ACUTE hepatitis C is being recognized in a high-risk sexual well being cohort in Madrid, with most instances occurring amongst males who’ve intercourse with males (MSM) and a considerable proportion reporting chemsex and slamsex. The findings additionally spotlight a low spontaneous clearance price and ongoing gaps in linkage to care.
Chemsex Patterns in Acute Hepatitis C Circumstances
The examine recognized 92 instances of acute or current hepatitis C virus (HCV) an infection between January 2023 and January 2025. Practically all instances (98.9%) occurred in MSM, with most sufferers both dwelling with HIV (76.1%) or utilizing HIV pre-exposure prophylaxis (PrEP) (20.7%).
Chemsex was reported by 78.3% of sufferers. On this examine, chemsex refers back to the intentional use of psychoactive substances in sexual contexts. Inside this subgroup, 52.8% additionally reported slamsex, outlined as injecting of medication throughout sexual exercise.
Of the 54 with extra accessible knowledge, 17 had concurrent sexually transmitted infections, indicating overlapping sexual well being dangers on this cohort.
Affected person Profile and Viral Traits
The median age was 43 years, with 26.1% aged over 50 years. HCV genotype knowledge from 84 sufferers confirmed genotype 1a in 59.8%, genotype 4 in 22.8%, and genotype 1b in 8.7%.
Viral burden was substantial, with HCV RNA exceeding 6 log in 44.6% of sufferers and seven log in 19.6%, indicating excessive ranges of viraemia in a major subset of instances. Interpretation of those findings ought to consider that greater than three-quarters of sufferers have been dwelling with HIV, which can have influenced the medical traits noticed on this cohort.
Low Spontaneous Clearance and Remedy Pathways
Most sufferers (79.3%) have been initially managed with watchful ready and reassessed at 12 weeks to guage spontaneous clearance. Nonetheless, clearance occurred in solely 6.8% of these noticed.
Following reassessment, 68 of 73 sufferers (93.2%) proceeded to direct-acting antiviral remedy, whereas a smaller quantity acquired speedy remedy at prognosis. Amongst handled sufferers, sustained virological response was achieved, indicating efficient viral eradication when remedy was accomplished.
Comply with-Up Gaps and Service Implications
Loss to follow-up earlier than remedy initiation occurred in 10.9% of instances, elevating issues about continuity of care inside affected providers. That is regarding given the elevated threat profile of this inhabitants. The mixture of delayed remedy initiation and affected person attrition highlights challenges in sustaining engagement throughout sexual well being and HIV care pathways.
The sample of excessive chemsex involvement, low spontaneous clearance, and remedy attrition helps requires strengthened HCV testing, improved linkage to care, and built-in hurt discount and substance use help inside HIV and PrEP providers.
Reference
Asensi Díaz E et al. Acute hepatitis C associated to chemsex: insights from a Spanish cohort. Intercourse Transm Infect. 2026;DOI:10.1136/sextrans-2025-056844.
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