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

Gay, Positive, Herpes and LGV

posted: 25/02/2011

Gay men living with HIV who have herpes may find symptoms flare up worse and last longer. Preventive treatment can help prevent herpes flare ups.

Herpes also makes it much easier to pass on HIV (and other STIs) because it raises your viral load, and the blisters contain HIV and provide a way in and out for HIV.
 

Herpes leaflet for gay men

As well as that herpes leafte for gay men, there’s also a new detailed briefing about herpes for sexual health and HIV professionals from Sigma Research, produced for CHAPS, England's gay men's HIV prevention and sexuial health partnership.

LGV
LGV (lymphogranuloma venereum) is a much more uncommon sexually transmitted infection and, like herpes, it's one that gay men living with HIV are more likely to get. It’s caused by varieties of chlamydia bacteria.

LGV caused ulcers, like herpes and syphilis do, and these surface wounds are always a route in and out for HIV.

Having LGV also increases your HIV viral load and that makes passing on HIV more likely.

LGV leaflet for gay men

THT have more information about herpes, LGV and other STIs, on their new website for people living with HIV, My HIV

Over 50s HIV Infections Double

posted: 18/08/2010

New HIV infections among people over 50 have doubled in England, Wales and Northern Ireland in the last seven years, and almost half the over 50s were diagnosed late, according to a new study in the latest issue of AIDS.
 

More and more HIV experts are now thinking hard about older people with HIV. Not only are the numbers of older people with HIV rising steeply, older people are also getting HIV, health prospects are worse when you are over 50, and it is clear that there are some different problems in living with HIV when older.
 

This latest study looked at older people with HIV in England, Wales and Northern Ireland between 2000 and 2007. The starting point for ‘older’ is age 50 or over.
 

While the numbers of over 50s with HIV tripled between 2000 and 2007, there was also a sharp rise in the number of older adults getting HIV. Is the tripling of the number of people with HIV over 50 because people are living longer because of HIV treatments, or is it because more people are getting HIV after 50?

To find out the Health Protection Agency decided to analyse the national HIV data for the time between 2000 and 2007.
 

Nearly 1 in 10 new infections among people over 50
They found 8% of all new HIV diagnosis were among people over 50. But the new infection rate among over 50s is still rising and in 2007 it reached 9%. The number of older people who were newly diagnosed more than doubled, from 299 in 2000, to 710 in 2010. Almost three-quarters of these new diagnoses were people aged between 50 and 59.
 

Gay and other men who have sex with men were 40% of all the people diagnosed over 50. A third of the newly diagnosed were heterosexual men, and 25% heterosexual women.
Almost all (94%) the gay men are of white backgrounds. Older heterosexual men and women were rather more likely to be white than heterosexual men and women under 50.
 

8000 and rising
A total of 8255 older adults used HIV clinics between 2000 and 2007. This is 16% of all the people using HIV clinics.
 

Late diagnosis and AIDS
20% of the older adults developed an AIDS defining condition in the years 2000 - 2007. Mostly (91%) an AIDS condition was diagnosed within three months of diagnosis with HIV – this means HIV was diagnosed at a really late stage. This is twice the rate of AIDS diagnoses found among the under 50s.
The Health Protection Agency definition of late HIV diagnosis is when the CD4 count is below 200 at diagnosis. People diagnosed over 50 are significantly more likely to have a CD4 count this low than the under 50s (48% for over 50s, 33% for under 50s).

HIV treatment is now started normally when the CD4 count is around 350, so really many more people were diagnosed late than these HPA figures suggest. By the time the CD4 has fallen to 200 avoidable health harm has already been done.

More deaths, sooner
538 (13%) of the people over 50 died between 2000 and 2007. People diagnosed with a CD4 below 200 were 14 times more likely to die than younger patients with this CD4 count (14% for the over 50s, 1% for the under 50s).
 

Moreover, over 50s who are diagnosed late were approximately two and a half times more likely to die within a year of their diagnosis than under 50s with a CD4 count below 200.
 

The overall mortality rate amongst older patients was 25 per 1000 person-years. In contrast, the mortality rate for younger patients was half that - 12 per 1000 person-years.
 

Half got HIV after 50th birthday
Based on CD4 cell count at the time of diagnosis, they worked out that 48% of the older people with HIV got HIV when they were aged 50 and over. This percentage hasn’t changed between 2000 and 2007.
 

Three-quarters of individuals aged over 50 when they became HIV positive are men, and 54% were gay men.

Source

Reference Smith RD et al. HIV transmission and high rates of late diagnoses among adults aged 50 years and over. AIDS 24: 2109-2115, 2010.
 

Rise in Over 50s HIV Infections

posted: 21/07/2010

People over 50 are as much at risk from unsafe sex as younger people, the UK’s Health Protection Agency (HPA) has just warned. Today it revealed evidence, at the International AIDS Conference in Vienna, that the number of people over 50 who are catching HIV has more than doubled in seven years.
 

In 2000 there were just 299 new HIV infections among the over-50s, according to the HPA. But in 2007 there were 710 people infected.
 

Gay and bi men are the majority infected when older, but white heterosexual men infected abroad - typically in Thailand - are another significant group of older men who are diagnosed.

Late diagnosis common
Half of those diagnosed when over 50 were diagnosed late. Younger people are much less likely to be diagnosed late. Late diagnosis is bad news when you are older - during the eight year study period three quarters of the deaths among people aged 50 and over occurred within one year of the diagnosis, with half of those diagnosed late. Unfortunately, late diagnosis with HIV reduces people's life expectancy and quality of life. If treatment is started late it cannot undo all the unnoticed damage already caused by HIV.

Some people diagnosed after 50 were infected when they were younger. After some early symptoms (such as flu-like symptoms with a rash), many people after HIV infection remain apparently fit, healthy and continue to feel well, without suspecting they have HIV, for as long as 10 years.

Most are recently infected by risky sex
But half of the over-50s diagnosed had recently been infected, through taking chances without condoms.

Getting away with risks in your earlier years doesn't mean that luck will continue.

Letting down your guard just because you are older can still catch anyone out. We often hear older people say, rather sheepishly, 'I should have known better'.
 

Keep on testing - and condoms
"This highlights the importance of HIV testing, whatever your age," said Ruth Smith, a senior HIV scientist at the HPA's Centre for Infections. "We must continually reinforce the safe sex message – using a condom with all new or casual partners is the surest way to ensure people do not become infected with a serious sexually transmitted infection such as HIV."
 

Her co-author, Dr Valerie Delpech, head of HIV surveillance at the HPA, said people in the older age group needed to be aware that they were just as much at risk as young people if they had unsafe sex.
 

"Although adults aged 50 and over account for just 8% of all new HIV diagnoses, the fact that cases have more than doubled in recent years serves as a timely reminder that anybody is at risk of HIV infection if they do not use protection and practise safe sex," she said.
 

More information from HPA

Source
 

HIV Transmission – All the Facts

posted: 14/04/2010

Clear, full, accurate information about HIV transmission can be hard to find. Even recent ‘official’ sources may mislead. For example, one NW England council’s HIV guide for schools suggests HIV transmission could happen at school.

While almost anything could happen at any school, HIV transmission is exceptionally unlikely, without risky sex - and that is not part of the curriculum. Suggesting HIV transmission could happen at school is unhelpful and tends to increase anxiety and feed HIV stigma.
 

HIV transmission without sex, without injecting drug use, or without mother to baby transmission is exceptionally rare. Of over 34,000 HIV diagnoses in the UK from the beginning of the epidemic to 1997, only 19 happened in non-sexual 'unusual circumstances' . Most of these ‘unusual’ transmissions were at clinics abroad, where infection control procedures were slack.

Everything you ever wanted to know about HIV transmission but were afraid to ask

Visit the HIV transmission section of the NAM / aidsmap website for detailed information on subjects including co-factors that affect transmission, viral load and risk of transmission, and protective measures.

NAM also produce a comprehensive book, HIV Transmission & Testing, available from their online bookshop.