Gays and hepatitis C: good news, bad news

Gays are no more prone to getting hepatitis C from sex than anyone else -- unless they happen to be HIV positive.

For gay and bisexual men not infected with HIV, the risks of developing hepatitis C are about the same as with HIV-negative heterosexuals, researchers in multiple countries have found.

That doesn't mean gays should let down their guards if they're HIV negative, however.

The so-called "epidemic" of HCV infection among those with HIV increases chances that the potentially fatal liver disease may yet break into the general gay population, some experts fear. Or already may be in the process, since individual cases of the disease often go unnoticed for years or decades.

A 2013 study suggests, in fact, that high rates of hepatitis infection among men who have sex with other men is nothing new, and have been occurring for decades. A summer 2013 report from the United Kingdom found "evidence of ongoing, but declining sexual transmission" among gay men.

Doctors and health advocates warn repeatedly that risky sexual behaviors associated with gay lifestyles present significant dangers -- not from the sex act alone, but from blood-on-blood transmission.

Those behaviors include aggressive anal sex, rimming, fisting, and use of "club drugs" such as GHB and ketamine.

Here are some ways to decrease the odds of hepatitis c infection while participating in gay sex:

• Use lubricants. Always. But never share.
• Use condoms. Employ oral protection such as dental dams, and gloves for fingering and fisting.

• Microscopic amounts of blood on sex accessories present significant dangers. Use condoms on sex toys and clean them with isopropyl alcohol as often as needed, certainly in between sex partners.
• Keep fingernails short. Don't brush or floss before sexual activity outside a monogamous relationship, especially if rimming is involved. (Don't share toothbrushes or razor blades.)
• Having sex while high presents several problems, not the least of which is a general lack of common sense among the inebriated. Some drugs also can dehydrate the anus, making invisible (and sometimes visible) cuts, rips and tears more likely.
• In group situations, take the time to clean yourself and disinfect before changing partners.

The practice of "serosorting" -- choosing partners according to self-reported disease status -- shouldn't give false confidence or replace any other safety techniques. The Centers for Disease Control experts expressed "general concern" that the community-developed strategy "in some particular contexts would not reduce HIV risk and might actually increase it."

HCV and HIV both have high instances of carriers who are unaware of their status, especially among minorities, the CDC team warned.

In addition, hep C reinfections -- among those who've previously cleared the virus -- are "strongly related to levels of ongoing risk behavior."

Still, the news is mostly good. "The HCV incidence in HIV-negative (men who have sex with men) indicaties that these men remain largely unaffected by the current outbreak of HCV," a research team from Amsterdam and Australia found.

Research: Gays and hepatitis C infection/transmission

Prevalent and Incident Hepatitis C Virus Infection among HIV-Infected Men
Shikha Garg, Lynn Taylor, Chris Grasso, Kenneth Mayer. Study of HIV-infected men at Fenway Institute, Boston (2013)
Quote: "HCV may be under-recognized in this population ... Prevalent and incident HCV was common in this HIV-infected population despite engagement in care."

Incident Hepatitis C Virus Infection in Men Who Have Sex With Men
Mallory Witt, Eric Seaberg, Annie Darilay, Stephen Young, Chloe Thio ... Department of Medicine, Johns Hopkins University, Baltimore (2013)
Quote: "The spread of HCV among both HIV-infected and -uninfected MSM in the United States has been ongoing since the beginning of the HIV epidemic."

Hepatitis C in the UK: 2013 Report
Public Health England, HP Scotland, PH Wales, HSC (2013)
Quote: "Enhanced surveillance of newly acquired HCV infection in (men who have sex with men) provides evidence of ongoing, but declining sexual transmission. ... Infection declined significantly from 7.0 per 1,000 person years in 2008 to 2.2 in 2012."

Prevalence and risk factors of hepatitis C in HIV-negative homosexual men ...
Fengyi Jin, Garrett P. Prestage, Susan C. Kippax, John M. Kaldor, Greg J. Dore, Andrew E. Grulich. National Centre in HIV Epidemiology and Clinical Research, Wales (2005). Quote: "The prevalence of HCV in this cohort was about the same as in the general population ... there was no evidence for sexual transmission."

Hepatitis C infections among HIV-infected men who have sex with men
A. Urbanus, T. van de Laar, I. Stolte, J. Schinkel ... Study of 3,125 patients at the STI clinic Amsterdam. AIDS Journal (2009).
Quote: "We found a high and increasing HCV prevalence in HIV-infected (men who have sex with other men). ... Rough sexual techniques and use of recreational drugs were associated with HCV-infection."

'Explosion' of Sex-Spread Hepatitis C in HIV-Positive Men
Daniel J. DeNoon, WebMD (2011)
Quote: "We have uncovered an emerging epidemic of sexual transmission of hepatitis C. And the main reason is men having anal sex without a condom."

Hepatitis C Virus Infections in the Swiss HIV Cohort Study: A Rapidly Evolving Epidemic
G. Wandeler, T. Gsponer, A Bregenzer ... Clinic for Infectious Diseases, University Hospital Bern, Switzerland. Swiss HIV cohort study (2012)
Quote: "Incidence of hepatitis C virus infections has increased 18-fold in HIV-positive gay men in Switzerland since 1998. ... Half of all infections occurred between 2008 and 2011. Incidence of hepatitis C fell in HIV-positive injecting drug users and remained stable in HIV-positive heterosexuals."

Sexual Transmission of Hepatitis C
Edwin J. Bernard. AIDS Treatment Update (2002).
Quote: "There is new evidence that sexual transmission of HCV is on the rise, particularly amongst gay men with HIV."