Sexual transmission of hepatitis C virus, which can lead to fatal liver disease, may be more widespread than previously thought, particularly amongst gay men, according to doctors at two of London’s leading HIV clinics. Both doctors are interviewed in this month’s AIDS Treatment Update, available here on aidsmap.com as an early release publication.
According to the Government’s Hepatitis C Strategy for England, published last month and available at the Department of Health website, as many as 200,000 people in the UK may be infected with hepatitis C. It is thought that the majority of these acquired the infection either through sharing injecting equipment or from contaminated blood products.
However, two London-based HIV clinics now report that a number of recent diagnoses of hepatitis C infection have been made in people whose only risk behaviour was unprotected sex.
Dr Sanjay Bhagani, who runs the HIV and hepatitis C coinfection clinic at the Royal Free Hospital, London, says: "In the last six months we’ve picked up six patients who have seroconverted for hepatitis C. We’ve been through all of them with a fine tooth comb in terms of risk factors and it seems that they had none of the other risk factors of hepatitis C transmission, leaving me in no doubt that these were due to sexual transmission."
Dr Mark Nelson is Consultant to the HIV and hepatitis C coinfection clinic at the St Stephen’s Centre, Chelsea and Westminster Hospital, which is the UK’s largest HIV clinic, and where 7% of patients are coinfected with HIV. Describing these patients, he says: "A lot have none of the major risk factors of intravenous drug use or blood transfusion and I think the majority is sexually transmitted."
Research into the likelihood of sexual transmission of hepatitis C (reviewed in this month’s AIDS Treatment Update) suggests that sexual practices which involve contact with blood are associated with hepatitis C transmission amongst gay men. These include unprotected anal sex, fisting and rimming. Though evidence suggests the risk of sexual transmission between heterosexuals is low, this risk may be higher in people with HIV infection because hepatitis C viral load (the amount of hepatitis C in the blood) is much higher in these individuals, presenting a greater risk of transmission.
About 20% of people with hepatitis C develop cirrhosis (scarring of the liver) over a ten to twenty year period, a progressive condition which eventually requires a liver transplant. The prognosis in people who are also infected with HIV is less good. Hepatitis C is a treatable condition, however.
Doctors Nelson and Bhagani call for increased screening for hepatitis C amongst gay men and people with HIV. Dr Bhagani adds: "I think the take home messages are that hepatitis C is sexually transmissible, so gay men and people with HIV should practice safer sex. In coinfected patients, hepatitis C is a particular concern because of the faster progression to end stage liver disease and complications with drug-related toxicity."
A detailed review of the prevention, diagnosis and treatment of hepatitis C is available here at aidsmap.com. Newly-revised one page NAM Factsheets on hepatitis C can be printed from aidsmap in html or pdf format.