Evidence of sexual acquisition of hepatitis C virus (HCV) among men who have sex with men (MSM) receiving pre-exposure prophylaxis through a San Francisco clinic has prompted a call for routine monitoring for the virus among PrEP users. In a letter to the editor in Clinical Infectious Diseases, clinicians from Kaiser Permanente San Francisco Medical Center describe new cases of hep C among two men out of 485 HIV-negative MSM receiving PrEP at the clinic between February 2011 and December 2014.
Considering the infections occurred during 304 person-years of follow-up, the hep C incidence rate was 0.7 per 100 person-years. This infection rate is lower than those observed among populations of HIV-positive MSM in published research. But the two cases add evidence to previous findings that the risk of sexual transmission of hep C is likely not reserved to those who are living with HIV. Additionally, however small the risk of hep C may be, its existence adds to the larger dialogue about having sex without a condom while on PrEP (or not on it, for that matter).
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