Transmisson after SVR

[bajajkawa]

Can you transmit Hep C through sex or blood after SVR?  

[Mr Liver]

Defining SVR as remaining below detection limits for 24 weeks post-tx, there is a small chance. One year post tx and the chance for transmission almost becomes nil.
Mr Liver

[bajajkawa]

What small chance of transmission would you suggest are there through sex after 24 weeks post-tx.   I know on chronic hep c the transmission rate is about 5 to 10 percent.

Thanks.  Bajajkawa

[desrt]

Please give your reference for a 5-10% sexual transmission rate. The rate that was passed around the internet as gospel for years was 3-5% - and that turned out to be based on a single study that was debunked when all the couples "who had no other risk factors" turned out to all have different genotypes or different variants of genotype. I've never heard of HCV transmission being anything but blood to blood.

[shastri20032003]

Here is an article  on hep c thru sex though it concentrates more on gay sex

Hepatitis C Threat Through Sex Seen
By: DUNCAN OSBORNE

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 *** 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."

heres the link to the article

http://www.gaycityn ews.com/site/ news.cfm? newsid=18683703&BRD=2729&PAG=461&dept_id=568864&rfi=6

[desrt]

Rough sex = blood to blood transmission.

Also, those who are immune compromised are more susceptible to bacterial, fungal, and viral infections. By this logic athlete's foot is a sexually transmitted disease.

[desrt]

As to the second half of your original question: At 4.5 years SVR I still won't leave my toothbrush or razor where anyone else might grab it by mistake - but I'm overly cautious.

[bobbyullc]

svr means there are no live viruses in your system. can you give away what you haven't got?
starnge?

[bajajkawa]

Cannot find the article where I read 10%.  Below is a link from Mayo that suggest upto 6%.
http://www.mayoclinic.com/health/hepatitis-c/AN00701

[pigeonca]

That was POINT six percent, if you read the article.  And that was the highest probability they gave.  They said your risks were 0 to 0.6 percent annually for those in monogamous relationships, up to 1 percent for those who sleep around.

[DoubleDose]

Of course the statistics for sexual transmission published over the recent years make no sense at all in some ways.  For someone in a monogamous relationship with an HCV+ partner, the odds of getting HCV are supposed to be near zero...or maybe up to 0.6% ( not even 1%).  Yet for those who sleep around, and just might , in a few cases, sleep with someone who is HCV+, their odds of getting HCV are supposedly higher...1% to 2% depending on the study.  Now how can that be?  If a person sleeps with an HCV+ partner every night, for years and years, why would they have a lesser chance of contracting HCV sexually than someone who just sleeps around, and MIGHT be exposed to an HCV+ partner for a short period?  I have always been amazed at the things the medical community proclaims about HCV, that make little sense.  

In other words:  HCV is not sexually transmitted, and couples with one HCV+ partner have little or no concern about transmission.  Almost zero odds.  But, those who are not monogamous, watch out!  HCV is often sexually transmitted for these bad people.  They are sleeping around!  HCV doesn't like people who are promiscuous!  

I also think the 'sharing coke straws' theory is also grasping for straws, if you will pardon the pun.  There is so much unknown about this virus, yet the medical experts like to write neat little, analytic articles, with lots of statistics, to present an appearance of certainty about the behavior of the virus.
I still believe that much of this supposed knowledge is little more than educated conjecture.

DoubleDose

[jmjm530]

DD:  Now how can that be?  If a person sleeps with an HCV+ partner every night, for years and years, why would they have a lesser chance of contracting HCV sexually than someone who just sleeps around, and MIGHT be exposed to an HCV+ partner for a short period?  
----------------------------------------
There is a sense to it, at least from what I've read. The theory behind this is that those with multiple partners are more likely to have/contract STDs as well as engage in higher risk sex practices -- both of which logically could raise the transmission percentage by increasing the likelihood of blood to blood contact. More reasoning behind this can be found in this article, but some time spent 'googling' can find other similar articles as well.
http://www.natap.org/2003/dec/120403_3.htm

[bajajkawa]

According to MR. Liver there is a little chance, what do you all think.  Is there any article or speculation you can refer me on this regard?  
Thanks again.  Bajajkawa

[meki]

Well -- let's just say this (again and again and again)

During HCV Infection --- AND ---- DURING and AFTER TX:

I had:

Wild Monkey Sex with Hubby in every imaginable way - during every moment of the month.

Gave Birth to a healthy daughter.

Cut myself and bled on them

They've bled on me

Been in a major car accident - where everyone bled on everyone

And ad infinitum...

They don't have it... I do. (I'm SVR)

This stuff is NOT """"THAT"""" CONTAGIOUS!

For Crying out loud.

I'm thinking that 99% of the people who have it got it through surgeries, dental places, innoculations - or through shared injections ---- Where blood had to be placed within the circulating system.

Find me ONE person here --- or anywhere...

That has HCV that ALSO --- HAS NOT HAD:

An HCV pos mother
Dental work
Surgery
Tatoos before 1995
Piercings
Innoculations (prior to 1995)

Show me ONE... Just one --- and then you can prove your theory of possible sex transmission.

Until then --- I just don't believe it.

At some point in time --- EVERYONE that I have known has had one of those risk factors above.

I almost do not believe that IVD is the route of transmission for most folks.... even though those one time or a couple of times users are finding themselves HCV pos and are blaming that. I'll almost lay odds down that if they went back to the folks they shared the needles with --- that most of them do NOT have HCV - so that would destroy that theory of them getting contaminated by IVDU. Which would ease a lot of guilt feelings.

But that's just a personal belief.

I think HCV has to be introduced into the body --- and circulated. It's a virus that needs a host.

But --- then heck, this is just my opinion.

Meki

[pigeonca]

Are there any studies of IV drug users who shared needles to determine if they all have hcv and if so, if they have the same genotype?  That would be very interesting to see.

[CockSparrow]

Yes there is. Its a bit Statisical giberish in bits but once again no sexual transmission.

DoubleDose - Never could understand how being promiscuous made you more likely to catch HCV.
Then I figured the same stat could well apply to Car accidents. Just statistical nonsense.

The abtract below discusses the following Study.
http://www.journals.uchicago.edu/JID/journal/issues/v195n11/37159/37159.web.pdf

Hepatitis C Transmission: Sex or Drugs?
http://infectious-diseases.jwatch.org/cgi/content/full/2007/502/6
A study among heterosexual couples provides additional evidence that sexual contact plays little role in HCV transmission.
Hepatitis C virus (HCV) is transmitted parenterally, most often via injection-drug use (IDU) or receipt of infected blood products. However, 10% to 15% of HCV-infected persons report no risk factors for parenteral transmission, leading some researchers to wonder whether the virus might also be spread through sexual contact or sharing of household items.
Now, in a study involving 265 drug-using heterosexual couples in New York City, investigators have assessed the role of sexual behaviors in HCV transmission. To account for the interdependence of risk factors shared by couples ("dyadic data"), they used a novel technique involving multilevel logistic-regression modeling. All couples provided blood samples for HCV antibody screening and detailed information regarding risk factors for HCV infection.
More than half of the participants (51% of women, 55% of men) were HCV-positive. HCV prevalences among those with and without IDU histories were 74% and 16%, respectively. The final multivariate analysis — performed after assessment of individual-, partner-, and couple-level risk factors — identified older age, history of IDU, receipt of a tattoo, and couple’s recent IDU (i.e., injecting together during the previous 30 days) as the only significant risk factors for HCV infection. Clustering of HCV within couples was associated with the couples’ recent drug-injection practices (adjusted P=0.006) rather than with their sexual behaviors.

Comment: In this interesting analysis of drug-using couples, sexual behaviours played no measurable role in HCV transmission. Although including only drug-using couples limited the authors’ ability to detect a small sexual transmission risk, these findings support prevention approaches that focus primarily on reducing HCV transmission in IDU populations. Even though condom use may have little effect on HCV transmission, it should still be recommended to prevent transmission of other pathogens common among HCV-infected persons.
— Daniel J. Diekema, MD, MS
Published in Journal Watch Infectious Diseases May 2, 2007
Citation(s):
McMahon JM et al. Individual and couple-level risk factors for hepatitis C infection among heterosexual drug users: A multilevel dyadic analysis. J Infect Dis 2007 Jun 1; 195; [e-pub ahead of print].

CS