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'Explosion' of Sex-Spread Hepatitis C in HIV-Positive Men

CDC: Hepatitis C From High-Risk Sex Is 'Widespread' in U.S., Europe, Australia

Anal Sex, Methamphetamine Linked to HCV continued...

There was "quite a laundry list" of behaviors linked to new HCV infections. But careful statistical analysis revealed two factors that independently raised an HIV-positive man's risk of HCV infection:

  • Receptive anal intercourse with ejaculation of the partner increased HCV risk 23-fold.
  • Having sex while high on methamphetamine increased HCV risk 28.5-fold.

"This is a smoking gun for classic sexual transmission with semen," Fierer says.

Fierer warns that while the study implicates semen, it does not suggest that anal sex without ejaculation is safe. It isn't. And a troubling study of outbreaks of HCV among HIV-positive German men suggested last March that prolonged or traumatic anal intercourse often exposes both partners to infected blood.

As for methamphetamine, Fierer says the problem is that it removes sexual inhibitions while prolonging the sex act.

"Crystal meth is an incredibly disinhibiting drug. This is very much used for sex, and judgment and all kinds of other things go out the window," he says. "Patients tell me, 'Well, now it seems like a very bad idea to take meth and have unprotected sex with a partner who ejaculates in you. But at the time it seemed like a great idea."

Taylor warns that using erectile dysfunction drugs to prolong sex also appears to be a risk factor for HCV transmission among HIV-positive men.

Sex-Spread HCV Threatens New HCV Treatments

New HCV treatments make it much more likely that a person can be cured of hepatitis C. But there's a catch.

Schiff notes that a person can be infected with hepatitis C over and over again. He's already seen patients who seem to be getting better with treatment, and then suddenly are reinfected.

That's going to be a problem, he says, because powerful new hepatitis C drugs have an Achilles heel -- the virus quickly becomes resistant. If a person is reinfected with HCV during treatment with one of the new drugs, there's a good chance the virus will acquire resistance to all similar drugs.

"If people are re-exposed to HCV after treatment with new antivirals, there will be resistant virus," he predicts.

Taylor predicts the same thing.

"The rates of HCV reinfection in HIV-positive men appear to be much higher than in other groups," she says. "So just like syphilis, they come in with hepatitis C again and again. ... [It is] a definite reality we are going to be dealing with drug-resistant hepatitis C by the end of this year."


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