Statement: Investigator initiated funding was received from Bristol MyersSquibb for co-EC. The funders had no input in these analyses or the decision to submit.

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