London clinic reports rising cases of sexually transmitted hepatitis C

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As we reported in September’s AIDS Treatment Update, a number of UK HIV clinics have observed an increase in hepatitis C virus (HCV) infections amongst people who appear to have been at risk only through sexual exposure. These cases appear to be concentrated amongst people with HIV infection. One of the centres featured in the ATU article, the Chelsea and Westminster Hospital, London, reported their findings at a recent HIV scientific conference in Glasgow.

Rita Browne and colleagues identified 21 people who tested positive for HCV infection during the period between 1997 and June 2002, having previously tested HCV-negative. Of these, 17 were known to be HIV-positive, two seroconverted for HIV at the time of HCV diagnosis, and the two others were HIV-negative. All 19 HIV-positive individuals were gay men. Of the 21, 17 did not report injecting drug use or blood transfusion (both common HCV transmission routes), whilst 13 reported having had unprotected sex recently. Six of the HIV-positive gay men had also been treated for syphilis in the year preceding their HCV diagnosis.

During the study period, which ran from 1997 to June 2002, there was an increase in the number of HIV-positive people testing for HCV as a consequence of observed abnormal liver function (a sign of underlying liver disease). However, the proportion of these which were found to be HCV-positive increased from 10.7% to 40.0%, a significant increase.



A sexually transmitted infection caused by the bacterium Treponema pallidum. Transmission can occur by direct contact with a syphilis sore during vaginal, anal, or oral sex. Sores may be found around the penis, vagina, or anus, or in the rectum, on the lips, or in the mouth, but syphilis is often asymptomatic. It can spread from an infected mother to her unborn baby.

Discussing their findings, Browne and colleagues say "The numbers identified in this study are small and may only represent a pocket of infection not indicative of increased risks in larger populations. The way that these infections parallel recent increases in sexually transmitted infections however gives cause for concern. Confirmation or refutation of these trends and clarification of risks by expanding screening studies within both the HIV and general sexual health settings is urgently required."

In a recent review in the medical journal Hepatology, Norah Terrault, of the University of California at San Francisco states that while the sexual transmissibility of HCV is low compared to other sexually transmitted viruses, sexual transmission is still likely to contribute significantly to national HCV epidemics given the common nature of sexual behaviour, and the high prevalence of people with HCV infection.

In August this year, the UK Government launched a draft Hepatitis C Strategy for England. Consultation on this document closed last Friday, and it is understood that a hepatitis C action plan will be available from the Department of Health soon.

You can view the original article in AIDS Treatment Update by clicking here.


Browne R et al. Increased incidence of HIV-positive individuals with acute hepatitis C due to sexual transmission: a new epidemic? 6th International Congress on Drug Therapy in HIV Infection, Glasgow, abstract P283, 2002.

Terrault NA. Sexual activity as a risk factor for hepatitis C. Hepatology 2002;36:S99-S105.