English clinic survey finds that 40% of gay men with new hepatitis C infections are HIV negative
Daniel Bradshaw presenting at BHIVA 2019. Photo by Gus Cairns.
A study of gay and bisexual men diagnosed with recently acquired hepatitis C infection and treated in three English clinics has found that 40% of them were HIV negative, the 25th Annual Conference of the British HIV Association (BHIVA) was told in Bournemouth this week, though all the HIV-negative men were in London.
Daniel Bradshaw of Public Health England said the HIV-negative men were on average younger and had a higher average number of sex partners than HIV-positive men with hepatitis C; 81% were using pre-exposure prophylaxis (PrEP) or had done in the last year.
This study adds to recent evidence from France and the Netherlands that PrEP may be associated with changes in sexual risk behaviour and the epidemiology of sexually transmitted infections. Historically, hepatitis C that is sexually transmitted – or rather, associated with sex, as sharing of drug injection equipment during ‘chemsex’ may also transmit infection – has been almost exclusively seen in HIV-positive gay men. So much so, that it was hypothesised that only HIV-positive people were susceptible to hepatitis C infection. An international review showed that the annual incidence of hepatitis C in HIV-positive men rose fivefold from 0.32% in 1990 to 1.6% in 2015; in contrast, it rose non-significantly from 0.04% to 0.08% in HIV-negative men over the same period.
Epidemic of sexually transmitted hepatitis C in gay men now involves both HIV-positive and HIV-negative men
Incidence of acute hepatitis C virus (HCV) among men who have sex with men (MSM) who use pre-exposure prophylaxis (PrEP) in Lyon increased tenfold between 2016 and 2017, according to research published in Clinical Infectious Diseases. There was also a doubling of incidence among HIV-positive MSM, mainly as a result of reinfection. There were distinct clusters of infections, over half involving both HIV-positive and HIV-negative men.
“Our cohort study clearly demonstrates that the HCV epidemic has now spread in HIV-negative MSM,” comment the authors. “The incidence of AHI [acute hepatitis C incidence] was particularly high in PrEP-using MSM.” The authors believe that measures to control the HCV epidemic among MSM should include routine and frequent testing for all high-risk individuals. For those diagnosed with acute infection, rapid initiation of HCV therapy with direct-acting antivirals (DAAs) and harm reduction is needed.
There’s now considerable evidence of sexual transmission of HCV among HIV-positive MSM. Outbreaks are now being reported among HIV-negative MSM. Investigators in Lyon wanted to further understand the dynamics of HCV transmission among both HIV-positive and HIV-negative MSM, including incidence, clustering and risk factors. They therefore designed a study involving all cases of acute HCV among MSM documented in the city between 2014 and 2017. HCV samples were genetically analysed to see if infections were clustered and whether there were distinct transmission networks.
Undiagnosed HBV, HCV, HIV prevalent in newly diagnosed cancer cases
Researchers discovered a substantial proportion of patients with newly diagnosed cancer and concurrent hepatitis C or hepatitis B were unaware of their viral infection and many had no identifiable risk factors, according to a recently published study.
Although the rate was low, some patients also presented with undiagnosed HIV.
Advanced fibrosis found in one-third of patients with HIV/HBV coinfection
Researchers observed significant fibrosis in more than one-third of patients with hepatitis B and HIV coinfection undergoing long-term combination antiretroviral therapy with viral suppression, according to a study published in American Journal of Gastroenterology.
Hepatitis C is detectable in rectal and nasal fluid
High levels of hepatitis C virus (HCV) can be found in the rectal and nasal fluids of people with high hepatitis C viral loads even when blood is not present, Austrian researchers reported on Sunday at the 2018 AASLD Liver Meeting.
The findings reinforce the plausibility of HCV transmission through sharing of rolled-up bank notes or other materials for snorting drugs. They also support the hypothesis that rectal bleeding is not needed for the sexual transmission of HCV during anal intercourse.
The findings were presented by Dr David Chromy of the Medical University of Vienna on behalf of the Vienna HIV & Liver Study Group.
Previous research has shown that in men who have sex with men who have hepatitis C and HIV co-infection, HCV can be detected in semen and is associated with a higher HCV viral load in blood. A study of men who have sex with men with co-infection in New York found that approximately half had detectable HCV in their rectal fluid and this was associated with having a high HCV viral load.
World Hepatitis Day 2018
Worldwide, 300 million people are living with viral hepatitis unaware. Without finding the undiagnosed and linking them to care, millions will continue to suffer, and lives will be lost. On World Hepatitis Day, 28 July, we call on people from across the world to take action, raise awareness and join in the quest to find the “missing millions”.
World Hepatitis Day, observed on July 28 every year, aims to raise global awareness of hepatitis — a group of infectious diseases known as Hepatitis A, B, C, D, and E — and encourage prevention, diagnosis and treatment.
Using hepatitis C-infected donor kidneys could reduce time on dialysis for transplant patients with HCV
CINCINNATI–Transplanting hepatitis C (HCV)-infected dialysis patients with organs from HCV-positive donors and then treating the infection after transplantation is more effective, costs less and will shorten wait times for donated organs, according to a computer analysis conducted by physician-researchers at the University of Cincinnati (UC) College of Medicine.
The findings are available online in the Annals of Internal Medicine. The study’s lead author is Mark Eckman, MD, professor and director of the UC Division of General Internal Medicine.
Another Adverse Effect of the Opioid Epidemic: Hepatitis C Infections
Amid the ongoing opioid epidemic, hepatitis C virus (HCV) infection should be at the forefront of health care providers’ minds. Although HCV has been widely viewed as predominantly affecting baby boomers—those born between 1945 and 1965—a younger generation is experiencing increased incidence of infection.
From 2010 to 2015, the number of newly reported HCV diagnoses almost tripled, with the highest rate among people in their 20s.
Hepatitis C in England 2018 report
Working to eliminate hepatitis C as a major public health threat
Hep C: Have men who have sex with men (MSM) reached a turning point?
Last year, 9940 people living with Hep C were treated with the new direct acting antiviral medications in the UK. Treatments typically last 12 weeks and are close to 100 percent effective. Many of those treated were gay men living in London.
In London and across the UK waiting lists are down. In most places there are no longer waiting lists at all. Those diagnosed with Hep C can now expect to start treatment shortly after diagnosis. The goal of health professionals, charities and campaigners is that patients will soon be able to start treatment on the day they are diagnosed.
Hepatitis A causes less severe disturbances in liver function in people with HIV but illness lasts longer
Acute hepatitis A is less severe in people with HIV but takes longer to resolve, investigators from Taiwan report in the online edition of Clinical Infectious Diseases. Antiretroviral therapy achieving HIV suppression was associated with a hepatitis A disease course which more closely resembled that observed in HIV-negative individuals.
Transmitting HIV Is a Crime in Most States. Is HCV Next?
Infectious disease docs worry about the implications for patients — and themselves
Back when AIDS was dominating the news, 33 states passed laws making it illegal for HIV-infected people to have sex without their partner’s knowledge of the individual’s HIV status. Such laws were based on the idea that their bodily fluids constitute a deadly weapon.
Curing hepatitis C reduces deaths and liver disease
Curing hepatitis C infection significantly reduces deaths from liver disease and reduces the incidence of decompensation, two large prospective studies from Italy and Scotland show. The findings were presented on Saturday at the 2018 International Liver Congress in Paris.
In particular, Italian researchers showed that people with compensated cirrhosis who were not cured of hepatitis C after direct-acting antiviral treatment were 15 times more likely to die of a liver-related cause during the 18-month period after starting treatment than people with compensated cirrhosis who were cured.
New affordable hepatitis C combination shows 97% cure rate
The combination of sofosbuvir and the new NS5A inhibitor ravidasvir cured 97% of people with hepatitis C in a study carried out in Malaysia, and could provide a safe and effective cure for hepatitis C in low- and middle-income countries for $300 or less, researchers of the Drugs for Neglected Diseases Initiative reported on the opening day of the 2018 International Liver Congress in Paris.
Approximately 70 million people live with hepatitis C worldwide but access to curative treatment is restricted by price and by the lack of investments in health systems and viral hepatitis diagnosis and treatment.
Eliminating Hepatitis C in England
England will not fulfill its commitment to elimination of hepatitis C by 2030 unless the number of people diagnosed and initiated onto treatment is greatly increased.
How HIV Alters Cells May Facilitate Sexual Transmission of Hepatitis C
HIV apparently leads to changes to a particular kind of immune cell in the mucosal lining of the rectum that facilitates the transmission of hepatitis C virus (HCV) through anal intercourse.
There is a rising epidemic of sexually transmitted HCV among HIV-positive men who have sex with men (MSM) in Western nations. HIV-negative MSM may also be at risk but apparently to a lesser extent than their HIV-positive counterparts.
Newly Discovered HCV Subtype is Resistant to Antiviral Treatment
A newly discovered hepatitis C virus (HCV) genotype 1 subtype harbors multiple resistance-associated mutations that combine to block therapeutic effect of NS5A inhibitor direct-acting antivirals (DAAs).
Josep Quer, PhD, Liver Disease Laboratory-Viral Hepatitis, Vall d’Hebron Institut Recerca-Hospital Universitari, Barcelona and colleagues report the identification of a new HCV genotype 1 subtype isolated from a treatment-naive patient in Equatorial Guinea.
Hepatitis C Is More Common In Vietnam Vets, But Nobody Is Sure Why
Some veterans say they contracted hepatitis from the “jet gun” that was used to immunize them in the Vietnam era, but researchers haven’t proven that link.
The jet gun injector has never been proven to spread hepatitis C, though the VA says it is scientifically possible. A 2005 VA study concluded that other factors were likely to put veterans at higher risk: intravenous drug use, blood transfusions, tattoos, or time in prison.
Study: Shorter hepatitis C treatment effective in black patients
An eight-week treatment regimen for hepatitis C is just as effective as the recommended 12 weeks in African-American patients, according to a Harvard study.
Because of the shorter treatment, patients with the serious liver disease can have their costs reduced, according to a study published this week in Clinical Gastroenterology and Hepatology.
WHO urges countries to scale up hepatitis C treatment
However, global access to hepatitis C treatment remains uneven, with a small number of countries accounting for the bulk of the increase. Egypt and Pakistan accounted for about half of all people starting direct-acting antiviral (DAA) treatment to cure hepatitis C in 2016. There has also been encouraging progress in countries as diverse as Australia, Brazil, China, France, Georgia, Mongolia, Morocco, Rwanda and Spain.
WHO’s report, titled “Progress report on access to hepatitis C treatment: focus on overcoming barriers in low- and middle-income countries”, reviews the progress made in expanding access to life-saving treatment for hepatitis C infection in 23 low- and middle-income countries. It also provides information from innovator and generic medicine manufacturers and multiple partner organizations working in the field of viral hepatitis.
Smoking threatens health gains from hepatitis C treatment, US researchers warn
People with hepatitis C in the United States are at least three times more likely to smoke than the general population but little is being done to help them stop smoking, and US researchers say it is folly to spend huge sums on hepatitis C treatment without trying to help patients stop smoking.
Severe fibrosis improves in most people after hepatitis C cure but persists in a quarter
Hepatitis C virus (HCV)-related liver fibrosis improves significantly in the majority of people with pre-treatment advanced fibrosis or cirrhosis after treatment resulting in a sustained virological response, Swedish investigators report in the Journal of Viral Hepatitis.
However, advanced fibrosis persisted in a quarter of people and worsened in a small subset of people, showing the need for regular monitoring after successful HCV therapy. Pre-treatment cirrhosis, older age and high body mass index were risk factors for the persistence of advanced cirrhosis.
‘Virus-cracking’ molecules advance fight against hepatitis B
Researchers have found that certain molecules — currently under clinical trial — are able to ‘crack’ the protective shell of the hepatitis B virus, suggesting it may be possible to attack the virus after its already taken hold in the body. There is currently no cure for the virus, which can cause liver failure and cancer.
Harm reduction scale-up needed to eliminate HCV in people who inject drugs, European model predicts
Smoking reduces survival after liver cancer diagnosis for people with viral hepatitis
Twelve people face court for feeding homeless in California
Hepatitis C treatment highly effective in harder-to-treat people with HIV co-infection, Spanish real-life study shows
Medieval Mummy Was Infected With Hepatitis B
HCV Genotype 6 Responds to 8-Week Oral Treatment
Hepatitis C Genotypes – Topic Overview
Six major strains (genotypes) of the hepatitis C virus (HCV) cause infection. You may be infected with more than one genotype at a time.
- Genotype 1 is the most common strain in the United States.
- Genotypes 1, 2, and 3 are found worldwide.
- Genotype 4 is found throughout northern Africa.
- Genotype 5 commonly is found in South Africa.
- Genotype 6 is common in Asia.
Genotype testing is done with a blood test.
Should uninfected patients accept hepatitis C-infected livers to reduce waiting time?
Hep C Is Linked to Kidney Disease but Treatment Mitigates the Risk
No Link Between Hep C Treatment With DAAs and Liver Cancer Risk
Fatty Liver Disease Is Linked to Liver, Colorectal and Breast Cancer
Liver Cancer Risk Higher for People With Well-Treated Hep B Versus Hep C
More work and lower drug prices are needed to eliminate hepatitis C worldwide
Alcohol Use and Metabolic Factors Work in Concert to Drive Liver Disease
In Australia, STIs Are Up, the HIV Rate Is Stable and Hep C Cures Abound
Global progress towards hepatitis C elimination still blocked by cost of treatment, lack of diagnosis
UK elimination of hepatitis C in jeopardy unless more patients found
Hepatitis C test-and-treat programme reduces HCV by two-thirds among men who have sex with men in Swiss HIV Cohort
High rate of hepatitis C reinfection in German men who have sex with men
Maviret cures most people with HCV genotype 3 and those with cirrhosis
Curing Hepatitis C is Linked to a Lower Risk of Type 2 Diabetes
HCV infection is rising among HIV-positive gay men in San Diego
Further information on Hepatitis & HIV for people living with a bleeding disorder is available by clicking the link below.