Hepatitis C Twice for HIV+ Gay Men
posted: 16/03/2011
Just over one-quarter of gay men with HIV cured of early stage hepatitis C in Amsterdam got it again within two years. The men got hepatitis C from different people the second time.
10 times more reinfection – better prevention needed
The hepatitis C reinfection rate among these Amsterdam HIV positive men is ten times higher than the rate they of first hepatitis C infection among men with HIV.
It is clear that much better health promotion work is needed if men are to avoid reinfection with hepatitis C.
Sexually transmission of hepatitis C among gay and bisexual men happens widely especially in cities like Manchester, Brighton, London, Amsterdam, Berlin, as well as in North America and Australia.
Sex risks and networks
Various explanations have been offered for the greater vulnerability of men with HIV infection, including chosing sexual partners who also have HIV (called sero-sorting), and networks of sexual partners where many of the men have HIV. However it is the sexual and drug-using practices which affects who gets hepatitis C.
Heptatitis C reinfection
Researchers from Amsterdam Academic Medical Centre and the Amsterdam Public Health Service reported HIV+ men reinfected after being successfully treated for hepatitis C.
Twenty-eight men were successfully treated. Two men relapsed and hepatitis C reappeared within two months of the end of their hepatitis C treatment. Of the remaining 26 men, 7 were reinfected within two years, an incidence of 19.6 per 100 person years of follow-up. The time to reinfection was typically one year but could be much sooner.
Different type of hepatitis C
In every man reinfected they had a different genetic version of hepatitis C - three who first had genotype 4 then got genotype 1, while two men who started with genotype 1 get genotype 4 the second time. One man got genotype 1 again but even this was from a different clade, a different subtype.
Better prevention
The researchers say that discussion about prevention measures needs to take place not only at the time of diagnosis, but during and after treatment.
In particular men need to understand all the possible sexual and drug sharing transmission routes, and must to feel free to have frank discussions with doctors about sexual practices, drug-using behaviour and other risk factors. Too many HIV positive men with hepatitis C feel unable to talk freely because they feel judged, shamed and blamed by their HIV clinic.
Keep testing
Regular HCV testing in previously-treated individuals is also essential. We reported recently that while around 8% of gay and bi men with HIV in the UK have hepatitis C, one quarter of positive gay men were not checked for this in 2008, when every person with HIV should be checked at least once a year.
A German study showed similar reinfection among HIV-positive men. 22% became reinfected within six years, despite the number of first hepatitis C infections in Germany falling.
Treatment of acute hepatitis C infection with pegylated interferon and ribavirin prevents early HIV infection progressing to chronic infection, which is harder to treat in HIV-positive people.
European guidelines on treatment of acute hepatitis C infection note that HIV-positive patients have a good response rate to treatment begun within a year of infection.
Source with reference
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About 1 in 10 have Hepatitis C
posted: 15/02/2011
9% of people living with HIV in the UK also have hepatitis C, the Journal of Viral Hepatitis tells us, which is low compared with other countries. “In comparison with other large cohort studies, the overall HCV [hepatitis C virus] prevalence of 8.9% in the UK…is low,” comment the investigators.
9% means there are about 6,000 people who are diagnosed with both HIV and hepatitis C in the UK.
But 13,000 more people with HIV still haven't been checked for hepatitis C.
George House Trust analysis suggests that the true UK rate of hepatitis C among people with HIV is probably 11%, not 9%.
As a result, 2% of UK HIV clinic patients receive substandard care - we estimate there are around 1300 people with hepatitis C that is ignored by their HIV clinic, simply because the clinic hasn't checked for it, despite guidance advising hepatitis C checks since 2004.
Are you curious why the hepatitis C rate is lower in the UK among people with HIV? Here, most drug injectors (the main group of people who get hepatitis C) do not have HIV.
Early in the epidemic, England did the right thing, by introducing harm reduction for injecting drug users - like providing clean needles and syringes to reduce onward HIV transmissions.
Countries which delayed doing this have higher rates of HIV now among injecting drug users. We are sorry to say that Scotland is one of the countries with higher rates of hepatitis C among people with HIV.
1 in 10, or even 1 in 9?
The level of hepatitis C must be above 9%, because about 20% of UK people with HIV have never been tested for hepatitis C, despite clear UK guidance to test everyone with HIV for this once a year.
The 20% of people untested for hepatitis C by clinics would, if tested, probably add another 2% to the total, meaning the actual rate of hepatitis C among the UK HIV+ population is about 11%.
Liver disease harm means hepatitis C matters
Liver disease caused by hepatitis C is a major cause of illness and death among people with HIV. What was uncertain was
- how common hepatitis C is among people with HIV in the UK now,
- whether people were being checked every year for hepatitis C following the guidelines, and
- how well treatment works when people have both HIV and hepatitis C.
So, the study used anonymous information about 31,765 people using ten HIV clinics between 1996 and 2007, from the UK Collaborative HIV Cohort (UK CHIC).
1 in 5 seen at HIV clinics in 2007 were untested
The proportion of patients screened for the virus increased from 9% in 1996 to 80% in 2007.
“There has been a clear instruction that all HIV-positive patients should be screened since at least 2004,” write the investigators. Nevertheless, “20% of patients under follow-up in 2007 had not apparently ever been tested. The latest BHIVA [British HIV Association] guidelines recommend screening all HIV-positive patients at diagnosis, with annual repeat testing in those who are negative.”
Although injecting drug use (IDU) is very closely linked with having hepatitis C, only half (50%) the people with a history of injecting drug use were known to have had a hepatitis C test.
Gay men with HIV were most likely to have had a hepatitis C test (74%), followed by heterosexual men and women (63%), then IDU (50%). The investigators think more drug injectors have been tested than the 50% they found, perhaps at services for drug users.
George House Trust commentary
In 2009, 65,319 HIV-infected individuals (of all ages) were seen for HIV care in the UK, so the 2% who clinics are not treating for hepatitis C means about 1300 people are being neglected with worryingly substandard care.
- Clinics admit they don't know the hepatitis C status of half the people with HIV infected through injecting drug use. From this study we know that 84% are very likely to have hepatitis C.
- Clinics don't know the hepatitis C status of 26% of gay men, the next most at risk group. We know from this study that 7% of these men probably have hepatitis C.
The failure to screen 20% of HIV clinic patients for hepatitis C harms people's health and can seriously shorten life. Hepatitis C causes permanent liver damage.
Anyone with hepatitis C and HIV needs careful health monitoring for both conditions and the coordination of treatment and care.
This isn't happening for half the people infected through IDU and about one third of gay men, the other main group at risk.
The 9% of people with HIV in the UK this study found to have hepatitis C, compares with just 0.44% among the general UK population.
Hepatitis C and how people got HIV
The rate of hepatitis C varies with how people got infected with HIV. 84% of the people who got HIV as an injecting drug user have hepatitis C, and the next largest group is gay men – but just 7% of HIV positive gay men also have hepatitis C.
Gay men injecting more?
However, the investigators suggest that some hepatitis C infections in gay men may be due to injecting drug use, which is “underreported by some MSM [men who have sex with men], sufficient to place them at risk of HCV infection … underreporting of IDU as a risk for HCV transmission in MSM may also affect other cohorts.”
Unsurprisingly (when most gay men in the UK are white and most injecting users are also white and male), most people with both HIV and hepatitis C are men (80%), white (82%), with the median age at 37.
Treatment working
4% of the 10,000 patients starting HIV treatment after 2000 also had hepatitis C. Overall, 91% reached an undetectable viral load, which is as good as for people with only HIV.
Ask for hepatitis test when your next bloods are taken
Jason Warriner, clinical director of Terrence Higgins Trust said: “It’s concerning that almost 13,000 people living with HIV could have Hepatitis C without knowing it because they haven’t been routinely checked for the infection.
It’s not just people who use drugs intravenously who’re at risk of Hepatitis C, the infection can also be passed on during sex, so we’re encouraging anyone who is HIV positive and hasn’t been tested for Hepatitis C to ask their health practitioner for a check the next time they’re getting their routine blood tests.”
More information on hepatitis C and HIV
Reducing the risk of getting hepatitis C
People injecting drugs can protect themselves and others from hepatitis C by using drugs more safely.
Gay men’s risk of getting hepatitis C sexually seems to come from unprotected anal sex, group sex, drug use and fisting. Sharing sex toys and lubricants also appear to be risky. Using condoms for anal sex, and gloves for fisting provide protection. Information on risk reduction for gay men.
Source with reference and weblink
further material : demand screening
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Compensation for Bad Blood
posted: 11/01/2011
More compensation will be paid to people (who are mainly people with haemophilia) who got hepatitis C from contaminated blood transfusions by the NHS over 20 years ago, the government announced.
Many people got HIV through the same contaminated blood scandal, while others got both HIV and hepatitis C and some just hepatitis C. The compensation arrangements for HIV and hepatitis C were different and people with hepatitis C felt cheated.
Hepatitis C campaigners are still unhappy and will continue to fight for more help. One of the campaigning groups, Tainted Blood, said the offer "hugely disappointing", and Haemophilia Society chief executive Chris James said the payments "would not bring closure to many people."
HIV complaint too
A man with HIV from Blackburn, Lancashire, 'John Smith' has also criticised the compensation scheme as inadequate.
‘Serious disease' payments
The announcement by the health secretary, Andrew Lansley, follows a three-month review of the compensation paid to those who were infected with hepatitis C, which can cause liver damage and cancer. Separate settlements were made to those who got HIV through blood transfusions. Some people were infected with both HIV and hepatitis C. Many of those who received contaminated blood in the 1970s and 1980s have died.
Cirrhosis and liver cancer
The new deal offers better compensation to those whose hepatitis C infection has progressed to cause serious disease. The current terms allow a one-off payment of £20,000 to all those infected, with a further £25,000 if they develop more severe diseases, such as cirrhosis or liver cancer.
Under the new deal, the second group – those with severe diseases – will get an annual payment of £12,800 a year. Those with severe diseases who have already been given a lump sum will have it increased from £25,000 to £50,000.
There will also be "discretionary payments" to those most in need, and the dependents of those who died before 2003 will for the first time be able to claim. There will also be a doubling in a one-off payment to £50,000 when people become very ill.
"I fully recognise that the unintended and tragic consequences of these treatments have seriously impaired the lives of many people, together with those of their families," said Lansley. "For too long those people infected with hepatitis C have received different support to those infected with HIV. We now intend to make the financial support for hepatitis C patients fairer and more comparable to the arrangements for those infected with HIV."
Campaigners’ disappointment
But, after decades of fighting for what they consider fair settlement, including the recent independent inquiry by Lord Archer which recommended much greater generosity from the government, campaigners said they were devastated.
Sue Threakall, secretary of Tainted Blood, said: "While there are some minor positive points, we are devastated by this announcement. There are a limited number of people that the new financial support will be available to and the level of payment to those who will qualify is hugely disappointing. It will not bring to an end the years of suffering and will mean that the campaign for achieving proper compensation for all will continue with a new vigour."
Chris James, chief executive of the Haemophilia Society, said he thought the reaction from the community would be that it is "a gesture rather than a settlement. People will not feel that this is going to bring closure in terms of the money being paid. The levels of compensation are not in the region that people still feel is appropriate for the impact on their lives."
Those who were infected but not severely ill would get nothing more – unless they were in serious need and qualified for a discretionary payment – and the new annual payment for those with liver cancer is only likely to be paid for very few years because life expectancy for people with liver cancer is short.
Sources
Guardian
BBC
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Europe, HIV and Hepatitis C
posted: 15/12/2010
Recommendations for treating acute hepatitis C infection in people with HIV in Europe have just been published in AIDS. The new European recommendations deal with detecting and treating hepatitis C and these follow the UK's own guide, written in 2010.
What they mean by ‘acute’ is recently infected, within the last 6 months.
Hepatitis C abroad (and at home)
Roughly a third of HIV-positive people in Europe also have hepatitis C. Few people in England have both HIV and hepatitis C because we introduced harm reduction (like clean needles and syringes) for injecting drug users, in the early years of HIV. In NW England only 2% of people with HIV were infected through injecting drug use.
However recently sexually transmitted hepatitis C among HIV-positive gay men has become a problem. So in spring this year doctors, researchers and activists met in Paris to develop guidelines for managing early-stage hepatitis C infection.
Their recommendations are about
- Defining acute hepatitis C infection
- Screening for hepatitis C
- Risk reduction advice
- Natural history
- Treatment during acute infection.
Acute hepatitis C means the first six months after infection with the virus. Many people do not develop symptoms when they first contract hepatitis C, and delayed antibody responses are found in some people with HIV.
Testing points
People with HIV should be tested for hepatitis C. Screening recommendations from Europe are to test everyone newly diagnosed with HIV for hepatitis C, and HIV-positive gay men should have checks at least annually.
HIV, gay men and hepatitis C
It is still not clear exactly how hepatitis C is being sexually transmitted between HIV-positive gay men. European hepatitis C sex-risk reduction advice is to discuss fisting, recreational drug use, group sex, use of sex toys, unprotected sex, traumatic sex, sharing injecting equipment, and risks from blood-to-blood contact.
Treat or natural recovery
Some people naturally get rid of hepatitis C infection without any treatment. But most people with HIV will need hepatitis C treatment. Up to 40% of HIV-positive people may naturally get rid of their early-stage hepatitis C infection.
Treatment for hepatitis C works better for people with HIV when started early, within the first year.
2010 UK Hepatitis C and HIV treatment guidelines
Source with reference for the European guidelines
Image 2009 European HIV treatment guidelines, from European AIDS Clinical Society
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Positive Gay Men's Bright Future
posted: 12/11/2010
Bright Future is the cover story in the latest issue of U+, for gay and bi men living with HIV. Mixed status relationships, insurance with HIV, being older, making new mates at Outdoorlads, and dealing with LGV and hepatitis C are all in the latest issue.
Mixed doubles looks at relationships where one guy is positive and the other negative. Tim tells us about making these relationships work and has some good tips.
Insurance of all types, life, travel, pension, and critical illness are all possible for people with HIV and Are you Covered? offers useful information and advice. We’ve found a useful Living with HIV – Financial Facts leaflet on the web.
Older and Wiser explores the world of older men with HIV and the realities of getting older and more experienced with HIV. The numbers of men with HIV who are over 50 are set to mushroom and will double within the next five to ten years. What’s around and what do older positive men need?
Walk on the Wildside is the story of Peter Scott, who makes tons of new mates, has gained a good physique, fitness and happiness, through activities across the country he enjoys through Outdoorlads.
In LGV: a bum deal Rob and Stewart tell their stories of anal encounters with LGV, and Simon is on the problem page worried about hepatitis C, after his mate got it and now has 6 months of treatment injections to face.
download U+ issue 6
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