High prevalence of hepatitis C infection among MSM in Baltimore: The BESURE study

Introduction: Hepatitis C (HCV) infection is an under-appreciated health concern among men who have sex with men (MSM). Baltimore data showed 16% HCV prevalence among venue-recruited MSM in 2004-05. We examined HCV prevalence and associated risk factors in a comparable 2011 sample for congruence to early reports and identification of current prevention and treatment implications. 

Methods: Cross-sectional study of 400 venue-recruited Baltimore MSM with a male partner in the past year, as part of CDC's National HIV Behavioral Surveillance (NHBS) project. Behavioral data and blood specimens for HIV and HCV testing were collected August-December 2011. Bivariate and multivariate logistic regression examined factors associated with HCV.

Results: Participants were 76% African-American, 58% under 35, and 42% HIV-positive. HCV prevalence was 14.3% overall; 60% among the 35 MSM with injection drug use history (IDU), 10% among those with no IDU; 22% among HIV-positive MSM and 9% among HIV-negative MSM. 61% of those who tested HCV positive reported no prior HCV diagnosis. Among never-IDU MSM, HCV was significantly associated with increased age, being HIV positive, and sexual risk behavior. Controlling for age and HIV status, HCV among never IDU MSM was positively associated with reporting any sex exchange male partners (A.O.R. 2.24, 95% CI: 1.01, 4.91) and multiple casual male partners (A.O.R. 2.53, 95% CI: 1.06, 6.49).

Conclusions: HCV prevalence among Baltimore MSM, including among HIV-positive and non-IDU MSM, is consistent with prior local reports and higher than published reports from other settings. Data supports non-injection pathways to infection among MSM. There is a strong need for HCV prevention, screening, treatment, and research among MSM in this setting and elsewhere.