Are Men Living With Hiv At Higher Risk
Rates of sexually transmitted hepatitis C are certainly higher among HIV-positive men who have sex with men than HIV-negative men who have sex with men, although its difficult to prove exactly why.
Fierer reasoned that more men living with HIV end up getting HCV through sex because HIV is much more efficient at transmission through sexwhich means that people at risk for getting HCV through sex are more likely to be those who have already been exposed to HIV.
If an HIV-negative man is at risk for acquiring hepatitis C through sex, that means he also might be at risk for acquiring HIV through sex. Chances are, hes going to become infected with HIV first, which is why these cases of hepatitis C appear as though theyre largely affecting HIV-positive men, he said.
The question is, with PrEP breaking down barriers between HIV-negative and HIV-positive men, will the number of hepatitis C infections among HIV-negative men start to rise?
Thats what Ive been saying, said Fierer. We are going to see more cases of sexually transmitted hepatitis C with increased use of PrEP. I dont have a prospective cohort to prove it, but its biological. The sun rises, the sun sets, and infectious diseases are transmitted.
For Safer Sex Treat Hepatitis C
If you have chronic hepatitis C, of the best strategies for preventing transmission of the virus is to get medical treatment. More than 90 percent cases of hepatitis C can be cured within 8 to 12 weeks of treatment, according to the CDC. Newer hepatitis C treatments are not only effective but generally have fewer and much less severe side effects than previous drugs.
Just be aware that during treatment, transmission can still occur. And a cure doesnt grant you protection against the virus for life. If you continue to engage in high-risk behavior, you can get re-infected, warns Kenneth Sherman, MD, PhD, a professor of medicine and the director of the division of digestive diseases at UC Health in Cincinnati, Ohio.
What Factors Are Linked To The Sexual Transmission Of Hepatitis C Among Gbmsm
A cluster of factors have been associated with the sexual transmission of hepatitis C.5,6 For sexual transmission of hepatitis C to occur, there must be exposure to the hepatitis C virus in one or more of these situations:
- condomless anal sex
- using recreational drugs before or during sex
- having HIV
- having an ulcerative STI
Drug use and sex
Where drug use is present, it is difficult to tease apart the extent to which drug use versus sex contributes to the transmission of hepatitis C. For example, party and play or chemsex is when certain drugs are used by gbMSM before or during sex to facilitate, sustain or enhance sexual encounters. The risk of hepatitis C transmission through party and play is twofold, through drug use and through sex. Hepatitis C can be acquired through shared drug use equipment. There is also concern that booty bumping or boofing can damage and/or irritate the tissue of the rectum, which could increase the risk of sexual transmission of hepatitis C.13 Party and play is also associated with types of sex that overlap with sexual risk factors for hepatitis C. For example, gbMSM who party and play are more likely to participate in condomless anal sex with one or more partners and participate in group sex compared with gbMSM who do not party and play.14 Thus, deciphering whether new hepatitis C infections among gbMSM who party and play were acquired through drug use or sex is challenging.
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Sharing Toothbrushes Scissors And Razors
There’s a potential risk that hepatitis C may be passed on through sharing items such as toothbrushes, razors and scissors, as they can become contaminated with infected blood.
Equipment used by hairdressers, such as scissors and clippers, can pose a risk if it has been contaminated with infected blood and not sterilised or cleaned between customers. However, most salons operate to high standards, so this risk is low.
How Do You Get It
Hepatitis A
You can get hepatitis A through contaminated food or water and by not washing hands after the toilet or before touching food.
Hepatitis A can be spread through unprotected sex which involves oral to anal contact .
Hepatitis B
Hepatitis B is spread:
- from mother to baby
- sharing items that may pierce the skin or have blood on them
- blood transfusion .
Hepatitis C
You can get hepatitis C through contact with infected blood, sharing needles, syringes and any other equipment and, possibly, through sexual contact. You can also get it with a blood transfusion in countries that do not pre-test blood for transfusion.
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How Do You Get Hepatitis C
Hepatitis C is most commonly spread through blood-to-blood contact. It is very infectious and the virus can stay alive outside the body for up to several weeks.
The infection can be spread by:
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sharing needles and syringes, particularly when injecting drugs
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medical and dental equipment that has not been properly sterilised
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the transfusion of unscreened blood and blood products.
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unsterilised tattoo and body piercing equipment
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sharing contaminated razors, toothbrushes or towels .
It can be transmitted sexually, especially during anal sex or other types of sex that may involve blood, although this is less common. Sharing uncovered or unwashed sex toys can also pass it on.
The risk of hepatitis C infection is increased when you have another STI especially one that causes sores. People with HIV are also more likely to get hepatitis C.
The virus can also be passed on from a pregnant woman to her unborn baby. For more details on hepatitis C in pregnancy read our in detail tab.
Can Hep C Be Cured Completely
Well, the good news is hepatitis C is curable. Though it is a chronic infection, recently developed drugs can clear the virus completely from the system. If the viral load is nil after three months of treatment completion, people are considered cured. This is called sustained virologic response and data suggest that, in these cases, people will stay virus-free for life.
However, people must remember that hepatitis C is a lot more than just liver disease. Hepatitis C is often associated with many medical complications, such as a heightened risk of developing kidney diseases and cancer in the future. The drugs used in the treatment are accompanied by adverse reactions like every other drug. Hence, prevention is the best cure in this case.
Intensive therapy with antivirals against hepatitis will significantly reduce the risk of liver failure, liver cancer and the need for a liver transplant. However, often, the disease causes severe liver scarring. This scarring of the liver is irreversible and can cause potential complications, such as liver failure. Hence, people with hepatitis C need lifelong monitoring.
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Why Should I Get Treated
Hepatitis C can be fatal when left untreated.
Untreated hepatitis C can lead to scarring of the liver known as cirrhosis.
A small number of people with cirrhosis will go on to get liver failure, the only treatment for which is a liver transplant. A small proportion of people with cirrhosis develop liver cancer.
What Effects Does Hepatitis C Have During Pregnancy
Hepatitis C can be passed on from a pregnant woman to her child during pregnancy and birth, but this is rare. The risk of passing hepatitis on is slightly higher for mothers with both HIV and hepatitis C .
Antivirals used to treat hepatitis are not currently recommended for pregnant women. This is because there isnt enough information to know if the drugs are safe for your unborn baby.
If you have hepatitis C and are pregnant speak to your doctor. They will be able to give you advice on how to keep yourself and your baby safe during pregnancy and birth.
If youre planning to have a baby, your doctor may recommend that you treat the hepatitis C before you get pregnant.
Breastfeeding with hepatitis C is considered safe. But if you have cracked or bleeding nipples, its generally recommended to stop breastfeeding until they have healed.
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What Are The Symptoms Of Hepatitis C
Many people with hepatitis C don’t have any symptoms, especially during the first 6 months.
The hepatitis C infection can go through two stages: acute and chronic. In the early acute stage, these symptoms can include:
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flu-like symptoms, tiredness, high temperature and aches and pains
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loss of appetite
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yellowing of the eyes and skin .
For some people the infection will clear without treatment.
In most cases an acute infection will develop into long-term chronic infection. Chronic infection may not become apparent for a number of years until the liver displays signs of damage.
Symptoms vary but some of the most common include:
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problems with short-term memory, concentration and completing complex mental tasks
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depression or anxiety
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nausea, vomiting or tummy pain
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dark urine
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joint and muscle pain.
How Do You Prevent Hepatitis C
There is no vaccine for hepatitis C but there are a number of ways to reduce the risk of infection.
Never share needles and syringes or other items that may be contaminated with infected blood, even old or dried blood can contain the virus.
Only have tattoos, body piercings or acupuncture in a professional setting, where new, sterile needles are used
You can also stop the spread of the virus by practising safer sex. Use condoms, especially during anal sex, rough sex or if youre menstruating. Use dental dams and latex gloves for rimming, fingering and fisting. Knowing the status of your sexual partner is another important way to stay safe.
If you have HIV, taking your antiretroviral treatment keeps your immune system strong. This way so youre less likely to get other infections, including hepatitis C. For more details on hepatitis C and HIV read our in detail tab.
Taking pre-exposure prophylaxis , the contraceptive pill or any other type of contraception apart from condoms doesnt protect you from hepatitis C and other STIs.
Having regular STI tests is one of the best ways to look after your sexual health. If you are having sex with multiple partners, its even more important to use condoms and get tested regularly even if you dont have any symptoms.
If youve been diagnosed with hepatitis C you should avoid sex until you have finished your treatment and a health care professional says its safe.
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General Tips For Prevention
Refrain from engaging in IV drug use and be cautious with all procedures that involve needles.
For example, you shouldnt share needles used for tattooing, piercing, or acupuncture. The equipment should always be carefully sterilized for safety. If youre undergoing any of these procedures in another country, always make sure the equipment is sterilized.
Sterile equipment should also be used in a medical or dental setting.
Why Are We Talking About Sexual Transmission Of Hepatitis C Among Gbmsm
Drug use, and injection drug use in particular, is a well-understood pathway for hepatitis C transmission. Sexual transmission of hepatitis C isnt as clear. The evidence suggests that sexual transmission of hepatitis C among heterosexual couples is rare.1 However, as we will discuss below, sexual transmission of hepatitis C can occur among gbMSM. Further, changing sexual practices among gbMSM2 using new HIV prevention approaches may be having an impact on the rates of sexual transmission of hepatitis C.
The Blueprint to inform hepatitis C elimination efforts in Canada indicates that gbMSM are an emerging priority population for efforts to eliminate hepatitis C infection. The Blueprint states that sexual transmission and/or transmission through drug use are the main risk factors for hepatitis C among gbMSM.3 However, hepatitis C infection may not be widely considered a priority for sexual health services and education for gbMSM.
It is challenging to understand the risk of sexual transmission among gbMSM, including separating the risks of transmitting hepatitis C through sex and through drug use. In the studies discussed in this article, where information on drug use is included in the research it is often based on self-reported data, which may be an underestimate because of the stigma that can be associated with drug use.
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How Do I Test For Hepatitis C
A simple blood test will show whether you have the virus. You may also be given an extra test to see if your liver is damaged.
If youve got hepatitis C you should be tested for other STIs. It’s important that you tell your recent sexual partner/s so they can also get tested and treated. Many people who have hepatitis C do not notice anything wrong, and by telling them you can help to stop the virus being passed on. It can also stop you from getting the infection again.
How Is Hepatitis C Treated
Treatment for hepatitis C depends on how long you have had the virus.
People with acute infection do not always need treatment because their immune system may clear hepatitis C on its own. If you test positive during the acute stage, your doctor may ask you to come back after a few months to re-test and to see if you need any treatment.
If you develop chronic infection, you will need treatment to help clear the virus. Treatment with drugs called direct-acting antivirals can cure hepatitis in most cases. These are usually taken for 8-12 weeks. Your doctor will also check your liver for any damage.
If youve had hepatitis C in the past, youre not immune to future infections which means you can get it again. You can also still get other types of hepatitis and having hepatitis C together with another type is more serious.
If youve already had hepatitis C, its advisable to have the vaccination against hepatitis A and B to protect your liver from further damage.
Whether you have symptoms or not, dont have sex until your healthcare professional says you can.
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Sexual Transmission And Hepatitis A
Transmission of hepatitis A virus can occur from any sexual activity with an infected person and is not limited to fecal-oral contact. People who are sexually active are considered at risk for hepatitis A if they are MSM, live with or are having sex with an infected person, or inject drugs. Vaccination is the most effective means of preventing hepatitis A transmission among people at risk for infection. CDC has published recommendations for prevention of hepatitis A that identify all groups recommended for vaccination, including hepatitis A vaccination for MSM.
How Do You Prevent Hepatitis
Both hepatitis A and hepatitis B can be prevented with a vaccine. There is currently no vaccine available to prevent hepatitis C.
To prevent spreading or getting hepatitis A:
- Wash hands with soap and warm water for at least 20 seconds after using the bathroom, changing diapers, touching garbage or dirty clothes, and before preparing food and eating
- Follow guidelines for food safety
- Avoid unpasteurized milk or foods made with it
- Thoroughly wash fruits and vegetables before eating
- Keep the refrigerator colder than 40°F and the freezer below 0°F
- Cook meat and seafood until well done
- Cook egg yolks until firm
- Wash hands, knives, and cutting boards after contact with raw food
To prevent spreading or getting hepatitis B or hepatitis C:
- Practice safe sex and use a latex condom each time you have sex
- Dont share razors, toothbrushes, or any personal objects that might have blood on them
- Dont share needles or syringes
- Cover cuts and open sores with bandages
- Clean blood off of things with a mixture of bleach and water: use 9 parts bleach to one-part water
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Epidemiology Of Sexually Transmitted Hcv
2.1.1 Trends in HCV infections in HIV-positive and -negative MSM
2.1.2 Molecular epidemiology
Molecular epidemiology is increasingly used to identify clusters and transmission pathways in rapidly evolving pathogens such as HIV and HCV. The main aim of these molecular approaches was to aid the public health response by identifying factors of the epidemic, such as hotspots or emerging clusters, otherwise missed.
2.1.3 Risk factors for acquiring sexually transmitted HCV
Finally, studies consistently show that biological factors might play a role: confection with STI, HIV-1 infection in itself, a lower CD4 cell count and higher HIV RNA levels are associated with an increased risk of incident HCV infection , , , . These factors might affect the mucosal microenvironment and activate specific immune cells within mucosal tissues, which would allow HCV entry and retention.
Can Hepatitis C Be Prevented
There is no vaccine against hepatitis C. The only way to prevent infection is to avoid contact with infected blood.
Hepatitis C cannot be spread by coughing, sneezing or sharing eating utensils. People should not be kept away from school, work, or other social settings because they have hepatitis C.
Here are some precautions that may prevent the spread of hepatitis C:
- Do not share personal care items, such as toothbrushes or razors, with others.
- Practice safe sex by using condoms.
- Dont share needles or syringes.
- Wear gloves when handling another persons blood.
- Use sterile equipment for body piercings or tattoos.
- If you are a healthcare worker, follow recommended safety measures.
People who are at greater risk for contracting hepatitis C should have their blood tested. The Centers for Disease Control recommends that Americans born between 1945 and 1965 be screened at least once for the disease.
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The Swiss Hiv Cohort Study
M. Battegay, E. Bernasconi, J. Böni, H. Bucher, Ph. Bürgisser, S. Cattacin, M. Cavassini, R. Dubs, M. Egger, L. Elzi, P. Erb, K. Fantelli, M. Fischer, M. Flepp, A. Fontana, P. Francioli , H. Furrer , M. Gorgievski, H. Günthard, B. Hirschel, L. Kaiser, C. Kind, Th. Klimkait, B. Ledergerber, U. Lauper, M. Opravil, F. Paccaud, G. Pantaleo, L. Perrin, J.-C. Piffaretti, M. Rickenbach , C. Rudin , P. Schmid, J. Schüpbach, R. Speck, A. Telenti, A. Trkola, P. Vernazza , R. Weber, and S. Yerly.