Hepatitis C: A South African literature review and results from a burden of disease study among a cohort of drug-using men who have sex with men in Cape Town, South Africa

Background. Hepatitis C virus (HCV) is a chronic infection of increasing importance, especially among people living with HIV/AIDS. Co-infection with HIV can accelerate progression of HCV liver disease to cirrhosis and end-stage liver failure and elevate the risk of hepatocellular carcinoma. Globally, men who have sex with men (MSM) and people who inject drugs are at increased risk of HCV infection compared with the general population. Few studies on HCV in these key populations have been done in South Africa (SA). Objective. To describe the disease burden of HCV in drug-using MSM who attend harm-reduction services at the Anova Health Institute’s Health4Men clinic in Cape Town, SA. Methods. In 2012 - 2014, attendees of an MSM-focused harm-reduction programme were invited to participate in our study. After informed consent, participants completed a brief demographic questionnaire and underwent phlebotomy for anti-HCV antibody, hepatitis B virus (HBV) surface antigen and surface antibody testing. Participants received counselling and education with regard to their results. HIV status was extracted from the case notes of participants who had previously been tested at the study site. Data were analysed using standard statistical techniques. Results. Forty-one MSM were enrolled – 11 (27.0%) tested anti-HCV antibody-positive, indicating prior exposure to HCV or chronic infection; 10/11 (91.0%) were positive for HBV surface antibodies, suggesting previous HBV exposure or vaccination; and 1 (2.0%) screened positive for HBV. Of the HCV-seropositive individuals, HIV status was known in 8/11; 3/8 (37.5%) were HIV-positive. Conclusion. We demonstrated a high burden of HCV exposure or infection among a small urban cohort of MSM who inject drugs. We recommend active screening of MSM (especially those who report drug use) for HCV, and the development of referral networks for access to treatment.