Response To Hcv Therapy
Sustained virologic response to HCV therapy has been linked to decreased rates of HCV-associated morbidity and mortality . HCV therapy is in an era of rapid change. The mainstay of therapy is expected to shift from pegylated interferon and ribavirin to all oral therapy with direct-acting antivirals with or without ribavirin in the next few years. Most of the current data available on HCV treatment is from outcomes with pegylated interferon and ribavirin and with triple therapy for genotype 1 with the addition of a protease inhibitor . Findings of some studies on treatment of HCV with pegylated interferon and ribavirin suggest that women may have an increased SVR with this therapy . Others have not shown much difference in outcomes in men compared with women .
Earlier studies looking at differences in response rates in standard interferon therapy found age to be predictive of SVR in women. There was no difference overall between the sexes, but being a younger female patient did favor better treatment outcomes . It has been postulated that the varied reports of the effect of sex on SVR might be related to reproductive status, with varying response rates for women before and after menopause. High treatment response rates have been reported with pegylated interferon and ribavirin in young women . Villa et al examined the effect of reproductive status for women on SVR, and they found that menopause, not age, independently predicted a lower rate of SVR for women.
How Can The Spread Of Hepatitis C Be Prevented
People who have had hepatitis C should remain aware that their blood is potentially infectious.
- Do not shoot drugs if you shoot drugs, stop and get into a treatment program if you can’t stop, never share needles, syringes, water or “works”, and get vaccinated against hepatitis A and B.
- Do not share personal care items that might have blood on them .
- If you are a health care or public safety worker, always follow routine barrier precautions and safely handle needles and other sharps get vaccinated against hepatitis B.
- Consider the risks if you are thinking about getting a tattoo or body piercing. You might get infected if the tools have someone else’s blood on them or if the artist or piercer does not follow good health practices.
- HCV can be spread by sex, but this is rare. If you are having sex with more than one steady sex partner, use latex condoms correctly and every time to prevent the spread of sexually transmitted diseases. You should also get vaccinated against hepatitis B.
- If you are infected with HCV, do not donate blood, organs or tissue.
Should You Get Tested
The CDC recommends that anyone over the age of 18 get tested for Hepatitis C. But you should especially consider being tested if you:
- Were born between 1945 and 1965
- Have used injected drugs
- Were born to a mother who had hepatitis C
- Were treated for a blood clotting problem before 1987
- Got a blood transfusion or organ transplant before July 1992
- Have been a long-term hemodialysis patient
- Work in health care or public safety and were exposed to blood through a needle stick or other sharp object injury
If you get tested and find out you have hepatitis C, tell your sex partner and anyone else who may have been exposed to your blood, including through drug use.
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Tips For Safe Sex With Hepatitis
When its time, find a private place where you can talk to your partner without interruption.
Recommendations For Service Providers
Integrate hepatitis C education into existing sexual health and HIV services for gbMSM:
- Know hepatitis C risk factors. Educate gbMSM about the sexual transmission of hepatitis C. Encourage gbMSM having sex that could lead to hepatitis C to:
- use a new condom for each partner, including on sex toys
- use a new glove for each partner when fisting
- use individual lube containers and regularly apply lube
Integrate hepatitis C testing services into existing sexual health and HIV services:
Integrate sexual health and harm reduction services and programs to support gbMSM:
References
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Fact : You Cant Get Tested Right After Sex
Some STDs can be detected soon after unprotected sex, but HCV isnt one of them, Dr. Diaz explains. The virus antibody generally appears 12 weeks after exposure, she says, but your doctor may wait a few additional months to be sure. In part, thats because about 15% to 30% of people clear the virus on their own in that time frame with no major health impacts, Dr. Diaz says. So, if youve had sex with someone with HCV, youll likely be advised to wait for that amount of time before being tested.
Fact : Boomers Should Especially Keep Hcv In Mind
Baby Boomers are five times more likely to have HCV than other generations. The reasons are not completely understood, but one factor may be that infection-control procedures, including screening donated blood, didnt begin until the 1990s, and many were likely infected before then. But thats not the only reason. Currently, STDs are on the rise in Boomers mainly because they often dont use condoms, raising infection risk.
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Sexual Transmission And Hepatitis C
Although not common, hepatitis C can be transmitted through sexual activity. Having a sexually transmitted infection, having sex with multiple partners, and engaging in anal sex appear to increase a persons risk for hepatitis C. MSM with multiple sex partners who are coinfected with HCV and HIV have been shown to transmit hepatitis C. There is no vaccine for hepatitis C. The best way to prevent hepatitis C is by avoiding behaviors that can spread the disease, especially sharing needles or other equipment to inject drugs. CDC recommends one-time hepatitis C testing of all adults and regular testing for people with risk factors. The American Association for the Study of Liver Disease and the Infectious Diseases Society of America also recommend that people who are infected with HCV be provided with curative, direct-acting antiviral medicationsexternal icon to treat their HCV infection.
Sexual Transmission And Viral Hepatitis
Certain adults who are sexually active should be vaccinated against hepatitis B.
CDC and the Advisory Committee on Immunization Practices recommend hepatitis B vaccination for
- sexually active people with more than one sex partner during the previous 6 months
- people seeking evaluation or treatment for a sexually transmitted disease
- sex partners of people with hepatitis B and
- men who have sex with men .
CDC recommends one-time hepatitis C testing of all adults and regular testing for people with risk factors.
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Love Sex And Hepatitis C
I’ve been writing about hepatitis C for twenty years, and am at risk of article redundancy. So, please bear with me devoted Healthwise readers, as I delve back into one of the most common topics relating to hepatitis C: sexual transmission. I couldn’t think of a better subject for February, the month celebrating love and chocolate.
Valentine’s Day is not the main reason I am writing about sexual transmission of hepatitis C. The inspiration came because of a disturbing email I received from someone who found me on the internet. In this article, I’ve changed some details to conceal his identity.
The man in question had a one-time extramarital affair, not long ago. After his wife found out about it, she was tested for sexually transmitted infections. The hep C test came back positive. She asked her doctor if the hep C could have come from her husband’s affair, to which the doctor stated that he was certain without a doubt that this was the source of transmission.
In the meantime, the man was waiting on his hep C test results. Clearly, he was consumed by guilt. He wanted to know if there was any possibility that his wife’s physician was wrong.
- Having a sexually transmitted disease or HIV
- Multiple sex partners
Related:
Lucinda Porter, R.N., is a long-time contributor to the HCV Advocate and author of “Free from Hepatitis C” and “Hepatitis C One Step at a Time.” She blogs at www.LucindaPorterRN.com and HepMag.com.
Lucinda K. Porter, R.N.
A New Hypothesis Of How Hepatitis C Is Transmitted During Sex
In 2016 and 2017, a team of researchers at the Icahn School of Medicine at Mount Sinai in New York published two research studies challenging the idea that blood needed to be present during sex for hepatitis C transmission to happen. Prior to that point, it was widely believed that only traumatic sex acts like fisting that produced blood put people at risk for hepatitis C.
Their first study showed that about one third of HIV-positive men who have sex with men, with recent HCV infection, have hepatitis C virus in their semen.
About one-third to one-half of men with HCV shed HCV into their semen, Daniel Fierer, MD, the lead investigator of the study explained to BETA. And some men just dont. The message is that if HCV is in someones semen, and the semen gets into a persons rectum, that person may acquire hepatitis C.
In the journal article, Fierer and colleagues explain that because 10 to 20 HCV particles is enough to establish a parenteral infection, an average ejaculate of virus) could plausibly be enough to establish an infection. These seemingly low HCV levels could play a significant role in sexual transmission of HCV when deposited into a rectum whose surface epithelial layer has been disrupted through anal intercourse, they said.
The results of this study explain how men who bottom without a condom might acquire hepatitis C. But what about when men topare they at risk for acquiring hepatitis C if they top without a condom?
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Building Healthy Sexual Relationships
Rule number one for a healthy sexual relationship: Be open and honest with your partners. I believe in transparency, says Talal. This conversation can be difficult, but its important to have. Part of discussing your status is talking about what exposure you may have had to hepatitis C, even in the distant past.
Its a good opportunity for you both to share your sexual history, as well as your experiences with other ways hepatitis C can be transmitted, such as using injection drugs or being exposed to items that may have blood on them, including needles, razors, and toothbrushes.
Sherman explains that even if you consistently use condoms during sex, other activities, such as sharing needles to inject drugs or sharing straws to snort them, increase your risk of spreading hepatitis C. People do not want to hear about this, he says. Its difficult to get the word out about risk.
If you and your partner find that hepatitis C is disrupting your relationship or your sex life, you might also consider working with a marriage and family therapist or a sex therapist.
Disease Burden And Sex
With women having a slower rate of disease progression, it is not surprising that the burden of HCV disease complications mainly affects men. Using a mathematical model, Davis et al predict that the number of cases of cirrhosis in the United States is only increasing and expected to peak in 2020 at 1.04 million cases. They estimate that 73.6% of cirrhosis cases occur in men and that cases in men will continue to make up the majority during the next 20 years . During the peak incidence years in the 1970s and 1980s, the incidence of acute HCV infections was similar in women and men however, as of 2009, a smaller proportion of women have developed cirrhosis because of increased clearance and decreased rates of progression. Davis et al report a similar trend with projected cases of hepatocellular carcinoma and decompensation from liver disease.
Stacked prevalence curves showing number of cirrhosis cases by year according to sex and age at initial hepatitis C virus infection .
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How Can I Protect Myself And Others
- Never share injecting drug equipment or things that may have blood on them such as toothbrushes and razors. Also avoid sharing straws or rolled up banknotes if snorting drugs with others.
- Use condoms for anal and vaginal sex and latex gloves for fisting.
- During group sex, cover anything which goes from one partner to another with a fresh condom or fresh latex glove for each new person it enters. Clean objects with warm water and anti-bacterial soap before using on a new partner.
- Dont share enema equipment or pots of lubricant.
If you have hepatitis C you may want to tell a partner and explain that youre infectious. They can then decide if they’re happy to take any risks and whether they want to take precautions. That way they cannot accuse you of infecting them without them knowing that the risk was there.
Can I Have Sex With My Partner
Yes. If you only have one sexual partner, the odds you’ll give hepatitis C to that person are very low. The CDC says monogamous couples don’t need to routinely use condoms. Your risk of passing hepatitis C goes up if you have multiple sex partners, have an STD, or are infected with HIV. Hep C is also more likely to spread if you and your partner have rough sex.
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What The Cdc Recommends
Were you born between 1945 and 1965? If so, then youre a member of the Hepatitis C generation. The CDC recently recommended that all people born between during this time have a 1-time screening test for Hepatitis C. We now have new drugs that can treat and cure Hepatitis C so you should go get tested today.
The life you save may be your own! Please contact your local healthcare provider.
How Hbv Is Spread
It is possible for the hepatitis B virus to be spread through the bodily fluids of an infected person, which is to say that the virus can be transmitted through the blood, sweat, tears, saliva, semen, vaginal secretions, menstrual blood, and breast milk of an infected person. That said, having hepatitis B does not necessarily mean that you are infectious only some people with HBV are actually contagious.
Opportunities for exposure can include sharing a syringe or getting tattoos or body piercings with infected tools. But it also means that it is possible to be exposed during childbirth as well as sexual contact and intercourse. In fact, nearly two-thirds of acute cases of hepatitis B in the United States are caused by sexual exposure.
Though HBV can be spread through blood, there is generally very little risk of contracting the virus through blood transfusions as most countries began screening for it by 1975.
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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.
What Are The Chances Of Getting Hep C Sexually
Hepatitis C spreads by contact with an infected persons blood. Although uncommon, hepatitis C can be transmitted through sexual activity, if the person has genital sores and cuts. It can also be transmitted during menstruation. However, just 2% of hepatitis C cases are sexually transmitted.
The risk of getting hepatitis C sexually increases in the following situations:
- Men who have sex with men
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