resubmitted form the Fatigue and Anemia Forum: Discordant couple - Risk of HCV transmission (Hepatitis C Virus Infections Among HIV-Infected Men Who Have Sex With Men: An Expanding Epidemic, 2010 )


I have been HIV+ about 5 years now and take Atripla as treatment. My CD4 is 650, viral load below detection. Very recently I have also been found HCV positive. My boyfriend is HIV and HCV negative. We are very much into fisting. He is top only and always (!) uses gloves. Is there a risk of transmitting HCV and if yes, how and is there a way to further protect him from getting infected?



Recent epidemiological studies have found increasing rates of hepatitis C in MSM (men who have sex with men). See below. Associated risk factors include HIV infection, intravenous drug use, fisting and use of GHB (gamma hydroxyl butyrate). Hepatitis C is transmitted primarily via blood-to-blood contact. Fisting can cause trauma to the rectum and anus resulting in bleeding. Latex gloves that completely protect the fisting hand, wrist, arm, elbow, whatever are essential. Neither HIV nor HCV can permeate intact latex. Care should be taken not to cause trauma and playtime should stop if bleeding is noted.

Dr. Bob

hepatitis c and hiv Oct 11, 2010

my partner is hep c and hiv i am also hiv.. we are very much in love and we would like to have sex with no condoms.. but my partner is scared of passing hep c to me... i have had the appropiate boosters and injections against hepc for the last 8 years and he is scared of passing it to me...his hep c count is 22 and he his hep c has been dourment for 2 years... and i am the only person he has had any sexual contact with for the last 3 mounths my hiv is 550 cd4 and i am hiv 1 his cd4 is 540 and he has hiv 1... can you please tell me if we can make love with out a condom please yours sincerley daniel

Response from Dr. Frascino

Hello Daniel,

There are two reasons you should not have unprotected sex with your partner: hepatitis C and HIV.

Regarding hepatitis C, you report you have "had the appropriate boosters and injections against hepatitis C . . . ." You may well have been vaccinated against hepatitis A and hepatitis B, but unfortunately there is no currently available vaccination against hepatitis C. Consequently, you are still vulnerable to contracting hepatitis C. It's also worth noting that there is an increasing pandemic of hepatitis C in men who have sex with men, suggesting that sexual transmission of the virus is increasing in this population. (See below.)

The second reason not to bareback (have unprotected sex) with your partner is the possibility of acquiring a different strain of HIV-1. (There are many different types of HIV-1.) You can read much more about HIV superinfection or dual infection in the archives of this forum. The bottom line for now is that latex condoms are definitely warranted for all penetrative sexual activity between you and your partner.

Dr. Bob

Hepatitis C Virus Infections Among HIV-Infected Men Who Have Sex With Men: An Expanding Epidemic August 23, 2010

Since 2000, outbreaks of sexually transmitted hepatitis C virus have been reported among HIV-positive men who have sex with men (MSM). In the current study, the authors conclude that the prevalence of HCV in this population is "high and increasing."

The setting for the research was a large STD clinic in Amsterdam, where the authors studied the prevalence and determinants of HCV among MSM.

In 2007 and 2008, an anonymous, bi-annual cross-sectional survey was administered to 3,125 patients, of whom 689 were MSM. Participants were interviewed and screened for HIV and HCV antibodies, and all anti-HCV-positive and HIV-positive persons were tested for HCV RNA. Phylogenetic analysis was used to compare HCV strains of the STD clinic patients with those isolated from MSM with acute HCV in 2000-2007. Logistic regression was used to analyze determinants of HCV infection.

HCV infection was diagnosed in two of 532 HIV-negative MSM (0.4 percent) and 28 of 157 HIV-positive MSM (17.8 percent). Among HIV-positive MSM, HCV prevalence increased from 14.6 percent to 20.9 percent during the study period. Acute HCV infection was noted among seven of 28 co-infected MSM (25 percent). Of the 28 co-infected men, only five reported any history of injection drug use (IDU).

HIV infection, IDU, fisting, and use of gamma hydroxyl butyrate (GHB) were found to be significantly associated with HCV infection. A high degree of MSM-specific clustering was found through phylogenetic testing.

"Though not statistically significant, this trend, and the relatively large population of acute infections suggest ongoing transmission of HCV in HIV-positive MSM," the authors concluded. "Regardless of IDU, rough sexual techniques and use of recreational drugs were associated with HCV infection; phylogenetic analysis supported sexual transmission. Targeted prevention, like raising awareness and routine testing, is needed to stop the further spread among HIV-infected MSM, and to prevent possible spillover to HIV-negative MSM."