Hepatitis: A, B, C

In Russia, according to unofficial data, about four million people are infected with viral hepatitis. Gay and bisexual men are in a vulnerable area. As part of the educational project #code103, we want to once again draw attention to the problem.

Viral hepatitis that affects the liver is not surrounded in the public consciousness with such an ominous aura as HIV. However, their prevalence, as well as mortality from some varieties, makes the hepatitis threat no less significant. Let us recall the main types of hepatitis viruses, why gays and bisexuals are in one of the groups vulnerable to hepatitis, and also briefly recall the prevention and treatment of these diseases.

Hepatitis A

The most common hepatitis A virus (HAV, or “jaundice” in Soviet parlance) is transmitted by consuming contaminated food or water. The cause of infection in most cases is neglect of hygiene (“dirty hands”) or lack of clean water.

Almost all people who get sick make a full recovery from hepatitis A with lifelong immunity. However, a very small proportion of people infected with hepatitis A will die from fulminant hepatitis.

There is no objective evidence that men who have sex with men (MSM) constitute any special risk group in the context of hepatitis A epidemics. The only indirect risk factor may be close communication between certain groups of MSM already at the height of the epidemic. However, for example, in the spring of this year, Rospotrebnadzor of the Russian Federation, warning Russians about the “dangers” of traveling to Europe, stated that an epidemic outbreak in 13 European countries was registered mainly among gays and bisexuals.

You can protect yourself in advance from hepatitis A with the help of a vaccine - it is administered in any clinic twice, with an interval of 6-12 months.

Hepatitis B

The hepatitis B virus, or HBV, was discovered by virologists about 50 years ago. As a result of an attack on the body, a considerable part of the liver tissue dies, but this is not fatal: the liver is an organ with a high ability to regenerate cells. As a result of the production of antibodies, in 95% of cases the body completely gets rid of the virus. In the remaining 5%, hepatitis B takes a chronic form, but treatment with modern antiviral drugs successfully stops the reproduction and synthesis of viral proteins: the person not only does not get sick himself, but is also unable to infect others.

About 400 million people in the world have chronic hepatitis. The greatest concentration of virus carriers is concentrated in Central and Southern Africa, Central and Southeast Asia, and somewhat less in Latin American countries.

This virus is not transmitted through dirty hands, food or water. To become infected with hepatitis B, direct contact with blood or damaged skin or mucous membranes is necessary. Of course, the most dangerous practice in this sense is intravenous drug use. The drugs themselves, the equipment needed to prepare the “dose,” as well as the syringe needle can become infected. Other classic ways of transmitting hepatitis B, which fortunately are increasingly rare, include manicures and pedicures, tattoos and piercings, scarring, dental procedures, as well as surgeries and blood transfusions.

But a significant number of infections also occur through sexual contact. Gays and bisexuals are a vulnerable group here. We are talking about both the more frequent change of partners than heterosexuals, and the traumatic nature of sexual practices common among MSM - namely anal sex and certain BDSM practices (for example, fisting). According to various sources, with one single unprotected sex, the probability of infection is from 15 to 25%. Here it is appropriate to recall the importance of banal precautions: the use of condoms and water-based lubricants.

Vaccination against hepatitis B has recently been carried out free of charge in clinics, but if you don’t have time to wait in line, you can pay about 1,200 rubles for it. The hepatitis B vaccine (Engerix B, Combiotech or Euvax) is administered in three stages. After the first vaccination, a second vaccination is given a month later, and a third is given 5 months after the second.

Hepatitis C

Hepatitis C, or the “gentle killer” (so named because most cases are asymptomatic), can cause either acute or chronic hepatitis infection that ranges in severity from a mild illness lasting a few weeks to a serious, lifelong illness. A significant number of patients eventually develop cirrhosis or liver cancer. Apart from the extremely rare hepatitis viruses D, E, and so on, this type of hepatitis is the most dangerous and severe.

Last year, official medical institutions in Russia recorded 1.9 million patients with hepatitis C. But according to experts and representatives of patient organizations, there are at least twice as many actual patients with viral hepatitis. Despite the emergence of innovative highly effective drugs, less than 15% of the total number of patients receive treatment.

The thing is that in Russia, the treatment of hepatitis C with the latest antiviral drugs is not fully funded by the state. Until 2013, he was treated with toxic interferon drugs, with a high incidence of severe side effects and a successful outcome of at best 40% of cases. Just a few years ago, pharmaceutical companies began to mass produce drugs like sofosbuvir, daclatasvir, dasabuvir, etc.: these drugs can get rid of the hepatitis C virus within one course (usually lasting up to six months) for more than 90% of patients. New drugs have already been registered in Russia, but their cost is about 900 thousand rubles per course.

A solution was found in the form of Indian, Egyptian and other generics - i.e. unlicensed copies of expensive American drugs. But officially, infectious diseases hospitals do not prescribe cheap versions of life-saving pills. Here everyone gets out as best they can: negotiates with a doctor they know or gets medications through online communities of hepatitis patients and online pharmacies that send medications from abroad. As part of compulsory medical insurance, a person can receive modern treatment for hepatitis C only if at the same time he is registered with the AIDS center as HIV-positive.

The officially undeclared epidemic of viral hepatitis C affects gays and bisexuals one of the first places. For a long time, almost until the beginning of the 2010s, it was believed that the main route of transmission of the virus was intravenous drug use (more precisely, neglect of the precautionary rules for such). The prevalence of drug use and associated risky behavior among MSM is a separate issue. But an increasing number of new infected people acquired the virus through sexual contact. As with hepatitis C, unprotected anal sex, for example, is particularly dangerous in this regard. But impeccable adherence to protective measures does not guarantee that you will not get sick: visiting a dental office or tattoo parlor can also be risky in this sense.

Unfortunately, there is no way to prevent hepatitis C: in other words, a vaccine for this disease has not yet been invented. So you can only rely on your own caution and luck, be sure to regularly do a blood test for hepatitis C - just like for HIV.

Author: Artyom Langenburg