As Vaccine-Preventable Hep Gets Fine-Tuned, Don’t Forget
About C
by Chael Needle
LifeGuide [Treatment Horizons]
Recently, the FDA approved an accelerated dosing schedule for Twinrix, the only combination hepatitis A/hepatitis B vaccine available in the U.S.: Three doses are given within three weeks, with a booster dose at twelve months. GlaxoSmithKline, the makers of Twinrix, have highlighted the dosing schedule’s usefulness for those who are traveling abroad to regions endemic for hepatitis A and B, as well as suggesting a benefit for emergency first care responders, especially those deploying to disaster areas overseas, and those at risk for hepatitis, such as people with STDS and those who are HIV-positive.
Speaking with Gal Mayer, MD, the medical director of Callen-Lorde Community Health Center in New York City, I emphasize this last suggestion. “I’m not quite sure this is going to affect people with HIV differently. People with HIV should not find themselves in a situation where they have to travel in one month and have never been vaccinated. If they’re in care for their HIV, their primary care provider should be vaccinating them because of their HIV not because of their travel.”
Vaccinations should be done as a matter of course, he says, especially for men who have sex with men (MSM), the population most at-risk for hep A because of oral-anal contact, a sexual practice arguably more common among this population than others. For upwards of ninety-eight percent of those infected with hep A, the illness can be very benign, says Dr. Mayer, but there have been rare cases of severe liver failure. If you are HIV/hep A coinfected and in care, “you may be at higher risk for complications because you might also be on other drugs that may be stressing your liver or HIV itself could stress your liver.” Hepatitis A virus, found in the stool of the person infected, is transmitted nonsexually as well, through contaminated food or drink, or close personal contact.
With hepatitis B, which is transmitted through infected blood or body fluids, and HIV coinfection, some individuals could develop chronic hepatitis B which “could limit the HIV medications that you could be given; it could develop into cirrhosis and cancer. It’s mostly easy to treat but it can also be difficult to treat if it becomes resistant to the medications and it’s a chronic illness that’s going to exacerbate the course of HIV. So it’s a very good disease to avoid,” says Dr. Mayer.
As someone experienced in both HIV and hepatitis, as well as LGBT, health, Mayer recommends that an individual living with HIV be vaccinated as quickly as possible, though with some risk assessments to consider first. “Depending on your risk, there are lower [vaccination] response rates at lower T-cell counts....If you have T cells above, let’s say, 200, then it’s a no-brainer. We’ll vaccinate you if you have never been vaccinated. If you have lower T-cell counts and you’re not engaged in behavior that can transmit hepatitis A or B we might wait until your T-cell count comes up and then vaccinate you. If we think that you’re at high-risk for hepatitis A or B we might vaccinate you now and hope for the best. And if you don’t respond, vaccinate you again when your T-cell counts are higher.”
If you are HIV-positive or at-risk for HIV, hep A, or hep B infection, talk with your physician about hep A/B shots (which come bundled or separate) if you haven’t been vaccinated. But also see about C.
While Dr. Mayer and the staff make patients aware of all three hepatitis infections, they raise special awareness about hep C, which is not vaccine-preventable. Their health center has seen increasing numbers of hep C infection, and, surprisingly, many have not reported traditional risk factors, such as sharing needles and fisting. “We think it’s a looming problem in the world of gay health because I think there’s more tendency right now than ever for people to serosort—for HIV-positive guys to find other HIV-positive guys for unprotected sex, some HIV-negative men are finding other people they think are HIV-negative for unprotected sex. But what nobody is talking about is hepatitis C.
“We have seen HIV-positive and HIV-negative men coming in with hep C that was sexually transmitted,” he says, and now many who are positive have this “double whammy,” a coinfection that can be a “disastrous combination.”
“Serosorting with HIV is not safe enough for barebacking. I wish it were but it’s not,” Dr. Mayer says, adding that health educators have found a level of awareness about hep C’s prevention and transmission similar to where HIV education was twenty-plus years ago. “None of these [hep A/B] interventions protect you from hep C, which is an emerging sexually transmitted infection between men and especially HIV-positive men. The best protection for hepatitis C is to use condoms.…People don’t know that [hep C] is transmitted through sexual contact between men, probably through anal sex. We don’t even know that much about it. But we know that we’re seeing way too much of it in people who don’t have any traditional risk factors, and are just having unprotected anal sex.”
Chael Needle wrote about Medicare Part D in the April issue.
May 2007 |
