Hepatitis C is a blood-borne virus (BBV) which is commonly passed on through unsafe injecting drug use (sharing of needles and injecting equipment), or in some cases the sharing of unsterilized equipment such as clippers, razors, toothbrushes and tweezers where there may be small amounts of blood. People in Australia who received blood or blood products prior to 1990 may have been exposed to HCV. A small number of needle-stick (sharps) injuries have transmitted HCV (in occupational settings), and similarly some people have been infected through unsterile tattooing or body piercing.
In the past, sexual activity was thought to be a low risk for hepatitis C transmission. Although still uncommon, sexual transmission of hepatitis C is increasing among gay men and men who have sex with men (MSM).
Sexual risk factors occur in the absence of condoms where there may be cuts, wounds, sores, abrasions or tears that may not be easily seen (with tiny amounts of blood present). Other blood exposure risks include fisting, rough sex, prolonged sex, group sex, and sharing unwashed sex toys, snorting straws and barrels for ‘booty bumping’ (anal drug administration). Using condoms and gloves with water-based lube, and thoroughly washing sex toys in warm soapy water, will prevent sexual transmission of hepatitis C (as well as protecting against other STIs). Vaccinate against Hepatitis A and B to avoid their concurrent sexual risks in these situations.
In non-sexual settings, people who inject drugs should use new sterile fits (needles and syringes) and your own equipment (spoons, tourniquets, filters, swabs). Injecting equipment should be safely disposed in a sharps container, to reduce the risks of HCV transmission (such as accidental needle-stick injury). Avoid sharing personal grooming items (toothbrushes, razors, tweezers).
There is no vaccine available to prevent HCV, but it can be cured. Highly effective oral pill-based treatments are now available which offer up to 95% cure rates of HCV within 8 to 12 weeks of treatment (in most cases). Over time, it is expected that exposure to HCV will diminish due to the effectiveness of these new curative treatments – simply put, less people will have HCV in the long run, as we move towards virtual elimination of HCV. However, you can be reinfected with HCV, as is the case with all curable STIs (except hepatitis A – which you can only get once).
Approximately 10% to 13% of PLHIV also have HCV coinfection. The prevalence of HCV among gay men without HIV is estimated at about 8%. In the total population HCV prevalence is much higher compared to HIV prevalence, so exposure risks to HCV can be fairly common. In 2014, over 230,000 people were estimated to be living with chronic HCV. As above, this will diminish over time as more and more people are cured of HCV through the new effective treatments for it.
25% of people clear the hepatitis C virus naturally without treatment, but the remainder go on to chronic infection (with 1% progressing to liver cancer) and will require treatment. People with HIV/HCV are less likely to clear the hepatitis C virus naturally, but are equally as likely as others to clear the virus with the new hepatitis C treatments (and achieve HCV cure).
Regular testing for HCV is recommended, as it is estimated that 15% with chronic HCV do not know they have HCV. Ask for a HCV test when you have your regular STIs screening tests. Like HIV, it can take up to 3months (but most often within 6 weeks) for antibodies to form after exposure to HCV – this is called the window period. People who have had a previous HCV infection may have antibodies for life, so a PCR (viral load) test may be used to confirm a current HCV infection.
Hepatitis C is best treated early before it causes permanent damage to the liver. Aside from seriously affecting your liver health, symptoms of HCV infection may include liver pain, excessive fatigue/tiredness. Some people don’t get any symptoms, so testing can be the only way to tell if you have HCV.
About Hepatitis C (HCV):
About HIV/HCV coinfection:
About HCV Sexual Transmission (for gay men):
Hepatitis Queensland: 07 3846 0020 or 1800 437 222 or www.hepqld.asn.au