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Sex and hepatitis C
May 19, 2014

Dear Dr.Taylor,

Greetings from Thailand! I'm HIV+ and co infected with hepa B. Currently, I'm on meds 3TC+TDF+EFV. This regimen works well on both HIV and hepa B: undetectable virus, CD4 = 600 up, HbeAg seroconverted to negative. Now I'm concerned about hepa C. I was tested last two years and a half and it was negative. I'm bi sex. Since then, I had sex with male and polygamy female with protection and awareness e.g. using condoms, avoiding touching semen, vaginal lubrication, no oral sex. I don't use any drugs. I wish to know what kinds of sexual practices that are likely to get hepa C for HIV+ on meds people? Do they get hepa C easier than HIV- people? Thank you very much for your help.

Response from Dr. Taylor

Although questions remain regarding the precise role of HIV infection in hep C sexual transmission, yes people living with HIV are at higher risk for catching hep C from sex and spreading hep C with sex, when compared to people who are HIV-uninfected. HIV-infected gay men and other HIV-infected men who have sex with men are at highest risk.

Remember that hep C is spread by blood that contains hep C. So sex that involves blood is what should be avoided in order to reduce the risk of catching and spreading hep C.

So again -- Sex that involves blood, such as having unprotected anal intercourse (sex in the butt), especially among HIV-infected gay men and men who have sex with men, may spread hep C. Rates of new hep C infections are on the rise among this population!

Putting fingers and fists deep into the butt, known as "fisting," and other sexual practices that may cause the soft tissues inside the butt to bleed (such as using sex toys), may increase the risk.

Certain drugs, such as crystal meth, and other party drugs (poppers, ecstasy), may make people less inhibited and can lead to a decreased pain threshold, allowing sex to be longer and more intensive, resulting in more bleeding.

Having group sex and more sexual partners increases the risk.

Sex without a condom, or if fisting, sex without gloves, increases risk of hep C. NEVER REUSE these items, as this may spread hep C. Throw them away after using once and use a new condom or glove. Reusing sex toys without cleaning and passing them around is also of concern. Using drugs by putting them up in the butt, sometimes called 'booty bumping,' can cause bleeding and increase risk.

Very low transmission (spread) rates among monogamous (you have sex with only the same 1 person) heterosexual couples in which 1 partner has hep C and the other does not, followed over many years, have established that hep C is not readily spread via heterosexual sex. Supporting this is the fact that hep C infection does not follow the same heterosexual sexual transmission patterns as classic sexually transmitted infections, such as gonorrhea and chlamydia. However, certain behaviors, such as anal intercourse and group sex, or sex while an HIV-infected woman has her period, could result in hep C transmission among heterosexuals.

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