'Explosion' of Sex-Spread Hepatitis C in HIV-Positive Men
CDC: Hepatitis C From High-Risk Sex Is 'Widespread' in U.S., Europe, Australia
Schiff notes that when HIV-positive men get HCV, they have much higher levels of the hepatitis C virus in their blood. Taylor and Schiff warn that hepatitis C infection progresses quickly in people with HIV infection.
"These men are sitting ducks for liver cancer," Taylor says. "If they don't get treated and get HCV eradication, they are at risk of cirrhosis or liver cancer. ... We are seeing tons of gay men newly diagnosed with HIV, and then with HCV. I could go to a funeral of an HCV patient every week."
Anal Sex, Methamphetamine Linked to HCV
Fierer and colleagues gave detailed questionnaires to 34 HIV-positive men with new hepatitis C infections, as well as to 67 closely matched HIV-positive men who tested negative for HCV. In detailed questioning and interviews, the men denied any form of intravenous drug use -- even the use of prescription testosterone.
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.