Doctors have long believed that hepatitis C, a deadly liver disease, is primarily spread by sharing needles. But they've also known that people with HIV are much more likely to contract hepatitis C.
Now medical professionals are buzzing about the disease and challenging conventional wisdom about how the illness spreads. Dr. Daniel Fierer of Mount Sinai Hospital in New York City has provided trailblazing evidence that shows hepatitis C is often spread through sex by men who have sex with men.
Once upon a time, a liver transplant was the only option to treat advanced hepatitis C, but new medications now offer a 90 percent cure rate. And while much of the focus on the most prominent drug Sovaldi has been on its $1,000 per pill price-tag, the medication is a “game changer,” according to Dr. Amesh Adalja, a critical care physician and infectious disease specialist at the University of Pittsburgh Medical Center.
Doctors and public health officials have launched aggressive testing campaigns and have begun lobbying lawmakers, pharmaceutical companies, and insurance companies to make sure the new medications are accessible.
“Hepatitis C increasingly is being recognized as a major public health problem,” Adalja told Healthline.
One Man’s Diagnosis
Kevin Maloney of Columbus, Ohio, learned he had HIV and hepatitis C in 2010. He told Healthline that he knows one thing for sure: “I got it from sex. I never shared a needle.”
Maloney’s story is familiar to many people who become infected with HIV. He had sex he knew was risky, and three weeks later, he developed a fever and body aches. “I thought, ‘Oh no, I have it,’" he said. "I went to the doctor and sure enough, I came back positive.”
Blood tests also revealed hepatitis C. The doctor first stabilized Maloney with antiretroviral medication, which boosted his T-cell count from 300 to 400 and suppressed his viral load to undetectable levels. He was then placed on a regimen of ribavirin and interferon to treat the hepatitis C.
Maloney was lucky. His doctor achieved a cure in six months with this older drug regimen, which is only about 40 to 50 percent effective, even after 12 months. Because Maloney’s hepatitis C was caught early, in the acute phase, treatment had a better chance of success. Even today, with new drugs, treatment in the chronic phase can prove difficult. The disease becomes chronic after about three to six months without treatment.
The drug treatment had bad side effects for Maloney. Interferon, which suppresses the immune system, is hard on the body. It significantly lowered his T-cell and white blood cell counts and caused headaches and extreme anxiety, a known side effect.
Study Shows Hepatitis C Can Be an STI
Fierer treated Maloney as part of research he conducted between 2005 and 2010. Fierer and his colleague Dr. Doug Dieterich, a renowned liver specialist at Mount Sinai, had seen several hepatitis C patients toward the end of 2005 who claimed they were not intravenous drug users. “They did not have the typical risk factors," Fierer said of the patients, who were men who had sex with men.
He set out to find other HIV-infected men with hepatitis C in New York City. What he found was an increasing number of gay and bisexual men contracting hepatitis C through sex. Meanwhile, the number becoming infected through intravenous drug use was dropping.
Fierer’s study of 74 men who had sex with men with acute hepatitis C infection and no reported intravenous drug use was published July 22, 2011 in the U.S. Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report.
Many of the men admitted to high-risk sexual behavior, including being high on crystal meth or other drugs during sex. The median age of the men was 39 and more than half were white. Most had not yet shown symptoms of hepatitis and had undergone a previous hepatitis test, most commonly within the past year.
Fierer’s findings, though almost three years old, have again been thrust front and center among infectious disease specialists. With Sovaldi now available to treat hepatitis C, public health advocates are rallying to spread the word about testing and treatment.
A 12-week course of Sovaldi costs about $84,000, but more hepatitis C drugs are in the development pipeline, and greater competition may drive down prices.
The FDA still recommends that new hepatitis C drugs be used with interferon, but with shorter treatment times, its toxicity is better tolerated. Many patients still cannot manage with interferon, and Fierer said he tends to avoid the use of interferon altogether.
Rethinking Sexual Norms
Community groups are bringing HIV and hepatitis C testing and education to areas hit hard by the diseases. Armed with a relatively new rapid testing device for hepatitis C, the Do One Thing campaign has taken the battle against HIV and hepatitis C directly into three Philadelphia ZIP codes. Led by Amy Nunn at Brown University's Alpert Medical School in Providence, R.I., and Dr. Stacey Trooskin at the Drexel University College of Medicine in Philadelphia, the campaign has found a 5 percent infection rate as workers attempt to knock on 2,000 doors.
The campaign targets neighborhoods comprised of mostly blacks and Hispanics, who share a disproportionate burden of HIV and hepatitis C infection. So far, nobody who has tested positive has been denied treatment. Still, getting authorizations from insurance companies has been “a moving target,” Trooskin told Healthline, and some have even required alcohol and drug testing prior to giving treatment approval, which Trooskin said is “ludicrous.”
Maloney decided to come forward about his experience with hepatitis C because he wants HIV positive men to get tested for hepatitis C regularly. Untreated hepatitis can rapidly accelerate in people with HIV. In healthy people, the disease can lie dormant for decades.
And Maloney said that while he believes in the benefits of Truvada, a once-daily pill to prevent HIV infection, he also wants to warn everyone about what can happen if you opt not to use condoms.
“People never want to do anything before it actually becomes a problem, but how bad do we want this to get before we start making changes?” Fierer said, adding that quarterly hepatitis screenings should be mandatory for people with HIV.