Hepatitis C : Who is at risk & how is it transmitted?

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Who is at risk & how is it transmitted?

Hepatitis C is common among people living with HIV. In the United States, 25 percent to 33 percent of people living with HIV are coinfected with HCV. This means that at least 300,000 people in the United States are living with HIV and hepatitis C.  

Hepatitis C is blood-borne. To cause a new infection, HCV must pass from the blood of an infected person into the blood of an uninfected (susceptible) person. In other words, HCV is most easily spread through direct blood-to-blood contact. Injection drug users (IDUs) who have shared needles or other injection equipment, including cookers, cotton, and measuring syringes, are at the highest risk of being infected with HCV—between 50 percent and 90 percent of people who got HIV from IDU are also infected with HCV. This is because both viruses can be spread easily through blood and blood products. 

Hepatitis C is transmitted by:
Sharing needles and other equipment (paraphernalia) used to inject illicit drugs, hormones or steroids.
Needle-stick injuries and exposure of open wounds or mucous membranes to infected blood (Note: The risk of transmission in the health care setting is actually quite low—a 4 percent to 10 percent risk through a needle-stick injury involving a needle previously used in someone infected with HCV).
Transfusion with infected blood or blood products (especially before 1992; the U.S. blood supply is now thoroughly screened, lowering the risk to one in 2 million).
Transplantation with an infected organ.
Invasive procedures with unsterilized medical or dental equipment.
Tattoos, if unsterilized needles, ink wells and other equipment are used.

Being HIV-positive appears to increase the risk for sexual transmission of hepatitis C. During the past decade, outbreaks of sexually transmitted hepatitis C have been reported among HIV-positive men who have sex with men (MSM) in Australia, Belgium, Canada, France, Germany, the Netherlands, Spain, the United Kingdom and the United States.
 
Researchers have found some common risks—along with HIV itself—that are associated with these sexually transmitted outbreaks, such as:
Participating in group sex
Finding sex partners on the Internet
Rougher, longer anal intercourse (receptive and insertive)
Receptive or insertive fisting
Shared sex toys
Non-injection drug use (nasal or anal)
Having another sexually transmitted infection

HIV may increase the risk of sexually transmitted hepatitis C infection among women. HIV-positive women who have a male IDU partner are more likely to be coinfected with hepatitis C than HIV-negative women with male IDU partners. 

Coinfected women can pass hepatitis C to their infants during pregnancy, labor and delivery. The risk for mother-to-infant transmission of HCV ranges from 5 percent to 10 percent in women with HCV alone. HIV increases that risk to between 10 percent and 25 percent. Although ARV therapy reduces the risk for HIV transmission from mother to child, it is not clear whether it lowers the risk of hepatitis C transmission. What’s more, delivering a baby via caesarean section, compared with vaginal delivery, does not appear to reduce the risk of mother-to-child HCV transmission. Breast feeding is known to transmit HIV, and it may increase the risk of HCV transmission when the mother is living with both viruses. 

You may be at risk for hepatitis C and should contact your health care provider for a blood test if you:
Were notified that you received blood from a donor who later tested positive for hepatitis C.
Have ever injected illegal drugs—even if it was only once.
Have ever gotten a tattoo or piercing in a non-professional setting where equipment such as ink, inkwells or needles are re-used and potentially unsterilized.
Received a blood transfusion or solid-organ transplant before July 1992.
Received a blood product for clotting problems before 1987.
Have ever been on kidney dialysis.
Have evidence of liver disease (for example, persistently elevated liver enzyme levels).
Have had multiple sexual partners, or sexual contact with an HCV-positive person.
Have an HCV-positive mother.

As explained in more detail below, some HIV-positive people can clear HCV by a strong immune response, or with treatment. It is possible, however, for a person who ultimately clears the virus—either spontaneously or through treatment—to become reinfected with HCV.


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Last Revised: April 03, 2012

This content is written by the POZ and AIDSmeds editorial team. For more information, please visit our "About Us" page.

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