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SNAHC pilot - Surveillance of Newly Acquired Hepatitis C in men who have sex with men

SNAHC image SNAHC pilot- Surveillance of Newly Acquired Hepatitis C in men who have sex with men

Hepatitis C (HCV) is a blood borne virus. Infection is commonly asymptomatic. The majority of infected individuals cannot clear HCV, and infection persists for many years leading to chronic liver disease, and in some cases hepatocellular carcinoma . In the UK, the main risk factor for HCV is injecting drug use (IDU). (see hepatitis C link below for general information). However, there has been an increase in HCV among men who have sex with men (MSM) in the United Kingdom.

Information about SNAHC

In recent years there have been an increasing number of reports of newly acquired HCV infections among HIV positive men who have sex with men (MSM) in London as well as several other major cities in Europe. HCV transmission in MSM is thought to occur primarily through sexual contact.

A 2006 joint HPA, British Association for Sexual Health and HIV (BASHH), and British HIV Association (BHIVA) survey of genito-urinary medicine (GUM) and HIV clinics across London and the Southeast Region found a total of 389 cases of newly acquired HCV in HIV+MSM between 2002 and June 2006. Incidence estimates from these data suggested a statistically significant, 20% year-on-year increase in incidence in HIV positive MSM over the study period. Only six cases were reported in MSM with negative or unknown HIV status (although less frequent routine HCV testing in MSM not known to be HIV positive in may have resulted in fewer cases being detected).

Dual HIV/HCV infection has significant impact on morbidity and mortality.

Although treatments and clinical management are improving, large gaps in our knowledge remain with regards to its epidemiology (such as how common is the infection among MSM) and risk factors associated with infection among MSM.
In response, the HPA is piloting the enhanced surveillance of newly acquired hepatitis C infections (SNAHC) among MSM attending HIV and GUM clinics in London, Brighton Hastings, Eastbourne, Oxford and Southampton. The SNAHC pilot is endorsed by BHIVA and BASHH.
The key objectives of the SNAHC pilot are to:

  • To assess the burden of newly acquired HCV in MSM attending GUM/HIV clinics in London and the South East
  • To monitor trends in newly acquired HCV in MSM over time and geographical areas
  • To monitor behavioural risk factors for acquisition of HCV
  • To inform public health interventions and prevention initiatives

 

Surveillance definitions of a newly acquired HCV case for MSM

A newly acquired hepatitis C case in MSM will be defined as:

  • Documented anti-HCV sero-conversion
  • HCV antibody positive and had a documented negative HCV antibody within the previous 36 months
  • Probable case
  • HCV RNA positive AND HCV antibody negative or equivocal

The pilot will be evaluated in late 2008 to inform the roll-out across England.

For more information on the project:

SNAHC Background (PDF, 125 KB)

SNAHC Protocol (PDF, 277 KB)

SNAHC Form (PDF, 61 KB)

hep c SNAHC case Reporting (PDF, 113 KB)

 

Related information

BHIVA guidelines for HIV and Hepatitis C coinfection: http://www.bhiva.org/cms1191560.asp
General information on hepatitis C: 


Project contact details

Dr. Samuel Lattimore
Senior Scientist
HIV and STI Department - HIV and AIDS Reporting Section
Health Protection Agency
Centre for Infections

Tel: +44 (0)20 8327 7420
Email: Sam.Lattimore@hpa.org.uk

 

Dr Valerie Delpech
Consultant Epidemiologist
HIV and STI Department - HIV and AIDS Reporting Section
Health Protection Agency
London Regional Epidemiology Unit

Tel: +44 (0)20 7759 6270
Email: valerie.delpech@hpa.org.uk


Last reviewed: 25 May 2010