HCV and HIV share common routes of acquisition. The risk of sexual (permucosal) transmission of HCV in people with HIV is increased, and the majority of sexual transmission of HCV occurs in HIV-positive people, particularly in men who have sex with men (MSM). High-risk practices include fisting, sharing sex toys, group sex and concurrent use of recreational drugs, particularly drugs absorbed through the mucosa.97 Unprotected anal intercourse alone has been associated with an increased risk of HCV transmission.
Education and discussion about harm reduction strategies to prevent parenteral or sexual transmission of HCV are important. HIV pre-exposure prophylaxis has no efficacy in preventing the transmission of HCV. Those wishing to minimise their exposure risk of HCV should be advised of safer sex practices, including condom use. Access to peer and social support; psychological, alcohol and drug counselling; and information about preventing transmission of HIV and HCV by parenteral and sexual routes and avoidance of HCV reinfection should be provided.
All people who are infected with HIV should be tested for HCV, and all HCV-positive people should be tested for HIV. It is recommended that people who are HIV-positive should be screened with HCV serological testing annually. Those who are at high risk of HCV acquisition should be rescreened using 3–6-monthly liver function tests, with HCV RNA PCR performed in the setting of an unexplained rise in transaminase levels. HIV-positive individuals who achieve SVR after DAA therapy remain at risk of reinfection with HCV and should continue to be screened with annual HCV RNA PCR and 3–6-monthly liver function test monitoring.