Download as PDF, PPTX
![Hepatitis C Transmission
HCV is only transmitted via blood
Populations at risk for Hepatitis C include injection drug users [IDU],
the baby boomer population, and children born to mothers with
HCV.
Tattoos from an unlicensed facility and accidental needlesticks are also transmission
pathways](https://image.slidesharecdn.com/a-1ppthepatitiscthecontroversialsti-150805190935-lva1-app6892/75/Hepatitis-C-The-Controversial-Sexually-Transmitted-Infection-10-2048.jpg)
![Hepatitis C Transmission
HCV is only transmitted via blood
Populations at risk for Hepatitis C include injection drug users [IDU],
the baby boomer population, and children born to mothers with
HCV.
Tattoos from an unlicensed facility and accidental needlesticks are also transmission
pathways
Those who have multiple sex partners, already have an STI, engage
in rough sex or other sex practices that may involve blood, or are
infected with HIV are at a higher risk for contracting HCV.](https://image.slidesharecdn.com/a-1ppthepatitiscthecontroversialsti-150805190935-lva1-app6892/75/Hepatitis-C-The-Controversial-Sexually-Transmitted-Infection-11-2048.jpg)
![Sexual Transmission of Hepatitis C
Drugs and alcohol can impair a person’s decision making ability as
well as cause them to forget prevention methods or use them
incorrectly [condoms, dental dams, etc.].
Ketamine: numbs the body so that a person may not realize how much
trauma they are experiencing. This makes it more likely that broken skin
may result.
Poppers: increase blood flow and therefore the likelihood that there will
be blood to blood contact.](https://image.slidesharecdn.com/a-1ppthepatitiscthecontroversialsti-150805190935-lva1-app6892/75/Hepatitis-C-The-Controversial-Sexually-Transmitted-Infection-28-2048.jpg)
![Monogamous Partners and Sex Acts
with Very Low Risk
Specialists have no risk reduction recommendations for sero-
discordant partners who are in monogamous relationships, as
studies show that transmission rates are extremely low.
Deep kissing: no known cases, though theoretically possible.
Oral sex [no menstruation]: no known cases, though theoretically
possible.](https://image.slidesharecdn.com/a-1ppthepatitiscthecontroversialsti-150805190935-lva1-app6892/75/Hepatitis-C-The-Controversial-Sexually-Transmitted-Infection-30-2048.jpg)
![HCV and other STIs
Increased level of susceptibility with any infection that creates a
sore [HPV, syphilis, herpes, etc.].
Sexual transmission is primarily permucosal – exposure to an infected liquid via a
disrupted membrane.](https://image.slidesharecdn.com/a-1ppthepatitiscthecontroversialsti-150805190935-lva1-app6892/75/Hepatitis-C-The-Controversial-Sexually-Transmitted-Infection-31-2048.jpg)
![HCV and other STIs
Increased level of susceptibility with any infection that creates a
sore [HPV, syphilis, herpes, etc.].
Sexual transmission is primarily permucosal – exposure to an infected liquid via a
disrupted membrane.
Syphilis and HCV: outside of HIV, highest risk for seroconversion.
Men with recent syphilis infection 2 X more likely to acquire HCV](https://image.slidesharecdn.com/a-1ppthepatitiscthecontroversialsti-150805190935-lva1-app6892/75/Hepatitis-C-The-Controversial-Sexually-Transmitted-Infection-32-2048.jpg)
![HIV & HCV: similarities and differences
Both can be transmitted via blood
HCV is 10 X more concentrated in the blood than HIV
HCV lives outside the body for much longer than HIV [up to 63 days in certain
environments]](https://image.slidesharecdn.com/a-1ppthepatitiscthecontroversialsti-150805190935-lva1-app6892/75/Hepatitis-C-The-Controversial-Sexually-Transmitted-Infection-35-2048.jpg)
![HIV & HCV: similarities and differences
Both can be transmitted via blood
HCV is 10 X more concentrated in the blood than HIV
HCV lives outside the body for much longer than HIV [up to 63 days in certain
environments]
Viral Load
HIV: correlates to progression of disease [high VL 5,000 – 10,000 copies/mL]
HCV: does NOT correlate to progression of disease [high VL anything greater
than 800,000, can reach up to 50 million copies/mL]
HCV: does correlate to an increase in vertical transmission](https://image.slidesharecdn.com/a-1ppthepatitiscthecontroversialsti-150805190935-lva1-app6892/75/Hepatitis-C-The-Controversial-Sexually-Transmitted-Infection-36-2048.jpg)
![HIV & Hepatitis C
HCV is categorized as an opportunist infection.
As many as 30% of people with HIV may also be co-infected with
HCV [30,000].
HIV +/IDU: could be up to 90%](https://image.slidesharecdn.com/a-1ppthepatitiscthecontroversialsti-150805190935-lva1-app6892/75/Hepatitis-C-The-Controversial-Sexually-Transmitted-Infection-38-2048.jpg)
![HIV & Hepatitis C
HCV is categorized as an opportunist infection.
As many as 30% of people with HIV may also be co-infected with
HCV [30,000].
HIV +/IDU: could be up to 90%
HIV triples the risk of severe HCV disease progression, is associated
with high viral loads and infectiousness, and a higher risk of
developing liver damage and cancer.
Lower T- cell counts may increase risk of HCV acquisition.](https://image.slidesharecdn.com/a-1ppthepatitiscthecontroversialsti-150805190935-lva1-app6892/75/Hepatitis-C-The-Controversial-Sexually-Transmitted-Infection-39-2048.jpg)
![HCV Treatment Options
Interferon
Harvoni [+ other drug cocktail options]
Genotype 1
Insurance/expense issues](https://image.slidesharecdn.com/a-1ppthepatitiscthecontroversialsti-150805190935-lva1-app6892/75/Hepatitis-C-The-Controversial-Sexually-Transmitted-Infection-46-2048.jpg)
Uploaded byPlanned Parenthood Advocates of Wisconsin
Hepatitis C: The Controversial Sexually Transmitted Infection
The document discusses Hepatitis C (HCV), a viral infection that primarily spreads through blood, emphasizing the lack of a vaccine and the potential severe health consequences if untreated. It outlines various risk factors for transmission, particularly among injection drug users, individuals with multiple sexual partners, and those with coexisting STIs, while also addressing the challenges in accurately identifying sexual transmission cases. Additionally, it highlights HCV’s relationship with HIV and offers prevention strategies to mitigate the risk of infection.
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Hepatitis C: The Controversial Sexually Transmitted Infection
- 1. Hepatitis C: The ControversialSTI Rachael Cooper & Veronica Shaheen Prevention Specialists ARCW Prevention
- 2. Click to editthe outline text format Second Outline Level Third Outline Level Fourth Outline Level Fifth Outline Level Sixth Outline Level Seventh Outline Level Eighth Outline Level Ninth Outline Level Who We Are Rachael Cooper – HIV/AIDS Prevention Specialist Veronica Shaheen – Opiate Overdose Prevention Specialist Where we work: ARCW Prevention Department • Free HIV, HCV, Gonorrhea, Syphilis & Chlamydia tests • Counseling, Testing, Referral • HIV/STD Education Groups LifePoint Needle Exchange • Clean Syringe Access since 1994 • Harm Reduction: Practical risk reduction strategies for behavior associated with negative health consequences. • Proven healthcare benefits
- 3. Key Words • Parenteral:Administered or occurring elsewhere in the body than the mouth and alimentary canal. • Permucosal: By way of, or through, a mucous membrane. • Seroconversion: When a specific antibody becomes detectable in the blood, and the corresponding antigen becomes undetectable. • MSM: Men who have sex with men. • PWID: People who inject drugs. • Harm Reduction: Strategies for reducing the consequences of risky behavior. • Fisting: Sex act that involves inserting hand/wrist into vagina or rectum.
- 4. Hepatitis C: what doyou know?
- 5. Hepatitis Basics All typesof Hepatitis: inflammation of the liver
- 6. Hepatitis Basics All typesof Hepatitis: means inflammation of the liver Hepatitis A and B have vaccines, Hepatitis C does not
- 7. Hepatitis Basics All typesof Hepatitis: means inflammation of the liver Hepatitis A and B have vaccines, Hepatitis C does not Hepatitis C can eventually lead to cirrhosis, liver cancer, and liver failure if untreated, but it can be treated and cured, unlike other forms of Hepatitis- on average, a person with Hepatitis C who does not get treated lives 22 years less than persons who are not infected.
- 8. Hepatitis Basics All typesof Hepatitis: means inflammation of the liver Hepatitis A and B have vaccines, Hepatitis C does not Hepatitis C can eventually lead to cirrhosis, liver cancer, and liver failure if untreated, but it can be treated and cured, unlike other forms of Hepatitis- on average, a person with Hepatitis C who does not get treated lives 22 years less than persons who are not infected. The CDC estimates that 3.2 million people are infected with chronic HCV in the US - & that up to 85% may not know they have it.
- 9. Hepatitis C Transmission HCVis only transmitted via blood
- 10. Hepatitis C Transmission HCVis only transmitted via blood Populations at risk for Hepatitis C include injection drug users [IDU], the baby boomer population, and children born to mothers with HCV. Tattoos from an unlicensed facility and accidental needlesticks are also transmission pathways
- 11. Hepatitis C Transmission HCVis only transmitted via blood Populations at risk for Hepatitis C include injection drug users [IDU], the baby boomer population, and children born to mothers with HCV. Tattoos from an unlicensed facility and accidental needlesticks are also transmission pathways Those who have multiple sex partners, already have an STI, engage in rough sex or other sex practices that may involve blood, or are infected with HIV are at a higher risk for contracting HCV.
- 12. Progression of HCV Twostages of HCV: acute & chronic
- 13. Progression of HCV Twostages of HCV: acute & chronic The transition between acute and chronic HCV is poorly understood, though important viral mutations may occur. Acute phase: HCV RNA levels fluctuate, cellular responses to HCV peak, wane and become dysfunctional, and neutralizing antibody responses become detectable. Chronic infection is associated with weak cellular immune responses, the presence of antibodies, and relatively stable HCV RNA levels between 500,000 IU/ml and 50 million IU/ml in 80% of individuals.
- 14. Hepatitis C Transmission Riskbehaviors
- 15. Hepatitis C Transmission Riskbehaviors Presence of co-existing STIs, especially those that cause a sore, increase the risk for men and women alike.
- 16. Hepatitis C Transmission Riskbehaviors Presence of co-existing STIs, especially those that cause a sore, increase the risk for men and women alike. Sexual transmission more likely to occur from men → women than women → men, but the risk increases during menstruation. Women: more likely to be in a sexual relationship with IDU partner, which can lead to more risk behaviors for IDU Higher risk for blood borne illnesses, also may clear acute HCV more easily
- 17. Hepatitis C Symptoms Duringthe acute state, many experience general malaise: fever, fatigue, nausea, abdominal pain, lack of appetite, jaundice.
- 18. Hepatitis C Symptoms Duringthe acute state, many experience general malaise: fatigue, nausea, abdominal pain, lack of appetite, jaundice Symptoms can develop as early as two weeks after infection, but many people remain asymptomatic for many years after infection.
- 19. Hepatitis C Symptoms Duringthe acute state, many experience general malaise: fatigue, nausea, abdominal pain, lack of appetite, jaundice Symptoms can develop as early as two weeks after infection, but many people remain asymptomatic for many years after infection. As Hepatitis C settles into the chronic phase, most people do not exhibit symptoms until their liver is severely damaged.
- 20. Long Term Effectsof Hepatitis C Chronic HCV is the leading cause for cirrhosis, liver cancer, and is the most common reason for liver transplants.
- 21. Long Term Effectsof Hepatitis C Chronic HCV is the leading cause for cirrhosis, liver cancer, and is the most common reason for liver transplants. 75% – 85% will develop chronic HCV infection, and of those: 60% - 70% will develop chronic liver disease 5% - 20% will develop cirrhosis 1% - 5% will die from cirrhosis or liver cancer
- 22. Long Term Effectsof Hepatitis C Chronic HCV is the leading cause for cirrhosis, liver cancer, and is the most common reason for liver transplants. 75% – 85% will develop chronic HCV infection, and of those: 60% - 70% will develop chronic liver disease 5% - 20% will develop cirrhosis 1% - 5% will die from cirrhosis or liver cancer This means that, at minimum, 32,000 people and, at maximum, 160,000 people who are currently infected with HCV will die from complications.
- 23. Sexual Transmission ofHepatitis C Menstruation Sex with an HCV + person during their period makes it more likely that the virus will be transmitted. Sex with a partner who is new, unknown, or doesn’t know their status and who is menstruating is risky.
- 24. Sexual Transmission ofHepatitis C Menstruation Sex with an HCV + person during their period makes it more likely that the virus will be transmitted. Sex with a partner who is new, unknown, or doesn’t know their status and who is menstruating is risky. Fisting Fisting can cause trauma to the sex organs that can lead to rips and tears, leading to HCV transmission Especially dangerous if the person has cuts/sores on their hands and/or wrists.
- 25. Sexual Transmission ofHepatitis C Menstruation Sex with an HCV + person during their period makes it more likely that the virus will be transmitted. Sex with a partner who is new, unknown, or doesn’t know their status and who is menstruating is risky. Fisting Fisting can cause trauma to the sex organs that can lead to rips and tears, leading to HCV transmission Especially dangerous if the person has cuts/sores on their hands and/or wrists. Multiple Sex Partners As with all STIs, multiple sex partners makes it more probable that an individual will come into contact with infections and viruses.
- 26. Sexual Transmission ofHepatitis C Group Sex Repeated insertion can cause tears & rips in the anus, vagina, rectum, and other sex organs.
- 27. Sexual Transmission ofHepatitis C Group Sex Repeated insertion can cause tears & rips in the anus, vagina, rectum, and other sex organs. Sex Toys Repeated insertion can lead to cuts & tears in sex organs If sex toys are shared, HCV can be transmitted. HCV can live on any surface for at least four days – including sex toys. Soap, rubbing alcohol, and other disinfectants are not 100% at killing the virus.
- 28. Sexual Transmission ofHepatitis C Drugs and alcohol can impair a person’s decision making ability as well as cause them to forget prevention methods or use them incorrectly [condoms, dental dams, etc.]. Ketamine: numbs the body so that a person may not realize how much trauma they are experiencing. This makes it more likely that broken skin may result. Poppers: increase blood flow and therefore the likelihood that there will be blood to blood contact.
- 29. Who is mostat risk of contracting HCV via sexual contact? HIV + MSM People with multiple partners
- 30. Monogamous Partners andSex Acts with Very Low Risk Specialists have no risk reduction recommendations for sero- discordant partners who are in monogamous relationships, as studies show that transmission rates are extremely low. Deep kissing: no known cases, though theoretically possible. Oral sex [no menstruation]: no known cases, though theoretically possible.
- 31. HCV and otherSTIs Increased level of susceptibility with any infection that creates a sore [HPV, syphilis, herpes, etc.]. Sexual transmission is primarily permucosal – exposure to an infected liquid via a disrupted membrane.
- 32. HCV and otherSTIs Increased level of susceptibility with any infection that creates a sore [HPV, syphilis, herpes, etc.]. Sexual transmission is primarily permucosal – exposure to an infected liquid via a disrupted membrane. Syphilis and HCV: outside of HIV, highest risk for seroconversion. Men with recent syphilis infection 2 X more likely to acquire HCV
- 33. The CDC supportsthat HCV can be transmitted sexually: where’s the controversy? In order for an HCV transmission to be ruled a result of sexual contact: Viral strains must match from partner to partner All other transmission routes must be ruled out New infection must chronologically follow sexual contact with a person who is positive Many experts believe that due to these difficulties, the number of sexually transmitted HCV cases could be drastically over or under estimated.
- 34. The CDC supportsthat HCV can be transmitted sexually: where’s the controversy? In order for an HCV transmission to be ruled a result of sexual contact: Viral strains must match from partner to partner All other transmission routes must be ruled out New infection must chronologically follow sexual contact with a person who is positive Many experts believe that due to these difficulties, the number of sexually transmitted HCV cases could be drastically over or under estimated. Once a new HCV case has been proved to be a result of sexual contact, it is still very difficult to determine which specific sex act caused the transmission.
- 35. HIV & HCV:similarities and differences Both can be transmitted via blood HCV is 10 X more concentrated in the blood than HIV HCV lives outside the body for much longer than HIV [up to 63 days in certain environments]
- 36. HIV & HCV:similarities and differences Both can be transmitted via blood HCV is 10 X more concentrated in the blood than HIV HCV lives outside the body for much longer than HIV [up to 63 days in certain environments] Viral Load HIV: correlates to progression of disease [high VL 5,000 – 10,000 copies/mL] HCV: does NOT correlate to progression of disease [high VL anything greater than 800,000, can reach up to 50 million copies/mL] HCV: does correlate to an increase in vertical transmission
- 37. HIV & HepatitisC HCV is categorized as an opportunist infection.
- 38. HIV & HepatitisC HCV is categorized as an opportunist infection. As many as 30% of people with HIV may also be co-infected with HCV [30,000]. HIV +/IDU: could be up to 90%
- 39. HIV & HepatitisC HCV is categorized as an opportunist infection. As many as 30% of people with HIV may also be co-infected with HCV [30,000]. HIV +/IDU: could be up to 90% HIV triples the risk of severe HCV disease progression, is associated with high viral loads and infectiousness, and a higher risk of developing liver damage and cancer. Lower T- cell counts may increase risk of HCV acquisition.
- 40. HIV & HepatitisC Impaired liver function can result in slower processing of drugs in the body Some HIV drugs are especially hard on the liver
- 41. HIV & HepatitisC Impaired liver function can result in slower processing of drugs in the body Some HIV drugs are especially hard on the liver HCV can affect HIV treatment by increasing the frequency of liver toxicity related to the processing of HIV drugs
- 42. HIV & HepatitisC Impaired liver function can result in slower processing of drugs in the body Some HIV drugs are especially hard on the liver HCV can affect HIV treatment by increasing the frequency of liver toxicity related to the processing of HIV drugs Beginning HIV treatment first is best if possible – HCV treatments work better for people with stronger immune systems. Some experts believe that controlling HIV can help slow HCV progression
- 43.
- 44. Prevention Methods Condoms andother barriers Even with sex toys Abstain from sex during outbreaks (herpes, syphilis, genital warts) Abstain from sex during menstruation if currently HCV positive Use gloves during fisting Sex toys Important to clean, but may not be effective to kill HCV. Do not share sex toys. Use condoms.
- 45. Prevention Methods Limit partners Lube HCVcan live in lube Less likely condom will break, less likely friction will cause abrasions. Ask their status Getting tested (not prevention, but essential. Abstinence
- 46. HCV Treatment Options Interferon Harvoni[+ other drug cocktail options] Genotype 1 Insurance/expense issues
- 47.
- 48. Sources Burchell, Ann N.,et al. "Hepatitis C virus seroconversion among HIV-positive men who have sex with men with no history of injection drug use: Results from a clinical HIV cohort." The Canadian Journal of Infectious Diseases & Medical Microbiology 26.1 (2015): 17. Centers for Disease Control and Prevention. "Sexual transmission of hepatitis C virus among HIV- infected men who have sex with men--New York City, 2005-2010." MMWR. Morbidity and mortality weekly report 60.28 (2011): 945. Fethers, Katherine, et al. "Sexually transmitted infections and risk behaviours in women who have sex with women." Sexually Transmitted Infections 76.5 (2000): 345-349. HCV Advocate. Hepatitis C Support Project, 2015. Web. May 2015. Kouyos, Roger D., et al. "Clustering of HCV coinfections on HIV phylogeny indicates domestic and sexual transmission of HCV." International journal of epidemiology (2014): dyt276. Project Inform. Sexual transmission of hepatitis C: A guide for HIV-positive gay men, 2015. PDF file. Reynolds, Andrew. “Can Hepatitis C be Sexually Transmitted?” Positively Aware. May 2015.
- 49. Sources Tahan, Veysel, etal. "Sexual transmission of HCV between spouses." The American journal of gastroenterology 100.4 (2005): 821-824. Terrault, Norah A., et al. "Sexual transmission of hepatitis C virus among monogamous heterosexual couples: the HCV partners study." Hepatology 57.3 (2013): 881-889. Tohme, Rania A., and Scott D. Holmberg. "Is sexual contact a major mode of hepatitis C virus transmission?." Hepatology 52.4 (2010): 1497-1505. Tracy, Daniel, et al. "Higher risk of incident hepatitis C virus among young women who inject drugs compared with young men in association with sexual relationships: a prospective analysis from the UFO Study cohort." BMJ open 4.5 (2014): e004988. Viral Hepatitis – Hepatitis C Information. Centers for Disease Control and Prevention, 2015. Web. May 2015.