A Vancouver doctor specializing in gay men’s health and HIV care says hepatitis C (HCV) rates among gay men and especially HIV —positive men are on the rise.
“We’ve known about Hep C outbreaks in London, Berlin and San Francisco,” says Dr Joss de Wet. “This news has slowly been coming out.”
News of the outbreaks prompted de Wet to check the numbers here. What he found was a “10 —fold increase in Hep C in men that are positive.”
De Wet investigated the incidence of Hep C infection in his patients after attending a lecture by Dr David Thomas from The Johns Hopkins University School of Medicine at the 18th Annual Clinical Care Options HIV Symposium in Rancho Mirage, California in May.
Thomas’ presentation included a study that demonstrated “a 10 —fold increase in HCV infection after 2000” in Amsterdam. Other studies in his presentation linked the increased infection to high —risk sexual behaviour among men who have sex with men, including unprotected receptive anal intercourse, rimming, fisting and unprotected group sex.
Transmission rates seem to be low in single —lover sex, de Wet says. “If you have sex with one partner, there’s a very low chance [of contracting HCV], even if it’s bareback sex.”
But unprotected group sex that potentially involves exposure to blood can be risky, he says. “Sharing toys, fisting and recreational drug use — in the sense of snorting — [are] activities [where] people can easily come in contact with blood.
“If you come in contact with blood, you could get hepatitis C,” de Wet warns. “[It] is highly contagious [and] people need to think [that] a little bit of blood can give me hepatitis C.”
At Spectrum Health Clinic where he works, de Wet says he’s witnessed a 94 percent increase in Hep C infections from 2005 to 2007. That number rises to 105 percent in HIV —positive men for the same period of time.
Identified in 1989, Hep C is a virus that causes inflammation of the liver, damaging it and preventing its proper function. As many as 80 percent of people infected with Hep C do not exhibit symptoms. In those who do, they may include nausea, diarrhea, fatigue, pain over the liver and jaundice.
Hep C is the most chronic of the hepatitis infections, says de Wet, adding that all three (A, B and C) are “completely different viruses. The only commonality is that [they inflame] the liver, [cause] liver cell destruction and liver cell death eventually.
“[They] have different routes of infection,” he continues. “Hepatitis A is oral contamination [from] food or feces. Hepatitis B is sexually transmitted. It is in semen, vaginal secretions, and blood. Hepatitis C is really contained to the blood compartment.”
Effective vaccines now exist for Hep A and B, he notes.
But “getting protected against hepatitis B and hepatitis A won’t protect you from hepatitis C,” points out Dr Mark Gilbert, physician epidemiologist in the Sexually Transmitted Infections/HIV Division of the BC Centre for Disease Control.
Gilbert says he’s not aware of the HCV increases that de Wet has uncovered. “I have certainly seen reports in the literature,” he acknowledges, “mostly from Europe, about increasing hepatitis C in the gay community. I have heard experiences from people in the community and some physicians as well.”
Still, he says, the BC Centre for Disease Control doesn’t have “the same kind of information on new HCV positive tests that we do for new HIV —positive tests where we can competently say which ones are in gay men. There are such large volumes of hepatitis C tests [done in BC] that we don’t have the same kind of follow up. In an ideal world, we’d collect this information.”
This summer, Gilbert plans to work with a research team that involves Vancouver Coastal Health, the Community —Based Research Centre, the Health Initiative for Men and the BC Centre for Excellence in HIV on a survey which combines a questionnaire with collecting a finger stick blood spot which can be tested for HIV and Hep C.
“Once we do that, we’ll get a better sense of what proportion of the gay population has HCV,” he says. “This survey is something that we’ll be doing over time, every three years or so. We’ll be better able to monitor how this is changing in the gay community.”
“It wasn’t necessary to know about Hep C in the past,” de Wet acknowledges, “because it wasn’t present in men who have sex with men. Today it is. We’re starting to see it because there’s liberation in sexual activities,” he says.
“If you practice safe sex there is no chance of coming in contact with blood,” he maintains, “but what has happened over time as HIV has become a chronic, manageable illness, [is that] people are starting to have unsafe sex. When you have unsafe sex, there’s a chance to come into contact with blood.”
“Clearly, [Hep C] is something that is being sexually transmitted,” confirms Gilbert. “We don’t know how often. It’s certainly not as frequent as HIV.”
De Wet recommends that if people suspect they have been exposed to Hep C they visit a doctor for a blood test that measures antibodies to see if the virus is present.
“There are treatments for HCV,” he adds. But they cost “thousands and thousands of dollars, take a year and the outcome is very poor.
“Your chance of clearing [the infection depends on the strain] of Hep C you have,” he explains. “[The success rate] varies between 70 and 80 percent if you’re HIV —negative. If you’re HIV —positive, [it] drops to less than 30 percent.
“We don’t have adequate prevention programs,” de Wet asserts. “I don’t see any Hep C messaging and that’s why [I’m trying] to get this message out: ‘Be careful of blood. Don’t share toys.'”