Scaling up epidemics of acute hepatitis C and syphilis in HIV ‐infected men who have sex with men in Spain

Background Outbreaks of acute hepatitis C in HIV ‐positive men who have sex with men ( MSM ) are being reported in large cities in western countries along with increasing rates of sexually transmitted diseases. Methods All HIV individuals attended at a large outclinic in Madrid within the last 5 years were examined. Incident syphilis was diagnosed based on rapid plasma reagin ( RPR ) reactivity, being negative previously or showing >4‐fold increase. Acute hepatitis C was diagnosed based on HCV antibody seroconversion and/or positive serum HCV ‐ RNA after being negative within the last year. Results A total of 859 episodes of syphilis and 19 of acute hepatitis C were diagnosed during the study period. Syphilis was recognized in 65/2,094 (3.1%) individuals attended in 2008 and rose up to 261/2,512 (10.4%) in 2012 ( P  < 0.001). Acute hepatitis C was diagnosed in only one subject in 2008 but rose up to 7 in 2012 ( P  = 0.12). All 19 HIV patients with acute hepatitis C were MSM . Syphilis was diagnosed concomitantly in seven. All eight individuals who were treated with peginterferon/ribavirin were cured, whereas only one untreated experienced spontaneous clearance ( P  = 0.004). Two clusters of infections by HCV genotypes 4 and 1a were identified by phylogenetic analyses. Conclusions The incidence of acute hepatitis C is low but steadily increasing in HIV ‐positive MSM in Madrid (<1% yearly), despite the very high rates of syphilis (currently 20% yearly in HIV ‐positive MSM ). Preventive measures for sexually transmitted infections and periodic HCV screening are warranted in this population as treatment of acute hepatitis C is very effective.