Hepatitis C incidence is higher among gay and bisexual men using pre-exposure prophylaxis (PrEP) compared to their HIV-positive peers, flagging another potential hurdle in meeting global elimination targets, a large study shows.

Although injecting drug use remains the main driver of hepatitis C virus (HCV) prevalence, the researchers say that as PrEP use rises, “greater HCV transmission might occur”.

In a global systematic review and meta-analysis of 194 studies, the team from the Kirby Institute at UNSW Sydney analysed data from 213,000 individuals to determine both HCV prevalence and incidence in men who have sex with men (MSM).

After excluding studies where at least 70% of participants were injecting drug users, they found the overall pooled estimate for HCV seroprevalence in MSM was 3.4%, which was lower than 4.7% pooled estimate reported three years ago.