Blood-borne viruses: HIV, HCV & HBV

A blood-borne virus is a virus that is transmitted not only by blood itself, but also by body fluids that contain blood. The most common blood-borne viruses are HCV, hepatitis B virus (HBV) and HIV. Many viruses can remain infectious in blood outside of the body for up to several weeks, in particular inside syringes.

The more common routes of transmission include:

  • sexual intercourse (common for HBV, HIV; inefficient for HCV);
  • sharing injecting equipment;
  • skin puncture by blood-contaminated sharp objects (eg needles, instruments or glass); and
  • childbirth (ie the mother infects the child either before or during birth, or through breast-feeding).

If you have previously injected your drugs, it is possible that you may have become infected with hepatitis C (HCV) or HIV. Around half of all injection drug users have HCV, around 1% have HIV and about 17% have been infected with HBV at some point. Your GP, sexual health clinic, genitourinary medicine (GUM) clinic or drug treatment service will be able to provide testing for infection with blood-borne viruses.

What is HIV?

HIV stands for human immunodeficiency virus. If left untreated, HIV can lead to the disease AIDS (acquired immunodeficiency syndrome). Unlike some other viruses, the human body can’t get rid of HIV completely. So once you have HIV, you have it for life.

HIV attacks the body’s immune system, specifically the CD4 cells (T cells), which help the immune system fight off infections. If left untreated, HIV reduces the number of CD4 cells (T cells) in the body, making the person more likely to get infections or infection-related cancers. Over time, HIV can destroy so many of these cells that the body can’t fight off infections and disease. No vaccine yet exists to protect a person from getting HIV, and there is no cure. However, HIV can be prevented and its transmission curtailed. HIV medications also help prevent HIV transmission and the progression of HIV to AIDS, greatly prolonging lives.

How is HIV spread?

HIV is transmitted by contact with the blood or other body fluids of an infected person. This can occur during unprotected sex or through sharing injecting drug-use equipment. If you share with someone who is HIV-positive, that person’s blood can stay on needles or spread to the drug solution. In which case, you can inject HIV directly into your body.

Around 1% of injecting drug users in the UK has HIV.

HIV-infected blood can also get into drug solutions by:

  • Using blood-contaminated syringes to prepare drugs
  • Reusing water
  • Reusing bottle caps, spoons, or other containers to dissolve drugs into water and to heat drugs solutions
  • Reusing small pieces of cotton or cigarette filters (“cottons”) to filter out particles that could block the needle

In addition, untreated infected women can pass HIV to their infants during pregnancy, delivery, and breastfeeding.

Exposed to HIV?

If you think that you have been exposed to the HIV virus within the last 3 days (72 hours) an anti-HIV medication, called post-exposure prophylaxis (PEP), may stop you becoming infected. PEP must be started within 72 hours of coming into contact with the virus.

Testing

The only way to know for sure if you have HIV is to get tested. Testing is widely available and free on the NHS. You can ask your health care provider for an HIV test. Many medical clinics, substance abuse programs, community health centers, and hospitals offer them too. You can also buy a home testing kit at a pharmacy or online.

The earlier that HIV is detected, the more likely it is that treatment will be successful, so if you think that you may be at risk you may wish to get tested. If you do test positive, the virus can be monitored over time. Treatment normally starts once tests show that the immune system has started to weaken.

Treatment

HIV is treated using a combination of medicines to slow down the spread of the virus in the body. This is called antiretroviral therapy (ART). ART isn’t a cure, but it can control the virus so that you can live a longer, healthier life and reduce the risk of transmitting HIV to others.

HIV can quickly adapt and become resistant to one single ARV, so patients tend to take a combination of HIV medicines (called an HIV regimen). These need to be taken every day and exactly as prescribed.

Treatment prevents HIV from progressing to AIDS. This means that if you have the virus you can live a long and healthy life; seeking treatment early will give you the best chance possible.

It is important for you to understand that regardless of whether you are ready to tackle your heroin/opioid dependence, you can still be treated for HIV to stay healthy. However, continuing to take drugs without support, as well as excessive drinking, may weaken your immune system and affect your ability to commit to HIV treatment, reducing its effectiveness.

Multiple infections

If you have a co-occurring illness, such as hepatitis, the immune system may start to weaken earlier than in someone who has HIV alone. Approximately one-third of HIV-positive people are also infected with HCV and so might want to think about being screened for HCV upon receiving a positive HIV diagnosis. If you have HCV, a doctor will decide whether it is appropriate to treat this infection first or together with HIV. While interactions between HCV and HIV medications are common, they can easily be managed by your doctor with dose adjustments.

What is hepatitis C (HCV)?

Hepatitis is a broad term referring to inflammation of the liver. You can get HCV in the same way you get HIV—through unprotected sexual contact and injection drug use. It’s estimated around 215,000 people in the UK have hepatitis C.

HCV infection sometimes results in an acute illness, but most often becomes a chronic condition that can lead to cirrhosis of the liver and liver cancer. Treatments have been continually improving and the latest treatments can cure HCV in as little as 12 weeks with minimal side effects. HCV infection is more serious in people living with HIV because it leads to liver damage more quickly.

How do you get hepatitis C (HCV)?

The hepatitis C virus is usually spread through blood-to-blood contact.

Some ways the infection can be spread include:

  • sharing contaminated injecting equipment – particularly syringes, needles, spoon, filters, water, tourniquets etc used to inject recreational drugs
  • sharing razors or toothbrushes
  • from a pregnant woman to her unborn baby
  • through unprotected sex – although this is very rare
  • tattoos
  • medical procedures abroad
  • blood transfusions prior to September 1991

In the UK, most hepatitis C infections occur in people who inject drugs or have injected them in the past. It’s estimated around half of those who inject drugs have the infection.

Symptoms of hepatitis C

Hepatitis C often doesn’t have any noticeable symptoms until the liver has been significantly damaged. This means many people have the infection without realising it.

When symptoms do occur, they can be mistaken for another condition. Symptoms can be mild to severe and can include:

  • Low mood, depression and irritability
  • Headaches
  • Disrupted sleep
  • Memory loss and difficulty concentrating ‘brain fog’
  • Night sweats and chills
  • Muscular pain and achy joints
  • Loss of appetite, nausea and weight loss
  • Pain in the abdominal and liver area
  • Dry and itchy skin

The only way to know for certain if these symptoms are caused by hepatitis C is to get tested.

Get tested

To find out if you are infected with HIV or HCV, ask your doctor or other healthcare provider to test your blood. There is no reason why you can’t be treated for this as well as your drug dependency. If untreated both HIV and HCV can have serious consequences.

There are two types of test for HCV, an antibody test, which tells you whether you have ever been exposed to the virus, and an RNA or PCR test, which tells you whether you currently have the virus. It’s important that you know the difference because having a positive antibody test does not necessarily mean you are currently infected.

There is around a 60–90% chance of curing the viral infection with medical treatment. Therapy is improving all the time, with newer medications having fewer side effects and reduced therapy times.

Treatment

There is currently no vaccination for HCV, so if you inject drugs, practising safer injecting is the best way to avoid catching and spreading the disease. If you have HCV, there is no need to panic about passing the virus on to loved ones or children as long as you take precautions to avoid blood-to-blood contact. If you are pregnant there is a small risk (3–6%) of passing the virus on to your child during childbirth.

Current hepatitis C treatments are made up of combinations of drugs called direct-acting antivirals (DAAs). DAAs directly target the hep C virus in different ways to stop it from making copies of itself and do this so well that they promise a much brighter future for people living with hepatitis C. DAAs promise treatments with shorter treatment times, much higher cure rates, and fewer side effects.

Using the latest medications, over 95% or more of people with hepatitis C may be cured.

However, it’s important to be aware that you won’t be immune to the infection and should take steps to reduce your risk of becoming infected again.

Ways to reduce your risk of becoming infected.

These include:

  • not sharing any drug-injecting equipment with other people – including needles and other equipment such as syringes, spoons and filters
  • not sharing razors or toothbrushes that might be contaminated with blood

The risk of getting hepatitis C through sex is very low. However, it may be higher if blood is present, such as menstrual blood or from minor bleeding during anal sex.

Condoms aren’t usually necessary to prevent hepatitis C for long-term heterosexual couples, but it’s a good idea to use them when having anal sex or sex with a new partner.

What is hepatitis A/B?

Hepatitis A and B (HAV and HBV) are common causes of liver inflammation. HAV is rarely life threatening; however, HBV, like HCV, can cause cirrhosis of the liver and liver cancer. HBV is transmitted through blood-to-blood contact and around 17% of injecting drug users in the UK have been infected with HBV at some point.

How is hepatitis A/B transmitted?

Hepatitis A is mainly transmitted through the fecal-oral route, for example by unclean hands that have been used to prepare drugs for smoking.

Hepatitis B is spread by blood and body fluids. The main routes of transmission are through sexual contact, sharing needles, tattooing and body piercing, and childbirth (when the baby is likely to pick up the virus from the mother through the birth canal). Hepatitis B has an additional complication – some infected people become lifelong carriers, whether they have symptoms or not. Many infected people are asymptomatic (without symptoms) but can pass on the virus.

Treatment

There are vaccines against both hepatitis A and B. They provide about 90% protection that can last from 10 to 20 years. Anyone who is at risk of getting these viruses should be vaccinated. Contact your GP, sexual health clinic or GUM clinic.