Hepatitis C virus (HCV) - What is it?

Hepatitis C is the most common viral hepatitis in the UK. Affecting almost every adult with haemophilia, a majority of intravenous drug users (IUDs) and an increasing number of gay men through sex (Though the mechanisms are unclear, the risk may relate to sexual practices which involve contact with blood, most noteably unprotected fisting and fucking).

It is also a significant problem worldwide and because of the similarity of the transmission routes, a major concern for people with HIV. The UK Government estimates the number of people chronically infected with HCV to be around 200,000 the majority of whom are currently unaware of their infection (Hepatitis C strategy for England 2002). Other groups have estimated the number to be as high as 400,000.

Factors which may impact on HCV:

• Age at infection: Contracting HCV after 40, has been associated with greater risk of progression in some studies;

• Alcohol consumption: An increased risk of cirrhosis is associated with sustained alcoholic consumption of more than 40g each day (equates to 5 units);

• Your own genetic make-up;

• HIV infection and a low CD4 count: A CD4 count of less than 200, is associated with an increased risk of cirrhosis; those with a higher CD4 counts were at no greater risk than their HIV-negative counterparts, suggesting that immune suppression facilitates liver disease;

• Other Hepatitis viruses: Co-infection with Hepatitis A or Hepatitis B increases the risk of liver disease;

• Gender: Men seem to progress faster to liver disease.

Vaccination for Hepatitis C:  There is no vaccine for Hepatitis C. It is currently treated by combination therapy, which requires regular assessment and monitoring, as the treatment can cause side effects which can significantly debilitate people.

HIV and Hepatitis C: In people co-infected with HIV, treatment can become more important to reduce the pressure on the liver as it has also processes aspects of HIV therapies as well.

BHIVA (British HIV Association) has made a number of recommendations about monitoring, testing and advice concerning Hepatitis and HIV.
For full details refer to BHIVA Guidelines, for summary details refer to aidsmap.com.

Major ways of transmission
You're most likely to become infected with hepatitis in the following ways:

• Sexual transmission. In 2003, British clinicians reported numerous new cases of Hepatitis C amongst HIV-infected gay men in London. These new cases of HCV have been attributed to sexual transmission due to the lack of other risk factors. They were associated with the presence of other sexually transmitted infections (STIs) such as syphilis or gonorrhoea, unprotected fucking and fisting, and sometimes recent snorting of drugs.

• Transmission through blood contact. Since 1991, blood donations in the UK have been screened for HCV. Any objects that come into contact with blood, can provide routes of transmissions. These include unsterilised tattooing, piercing's and acupuncture equipment, as well as shared personal items such as razors and toothbrushes.

• Sharing Straws to snort: This can provide another means of HPC transmission.

HCV transmission rarely occurs through household contact - however for about 10% of people with HCV,
the route of infection is unknown.

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Gay men's Hepatitis C support group

The Hepatitis C project is running a support group for gay men with hepatitis C on the third wednesday of every month, commencing from 19th March 2008. The group is run by gay men for gay men in response to increasing demand from those who are:

• Just diagnosed with hepatitis C;

• Doing treatment;

• Living with HIV and hepatitis C.

The group will focus on issues specific to gay men including; sexual transmission, HIV co-infection, stigma and discrimination within the gay community., and of course need for peer support from ones peers.

Venue: The Hepatitis C trust, 27 Crosby Row, London SE1 3YD

For more information, contact the Hepatitis C helpline on 0845 223 4424 or email: helpline@hepctrust.org.uk