Clinical Scorecard: Epidemiological Insights and Risk Factors for HCV Infection in MSM With or Susceptible to HIV in Madrid (2022–2024)
At a Glance
Category
Detail
Condition
Hepatitis C virus (HCV) infection and reinfection
Key Mechanisms
Transmission primarily via high-risk sexual behaviors including condomless receptive anal intercourse with multiple partners and drug use in sexual contexts (chemsex/slamsex); injection drug use remains leading global mode
Target Population
Men who have sex with men (MSM) with HIV and MSM on HIV pre-exposure prophylaxis (PrEP)
Care Setting
HIV clinics, sexually transmitted infection (STI) clinics, and hospital-based cohorts in Madrid region
Key Highlights
Baseline HCV prevalence higher in MSM with prior HCV exposure (5.60%) compared to those without (0.72%), prevalence ratio 7.72
Overall HCV incidence 1.45/100 person-years; reinfection incidence notably higher (4.32/100 PY) especially among PrEP users (12.90/100 PY)
Independent risk factors for HCV infection and reinfection include slamsex and condomless receptive anal intercourse with ≥4 partners
Guideline-Based Recommendations
Diagnosis
Screen MSM with or at risk for HIV for HCV using serologic assays with confirmatory HCV-RNA testing
Perform regular STI screening including syphilis, chlamydia, and gonorrhea by PCR at multiple anatomical sites
Implement behavior-informed prevention strategies targeting high-risk sexual practices to reduce transmission
Monitoring & Follow-up
Schedule follow-up visits at baseline, 3, 6, 9, and 12 months for MSM on PrEP and baseline, 6, and 12 months for MSM with HIV
Monitor liver enzymes and HCV-RNA longitudinally to detect new infections and reinfections
Risks
High-risk sexual behaviors including slamsex and condomless receptive anal intercourse with multiple partners increase risk of HCV acquisition and reinfection
Prior HCV exposure markedly increases risk of reinfection regardless of HIV status
Patient & Prescribing Data
MSM with HIV and MSM on PrEP in Madrid region
DAA therapy is widely accessible and effective; however, reinfections remain common especially among those engaging in high-risk behaviors, underscoring need for integrated behavioral interventions
Clinical Best Practices
Integrate routine HCV screening into HIV and PrEP care programs for MSM
Address behavioral risk factors including chemsex/slamsex through counseling and harm reduction
Use multidisciplinary approaches combining antiviral treatment with prevention strategies to sustain HCV elimination efforts
Maintain epidemiological surveillance to monitor incidence and reinfection trends in high-risk populations
by Pablo Ryan, Juan Berenguer, Luis Ramos-Ruperto, Mar Vera, Luz Martín-Carbonero, Leire Pérez-Latorre, Ignacio De los Santos, Adriana Pinto, María J Vivancos, Eva Orviz, Beatriz Álvarez, José Sanz, Pilar Ruiz-Seco, Rafael Torres, Beatriz Brazal, Marta De Miguel, Beatriz López-Centeno, Inmaculada Jarrín, Salvador Resino, José M Bellón, Juan González-García, GeSIDA 12121-CoRIS Cohort 08_2021 ATHENS study group
