Health Alert: Hepatitis C Threat Through Sex

A growing body of evidence suggesting that hepatitis C can be transmitted sexually is prompting some AIDS activists to call for more research and for AIDS groups to talk to clients about the health threat. "People are starting to hear that message," said Spencer Cox, founder and executive director of the Medius Institute for Gay Men's Health. "Do we need to start ramping it up? I think we do... That data has just started to arrive. We're not necessarily way behind the curve." Hepatitis C, a virus that attacks the liver, is known to be transmitted through needle-sharing by drug injectors. AIDS groups have generally said that the risk of sexual transmission is low, but some recent European studies have documented sexual transmission among groups of gay men who do not inject drugs. Most of the hepatitis C infections found in those studies are among gay men who are also infected with HIV, the virus that causes AIDS, but some research suggests that sexual transmission of hepatitis C is happening among gay men who are not HIV-positive.

"I think these case reports coming out of Europe are that these clusters of acute hepatitis C infections are likely the result of transmission during risky sex among HIV-positive men," said Dr. Joanna Buffington, a medical officer in the Division of Viral Hepatitis at the federal Centers for Disease Control and Prevention (CDC). "We can't really extrapolate for HIV-negative men."

A problem is that the hepatitis C infections among these men are associated with having many sex partners, fisting, rimming, and non-injection drug use so the exact transmission cause is unknown.  "There have been these reports popping up over and over again, but we still don't necessarily know the mechanism," Cox said. "We don't know if this is a case of transmission through routine anal intercourse or during 15 hours of ass play."

In a 2007 study published in Public Health Reports, Buffington tested 1,699 men who have sex with men and 3,455 straight men for hepatitis C in clinics in three cities from 1999 through 2003. None of the men were drug injectors. Just 1.5 percent of the gay men were positive for hepatitis C as were 3.6 percent of the straight men.

"It says that sexual transmission among men is probably not as efficient as expected," Buffington said, indicating that hepatitis C can be spread through sex, but not easily.

There are effective vaccines for hepatitis A and B, but not for C. Twenty to 25 percent of people infected with hepatitis C will progress to cirrhosis of the liver though that can take years. Four percent will develop liver cancer.

Some data suggests that people who are HIV-positive have a faster hepatitis C progression. Buffington said treatment is complicated when a patient has both conditions because HIV medications can negatively affect the liver, the same organ that is damaged by hepatitis C.

"People with HIV are living longer lives and many of them are dying from liver problems," she said. "Hepatitis C is a lifelong chronic infection that can kill you. That is an important thing to avoid too."

The Latino Commission on AIDS has been telling its clients about the possibility of sexual transmission of hepatitis C for five years, according to Dennis deLeon, the group's president.

"We do courses on HIV treatment and in the course of that we talk about hepatitis C infection and the possibility of that," deLeon said. Many AIDS groups do not do the same.

"They hedge the sexual stuff," deLeon said. "They've always hedged the sexual stuff, they claim there's no evidence... I have been following that and I have been urging people to change their language when discussing it."

Michael A. Roberson, executive director of POCC, a Brooklyn AIDS group, said his organization typically associated hepatitis C with injection drug use (IDU). "From everything we've been talking about, from everything we've heard, hepatitis C is more of an IDU transmission," he said though he did not foreclose the possibility of discussing sexual transmission.

"This would be of interest," he said. "It may have implications for HIV-positive individuals and the kind of sex they're having."The Gay Men's Health Crisis (GMHC) did not respond to two e-mails seeking comment for this story.

While there are effective treatments for hepatitis C, they can have unpleasant side effects. "The treatment is horrible," deLeon said. "It causes terrible depression and feelings of lethargy." [ Source ]

Comments

[Pixie]

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