Christoph Boesecke - European ChemSex Forum 2016, London

1. Co-infection linkages
Christoph Boesecke
Department of Medicine I
Bonn University Hospital
Germany

2. Among STIs two diseases of particular interest:
• (Acute) Hepatitis C
• HIV

3. Sparse published data

4. Boesecke et al, Liver Int 2015
Acute HCV as an indicator disease for Chemsex?
HCV Seroconversions in EuroSIDA
0
200
400
600
800
1000
1200
1400
1600
1800
0,00
0,50
1,00
1,50
2,00
2,50
3,00
3,50
4,00
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
TotalHCVAbtest
Percentageofpositivetests
(95%Confidenceinterval)
Calendar year
Positive test % Total HCVAb tests
No. tested
participants: 797 992 1091 1242 1374 1302 1515 1398 1511 1455 1572 1300
No. coinfected
In EuroSIDA: 1685 1850 1955 2089 2370 2283 2682 2578 2428 2343 2647 2460
Multivariable OR:
Tested for HCVAb: 1.07 (1.06 – 1.08; p<0.0001) per calendar year
Testing HCVAb positive: 1.04 (0.99 – 1.09; p=0.10) per calendar year

5. Schmidt et al. PLoS ONE 2011
First hints:
Risk factors for acute HCV in HIV+ MSM

6. • Optional part of PROBE-C
• 3x per individual follow-up of 3 years
• 49 questions regarding social background, sexual behaviour, use of
recreational drugs

7. • In total, 496 questionnaires collected (313 baseline, 112 week 48, 71 week 144)
• 65% from Germany
• Median age: 41 years (IQR 34 – 47)
%
%

8. %
%
%

9. %
%

10. • Online survey, Berlin: 287 participants
• 20.9% HIV+, of which 21.7% HCV+
• # sex partners in previous 12 mths:
• 11-50: 58.3% in HIV+, 15.4% in HIV-
• >50: 23.3% in HIV+, 7.5% in HIV-
• 14% Crystal Meth users: 21.7% in HIV+, 8.4% in HIV-
• 2/3 of HIV+ crystal users using additional drugs (cocaine,
ketamine)
• Slamming only reported by 2
• Rest: snorting, >50% sharing devices
Party Time! Wilke T & Berliner AIDS-Hilfe 2015

11. Bourne A et al, International Journal of Drug Policy2015
• Interviews with 30 community-recruited gay men in South London
• Reported use of crystal methamphetamine, mephedrone or GHB/GBL either
immediately before or during sex with another man during the previous 12
months.
• Mostly mephedrone and crystal methamphetamine were snorted.
• A third of participants had injected either one or the other.
• A majority described overdoses, particularly in relation to GHB/GBL.

12. 91,477 men from 38 countries
Kramer SC et al, BMC Public Health 2016

13. • Positive Voices: online survey with 777 HIV+ participants (MSM n=532)
• 30 HIV clinics in England and Wales between May-November 2014
Chemsex @ CROI 2016
Pufall EL et al, CROI 2016 #913
n=387

14. Bourne A et al, Sex Transm Infect 2015
• Interviews with 30 community-recruited gay men (age range 21–53) in
South London
• Reported use of crystal methamphetamine, mephedrone or GHB/GBL either
immediately before or during sex with another man during the previous 12
months.
• Around one-third of participants described multiple instances of unintended
sexual risk behaviour that they directly attributed to drug use.
• Conversely, around a quarter of participants felt in control of their drug use,
and maintained strict personal rules about sexual risk management.

15. Missed opportunities:
Acute HCV in HIV negative MSM
McFaul K, J Viral Hepat 2015
HIV negative MSM
attending for sexual
health screening
n=3811
Tested for HCV
n=565 (14.82%) 44 (8%) acute HCV