| |
More gay men getting hepatitis C; Increased HCV Infection Among HIV+ Gay Men
|
| |
| |
Sunday Herald
Gus Cairns, www.guscairns.com
Friday 27 April, 2007
More UK gay men are getting hepatitis C through sex every year, the 13th BHIVA Conference heard in Edinburgh yesterday.
Dr Murad Ruf of the Health Protection Agency said that between 2002 and June 2006 there were 389 cases of recently-acquired hepatitis C in HIV positive gay men gay men attending 15 HIV clinics. The clinics between them serve 85% of London's HIV positive population.
There were also six cases in HIV negative men attending London GUM (genito-urinary medicine) clinics.
But whereas all but one of the HIV centres routinely monitors patients for raised liver function results, which are usually the best sign of hepatitis infection, only three of London's GUM clinics routinely screen for hep C, so there could be more infections going undetected.
The number of hepatitis C cases has increased each year. There were 60 in 2002, 77 in 2003, 85 in 2004, 100 in 2005 and 67 in the first six months of 2006.
This means that hepatitis C infections are increasing by one-third more each year. The overall infection rate in HIV positive men was one infection per 110 clinic patients per year, but by 2006 this had gone up to one infection per 83 patients a year.
The HPA's figures don't include information that might rule out other known causes for hepatitis C infection such as injecting drugs, but Dr Ruf said that as few gay men had other major risk factors for hepatitis C, most of it was probably being acquired sexually.
As hepatitis C is carried in blood rather than semen, the upsurge in hepatitis C cases has been blamed on fisting, something done by between one in 10 and one in 16 gay men last time the Gay Men's Sex Survey asked about it in 2002. But Dr Ruf told Gay.com: "It could be any kind of sex where there's trauma to the mucous membranes - rough sex, basically."
We don't know if there's something about having HIV that also makes you more susceptible to hepatitis C, but Dr Ruf pointed out that 85% of cases of lymphogranuloma venereum (LGV) seen since 2002 were in HIV positive men and 44% of the syphilis cases seen since 1999.
There is currently a study underway at the GUM clinic at Mortimer Market in central London to look at cases of hepatitis C in HIV negative gay men. A study from Brighton's GUM clinic last year found five cases of hepatitis C in HIV negative men, 16 in positive men, and four in men who were untested. The clinic worked out that men with HIV were 13 times more likely to get hepatitis C than negative men - but negative men were getting it too.
Once you'd got hepatitis C, however, it was a really strong predictor that you were likely to get HIV soon as well, showing that the risk factors are similar.
In one London clinic at St Mary's Hospital in Paddington, 10 out of a group of 155 gay men who had become recently infected with HIV went on to get hepatitis C too. The average length of time between becoming HIV positive and hep C positive was 17 months.
Five out of the 10 had symptoms of acute hepatitis and seven had raised liver function tests but three of the infections would have been missed altogether without careful monitoring for hepatitis C antibodies. Interestingly, around the time of hepatitis C infection patients had significant rises in their HIV viral load, showing that the two viruses may have an effect on each other.
In a study of hepatitis C treatment at the Chelsea and Westminster Hospital, two-thirds of gay me with recently-acquired hepatitis C responded to treatment with pegylated interferon and ribavirin and were effectively cured - but five patients went on to get second hepatitis C infections.
Out of 118 patients, 17 (14%) spontaneously cleared their hepatitis C. Of those offered treatment, three-quarters accepted it.
At north London's Royal Free Hospital, a better cure rate was observed with 77% of recently-infected gay men who took hepatitis C treatment responding to it.
However hepatitis C treatment is hard to tolerate. At the Chelsea and Westminster 30% complained of psychiatric side effects like depression and 11% stopped their treatment because of them.
|
|
| |
| |
|
|
|
