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Beyond injecting drug use: investigation of a Victorian cluster of hepatitis C among HIV-infected men who have sex with men

Hepatitis C virus (HCV) has emerged worldwide as a major infectious disease. An estimated 221 000 Australians (about 1% of the population) were living with chronic hepatitis C by the end of 2010, and HCV infection is now the most common indication for liver transplantation.1,2 While HCV diagnosis rates have declined nationally over the past 10 years, the persistence of risk behaviours, and the relatively limited uptake of HCV treatment (only 3760 Australians were treated for HCV infection in 2010) suggest that the epidemic is ongoing.1

Public health measures to curb HCV infection in Australia have focused on harm reduction. Injecting drug use (IDU) remains the predominant risk factor,3 but there has been accumulating evidence of sexual (permucosal) transmission over the past decade. Two per cent of the 899 newly acquired Australian cases from 1997 to 2000 were considered related to sexual contact,4 and more recent recognition of HCV–HIV co-infection in men who have sex with men (MSM) has prompted reconsideration of what constitutes blood-to-blood…