Sexually Transmitted Hepatitis C Infection in HIV-infected Men in NYC

[mikesimon]

New Epidemic of Sexually Transmitted Hepatitis C Infection in HIV-infected Men
in NYC
Presentation: Sunday, November 1, 2009, 8:00 am Eastern Time in Boston, MA

ALEXANDRIA, Va. and BOSTON, Oct. 30 /PRNewswire/ -- Researchers in New York
City are reporting their work uncovering a new epidemic of hepatitis C virus
(HCV) infection among men-who-have-sex-with-men (MSM) who have HIV infection.
These authors have previously reported unusually rapid fibrosis progression
due to new HCV in MSM who have HIV infection and now expand on their findings,
demonstrating that sexual transmission rather than injection drug use is the
route of infection. Treatment is highly successful if started early in the
course of infection, however, they report ominous news about liver disease
progression. "This epidemic represents a new clinical syndrome for HCV
infection that turns much of our knowledge on its ear: a new risk group
becoming infected through a previously rare route of transmission resulting in
unprecedented progression of liver fibrosis," said Daniel Fierer, MD,
principal investigator on this study.

In an analysis of 21 HCV-infected patients matched with uninfected controls,
unprotected receptive anal and oral sex were significantly associated with new
HCV infection. Neither current nor prior injection drug use was associated
with HCV infection. In addition, treatment with pegylated interferon and
ribavirin, initiated within 6 months of diagnosis, was completed in 16
patients with genotype 1 HCV infection; 12 (75%) achieved sustained viral
response (SVR), compared to the 15-30% SVR rate expected with chronic genotype
1 HCV infection.  Of significant concern, however, 30 patients underwent liver
biopsy during the early infection period and 23 (77%) already had moderate
fibrosis, making early curative treatment even more important to prevent
further progression of liver fibrosis.  

Because of these findings, study authors recommend routine screening for acute
HCV for all MSM patients with HIV, using a simple and inexpensive algorithm of
ALT measurement every 3 months and HCV antibody measurement every 6 to 12
months.  "Changing the perception and behavior of physicians and patients is
difficult," said Dr. Fierer, "One of the main barriers to early detection is
the lack of recognition by physicians and patients alike that HIV-infected MSM
are at risk for HCV infection.  This lack of perception of the problem results
in lack of screening of HIV-infected MSM and therefore lack of timely
diagnosis and treatment."

Dr. Fierer thinks the next steps in battling this epidemic are educating HIV
providers about the existence of this world-wide epidemic, educating patients
at risk that unprotected sex among HIV-infected men is a significant risk for
HCV infection, and changing the official recommendations by the US national
authorities such as the CDC, HIVMA, etc, as has already been done in Europe
and more recently at the state level in New York.


Abstract title:
Characterization of an epidemic of sexually-transmitted acute hepatitis C
infection in HIV-infected men in New York City

About the AASLD

AASLD is the leading medical society focused solely on advancing the science
and practice of hepatology and represents more than 3,300 practitioners,
researchers, and allied health professionals worldwide. Founded by physicians
in 1950, AASLD has upheld the standards of the profession and fostered
research that generates treatment options for the millions of patients with
liver diseases.

This year's Liver Meeting, held in Boston, Massachusetts, October 30 -
November 3, will bring together more than 7,000 researchers from 55 countries.
A pressroom will be available from October 31 at the annual meeting. For
copies of abstracts and press releases, or to arrange for pre-conference
research interviews contact Gregory Bologna at 703-299-9766. To pre-register,
call Ann Tracy at 703-299-9766.

Press releases, additional information for the media, and all abstracts are
available online at www.aasld.org.

    Media Contact: Gregory Bologna
    703/299-9766
    ***@****

    Press Room: October 31 - November 3, 2009
    Hynes Convention Center, Room 209
    Telephone: [phone]

    Researcher: Daniel Fierer, MD
    Email: daniel.***@****
    Phone: [phone]


This release was issued through The Xpress Press News Service, merging e-mail
and satellite distribution technologies to reach business analysts and media
outlets worldwide. For more information, visit http://www.XpressPress.com


SOURCE  American Association for the Study of Liver Diseases (AASLD)

Gregory Bologna, [phone], ***@****

[Joey_M]

I also read that about 2/3rd's of the people with HIV became infected with HCV after 1996. That was the year the protease inhibitors came out for HIV which rapidly slowed down the death rate from HIV. Prior to that, the life expectancy living with HIV was 1 - 2 years. So Hep C wasn't much of an issue prior to 1996 for HIV positive people.

[Trish77]

I think you're missing the thrust of the information posted.  The ability for HCV to be transmitted sexually is a touchy subject.  What this evidence seems to indicate is that, in co-infected individuals particularly, the ability to transmit HCV via semen rather than blood may be possible.  It may mean that some aspect of co-infection allows semen to be a transmissible vehicle for HCV in SOME people.    

Sobering food for thought. Uncomfortable and sobering yet necessary to investigate and determine what the implications are and continue to educate properly as required.

[GrandOak]

Not all that surprising since they developed ability to test for HIV separate from HCV a few years ago.  Seems to be they then realized that many with HIV were already co-infected with HCV and that many of the deaths which have been reported might actually have been a result of the HCV, especially those which were not easily attributed to other causes of death.

Not surprising is that since then there has been a noticable increase of studies being performed which have a co-infection of HIV with HCV or HBV listed as the core of their focus.

Not surprising is that many doctors and health workers may not be aware of this, but then again as we have seen in other threads here, they are not all that knowledgable on Hepatitis either so it should come as not surprise I guess.

[Joey_M]

So glad this information is finally getting more publicity. Much of the HIV positive community is in denial including doctors and healthcare workers. I have been infected twice through sex (I am HIV poz). The first time was 5 or 6 years ago and everyone thought it was some other way (I injected a drug once but didn't share a needle and tested neg for Hep C several months later). I was surprised the second time and have done a bunch of research and met many HIV poz men who have no other risk factor besides sex.

I hope more HIV poz people and gay men become aware and understand our risks through sex are way higher than the studies based upon heterosexual monogamous couples that are HIV negative.

[Trish77]

Just some interesting items to add to this:

http://www.liverdisease.com/transmissionhcv.html

An excerpt:

"Sexual contact, whether it be genital, oral, or anal, appears to be an extremely inefficient means of HCV transmission. In fact, many studies evaluating this mode of transmission have failed to detect the presence of HCV in either the saliva, semen, or urine of HCV-infected people—except when these body fluids have been contaminated by the person’s blood. However, it is important to emphasize that HCV has the potential to be transmitted through intimate contact if there is active bleeding -such as during menses (if the woman is infected with HCV), or if there are breaks in the skin or in the lining of the mouth, vagina, penis or anus. Breaks may occur for a variety of reasons including the presence of active, bleeding herpes sores or as a result of traumatic or rough sex, especially anal intercourse. In fact, it has been found that people with sexually transmitted diseases such as trichomonas, gonorrhea, as well as herpes, as well as men who have sex with men, are both factors that have been found to increase the likelihood of sexual transmission.  Since HCV can be present in menstrual blood, extra precautions (the use of dental dams and condoms) should be considered during and just after menstruation to decrease the chance of transmission, particularly if the sexual partner has open cuts or wounds.  Also, sanitary napkins or tampons should be placed in a leak-proof sealed bag and promptly disposed of. Finally, it has been found that people co-infected with both HIV and HCV may have an increased potential for transmitting HCV through sexual contact. Of interest is that it appears to be easier for a man to transmit HCV to a woman than vice versa."

http://www.natap.org/2005/HCV/102005_01.htm

An excerpt:

"Note from Jules Levin: In AIDS journal Nov 2005 researchers report finding HCV in the semen of men coinfected with HCV & HIV more frequently than in the semen of HCV monoinfected men (37% vs 18%; p=0.033). The coinfected men with HCV+ semen had significantly higher HCV blood load than men with HCV- semen, which could explain why the coinfected men had a higher prevalence of HCV in semen than non-coinfected men. This report fuels the controversy of whether HCV can be transmitted sexually, among MSM and among heterosexuals. Many anecdotal reports in the USA support the notion that HCV can be transmitted sexually among heterosexual couples when one partner has HIV. Studies find that sexual HCV transmission is facilitated by the presence of STDs. Traumatic sex may increase risk for transmission. Reports from conferences and publications find increased cases of acute HCV among MSM in the UK & France. The researchers report with confidence that injection drug use is not the cause. It is therefore suggested that the presence of STDs & higher HCV viral loads among HIV+ individuals may be the reasons for HCV sexual transmission. Of interest is the study reported in this article, but bear in mind this study was conducted 4 years ago. Lifestyle practices may be different in Montreal in 2001 than in the UK & Paris in 2005."