OBJECTIVES:To identify sexual/sex-associated risk factors for hepatitis C transmission among men who have sex with men (MSM) and visualise behavioural trajectories from 2019 to 2021. METHODS:We linked a behavioural survey to a hepatitis C cohort study (NoCo), established in 2019 across six German HIV/hepatitis C virus (HCV) treatment centres, and performed a case-control analysis. Cases were MSM with recent HCV infection, and controls were matched for HIV status (model 1) or proportions of sexual partners with HIV (model 2). We conducted conditional univariable and multivariable regression analyses. RESULTS:In all, 197 cases and 314 controls completed the baseline questionnaire and could be matched with clinical data. For regression models, we restricted cases to those with HCV diagnosed since 2018 (N = 100). Factors independently associated with case status included sex-associated rectal bleeding, shared fisting lubricant, anal douching, chemsex, intravenous and intracavernosal injections, with population-attributable fractions of 88% (model 1) and 85% (model 2). These factors remained stable over time among cases, while sexual partner numbers and group sex decreased during COVID-19 measures. CONCLUSIONS:Sexual/sex-associated practices leading to blood exposure are key factors in HCV transmission in MSM. Public health interventions should emphasize the importance of blood safety in sexual encounters. Micro-elimination efforts were temporarily aided by reduced opportunities for sexual encounters during the COVID-19 pandemic.

HIV MedicineEarly View LETTER TO THE EDITOR Immunological alterations with GLP-1 agonists in people living with HIV Sebastian Noe, Corresponding Author Sebastian Noe [email protected] MVZ München am Goetheplatz, Munich, Germany Correspondence Sebastian Noe, MVZ München am Goetheplatz, Munich, Germany. Email: [email protected]Search for more papers by this authorAnna Ivanova, Anna Ivanova UHasselt, Data Science Institute, Hassel, BelgiumSearch for more papers by this authorCelia Johnsson-Oldenbüttel, Celia Johnsson-Oldenbüttel MVZ München am Goetheplatz, Munich, GermanySearch for more papers by this authorGuido Schäfer, Guido Schäfer ICH Study Center, Hamburg, GermanySearch for more papers by this authorKnud Schewe, Knud Schewe ICH Study Center, Hamburg, GermanySearch for more papers by this authorChristian Hoffmann, Christian Hoffmann orcid.org/0000-0002-1082-8093 ICH Study Center, Hamburg, Germany University Hospital of Schleswig Holstein, Campus Kiel, GermanySearch for more papers by this author Sebastian Noe, Corresponding Author Sebastian Noe [email protected] MVZ München am Goetheplatz, Munich, Germany Correspondence Sebastian Noe, MVZ München am Goetheplatz, Munich, Germany. Email: [email protected]Search for more papers by this authorAnna Ivanova, Anna Ivanova UHasselt, Data Science Institute, Hassel, BelgiumSearch for more papers by this authorCelia Johnsson-Oldenbüttel, Celia Johnsson-Oldenbüttel MVZ München am Goetheplatz, Munich, GermanySearch for more papers by this authorGuido Schäfer, Guido Schäfer ICH Study Center, Hamburg, GermanySearch for more papers by this authorKnud Schewe, Knud Schewe ICH Study Center, Hamburg, GermanySearch for more papers by this authorChristian Hoffmann, Christian Hoffmann orcid.org/0000-0002-1082-8093 ICH Study Center, Hamburg, Germany University Hospital of Schleswig Holstein, Campus Kiel, GermanySearch for more papers by this author First published: 03 March 2024 https://doi.org/10.1111/hiv.13631Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. REFERENCES 1Zino L, Tack CJ, Richel O, Burger DM. GLP-1 agonists for people living with HIV and obesity, is there potential? HIV Med. 2023; 24: 1029-1034. 10.1111/hiv.13521 CASPubMedWeb of Science®Google Scholar 2Aso Y, Fukushima M, Sagara M, et al. Sitagliptin, a DPP-4 inhibitor, alters the subsets of circulating CD4+ T cells in patients with type 2 diabetes. Diabetes Res Clin Pract. 2015; 110: 250-256. 10.1016/j.diabres.2015.10.012 CASPubMedWeb of Science®Google Scholar 3Liberman A, Esser M, Marx N, Burgmaier M. Glucagon-like Peptide-1(9-36) inhibits chemokine-induced migration of human CD4-positive lymphocytes. PloS One. 2013; 8:e58445. 10.1371/journal.pone.0058445 CASPubMedWeb of Science®Google Scholar 4Rode AKO, Buus TB, Mraz V, et al. Induced human regulatory T cells express the glucagon-like Peptide-1 receptor. Cells. 2022; 11: 2587. 10.3390/cells11162587 CASPubMedWeb of Science®Google Scholar Early ViewOnline Version of Record before inclusion in an issue ReferencesRelatedInformation

INTRODUCTION:Direct-acting antivirals (DAAs) are key to eliminating hepatitis C virus (HCV). In men who have sex with men (MSM) with HIV co-infection, recently acquired HCV infection is common. Sexual practices and reinfection rates may hamper micro-elimination despite high treatment rates. METHODS:The cohort included MSM with recently acquired HCV infection from 2014 to 2021. The patients' demographic, clinical, behavioural, and laboratory data and treatment and reinfection outcomes were documented. RESULTS:A total of 237 men with recently acquired HCV infection were included: 216 (91%) had HIV. The median age was 46 years (interquartile range [IQR] 39-52), and the median CD4 count was 660/mm3 (IQR 527-835). The annual incidence of recently acquired HCV remained between 0.28% and 0.43% but dropped to 0.02% in 2021 during the COVID pandemic, almost reaching micro-elimination. The reinfection incidence was 15.5 per 100 patient-years (95% confidence interval 12.6-18.8), and reinfection was associated with the use of crystal methamphetamine (p = 0.032) and ketamine (p = 0.042). In total, 31.3% had multiple reinfections, and four reinfections occurred in users of pre-exposure prophylaxis. CONCLUSIONS:High treatment and cure rates did not lead to HCV elimination. A change in sexual behaviour, potentially imposed by COVID-19 restrictions, led to micro-elimination in the NoCo cohort. As recently acquired HCV is prevalent in MSM with and without HIV, surveillance is necessary to consolidate elimination goals.

Zusammenfassung Hintergrund Untersucht wurden die Auswirkungen der HIV-Präexpositionsprophylaxe (PrEP) als neue Leistung der gesetzlichen Krankenversicherung (GKV) auf das Infektionsgeschehen von HIV und anderen sexuell übertragbaren Infektionen (STI) in Deutschland. Zusätzlich wurden PrEP-Bedarfe sowie Zugangsbarrieren analysiert. Methoden Im Rahmen des Evaluationsprojektes wurden folgende Daten ausgewertet: HIV- und Syphilis-Meldedaten und erweiterte Surveillance des Robert Koch-Instituts (RKI), Apothekenabrechnungsdaten, GKV-Daten, PrEP-Gebrauch in HIV-Schwerpunktzentren, Checkpoint‑, BRAHMS- und PrApp-Studie sowie ein Community-Beirat. Ergebnisse Die PrEP-Nutzenden waren zum größten Teil männlich (98–99 %), zum Großteil im Alter zwischen 25–45 Jahren und überwiegend deutscher Staatsangehörigkeit oder Herkunft (67–82 %). Der Großteil zählte zur Gruppe der Männer, die Sex mit Männern haben (99 %). In Bezug auf HIV-Infektionen zeigte sich die PrEP als hocheffektiv. Es fanden nur vereinzelt HIV-Infektionen statt (HIV-Inzidenzrate 0,08/100 Personenjahre), in den meisten Fällen war der vermutete Grund eine geringe Adhärenz. Die Inzidenzen von Chlamydien, Gonorrhö und Syphilis nahmen nicht zu, sondern blieben nahezu gleich oder gingen sogar zurück. Es zeigte sich Informationsbedarf zur PrEP für Personen in trans*/nichtbinären Communitys, Sexarbeitende, Migrant*innen und Drogengebrauchende. Notwendig wären bedarfsgerechte Angebote für Zielgruppen mit erhöhtem HIV-Risiko. Diskussion Die PrEP erwies sich als eine sehr wirkungsvolle HIV-Präventionsmethode. Die teils befürchteten indirekten negativen Einflüsse auf STI-Raten wurden in dieser Untersuchung nicht bestätigt. Aufgrund der zeitlichen Überschneidung mit den Eindämmungsmaßnahmen während der COVID-19-Pandemie wäre für eine abschließende Beurteilung ein längerer Beobachtungszeitraum wünschenswert.

BACKGROUND:We investigated the impact of HIV pre-exposure prophylaxis (PrEP) as a new service of the statutory health insurance (SHI) on the incidence of HIV and other sexually transmitted infections (STIs) in Germany. In addition, PrEP needs and access barriers were analyzed. METHODS:The following data were evaluated as part of the evaluation project: HIV and syphilis notification data and extended surveillance by the Robert Koch Institute (RKI), pharmacy prescription data, SHI routine data, PrEP use in HIV-specialty care centers, Checkpoint, the BRAHMS and PrApp studies, as well as a community board. RESULTS:The majority of PrEP users were male (98-99%), primarily aged between 25-45 years, and predominantly of German nationality or origin (67-82%). The majority were men who have sex with men (99%). With regard to HIV infections, PrEP proved to be highly effective. There were only isolated cases of HIV infections (HIV incidence rate 0.08/100 person years); in most cases the suspected reason was low adherence. The incidences of chlamydia, gonorrhea, and syphilis did not increase but remained almost the same or even decreased. A need for information on PrEP for people in trans*/non-binary communities, sex workers, migrants, and drug users emerged. Needs-based services for target groups at increased risk of HIV are necessary. DISCUSSION:PrEP proved to be a very effective HIV prevention method. The partly feared indirect negative influences on STI rates were not confirmed in this study. Due to the temporal overlap with the containment measures during the COVID-19 pandemic, a longer observation period would be desirable for a conclusive assessment.

Abstract Introduction Directly-acting antivirals (DAA) are the cornerstone to reach HCV elimination. In men who have sex with men (MSM) with HIV coinfection, recently acquired HCV infection (RAHCV) is common. Sexual practices and reinfection rates may hamper micro-elimination despite high treatment rates. Methods The cohort included MSM with RAHCV from 2014 to 2021. The patients’ demographic, clinical, behavioral, and laboratory data were documented, as well as treatment and reinfection outcomes. Results 237 men with RAHCV were included, 216 (91%) were PLWH. Median age was 46 years (IQR: 39–52), median CD4 count was 660/mm3 (IQR: 527–835). The annual incidence of RAHCV remained between 0.28% and 0.43%, but dropped to 0.02% in 2021 during the onset of the COVID-pandemic almost reaching micro-elimination. The reinfection incidence was 15.5 per 100 patient-years (95%-CI: 12.6-18.8), reinfection was associated with use of crystal methamphetamine (p=0.032) and ketamine (p=0.042). 31.3% had multiple reinfections, four reinfections occurred in PrEP users. Conclusions High treatment and cure rates did not lead to HCV elimination. A change in sexual behavior, potentially imposed by COVID-19 restrictions, led to micro-elimination in the NoCo cohort. As RAHCV is prevalent in HIV-positive and -negative MSM, surveillance is necessary to consolidate elimination goals.

Eine hohe Anzahl von Menschen, die mit HIV leben, werden erst in einem fortgeschrittenen Stadium der Infektion diagnostiziert, was mit einer erhöhten Morbidität, Mortalität sowie erhöhten Kosten einhergeht. Ziel der FindHIV Studie ist die Entwicklung eines Scoring-Instrumentes zur Beförderung einer frühzeitigen Diagnose von HIV Infektionen. Bundesweit wurden Daten von Menschen mit neuer HIV Diagnose in den letzten 6 Monaten zu Symptomen und Erkrankungen erhoben, die als verpasste Chancen einer früheren HIV Diagnosestellung gewertet werden können. Basierend auf den Ergebnissen wurde ein Scoring-Instrument zur Beförderung einer frühzeitigen HIV Diagnosestellung entwickelt, welches in Fokusgruppen diskutiert und daraufhin angepasst wurde. Die am häufigsten angegebenen Symptome/Erkrankungen mit verpassten Chancen einer Diagnose der HIV Infektion wurden in das Scoring-Instrument aufgenommen. Dazu zählten ungeklärter Gewichtsverlust, ungeklärtes Fieber oder Nachtschweiß, allgemeine Leistungsminderung, Hautausschlag, chronische Durchfälle ohne nachgewiesene Erreger, akuter hochfieberhafter Infekt, Lymphadenopathie, sexuell übertragbare Erkrankungen, Indikator-/HIV-assoziierte Erkrankungen sowie AIDS-definierende Erkrankungen. Zusätzlich zum Scoring-Instrument wurden Handlungsempfehlungen erstellt. Das entwickelte Scoring-Instrument hat das Potential, Aufmerksamkeit für die HIV-Infektion zu schaffen und bei Anwendung eine frühzeitige Diagnosestellung zu befördern.

Delayed HIV diagnosis at advanced stages of disease remains common (33%-64%). This analysis of the multi-center FindHIV study including newly diagnosed HIV-infected adults in Germany, focused on the potential role of socio-demographic and psychological factors on late diagnosis (formerly "late presentation", AIDS diagnosis or CD4 cells <350/mu L). These data were collected from patient profiles, physician-patient interviews and questionnaires. Participating centers (n = 40) represented the diverse health care settings in HIV care and geographic regions. Of 706 newly diagnosed adults (92% male, median age 39 years) between 2019 and 2020, 55% (388/706) were diagnosed late with a median CD4 cell count of 147/mu L; 20% (142/706) presented with AIDS. From the physicians' perspective, earlier diagnosis would have been possible in 45% of participants (late versus non-late presentation 58% versus 29%). The most common physician-perceived reason was an underestimated risk for HIV infection by the patient (37%). In multivariable logistic regression analysis, older age, sexual contacts with both sexes as possible route of HIV transmission, being married, and a poor level of knowledge about HIV treatment were found to be associated with a significantly elevated risk for late presentation. Education, employment status, sexual relations, migration background and personality traits were not.

In den westlichen finanzstarken Ländern sinken seit einigen Jahren die HIV-Infektionen.Dahingegen steigen die Inzidenz und Prävalenz bei den anderen STI wie Syphilis und

BACKGROUND:The ongoing monkeypox virus outbreak includes at least 7553 confirmed cases in previously non-endemic countries worldwide as of July 2022. Clinical presentation has been reported as highly variable, sometimes lacking classically described systemic symptoms, and only small numbers of cutaneous lesions in most patients. The aim of this study was to compare clinical data with longitudinal qPCR results from lesion swabs, oropharyngeal swabs and blood in a well characterized patient cohort.METHODS:16 male patients (5 hospitalized, 11 outpatients) were included in the study cohort and serial testing for monkeypox virus-DNA carried out in various materials throughout the course of disease. Laboratory analysis included quantitative PCR, next-generation sequencing, immunofluorescence tests and virus isolation in cell culture.RESULTS:All patients were male, between age 20 and 60, and self-identified as men having sex with men. Two had a known HIV infection, coinciding with an increased number of lesions and viral DNA detectable in blood. In initial- and serial testing, lesion swabs yielded viral DNA-loads at, or above 106 cp/ml and only declined during the third week. Oropharyngeal swabs featured lower viral loads and returned repeatedly negative in some cases. Viral culture was successful only from lesion swabs but not from oropharyngeal swabs or plasma.DISCUSSION:The data presented underscore the reliability of lesion swabs for monkeypox virus-detection, even in later stages of the disease. Oropharyngeal swabs and blood samples alone carry the risk of false negative results, but may hold value in pre-/asymptomatic cases or viral load monitoring, respectively.

Introduction Objectives of this study, as part of a nation-wide HIV pre-exposure prophylaxis (PrEP) evaluation project, were to determine the incidence of infections with HIV, chlamydia, gonorrhea, syphilis, hepatitis A/B/C in persons using PrEP, and to describe the health care funded PrEP use in Germany. Additionally, factors associated with chlamydia/gonorrhea and syphilis infections were assessed. Methods Anonymous data of PrEP users were collected at 47 HIV-specialty centers from 09/2019–12/2020. Incidence rates were calculated per 100 person years (py). Using longitudinal mixed models, we analyzed risk factors associated with sexually transmitted infections (STIs). Results 4620 PrEP users were included: 99.2% male, median age 38 years (IQR 32–45), 98.6% men who have sex with men (MSM). The median duration of PrEP exposure was 451 days (IQR 357–488), totaling 5132 py. Four HIV infections were diagnosed, incidence rate 0,078/100py (95% CI 0.029–0.208). For two, suboptimal adherence was reported and in the third case, suboptimal adherence and resistance to emtricitabine were observed. One infection was likely acquired before PrEP start. Incidence rates were 21.6/100py for chlamydia, 23.7/100py for gonorrhea, 10.1/100py for syphilis and 55.4/100py for any STI and decreased significantly during the observation period. 65.5% of syphilis, 55.6% of chlamydia and 50.1% of gonorrhea cases were detected by screening of asymptomatic individuals. In a multivariable analysis among MSM younger age, PrEP start before health insurance coverage and daily PrEP were associated with greater risk for chlamydia/gonorrhea. Symptom triggered testing and a history of STI were associated with a higher risk for chlamydia/gonorrhea and syphilis. A significantly lower risk for chlamydia/gonorrhea and syphilis was found for observations during the COVID-19 pandemic period. Conclusions We found that HIV-PrEP is almost exclusively used by MSM in Germany. A very low incidence of HIV infection and decreasing incidence rates of STIs were found in this cohort of PrEP users. The results were influenced by the SARS-CoV-2 pandemic. Rollout of PrEP covered by health insurance should be continued to prevent HIV infections. Increased PrEP availability to people at risk of HIV infection through the elimination of barriers requires further attention. Investigation and monitoring with a longer follow-up would be of value.

Background Prior to direct-acting antivirals (DAAs), HCV incidence rose among men who have sex with men (MSM) living with HIV infection in Germany despite high hepatitis C virus (HCV) treatment rates. We establish a HCV elimination modeling framework to evaluate whether existing treatment rates can achieve the World Health Organization (WHO) incidence target among MSM living with HIV in Germany. Methods To evaluate progress towards HCV elimination in Germany, we adapted a previously published HCV transmission model among MSM living with diagnosed HIV. We modelled HCV incidence and prevalence until 2030 (relative to 2015) under existing treatment and DAA scale-up and explored potential impacts of disruptions in treatment and behavioral risk reduction due to the COVID-19 pandemic. Results Continuing current treatment rates will result in stable HCV incidence among MSM living with HIV in Germany between 2015–2030. The WHO HCV incidence target is achievable under DAA scale-up to 100% treatment combined with treatment of those previously diagnosed and untreated (at a rate of 15%/year) and would result in greater reductions with early treatment (3 vs 6 months) reducing incidence from 4.0/100person-years to 0.8/100person-years by 2030. A 12-month disruption to HCV treatment (20% reduction) and risk behaviors (25%,50%,75% reduction) during the COVID-19 pandemic would result in a 15% relative increase in total HCV incidence in 2030 compared to that expected under the status quo. Conclusions HCV elimination among MSM living with HIV in Germany requires further DAA scale-up among those newly diagnosed combined with efforts to treat those previously diagnosed but untreated. Prospective monitoring will establish whether Germany is on track for HCV microelimination.

Many patients infected with HIV are diagnosed at an advanced stage of illness. These late presenters are individuals with a CD4 cell count of less than 350 cells/mu L and/or an AIDS defining disease at initial HIV diagnosis. Purpose of FindHIV is to develop and distribute a questionnaire/scoring system aimed at a reduction in late presentation. FindHIV uses a mixed methods approach. In a first step, primary data of patients were collected. Inclusion criteria were: age >= 18 years, cognitive ability and language skills to participate in the study, initial HIV diagnosis within the past 6 months, and patient informed consent. Descriptive methods and regression models are used to identify: (1) patient characteristics associated with late presentation and (2) contacts to the healthcare system with indicator diseases that did not lead to HIV testing. Secondly, a questionnaire/scoring system is created by an expert panel. Afterwards the questionnaire/scoring system is to be disseminated. The greatest challenge was in reaching an adequate sample size. Another risk may be a recall bias. Nevertheless, FindHIV is devised as an in-depth study of the phenomenon of late presentation with potential to significantly improve HIV detection.