Sexual Transmission of Hepatitis C: Are HIV-Positive Gay and Bisexual Men at Risk?
Table of Contents
- What Is Hepatitis C?
- How Does Someone Get Hepatitis C?
- How Many People Have Hepatitis C in Canada?
- What Is the Evidence That HCV Can Be Transmitted Sexually?
- How Might HIV-Positive MSM Be Getting HCV?
- Is HCV Transmitted Through Semen or Blood During Sex?
- Why Are Group Sex, Anal Fisting and the Use of Sex Toys Risk Factors?
- Why Are STIs Risk Factors?
- Why Is the Use of Recreational Drugs a Risk Factor?
- Considerations for Front-Line Community Workers and Healthcare Professionals
Research shows that the hepatitis C virus (HCV) may be transmitted sexually, especially among HIV-positive gay men, bisexual men and other men who have sex with men (MSM). This article will look at the evidence that HCV can be transmitted sexually and why HIV-positive MSM appear to be at higher risk.
Hepatitis C is a liver disease caused by the hepatitis C virus. This virus is carried in the blood, infects liver cells and causes liver damage (inflammation, scarring, fibrosis and sometimes cirrhosis), which can result in sickness and death. There is no vaccine for hepatitis C, but treatment exists that can clear the virus from the body in about half the people who try it. Because the body does not develop immunity against the virus, it is possible for a person who has been successfully treated for hepatitis C to be re-infected, with either the same strain or a different strain of HCV.
Men and women who are living with both HIV and HCV face greater health and social challenges than those who are living with HCV or HIV alone. Each infection makes the other one worse.
|More About Why HIV/HCV Co-Infection Matters|
HIV/HCV co-infection can lead to:
People get hepatitis C when their blood comes into contact with the blood of someone who has HCV (blood-to-blood contact). People can come into contact with blood containing HCV in many ways, including:
- sharing equipment to inject drugs (such as filters, cookers, needles or syringes)
- sharing equipment, jewelry or ink for piercing/tattooing
- sharing pipes, straws or bills for smoking or snorting drugs
- sharing toothbrushes, razors or nail clippers
- accidental exposure of healthcare workers in a healthcare setting
- unprotected sex
- transmission to a fetus during pregnancy or childbirth
- unsterilized and reused medical equipment (this is rare in Canada today, but may explain previous exposures or exposures in countries where procedures for controlling infection are less strict)
An estimated 242,500 people in Canada were living with HCV in 2007 (this is the prevalence of HCV in Canada).7 This means that an estimated 0.78%, or almost 8 out of every 1,000 Canadians, were living with HCV in 2007.7 That same year, an estimated 7,945 people were newly infected with HCV in Canada (this is the incidence of HCV).7
An estimated 83% of people became infected with HCV as a result of sharing injection drug-use equipment with someone who has HCV.7 The remaining 17% of estimated new infections have been lumped together into one category and attributed to "other" causes, so it is impossible to know how many of these infections may be due to sexual transmission.
While there is no conclusive evidence that HCV can be transmitted sexually, there is some evidence to suggest that it is occurring, especially among HIV-positive MSM. However we don't know how often it is occurring and why a higher proportion of HIV-positive MSM may be getting HCV than other populations.
How Prevalent Is Hepatitis C in HIV-Positive MSM?
Numerous studies tell us that a higher proportion of HIV-positive MSM are living with HCV infection than HIV-negative MSM. This suggests that there may be something about HIV-positive MSM that makes them more likely to become infected with HCV. However, it should be noted that not all studies have shown that HIV-positive MSM are at higher risk, so some controversy continues in the medical field.
|More About These Studies|
While most studies have found a higher prevalence of HCV among HIV-positive MSM, a few studies have not found any increased risk for HCV in HIV-positive MSM.17-20
Research also suggests that the number of HIV-positive MSM infected with HCV each year may be on the rise. Studies from Amsterdam, the United Kingdom and France show us that rates of HCV are increasing in this population.10,13,21,22 Since HCV started to affect MSM, its spread has continued at an increasing pace, as more and more HIV-positive MSM become infected with HCV.
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