by Dr. Joanne Stekler -
Special to the SGN
This is one of a series of articles focusing on HIV and other STD prevention and care topics for Gay/Bisexual men and Transgender individuals in Seattle and King County.
Recently I've been hearing a buzz about hepatitis C that reminds me of HIV.
For those of you who don't know, hepatitis C is a virus, just like HIV. It infects the liver, the organ that helps you break down medicines and cleans your blood of toxins like alcohol. When people first get infected with hep C, they may get a flu-like illness or their eyes may turn yellow, but most people have no symptoms at all. If the infection stays active, which it usually does, hep C causes chronic inflammation of the liver. Over time, this inflammation can lead to liver failure (called cirrhosis) or liver cancer.
It's estimated there are about 3 million to 4 million people living with hep C in the United States - two to three times the number living with HIV. Hep C is the number one reason someone will need a liver transplant in the United States. Like HIV, hep C can be spread from a mother to her baby, by sharing needles or works when injecting drugs, or by getting a tattoo with equipment that's not sterile. We used to think that hep C wasn't easily spread by sex. But we now know that people do get hep C through sex, especially HIV-positive Gay and Bi men who don't use condoms.
Right now, we don't know a lot about sexual transmission of hep C. We still think that oral and vaginal sex have low risk of transmitting hep C. Rimming puts you at risk for hepatitis A (another virus that infects the liver), but it isn't a risk for hep C. Fisting, on the other hand, may be, as is sex with trauma and bleeding. And HIV-positive Gay and Bi guys have a greater risk of getting hep C from anal sex compared to HIV-negative guys, especially if condoms aren't used.
What can you do about hep C? You can get tested. The Centers for Disease Control and Prevention (CDC) recommends testing for people at risk for hepatitis. This includes people who ever injected drugs or got stuck by a needle (even a long time ago), who are on dialysis for kidney disease, who have abnormal liver tests, or who are HIV-positive. And recently the CDC has been thinking about recommending tests for all people born between 1945 and 1965. If you meet any of these criteria, you should get tested.
If hepatitis infection can last for years without causing problems, why get tested now? Because treating the inflammation now can prevent future complications. And because there are new hep C medicines, called protease inhibitors, that are like meds for HIV. The good news is that when people take a hepatitis C protease inhibitor plus standard treatment (interferon plus ribavirin), the combo works better than standard treatment. The bad news is that hep C protease inhibitors interact with other medicines, particularly HIV meds. This can decrease the level of HIV meds in the blood and may lessen their effectiveness.
If you are already infected with hep C, here are some things you can do to manage your health and avoid passing it to others. Talk with your primary care doctor to see if hep C treatment is right for you. Avoid alcohol, and be careful about taking over-the-counter medicines, particularly acetaminophen, the medicine in Tylenol. Make sure you get the hepatitis A and B vaccines. Don't share needles, crack or meth pipes, razors, or your toothbrush with anyone. And use condoms for anal sex, because they'll protect you and your partners against many STDs.
If you are not infected with hep C, you can protect yourself from hepatitis infections. Avoid sharing pipes if you smoke, or sharing needles or works if you inject drugs. If you need injection equipment, visit the needle exchange or check with your local pharmacy. Get vaccinated against hep A and B. And if you're HIV-positive, using condoms for anal sex can probably reduce your chance of getting hep C.
Saturday, May 19, is the first-ever National Hepatitis Testing Day. If you're a guy who has sex with other guys, you can get tested for HIV, hepatitis viruses, and other STDs at Public Health's STD Clinic, Gay City, the baths, and at your doctor's office. For hours and locations, call (206) 296-4649 or go to www.kingcounty.gov/health/hiv. Fees are based on income and risk criteria.
For more information about hepatitis infections in Seattle, check out the Hepatitis Education Project at www.hepeducation.org. They're having a testing event on May 19 at Victor Steinbrueck Park from 10 a.m. to 3 p.m. If you can't make that, you can schedule an appointment with them for hepatitis virus testing at (206) 732-0311.
Joanne Stekler, M.D., M.P.H., is deputy director of community services for the HIV/STD Program at Public Health - Seattle & King County. She is also an internal medicine and infectious disease physician at Harborview Medical Center and assistant professor of medicine and epidemiology at the University of Washington.
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