Hepatitis C virus often found in semen
Researchers continue to investigate the biological mechanisms which could explain the ongoing epidemic of sexually transmitted hepatitis C in HIV-positive gay men.
Some studies have suggested that sexual transmission is mostly linked to sexual practices that involve some contact with blood (including tiny traces of blood you don’t notice). This makes sense as it is well known that hepatitis C is present in infectious quantities in blood. These sexual practices may include anal sex (especially when it goes on for a long time) as well as fisting and using sex toys.
Until now, it’s generally been thought that while hepatitis C may be present in semen, it’s usually at a low level that isn’t infectious. A new study questions that belief.
Researchers took semen and blood samples from 33 gay men who had both HIV and hepatitis C. They found that one third of the men had detectable hepatitis C in their semen and that it was present in levels that were plausibly high enough to transmit the virus.
When individuals had high levels of hepatitis C in their blood (for example, soon after infection) they tended to have high levels in their semen. But this was not always the case – some men who had low levels of hepatitis C in their blood had high levels in their semen.
The results suggest that hepatitis C can be passed on during anal sex even when there has been no bleeding. They suggest that condoms can play an important role in preventing the transmission of hepatitis C.
There’s more information on this issue in NAM’s illustrated leaflet ‘How hepatitis C is passed on during sex’.
Drug resistance in steep decline
The number of people with virus that is resistant to some anti-HIV drugs has fallen significantly in recent years, according to a Swiss study.
A drug-resistant HIV strain is one which is less susceptible to the effects of one or more anti-HIV drugs. Having drug-resistant HIV limits the range of drugs you can use, but you will still usually be able to find an effective treatment.
Drug-resistant HIV can emerge if you regularly miss doses of your anti-HIV drugs or take them late. Because HIV treatment is now easier to take, with fewer side-effects, resistance is less of a problem than it used to be.
Resistance can also develop when people take HIV treatment regimens which are not powerful enough to keep HIV under control – this was a problem in the 1990s, but is generally no longer an issue for people receiving care in the UK and similar countries.
Looking back at data on thousands of people living with HIV in Switzerland between 1999 and 2013, the researchers found that in 1999 there were 401 patients with a new case of drug resistance, including 69 people who had resistance to multiple drugs. Although many more people were living with HIV in 2013, there were only 23 new cases of drug resistance, including three people with resistance to multiple drugs.
These new cases of resistance in recent years are mostly due to resistant virus being sexually transmitted – individuals having resistant virus when first diagnosed with HIV.
Other people continue to have resistance to some drugs, as a legacy of problems with HIV treatment several years ago. Looking at those individuals who had resistant virus in 2013, most started to take HIV treatment before 2006. Only 15% of cases involved people who began HIV treatment after 2007.
There’s more information about drug resistance and how to prevent it in NAM’s booklet ‘Taking your HIV treatment’.
People not taking treatment
Two recent studies shed light on the experiences of people who have chosen not to take HIV treatment or who have had difficulties taking treatment regularly. Researchers have called on clinicians and policy makers to pay more attention to the experiences of people who have fears or concerns about HIV treatment.
In an Australian study, some people were reluctant to start treatment for as long as they felt healthy and normal. They worried that starting treatment would make HIV feel more real rather than lessening its impact. The interviewees were aware of the evidence that HIV treatment reduces the infectiousness of people living with HIV and described feeling pressurised by friends and professionals to take treatment and ‘do the right thing’ for the sake of the wider community – a call that brought about ambivalence and resentment.
These people who had decided not to take treatment often said that they did not know anyone else who had HIV and was not taking treatment. They felt marginalised and silenced within groups of people living with HIV and by HIV support organisations.
In a separate study, researchers interviewed west African women living in London who had had difficulties adhering to their HIV treatment. Internalised stigma about HIV was an undercurrent in many of these women’s accounts, with some women feeling as negatively about the medications as about the illness they are used to treat. Several described HIV treatment as making them feel they were trapped in a monotonous life sentence. As one woman said, “They will tell you that you have to take it. It’s the words ‘for life’ I hate, I can’t stand it.”
But some interviewees talked about how their adherence and their health had improved, citing the support of family members and of doctors who treated them as equal partners. The researchers say that healthcare staff should educate patients about how HIV treatment works and fully involve them in decisions about treatment. They also say that, when possible, it’s helpful for people living with HIV to be open about their HIV status to friends and family, so that they are not isolated and can get support.
Editors' picks from other sources
UK PrEP decision re-ignites HIV activism
from The Lancet (editorial)
The NHS should reopen the public consultation, emboldened by the renewed and much needed HIV activism.
Heterosexual identity crisis
from Positive Lite
Straight poz guy Joshua Middleton and the untold story of shame amongst straight men.
The graying of HIV: 1 in 6 new US cases are people older than 50
from Washington Post
Thousands of people 50 and older are diagnosed with HIV each year in the United States, a development that has significant consequences for the health care and social support they need and the doctors, counselors and others who provide it. Older people tend to be sicker when the infection is finally discovered. They usually have other health conditions that accompany ageing and often are too embarrassed to reveal their illness to family and friends.
Media outlets falsely claim that a cure for HIV may be only three years away
from Poz
A series of media outlets have erroneously reported that scientists may be just three years away from developing a cure for HIV. This false claim traces to an article published in the UK’s The Telegraph concerning researchers who recently succeeded in editing HIV’s genetic code out of immune cells in a laboratory setting.
Greed and the necessity for regulation
from TAG
The story of US drug pricing run amok isn’t just about corporate arrogance and avarice – it is also about government permissiveness and inaction.