March 30, 2009
At a recent San Francisco forum entitled "Could you survive HIV only to die from hepatitis C?" presenters talked about the growing number of hepatitis C virus (HCV) infections found among HIV-positive men who have sex with men (MSM).
The Conant Foundation's Dr. Marcus Conant said outbreaks of hepatitis C apparently linked to sexual activity began appearing among MSM in London and continental European cities around 2002. University of California-San Francisco researcher Dr. Brad Hare said 42 percent of HIV-positive men in UCSF's Positive Health Program now have HCV.
Recent acute HCV co-infections among HIV-positive men appear to represent "a new 21st century clinical syndrome," said Dr. Daniel Fierer of New York's Mt. Sinai School of Medicine. Previous studies of monogamous HIV-negative heterosexuals indicated a sexual HCV transmission rate of less than 5 percent -- suggesting sexual transmission is rare. Though specifics vary among studies, the recent acute HCV outbreaks among MSM have been linked to unprotected anal sex, fisting, group sex, sharing sex toys, co-infection with other STDs, and the use of non-injected recreational drugs.
The process whereby HCV destroys the liver typically takes years or decades. But Fierer said his analysis of a small but growing number of co-infected MSM in New York suggests acute HCV infection in a person already infected with HIV leads to unusually rapid liver damage. He has theorized that existing HIV infection may predispose patients to accelerated liver fibrosis if they are subsequently infected with HCV. This rapid disease progression is not common in co-infected injection drug users, who typically acquire HCV before HIV.
Fierer's findings are controversial, as UK and European researchers have not reported similar rapid disease progression. However, they have tended to use non-invasive methods, not the more accurate liver biopsies employed by Fierer's team, to evaluate liver damage.
Fierer added the good news that if HCV treatment is begun during the acute phase of infection, there is a good chance of both eliminating HCV and improving liver damage.