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Hepatitis C Transmission

March 2009

How HCV is caught and passed on

"One thing that bothers me is that even in the HIV community there is discrimination against drug users ... assumptions are often made by other HIV-positive women regarding drug users. Especially if they want to have children ... It is the same with some doctors ... and sometimes they don't pass the information that we need ..."

HCV is mainly transmitted when infected blood directly enters another person's bloodstream. Saliva and tears are not infectious. Semen and genital fluids may be infectious.

As with HIV, you cannot transmit or catch hepatitis C by touching, kissing, hugging, or from sharing cutlery and crockery.

Unlike HIV, which dies in a few minutes outside the body, HCV survives as an infectious virus in dried blood for several days. This is why you should not share items that may contain tiny traces of blood.

Hepatitis C can be transmitted by:

  • Injecting (or snorting) drug use with shared, unsterilised equipment
  • Tattooing or piercing that does not use new sterilised needles and ink
  • Medical or dental procedures with unsterilised equipment, including kidney dialysis (rare)
  • Needlestick accidents in health care workers
  • Sharing items that may contain blood, such as razors, toothbrushes, nail scissors and nail files
  • Sex with someone who has HCV

Hepatitis C can also be transmitted from mother to infant during pregnancy, or during labour and delivery.

Hepatitis C, blood products and blood transfusions

People who received a blood transfusion or blood products before the blood supply was thoroughly screened (early 1990s) may have been infected with HCV. Since then, the risk has been brought down to virtually zero in the UK, Western Europe, and the US.

However, up to 90% of people with haemophilia who were treated with clotting factors before screening was introduced were infected with HIV and HCV.

In some countries, infections still occur from blood transfusions because blood is not screened thoroughly.

Injecting drug use and HCV

Transmission of HIV and hep C differ, particularly in terms of injection drug use ... because hep C is not just transmitted by sharing a needle, and HCV is much more infectious than HIV. So, I know many people who are taking exactly the same measures to prevent transmission of both, but we know that's not enough to prevent HCV. Sometimes people make decisions based on insufficient information, both in terms of HCV prevention and treatment.

Sometimes people make decisions based on insufficient information, both in terms of HCV prevention and treatment.

Worldwide, most hepatitis C (HCV) infections are related to injecting drug use, through sharing needles and other drug injecting paraphernalia.

Hepatitis C is a tougher and smaller virus than HIV. It can live in a syringe for several days to weeks, and can be transmitted not only through shared needles but also through other injection equipment, such as cookers, cotton, water, measuring syringes and ties.

Cleaning syringes with bleach reduces the risk for HIV transmission, but it may be less effective against hepatitis C. Using clean needles and your own works each time you inject stops both HIV and HCV transmission (and reinfection).

It also reduces the risk of other infections.

Hepatitis C and other (non-injecting) drug use

"I also worry about sharing a rolled up note when I do coke -- but it doesn't stop me from doing it or my friends from being willing to share. I guess this all comes down to individuals agreeing to own and share risks that they feel to be acceptable. These risks feel ok most, but not all of the time."
Hepatitis C is more common among non-injecting drug users than the general population. It is not clear why.

It may be possible to catch the virus from sharing straws or rolled bank notes for snorting drugs, and maybe from crack pipes. Sharing these items is therefore not recommended.

HIV, hepatitis C and sex

HIV transmission

Worldwide, sexual transmission of HIV accounts for the majority of new HIV infections each year.

The ways that HIV is transmitted are well understood. HIV is present in blood, semen, genital fluids and breast milk.

The risk of sexual transmission is greatly reduced by using condoms during sex.

Different types of sex carry different risks -- for example body rubbing and mutual masturbation is zero risk, oral sex is low risk, and anal or vaginal sex without a condom is high risk. Higher viral load in the HIV-positive partner will increase each of these risks and lower or undetectable viral load will reduce them.

Other sexually transmitted infections (STIs), including herpes, gonorrhea and syphilis, increase the risk of transmitting HIV. This is because they increase the amount of HIV virus in genital fluids and make the HIV-positive partner more infectious. STIs in an HIV-negative partner make them more vulnerable to HIV infection.

All this information is important when talking about heptatis C.

Hepatitis C transmission

The risk for sexually transmitted hepatitis C (HCV) is very low in monogamous, HIV-negative heterosexual couples (in which one partner has HCV), but it is higher for HIV-positive gay men.

The mechanism involved with sexual transmission among HIV-positve gay men remains unclear.

HCV is mainly contracted when infected blood from one person enter another person's body. Although the hepatitis C virus has been found in semen and vaginal fluid it is unclear whether this is infectious.

Sex will be riskier if it involves exposure to blood. This could include longer and more energetic sex, anal sex, fisting, sex with a woman during menstruation, and group sex. Condoms and latex gloves reduce these risks.

With HIV/HCV coinfection, sexual transmission of HCV appears to be different for gay male and straight partners.

Heterosexual transmission of hepatitis C

The risk of heterosexual sexual transmission of hepatitis C (HCV) in people who are HIV-negative is very low.

One study following almost 900 heterosexual monogamous couples did not report any HCV infections over up to 10 years of follow-up. The risk is generally reported as less than 1%.

These couples did not use condoms, but also did not have anal sex or have sex during menstruation. The mechanism for this protection is likely to be through reduced exposure to blood-to-blood contact, but is not clearly understood.

Sexual transmission of HCV in HIV-positive gay men

Crystal meth, ecstasy, coke and hepatitis C

Although sex seems to be the source of infection, among HIV-positive men who have sex with men, non-injection drug use increased the risk.

This includes "party drugs" such as crystal meth. cocaine and ecstasy. Injecting crystal is as high a risk as injecting any other drug.

These drugs can lower your immune systyem so you may be more vulnerable to HCV infection.

In the UK, sexual transmission of hepatitis C (HCV) to HIV-positive gay men has been reported since 2003.

A similar link between HCV sexual transmission and HIV-positive gay men has been reported in some other European and U.S. cities. HIV is clearly an important factor because, so far at least, new cases of HCV sexual transmission in HIV-negative gay men are not being reported nearly as often.

Other risk factors for gay men include:

  • Unprotected anal intercourse (not using condoms)
  • 'Heavier' sex including fisting, longer sex and sharing sex toys
  • Group sex
  • Use of some recreational drugs
  • Having other sexually transmitted infections
  • Among some groups of gay men, many of who meet partners online

There is still a lack of clear information about sexual transmission of HCV between HIV-positive gay men.

Mother to child transmission of hepatitis C

"We need a lot more information and research about transmission of mother to child -- and transmission in general. A friend who is co-infected just recently had a child and had to have a Caesarean section because of the HCV (her viral load was undetectable and CD4 count was high -- so she could have delivered vaginally) but she was not able to because of HCV.

As with HIV, a baby can catch hepatitis C (HCV) from his or her mother during pregnancy or at birth. This risk is 3- 4 times higher if the mother has both HIV and HCV (perhaps up to 20% risk).

HIV treatment dramatically reduces the risk of mother-to- child transmission of HIV, regardless of the mother's hepatitis C status, and it may also lower the risk of HCV transmission.

HCV treatment is not possible during pregnancy. This is because one of the HCV drugs (ribavirin) causes birth defects, and the other (interferon) can cause brain and nerve damage in infants less than two years old.

Planned delivery by Caesarean section (C-section) reduces the risk of mother-to-child HCV transmission among HIV-positive mothers.

UK guidelines (from the British HIV Association) currently recommend planned C-section delivery for mothers with have both HIV and HCV.

i-Base guide to HIV, pregnancy and women's health.
British HIV Association website.

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This article was provided by HIV i-Base. It is a part of the publication Hepatitis C for People Living With HIV. Visit HIV i-Base's website to find out more about their activities, publications and services.
 

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