Eligible And Enrolled Couples
Of the 2,077 couples screened for study inclusion, 672 were eligible. Reasons for study exclusion occurring in 5% of the 1,405 ineligible couples included lack of sexual activity , prior organ transplant , refused study participation , doctor refused , HIV or HBV coinfection , partnership less than 3 years or nonmonogamous , and history of IDU in both partners . Of the 672 eligible couples, 500 enrolled and completed all the study requirements, at which time study enrollment was halted. The primary reasons for failure to participate among the remaining 172 eligible couples were nonresponse or refusal . Of the 500 enrolled couples, 43% were referred from tertiary referral practices, 34% from community sources, and 21% were blood donors.
The Types Of Viral Hepatitis
There are five main types of viral hepatitis known as hepatitis A , hepatitis B , hepatitis C , hepatitis D , and hepatitis E . That said, there have been cases of acute hepatitis that could not be attributed to one of these five types of hepatitis viruses, alcohol, drugs, or autoimmune disease, which lead researchers to try to find another cause.
Though the etiology of these viruses have not yet been fully established, researchers have identified three other types of viral hepatitis , which they have named hepatitis F , hepatitis G , and transfusions transmitted virus . As relatively new diseases and viral discoveries, information about them and how they work is relatively scarce. We do know, however, that cases of TTV have only been associated with hepatitis in people who have had a blood transfusion.
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What Should You Know About Pregnancy And Hepatitis B
A pregnant woman who has hepatitis B can pass the infection to her baby at delivery. This is true for both vaginal and cesarean deliveries.
You should ask your healthcare provider to test you for hepatitis B when you find out you are pregnant. However, while it is important for you and your healthcare provider to know if you do have hepatitis B, the condition should not affect the way that your pregnancy progresses.
If you do test positive, your provider may suggest that you contact another healthcare provider, a liver doctor, who is skilled in managing people with hepatitis B infections. You may have a high viral load and may need treatment during the last 3 months of your pregnancy. A viral load is the term for how much of the infection you have inside of you.
You can prevent your infant from getting hepatitis B infection by making sure that your baby gets the hepatitis B vaccine in the hours after they are born along with the hepatitis B immunoglobulin. These two shots are given in two different locations on the baby. They are the first shots needed.
Depending on the type of vaccine used, two or three more doses must be given, usually when the baby is 1 month old and then 6 months old, with the last by the time the baby is 1 year old. It is critical that all newborns get the hepatitis B vaccination, but even more important if you have hepatitis B yourself.
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What Are The Rates Of Sexually Acquired Hepatitis C Infection Among Gbmsm
gbMSM living with HIV
In the early 2000s, reports began to appear of hepatitis C outbreaks among populations of gbMSM living with HIV where the vast majority of the men did not report typical blood-related risks for transmission, such as injection drug use or medical/dental care in countries where universal precautions to prevent hepatitis C infection have not been consistently implemented.6,15 These were the first reports to suggest that hepatitis C could be passed through sex. Over time, as more research was published globally on rates of hepatitis C infection among gbMSM living with HIV, it became accepted that sex was a pathway for transmission of hepatitis C among gbMSM living with HIV.6,10,16
Two international systematic reviews reported that the hepatitis C prevalence rate among HIV-positive gbMSM with no history of injection drug use is about seven in 100.17,18 This is higher than the estimated prevalence rate of five in 100 among gbMSM with/without HIV in a survey across five cities in Canada.19
HIV-negative gbMSM
HIV-negative gbMSM have much lower rates of new hepatitis C infections than HIV-positive gbMSM. Rates ranged from 0.4 to 1.5 new hepatitis C infections per 1000 person-years among HIV-negative gbMSM.16
Can Hepatitis C Be Spread During Vaginal Sex
Its rare for the hepatitis C virus to be transmitted through vaginal intercourse. Unless the isnt lubricated or intercourse is very rough and leads to tears in the vaginal walls, theres no opportunity for blood to be exchanged. The risk of transmission with vaginal intercourse is about 1 in 190,000, according to research published in the journal Hepatology.
The U.S. Department of Veteran Affairs, which is the largest care provider for people with hepatitis C, says if one partner in a monogamous, heterosexual relationship has hepatitis C, the risk of transmission is very low, but they do recommend that the other partner get tested. Concerned couples can also discuss using a condom to lower the already very low risk of spreading the virus, says Talal.
Just how safe sex is when a partner has hepatitis C hinges on other factors as well. For example, its important to use a new condom with each sexual act that has the potential to expose the uninfected partner to the infected persons blood, even if youre in a committed relationship, says the Centers for Disease Control and Prevention . Some of these situations include sex when one partner:
- Has an open cut or sore
- Has another sexually transmitted infection , especially one that causes sores or lesions
- Is having a menstrual period
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What Are The Types Of Hepatitis B
There are two types of hepatitis B infection: acute and chronic.
Acute
An acute infection happens at the beginning, when you first get infected with hepatitis B. Many people are able to clear it from their bodies and recover. In fact, this is true of about 4 in 5 adults who are infected.
Chronic
If you are not able to clear the infection within six months or longer, you have chronic hepatitis B. It is chronic hepatitis B that leads to inflammation and the serious, and possibly fatal, illnesses of cirrhosis of the liver and liver cancer. Treatment can slow disease progress, reduce the chance of liver cancer and increase your chances of surviving.
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Risk Of Perinatal Hcv Transmission
Perinatal transmission of hepatitis C occurs in approximately 5 to 6% of pregnant women with HCV who have viremia, a rate significantly lower than with perinatal transmission of hepatitis B or HIV. The timing of perinatal HCV transmission is poorly understood, but intrauterine, intrapartum, and postnatal transmission are possible, with the majority of infants likely becoming infected in utero or around the time of delivery. In a systematic review of 77 studies published between 1990 and 2000, investigators calculated a 4.3% rate of mother-to-infant transmission among women with HCV viremia. A more recent systematic review and meta-analysis of 109 articles reported a 5.8% risk of perinatal HCV transmission among women who are HCV antibody positive and HCV RNA positive.
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What Can Explain The Rates Of Sexually Acquired Hepatitis C Infection
Another theory on why higher rates of hepatitis C may be seen in HIV-positive men is that HIV is more sexually infectious than hepatitis C, so gbMSM having types of sex that pass both infections are more likely to get HIV before hepatitis C.6,15 An additional theory is that the higher rates of hepatitis C infection among HIV-positive gbMSM may be random.6,15 Once hepatitis C entered the population of gbMSM living with HIV, hepatitis C may have been ring-fenced around gbMSM living with HIV through practices such as serosorting .6,10,15 Research analyzing strains of hepatitis C virus to trace patterns of infection supports this theory. The studies suggest there was a rapid expansion of gbMSM-specific hepatitis C virus strains in Europe after 1996, which followed the introduction of highly effective antiretroviral therapy for HIV.6,26 The studies also suggest that hepatitis C was being passed among gbMSM living with HIV and that there was minimal overlap with strains of hepatitis C virus among injection drug use networks.26
Many People With Hepatitis C Could Benefit From Hiv Prep
Many people with HCV are eligible for PrEP, but most are not aware of it and even fewer are using it.
Although a third of people with hepatitis C surveyed in Washington, DC, and Baltimore were potentially eligible for HIV prevention pills or long-acting injections, most had not heard of pre-exposure prophylaxis and very few were using it, according to research published in Open Forum Infectious Diseases.
HIV and hepatitis C virus share some of the same transmission routes, such as shared drug injection equipment and condomless sex, suggesting that many people living with HCV could benefit from HIV PrEP. In 2012, 68% of new HIV cases in the United States were attributed to sex between men, 7% to injection drug use and 4% to both risk factors, the study authors noted as background.
Kristi Hill, MD, of Harvard Medical School, and colleagues assessed PrEP awareness and use among participants in GRAVITY , an observational study conducted between March 2016 and November 2020 that collected epidemiologic data and blood samples from people with HIV or hepatitis C in Washington, DC, and Baltimore.
However, just 85 of the 314 participants had ever heard of PrEP, only 32 people had been offered PrEP by a provider and only six people were currently taking PrEP. Results were no better for the 15% of participants who considered themselves to be at high risk for HIV: 21% had heard of PrEP, 11% had been offered PrEP and three were using it.
Click here for to read the study abstract.
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The Need For Guidelines
Hepatitis C virus is a major health care concern in the UK affecting some 200 000 to 400 000 individuals. The majority of these patients will have chronic HCV infection and many will develop chronic liver disease with the risk of developing cirrhosis and hepatocellular carcinoma . Successful treatment will arrest the progression of liver disease and so prevent the serious complications of chronic HCV infection. In addition, treatment will reduce the numbers of HCV infected individuals.
The relatively high cost of treatment enforces the need for a systematic approach for this condition so that resources are used most effectively. The development of clinical guidelines is important, as these will assist purchasing authorities, providers, clinicians, primary care groups, and patients in making decisions about appropriate treatment.
Potential For Household Hcv Transmission
Although HCV is transmitted most efficiently through the parenteral route, some epidemiologic studies have shown household contacts of HCV seropositive patients to have a slightly elevated risk of HCV infection. Confounding factors include the potential for shared parenteral exposures, such as medical or dental procedures and injections sexual exposure between partners and spouses and vertical transmission between mother and infant. Thus it is difficult to quantify risk associated with nonsexual, household only exposures to HCV. A systematic review of this found an increased risk for HCV infection in siblings and household contacts of persons living with chronic HCV infection. The increased risk for HCV infection in families and spouses included in the controlled studies correlated with the severity of liver disease in the index patient, the number of family members infected with HCV, the duration of exposure to the index patient, and sexual contact with the index patient. Additional domestic risk factors for HCV transmission identified in uncontrolled studies were sharing razors and nail clippers between family members and patients, reuse of syringes, and coinfection with HIV.
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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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Is Hepatitis B Contagious
Hepatitis B is highly contagious. Its transmitted through contact with blood and certain other bodily fluids. Although the virus can be found in saliva, its not transmitted through sharing utensils or kissing. Its also not transmitted through sneezing, coughing, or breastfeeding.
Symptoms of hepatitis B may not appear for 3 months after exposure. Symptoms can last for several weeks.
But even without symptoms, you can still transmit the infection to others. The virus can live outside the body and remains infectious for at least
Hepatitis B is a highly contagious condition. Its associated with many serious complications, some of which can be life threatening.
But there are many treatment options available and multiple ways you can prevent infection, including getting vaccinated.
If you suspect you may have been exposed to hepatitis B, its important to talk with a doctor to prevent infection and determine the best course of treatment for you.
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Heterosexual Transmission Of Hcv
Heterosexual transmission of HCV is widely considered to be inefficient . Prospective studies of heterosexual monogamous couples reported incident transmission rates of up to 0.6% per year . A literature review found no increased risk of sexual transmission of HCV among heterosexual couples in monogamous relationships
Gay Men Chemsex And Hep C
Group sex and chemsex parties provide the perfect storm for hepatitis C transmission.
The iBase guide Safer HCV sex for gay men is a useful reminder of what to avoid and what steps to take to protect yourself.
The Hepatitis C Trust has some useful information about transmission. They also provide an advocacy service for men who have sex with men who have been re-infected with hepatitis C after previously being successfully treated.
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Screening For Hcv During Pregnancy
In the United States, in recent years, there has been a significant increase in HCV infection among women of childbearing age, which has raised concerns for potential significant increases in the number of perinatal HCV infections. In this setting, it is important that women of childbearing age with risks for HCV infection undergo HCV testing, as this could identify women who would be candidates for HCV treatment prior to becoming pregnant. Similarly, the U.S. Preventive Services Task Force and CDC now recommend routine, universal HCV screening of all adults, including all pregnant women.
More Ways To Reduce The Risk Of Infection
If you arent sure whether you have hepatitis C, get tested. Testing is especially important if you are having sex with more than one person or if you have other risk factors for hepatitis C, including having had a blood transfusion prior to 1992 or injecting drugs .
Talk to your partner about getting tested as well, for hepatitis C and other STIs, so you know the risks before having sex. People who are at risk for hepatitis C are also at risk for HIV and other STIs, notes Talal.
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Hepatitis C Virus And Alcohol
There are high rates of HCV antibody positivity among alcoholic patients., Most antibody positive patients are also HCV RNA positive and some studies suggest higher levels of HCV RNA in this group of patients, although this remains to be confirmed. The presence of anti-HCV antibodies is associated with more severe liver disease in alcoholic patients.
The importance of alcohol in chronic HCV infection was shown in the recent study of Poynard et al showing that daily consumption of more than 50 g of alcohol is associated with an increased rate of fibrosis progression.
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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