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This strongly suggests that the epidemiology of HCV in this population is changing, with permucosal sexual factors becoming a potentially important route of transmission. A recent molecular epidemiological study revealed that ten hepatitis A virus HAV outbreaks among MSM in seven European countries between and actually represented one large outbreak among interconnected MSM communities, within which HAV transmission has become endemic [ 13 ]. These emergent high-risk sexual networks are susceptible to the introduction and spread of various infectious agents, such as HCV, for which sexual contact is not usually considered to be a primary mode of transmission [ 14 ].

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