April 3, 2014
Hepatitis C virus (HCV) can infect the liver, causing inflammation that injures this organ. If HCV is left untreated, injury can spread throughout the liver and this organ consequently becomes increasingly dysfunctional. As a result, the eventual appearance of serious symptoms related to liver damage occurs and a person's quality of life degrades. HCV infection also increases the risk for liver cancer.
HCV (and other germs) can be spread in a number of ways, including:
For more information about HCV prevention (and treatment) visit CATIE's Hepatitis C section.
For at least the past decade, an outbreak of sexually transmitted HCV has been occurring among MSM. The vast majority of these cases have occurred in HIV-positive MSM. Researchers in four high-income countries -- Sweden, Switzerland, the Netherlands and Australia -- have been investigating this outbreak among both HIV-negative and HIV-positive MSM. Their findings suggest that in MSM who are HIV negative and who do not engage in high-risk sexual and/or drug-using behaviour, HCV infection is relatively rare.
Doctors at Stockholm's leading sexually transmitted infections (STI) clinic offered HCV testing to MSM who did not have HIV. This study took place between October 2012 and March 2013. Blood samples that tested positive for HCV antibodies were later analysed with other tests, including those that could detect HCV's genetic material (RNA). The antibody test can reveal if someone was exposed to HCV in the past but it cannot distinguish between past and current infection. The RNA test can reveal if HCV is being produced by infected cells and can uncover active and therefore current infection.
A total of 1,008 out of 1,061 men (95%) agreed to participate in the study. Their ages ranged from 16 to 82 years.
Six of the men tested positive for HCV antibodies and further testing revealed the following:
There were several possible causes of exposure to HCV in these men, which the doctors identified as follows:
Doctors did not have information about the third man's risk factors.
One of these men had a history of genital herpes and syphilis but no other STIs at present. This is an important point because these and other STIs can cause inflammation, sores or lesions (sometimes painless) that can act as an entry point for other germs, like HCV. He also disclosed that he did not engage in rough anal sex or sharing of sex toys.
The other man with HCV infection had a rectal Chlamydia infection and disclosed that he had engaged in fisting since 2012.
Overall, the Swedish team found that less than 1% (0.2%) of MSM in their study had ongoing HCV infection. This rate of HCV infection in HIV-negative MSM is similar to what is observed among the average HIV-negative Swedish population who do not use street drugs.
Researchers at a sexual health clinic in Zurich recruited MSM for their study between January 2009 and July 2010. All blood samples were tested for HCV antibodies and HCV-related proteins. Samples that tested positive for either of these were further analysed for HCV's genetic material. In total, the researchers analysed data from 840 MSM, whose ages ranged between 17 and 79 years. Researchers relied upon participants' self-reports about their HIV status.
As with the previously mentioned Swedish study, a large proportion of men (95%) who were offered HCV testing consented.
Overall, seven men tested positive for HCV antibodies. None of the seven disclosed a previous diagnosis of HCV. Furthermore, HCV RNA was detected in only two participants, indicating active infection. Both of these men had immigrated to Switzerland from other countries. In one of those countries HCV infection is relatively common.
Overall, less than 1% of MSM in this study had HCV infection, broadly similar to what is seen among the average HIV-negative Swiss person who does not use street drugs. Among MSM who stated that they did not have HIV infection, researchers found a marginal statistical link between having tattoos and HCV. Bear in mind that the design of the Swiss study was cross-sectional. Such study designs are unable to make definitive links between cause and effect. That is, in the case of the Swiss study, researchers cannot be certain that unsafe tattooing was the source of HCV infection in some men.
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