Division of Liver Diseases, University of California, San Francisco.
San Francisco AIDS Foundation, San Francisco.
NYU Langone Medical Center, New York City.
Callen-Lorde Community Health Center, New York City.
Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York City.
Sexually-acquired HCV infections among HIV-uninfected men who have sex with men (MSM) have been rare. With the introduction of pre-exposure prophylaxis (PrEP) against HIV, we hypothesized that these infections would increase. Between 2013 and 2018 we diagnosed 15 likely sexually-acquired HCV infections among 14 MSM using PrEP. Most (87%) were asymptomatic, detected by routine ALT or HCV monitoring. Half reported increasing sex partners and drug use after starting PrEP; 5 reported injection of methamphetamine. Interventions are needed to prevent sexually-acquired HCV infections by MSM using PrEP. CDC guidelines for monitoring during PrEP should include regular ALT and HCV testing.