HIV and hepatitis C – transmission
New Swiss research shows the seriousness of the epidemic of hepatitis C in HIV-positive gay men.
The researchers found that 60% of all new hepatitis C diagnoses in HIV-positive people in Switzerland since 1998 were in gay men. Most of the other infections were in injecting drug users.
Epidemics of sexually transmitted hepatitis C in gay men with HIV have been documented in the UK as well as in several other European cities and New York.
According to the latest research, new hepatitis C infections in HIV-positive gay men now exceed those seen in HIV-positive injecting drug users.
The proportion of HIV-positive gay men newly infected with hepatitis C was 0.2% in 1998, but it has now increased to over 4%. Over the same period, the rate of new infections fell gradually in HIV-positive injecting drug users. Annual incidence in this group is now 2% – half that seen in gay men.
Hepatitis C is spread by blood-to-blood contact. Sharing equipment in injecting drug use is the main mode of transmission. However, any sexual activity that involves contact with blood also involves a risk, especially rougher and more prolonged sex. This includes fisting, sex while on drugs and group sex. Unprotected anal sex between HIV-positive gay men has also been identified as a risk factor. Condoms for penetrative sex, the use of latex gloves for fisting and cleaning sex toys can help reduce the risks.
Routine HIV care should involve regular tests for hepatitis C. More frequent tests are recommended for people with ongoing risk factors for the infection.
For more information on hepatitis C visit our booklet HIV & hepatitis.
HIV and pregnancy – treatment
French researchers looked at the proportion of pregnancies in HIV-positive mothers that ended in a premature delivery (before 37 weeks) between 1990 and 2009.
They found that treatment with a ritonavir-boosted protease inhibitor significantly increased the risk of preterm delivery.
The risks associated with HIV treatment during pregnancy appear small, and are certainly outweighed by the risk of HIV transmission if treatment is not used.
However, some European research has shown that the use of antiretroviral drugs during pregnancy increases the risk of a preterm delivery.
French researchers wanted to explore this issue in more detail. They therefore examined the records of over 13,000 pregnancies involving HIV-positive women.
Their research showed that HIV treatment did increase the risk of a preterm delivery.
The risk of a premature delivery was higher for women who were taking treatment when they became pregnant than for those who started therapy during pregnancy.
The rate of preterm births was approximately 14% for women who took a ritonavir-boosted protease inhibitor compared to 9% for women treated with an unboosted protease inhibitor.
The researchers made a distinction between spontaneous preterm delivery and induced preterm delivery (where a decision is made to deliver the baby before 37 weeks of pregnancy because of complications such as pre-eclampsia or gestational diabetes). Taking a ritonavir-boosted protease inhibitor was more strongly associated with induced preterm delivery than with spontaneous preterm delivery.
The investigators suggest that the complex metabolic changes caused by ritonavir in both a mother and her infant could be a partial explanation for their findings. The authors note, “Patients treated with ritonavir had more maternal metabolic and vascular complications, leading to an increase in induced premature births.”
Taking HIV treatment during pregnancy is a very effective way of reducing the risk of HIV being passed on from mother to baby, but people understandably have concerns about the effect it could have.
If you’re planning a pregnancy, or are already pregnant, talk to your doctor or someone else in your healthcare team about the best treatment and care options for you and your baby. You can find out more about conception and pregnancy in our booklet HIV & women.
HIV and hepatitis C – care
Two new studies show that care needs to be taken when interpreting CD4 cell counts and CD4 percentages for people with both HIV and liver disease caused by hepatitis C.
CD4 cell counts are one of the key tests used to monitor the health of people with HIV. They measure the number of CD4 cells in a small sample of blood. They give an indication of the health of the immune system, and they therefore help guide decisions about when to start HIV treatment and help show its effectiveness.
Another method of monitoring the immune system involves looking at the proportion of all immune system cells which are CD4 cells. This is called the CD4 percentage.
Research conducted in people with hepatitis C mono-infection (i.e. people who have hepatitis C but do not have HIV) has shown that liver disease is associated with a lower than expected CD4 cell count for a given CD4 percentage.
If this is also the case for people with HIV it could have implications for the use of this key test.
They found that 34% of patients had a higher CD4 cell percentage than would be expected for their CD4 cell count. The likelihood of this was increased by significant liver fibrosis and having a low total immune cell count.
This was associated with liver fibrosis and other markers of liver disease.
The implications of these studies aren’t clear. Researchers are therefore calling for further studies to see if this disagreement between test results is associated with poorer medical outcomes.