Hepatitis C - an overview

Hepatitis C is relatively common among gay men with HIV. Hepatitis C (HCV) is a serious and hard-to-treat chronic liver disease. In about four out of ten people who have it, hepatitis C will go away on its own, without treatment. Among people with HIV, that is somewhat less likely. Most people who contract hepatitis C will not notice anything at first. After a while, about half of them will notice adverse health effects. Fatigue is a common complaint, while jaundice (yellow skin and yellow eyes) is rare. The degree and the seriousness of the symptoms do not necessarily say anything about the seriousness of the liver disease. The speed with which hepatitis C can damage your health varies: the older someone is and the more alcohol he or she drinks, the faster the disease will progress. If hepatitis C does not heal, whether by itself or by means of the treatment, it can be fatal after 20 or 30 years; the progression of the disease can vary a lot from person to person.

How do you get hepatitis C?
Hepatitis C is almost only ever passed on sexually between gay men with HIV, usually through unprotected sexual contact. It is not known exactly how hepatitis C is and is not passed on. Risk factors seem to be:

  • fucking without protection
  • fisting without protection
  • having group sex
  • sharing sex toys.

Other risks in terms of transmission include:

  • sharing toothbrushes and razors
  • sharing syringes or snorting tools when using drugs.

But hepatitis C also occurs among gay men who have not had rough sex. The sexual transmission of hepatitis C seems not to take place among heterosexuals with HIV, although we cannot be completely sure of that.

What is the difference with hepatitis B?
Hepatitis C is not to be confused with hepatitis B. Hepatitis B is much easier to pass on through sexual contact and there is a vaccine against it. Some HIV medicines are also effective against hepatitis B. There are no HIV medicines that also work against hepatitis C, however.

How does hepatitis C affect HIV?
It appears that among people with hepatitis C who start taking HIV medicines, their CD4 count will be slower to rise.

How does HIV affect hepatitis C?
If you have HIV, you will usually get health problems more quickly if you have hepatitis C. That is definitely the case if your immunity is weaker.

Who provides treatment for hepatitis C?
The treatment of hepatitis C is given by the HIV doctor and HIV nurse at an HIV treatment centre, usually in consultation with a liver doctor.

Is it possible to tell how long someone has had hepatitis C?
Yes, that can be determined by means of an antibody test, by measuring the hepatitis viral load (the HCV load) and the liver values, and by making an ultrasound image of the liver. If you have acute hepatitis C (i.e. if you have only recently contracted it), the treatment you receive might be different than if you have chronic hepatitis C (i.e. if you have already had it for a longer period).

How is hepatitis C treated?
The treatment for hepatitis C is heavy and not always successful by any means. If the treatment does not work, you need to hope that your liver will last until new treatments become available. The treatment of hepatitis C among people with HIV lasts 24 to 72 weeks, and just like the treatment of HIV, it consists of a combination of various different medicines. The basic combination includes a weekly injection and tablets that you will need to take twice a day with food. In some cases, that could be supplemented with extra pills that you would need to take three times a day with food. Important side effects of the current treatment include depression, a reduced number of white blood cells, a lowered immune system and anaemia.

How often is the treatment successful?
The chance that the treatment will be successful depends on the type of hepatitis C you have and on your HCV load. New, promising medicines are currently being developed: in the future, the treatment will probably be more effective, take less time and have significantly fewer side effects.

Can you get hepatitis C again?
Yes, unfortunately that is possible. You can get reinfected with hepatitis C after but also during the treatment. There is also no vaccine against hepatitis C.

Well informed
I have become well informed about my chances of contracting hepatitis C. In the past, when I felt the need, I occasionally used to go to darkrooms or sex parties. I hardly ever do that anymore. That is because I no longer find those very exciting but also because of the risk: the men there often have sex with several others on the same night, so it’s not always very hygienic.
Alexander

Negative spiral
If someone gets hepatitis C in addition to HIV, that can result in sexual problems. Your partner might become angry: ‘Didn’t we agree that you would have safer sex?’ You might think: ‘Will I ever be able to just enjoy sex?’ Many people who are being treated for hepatitis C are automatically given antidepressants. I try to motivate people to remain active and go out and do things in order to avoid getting caught in a negative spiral. And to deal with the shame and the feelings of guilt and with people who point their finger at them. Sometimes the pointing finger really is there and not just in the patient’s head. In that case, those people think: ‘Of all people, you – with your HIV – should have known better!’
Eva Buitenhuis, psychologist and sexologist

Mood problems are side effects
I think it’s important that sexually active gay men with HIV should be well informed about hepatitis C. It is not something you can be vaccinated against. And if you have had hepatitis C once, you can always get it again. The treatment is physically heavy and it is often psychologically hard to take as well. People are not proud to have it and usually do not talk about it with others around them. Especially if someone has a course of treatment that lasts 48 weeks, he usually loses so much weight that it will become noticeable to others. People are often chronically tired and it’s often not possible for them to hold a full-time job.

If it becomes clear after twelve weeks that the treatment is working, that is a major incentive to stick with it. But it will still be very heavy for many people. After the injection many people will get flu-like symptoms for a few days. Most people can deal with those with paracetamol. But the mood problems are very intense: people become irritable and grow sombre. You really need to make it very clear to people that those mood problems are a side effect of the treatment, but it is very difficult to experience them as such. Often a person will visit a psychiatrist before starting the treatment. That way we know something about the person’s mood before the treatment begins and it makes it easier for him or her to go to the psychiatrist during the treatment as well.
Loek Elsenburg, HIV nurse

 

 

 

 

 

 

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