Hey Dr. Frascino,
First off, thanks for everything you do. Your hard work and dedication to all of us who need answers doesnt go unnoticed. You are a great person.
I have a couple of questions.
What is your oppinion on hepatitis c as an STD. Ive heard that it's not and I also heard that it is. Ive been tested for HIV 4 times and all the other stds twice out to 8 months after any possible exposure, but my doctor never included Hep C. Is that something that should be a worry from sex or do you feel it's more of a drug injection disease from blood to blood contact?
Also, if someone is infected with multiple viruses at the same time will the body's immune system still be able to make antibodies for each virus in a normal amount of time? Or would they be delayed significantly? If infact I dont have Hep C, do you feel 8 months negative HIV test is conclusive even though i had a positive mono spot test and EBV titers about a month after my possible exposure to someone of unknown status?
And lastly I have more of a scientific question. Why is it that we are not able to cure the HIV virus yet we are able to use current medication to bring someone's viral load from a very high number to undetectable in the blood? How can we kill off so much of the virus but not be able to completely rid it from the body?
Im sure you are a very busy guy but if you could possibly answer me I would greatly appreciate it, if not no love lost. I hope you are having a great holiday season. Stay well.
Oh and how would i go about making a donation?
- I've discussed the sexual transmission of hepatitis C many times in this forum. Check the archives! As an example, I'll reprint below some information form the archives pertaining to this topic.
If someone is infected with several viruses simultaneously, the body's immune system will react to each virus individually and simultaneously. The immune system is very capable of multitasking! There has been some concern about hepatitis C and HIV coinfection causing delayed seroconversion. I've discussed this multiple times previously. See below.
Regarding a cure for HIV, we have a whole chapter devoted to this topic in the archives. Check it out! Briefly, the reason cure is so difficult is that HIV attaches itself to CD4 cells, which are part of our immune system, the very system that is designed to help us fight off invading germs. The virus is very clever. It actually inserts its genetic material into human cells and uses these cells as virus factories to make more virus, which then infects more immune cells. HIV can also hide in places that drugs can't get to. I'll reprint some information about finding a cure below.
Thanks for your donation to the Robert James Frascino AIDS Foundation (www.concertedeffort.org).
Topping and Hep C (SEXUAL TRANSMISSION OF HEPATITIS C, 2008)
Oct 13, 2008
Okay so this is my question.... I am an HIV positive gay man, and currently I had unsafe sex with another HIV positive person, both of us are undetectable, but I later found that he also is co-infected with Hep C. During the sex, we didnt have rough sex and I was the top while he bttmd. So know I am really freaking out because I keep looking online and everything that I am reading says that it a very low risk that you can get through sex and that is is more blood to blood contact. Is Hep C the same as HIV in the regaurds that if you are under going treatment it is harder to catch, and being that I am the top is it harder for me to get it and what are the chances that I can be infected aswell... Please help... Thanks
Response from Dr. Frascino
Hello Top Gun,
Hepatitis C is yet another reason barebacking is risky for MSM (men who have sex with men). We have seen an increase in sexually transmitted hepatitis C in MSM. (See below.)
As for hepatitis C-transmission risk, it's not really analogous to HIV. The transmission is primarily blood-to-blood transmission that occurs due to trauma during the sexual activity. I'm not aware of any data that indicates lower hepatitis C viral load decreases transmission risk, but it very well may be true. Your HIV specialist can easily screen you for hepatitis C. I urge you to reconsider your decision to bareback. Contracting an STD can have very negative consequences on your HIV disease.
Accidental Spit in Eye (Hep C) (HEPATITIS C TRANSMISSION) Aug 26, 2008
I have the same question as asked in "blood tainted saliva in eye" asked by another visitor, but my question is concerning Hepatitis C? While talking in a session, a client of mine (I'm a counselor) with that dx in her chart (at some pt), accidentally let a small amount of spit out which hit my eye. What are the chances of Hepatitis C transmission that way
Response from Dr. Frascino
Your risk of acquiring hepatitis C from getting a "small amount of spit" in your eye is nonexistent. I'll reprint some information about hepatitis C transmission below.
Hepatitis C Transmission
HCV is mainly transmitted when infected blood from one person directly enters another person's bloodstream. HCV has been detected in semen and vaginal fluid, so genital fluids may be infectious. Saliva and tears are not.
HCV, like HIV, cannot be transmitted by touching, kissing, hugging, sharing eating utensils, or drinking from the same glass. However, unlike HIV, which dies in less than a minute outside the body, HCV survives and is infectious in dried blood for days or even weeks. People can become infected by sharing items that contain only tiny traces of dried blood.
HCV can be transmitted through:
injecting drugs using shared syringes and/or spoons, caps, and other cookers; water; filters; and ties that may have been used by someone else;
tattooing or piercing using unsterilized needles, contaminated ink, or inkwells;
needlestick accidents (a problem for health care workers);
medical or dental procedures with unsterilized equipment, including kidney dialysis (rare);
sharing items that may contain blood, such as razors, toothbrushes, and manicuring equipment; and
unprotected sex with someone who has HCV.
Hepatitis C can also be transmitted from a pregnant woman to her fetus in the womb or to an infant during labor and delivery.
Before thorough screening of the blood supply began in the early 1990s, some people received blood or blood products containing HCV. Since then, infection control procedures have virtually eliminated the risk in the United States and Western Europe.
However, up to 90% of people with hemophilia were infected with HIV and HCV after being treated with unscreened clotting factors; screening and viral inactivation procedures were introduced in the late 1980s.
In some countries, infections still occur from blood transfusions because blood is not screened. Unsafe medical procedures, such as using unsterilized equipment to vaccinate people, continue to spread HIV and hepatitis C in many parts of the world.
Hepatitis C and Injection Drug Use Worldwide, most HCV infections are attributable to injection drug use. This happens when people share injection equipment, including syringes, cookers, possibly cottons, and other injection paraphernalia.
Hepatitis C is a smaller, more durable virus than HIV. As discussed above, the hepatitis C virus can live in syringes and other objects for days or weeks. This is why it's so important to talk to people you get high with about how to make sure you're getting high safely, and in a way that protects everyone.
Cleaning syringes with bleach reduces the risk for HIV transmission but may be less effective against hepatitis C. If you're getting high, use a new set each time you inject. If you're injecting drugs with other people, mark your equipment and be sure that everyone has his/her own spoon or cooker. Using clean needles and your own works each time you inject stops both HIV and HCV transmission.
What About Hepatitis C in Drug Users Who Don't Inject? "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 okay most but not all of the time."
Hepatitis C is more common among non-injection drug users than among the general population. Researchers are not sure why. Since HCV is so common among IDUs, most drug users -- whether they inject or not -- know people who have HCV.
It may be possible to get HCV from sharing straws or rolled dollar bills for snorting drugs, and possibly from sharing crack pipes. Use your own bills and straws, and if you're smoking crack or heroin, use a stem to protect yourself.
HIV, HCV and Sex Sexual Transmission of HIV
Worldwide, sexual transmission accounts for the majority of new HIV infections each year. The risk of sexual transmission is greatly reduced by using condoms during sex.
The ways that HIV is transmitted are well understood. HIV is present in blood, semen, vaginal fluid, and breast milk.
We also know that different sexual acts carry different risk factors. For example, mutual masturbation and body rubbing are zero risk, and oral sex is very low risk. On the other hand, anal or vaginal sex without a condom is high risk. A high viral load in the HIV-positive partner increases the risk for infection, and a low or undetectable viral load will reduce the risk.
An HIV-positive person with untreated STDs (such as herpes, gonorrhea, and syphilis), is more likely to transmit HIV. This is because STDs increase the amount of HIV virus in genital fluids and make the HIV-positive partner more infectious. Similarly, an HIV-negative partner with untreated STDs is more vulnerable to HIV infection.
Sexual Transmission of HCV
The risk for sexually transmitted HCV is very low in monogamous, HIV-negative, heterosexual couples in which one partner has HCV. One study following almost 900 heterosexual monogamous couples did not report any HCV infections over ten years of follow-up. These couples did not use condoms, but also did not have anal sex or sex during menstruation. Presumably, the uninfected partner in these couples may have had less exposure to blood, and therefore less chance of catching HCV during sex.
The risk for sexually transmitted HCV is higher for HIV-positive gay men and is probably also higher for men or women who have numerous partners and/or lots of anal or vaginal sex without condoms.
HCV is usually contracted when infected blood from one person enters another person's body. Although the hepatitis C virus has been found in semen and vaginal fluid, it is unclear whether and to what extent these fluids are infectious.
Sex is 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 can reduce these risks. Latex gloves can reduce exposure to blood during fisting.
HIV-Positive Gay Men In the United Kingdom, more than 300 cases of sexually transmitted HCV infection have been reported in HIV-positive gay men. A similar link between HCV sexual transmission and HIV-positive gay men has been reported in some other European and US cities.
So far, new cases of HCV sexual transmission in HIV-negative gay men are not being reported nearly as often. This suggests that HIV plays an important role.
Some studies have reported associations between HCV transmission and the following risk factors among gay men:
anal intercourse without condoms;
"heavier" sex, longer periods of sex, fisting, and sharing sex toys;
sex with a higher number of partners;
use of some recreational drugs that lower inhibitions and may make condom use less likely;
infection with other sexually transmitted diseases, especially syphilis; and
meeting partners online.
We can speculate about each of these points, but there is still a lack of clear information about why HIV-positive gay men seem more likely than HIV-negative gay men to acquire HCV through sexual contact.
Crystal Meth, Ecstasy, Cocaine and HCV Infection Although sex seems to be the route of HCV infection among the HIV-positive gay men discussed above, taking drugs in this situation can increase the risk, even if the drugs are not injected. Drugs like ecstasy, coke, and crystal meth, all of which can make people less careful than usual, are frequently found at parties where there is group sex. Under these circumstances, the desire to dispense with condoms may be high.
I REALLY NEED YOU!!!! (HEPATITIS C AND DELAYED HIV SEROCONVERSION)
May 20, 2008
Dr. Bob, I asked you awhile back if HEP C would delay HIV seroconversion.
You said that HEP C would not delay HIV seroconversion! However, Dr. McGovern of the body says that HEP C will delay the HIV window period and that someone who was exposed to both should wait until 6 months to 1 year!!!! Before getting a result!
What's up with that????
Now I know my risk (sharing dollar bill to sniff cocaine) was a low risk incident but what should I do????
I got tested for HEP C at 14 weeks....NEGATIVE!
And HIV at 15 and 17 weeks!!!! NEGATIVE
What should I do???? I think that I am ok and then I hear this stuff!?
Response from Dr. Frascino
No, you don't really need me! What you really need is to pay more attention to what both Dr. McGovern and I have told you on multiple occasions: You are HIV negative. I may need to put a restraining order out on you if you continue to ask your same question over and over again in multiple forums. Come on guy! Give it up! Accept the truly wonderful news you're HIV negative and give other worriers a chance to have their concerns addressed, OK?
This is the last time I'm going to go over this information with you, so pay attention! The Centers for Disease Control has published guidelines for health care workers who sustain a significant occupational exposure to a patient coinfected with HIV and hepatitis C viruses. (This is a far cry from snorting coke through a rolled-up Ben Franklin!) The health care worker guidelines for occupational exposure to coinfected patients suggest HIV-antibody testing at baseline, six weeks and twelve weeks after exposure. There is a caveat, however: If, and I must stress this "if," the health care worker develops acute hepatitis C infection, then and only then (I also stress the "then and only then") would additional HIV-antibody testing be recommend. In this case, and only in this case, are HIV tests out to 12 months recommended. Put another way, if the health care worker does not get ill with acute hepatitis C infection, additional tests would not be recommended!
You have tested hepatitis C negative out to 14 weeks. You do not have acute hepatitis C infection. Hence even if you were a health care worker with documented significant exposure to a coinfected patient, you would not need additional HIV testing. I just can't make it any plainer or clearer than that. Those are the facts, plain and simple. How you choose to live with the incontrovertible evidence that you do not have hepatitis C and that you are conclusively HIV negative is now up to you.
So, I'm signing off on this case permanently. If you require additional reassurance, you can either reread my many (too many) responses to your repetitive and ongoing unwarranted worries or you can seek psychological help. Your problem is not virological; it's psychological!
I'll repost Dr. McGovern's and my responses to you below. We are in absolute agreement!
Can you please tell me if my test results are conclusive???? May 9, 2008
Hello, I emailed you a few weeks ago about sharing a dollar bill to sniff cocaine!( Since I have never touched the stuff!!!!)
Anyway, I got a blood test from my doctor and my test came out negative!!!! This was 14 weeks after sharing the dollar bill.
I also got tested for HIV and that was negative!!!!
So in conclusion, would you say that my negative test results are conclusive? Can I forget all about this?
Response from Dr. McGovern
The risk of HCV transmission through sharing a dollar bill is very low. With this negative blood test, I would suggest that you have had adequate testing.
Remember also that cocaine can lead to heart attacks.
Dr. Bob 3rd time asking......donation coming if you answer! Feb 11, 2008
Dr, Bob I hope you answer this Dr. Bob because I have asked numerous times....
My only fears involving HIV is that I shared a dollar bill to sniff cocaine with a group of people...what would the chances be of getting HIV from this? Has it ever happened? What if there was blood on the dollar bill and I didn't notice? Should I get tested? Not due to fears but scientifically speaking.
My second question is....is it possible to get HIV from deep kissing? I have a moderate case of Gingivitis? I was out drinking alcohol and made out with a girl. What are the chances? I know it happened once right? With that married couple in 1997?
Oh and are 3 month tests conclusive?
Please help and I will send a donation!
Response from Dr. Frascino
Theoretical chances of contracting HIV via rolled-up-dollar-bill coke sniffing would be negligible to nonexistent. Has it ever happened? Not to my knowledge. However, please note we haven't run studies on this, as the Investigative Review Board and ethics committee would tend to frown on such a clinical trial. Testing would be primarily to put your residual fears permanently to rest.
Kissing is not considered to be a significant risk for HIV transmission, even with a moderate case of gingivitis. Once again, if you're worried, get tested! You'll have an accurate result in less than 20 minutes with a rapid test.
Yep, three months is conclusive, unless there are extenuating circumstances.
Thanks for your donation (www.concertedeffort.org).
One final piece of advice: Things don't go better with coke! I recommend strongly you stop.
I WANT TO GET MARRIED!!!! DON'T HATE ME! May 11, 2008
Dr. Bob, I am so sorry to bother you again! I forget to ask a question in my last post!
I was hoping you could clear something up for me because I was confused from your response.....so just 1 question please! I want to marry my gf and I need to know this before I can!
I am the guy who asked you about the risk of sharing a dollar bill to sniff cocaine/ and french kissing with gingivitis! (Please answer last question forever!!!!)
Now just to jog your memory....shared dollar bill to sniff cocaine with group of people/ waited 15 weeks...test NEGATIVE!!!!!
Kissing with Gingivits....waited 12 weeks....test NEGATIVE!!!!
Both tests were ORAQUICK!
Do I need to retest at 6 months, or is my 15 week and 12 week tests conclusive???? Sometimes you say 6 months....is this one of those cases?
I want to get married but need to know this! I am sorry for asking again!!!!
Response from Dr. Frascino
Maybe you shouldn't make those "last question forever" type statements. Something tells me you're more of a "hey doc, I just thought of another question" type of guy.
Regarding your latest question, your negative results are definitive and conclusive. No additional testing is warranted.
Congratulations on the upcoming nuptials!
Be well. Stay well.
Cure for HIV?
By David Scondras
July 15, 2007
Once again we are hearing about efforts to eradicate HIV, at least in some people. These efforts are being made, not by marginal actors, but by some of the country's top doctors, such as Anthony Fauci, M.D., longtime director of many HIV research efforts at the National Institutes of Health. On May 24th the Bloomberg report (Bloomberg.com) headlined the issue this way:
"Top U.S. Scientist to Use New AIDS Drugs Seeking Cure"
A summary of scientists' efforts exploring the possibility of eradication can be found here.
So what happened?
Well, for many years scientists have understood that after HIV gets into someone's body, it starts infecting lots of T helper cells. These cells are also sometimes called CD4+ T cells. T helper cells are the cells that recognize that the body has been invaded by some enemy germ. If these kinds of cells are significantly reduced, the body is unable to recognize many illnesses. As a result, people with HIV can get sick with many serious illnesses.
Once HIV gets into someone's body, HIV begins inserting instructions into these T helper cells on how to make more HIV. These instructions are known as "provirus." They are kind of the brain of HIV and it is these instructions that transform the T helper cell into a factory that can make HIV.
Soon after an HIV-positive person begins taking HIV medications, known as antiretrovirals, the number of these factories is dramatically reduced. But, unfortunately the medicines we have today do not actually eliminate all of the provirus.
In fact, if you checked the cells of people with HIV who are taking antiretroviral medicines, you'd see that although these medications have eliminated most of the HIV from their bloodstream, some cells with these instructions on how to manufacture HIV still remain. Scientists don't yet understand why these cells containing instructions remain while most of the virus has been eliminated. The cells that have provirus but are not producing HIV are known as "latently infected cells." They are "latent" because they have the ability to spring into action at any time.
Scientists have at least two different theories that might explain why the HIV in someone's body does not disappear altogether with the use of antiretrovirals.
The first theory is that these latently infected cells can hang around for as long as twenty or thirty or forty years. As soon as someone stops taking antiretroviral medicines, these cells can spring into action and manufacture HIV.
The second theory is that the medicines we have been using until now do not shut off all HIV reproduction, just most of it and that is why when antiretrovirals are stopped, the virus comes back.
The first theory makes researchers pessimistic about getting rid of HIV and curing someone infected with it.
As I mentioned, provirus does not make virus until the cell containing it is "activated." All this means is that the cell remains quiet until it finds evidence of a germ which it recognizes as an enemy. This causes the T cell to produce proteins that get the immune system ready to fight. When the T cell begins to manufacture these proteins, it also starts making HIV.
No one knows exactly HOW long it takes before all latently infected cells in someone's body are activated. For this reason, most scientists, doctors and activists have been skeptical about finding a cure for HIV. Finding a cure would require getting rid of all cells which contain provirus. Unfortunately, the HIV medications we currently use do not get rid of these latently infected cells.
The second theory suggests that with more powerful drugs we might eliminate all HIV from the body.
In fact, we are in an exciting period in the development of HIV medicine. We actually have new drugs such as integrase inhibitors and entry inhibitors which are in the pipeline that are much more powerful than the antiretroviral drugs we have right now.
This leads us to a hopeful possibility. What if we could eliminate virtually all infected cells with the help of these brand new HIV medications that are more powerful than ever before? What if the new drugs work so well that the immune system is able to get rid of the few infected cells that are left? This is the operating theory behind radiation treatments for cancer.
How can we find out which theory is correct?
First we would use these powerful new HIV medications and see if they can successfully shut down all HIV replication completely and if the body then clears HIV infection.
Then, after testing to make sure no virus or provirus can be found, we would stop using the powerful drugs and wait and see if the virus comes back.
Sounds interesting, doesn't it? This extraordinary experiment is actually taking place right now.
Why try this now?
First, because it was recently discovered that latently infected cells, containing provirus, DO get eliminated from the body. It is not clear why or how, but the data shows that the body does in fact get rid of these latently infected cells (provirus).
Dr. Fauci at the National Institutes of Health, whom I mentioned above found that in seven HIV-positive people who used strong antivirals within four months of being infected with HIV saw a reduction in the amount of provirus by 50% every 4.6 months. If these results hold up, the scientists estimate that 7.7 years of antiviral therapy could possibly eliminate HIV.
The experiment is underway. Patients will be given the powerful new antivirals. These drugs will, hopefully, shut down replication altogether for one year. Then these patients will be taken off the medication -- assuming no virus can be found -- to see if the virus comes back.
This is an experiment which needs to be done, and it's fine to hope for good results. However, there are good reasons to think it will not work, and we should not raise our expectations too high. Perhaps it will work in a few unusual people, such as people who not only were diagnosed with HIV soon after they were infected, but those who also almost immediately went to a doctor and got HIV medication.
Clearly we are far away from understanding how this could work for the majority of people with HIV. Perhaps it will work for a limited period of time in some people, giving them a vacation from HIV medications. Perhaps it will succeed completely and we can look forward to a cure.
The world will be waiting to hear the results.
David Scondras is the founder of Search For A Cure. He developed the nationally-recognized HIV treatment series, Reasons for Hope. All articles in the series are reviewed by expert HIV doctors and scientists as well as an HIV positive and negative focus group to ensure both accuracy and understandability.
This article has been reviewed by Alfred DeMaria, Jr., M.D. Chief Medical Officer, State Epidemiologist; Director, Bureau of Communicable Disease Control State Laboratory Institute and Dr. Cal Cohen of Community Research Initiative of New England.