Monthly Archives: June 2014

HCV & Gender

By: Marcus Hopkins, Blogger

In the course of discussing the health risks associated with infectious disease, health care professionals often speak in broad terms – the basic symptoms of the disease; how the disease impacts the human body – but what is not as often discussed is how diseases differently affect members of the opposite sex.

As modern society moves closer to social equality between the sexes, what often gets lost in the pursuit of gender equality is the very real role that biology and human physiology plays in differentiating the sexes in terms of how their bodies react to various diseases and medications.

Gender Differences

There are several ways in which Hepatitis C (HCV) differently affects members of the opposite sex, many of which can play key roles in determining which populations should be more closely monitored over the course of the next decade as we approach treating and hopefully eradicating the burgeoning HCV epidemic.

Cirrhosis (scarring of the liver), for example occurs in 5%-20% of people with chronic HCV, according to the U.S. Centers for Disease Control and Prevention. Women, however, appear to be less susceptible to liver cirrhosis than men. Scientists believe that the female hormone estrogen is responsible for this extra protection, but that protection very likely dissipates as women age and enter into menopause, when estrogen production lessens.

As HEAL Blog is primarily concerned with HIV/HCV co-infection, this presents an excellent opportunity for advocacy to the HIV-positive community, as males represent a majority of the HIV-positive population. As such, reaching out to males who are HIV-positive is of particular importance in helping to ensure that information about HCV is adequately disseminated.

Another phenomenon that favors females is the incidence of “spontaneous clearance” – when the body is able to rid itself of a virus or infection without the aid of medication. Of those who are infected with HCV, an estimated 15% are able to avoid the potential ravages of chronic HCV infection. This clearance rate is higher in women than men, and once again, it is thought that estrogen plays a significant role in this difference.

While these two advantages favor females in how HCV impacts the human body, there are several reasons why women should be no less vigilant than men in aggressively screening and treating HCV.

As we have stated in previous postings, HCV is inefficiently spread through sexual contact. Like HIV, HCV is more efficiently spread through anal penetrative sex than vaginal, because of the greater risk of blood exposure. Women, however, are at greater risk of exposing their sexual partners when they are menstruating due to the presence of menstrual blood.

Additionally, women who gave birth via Cesarean delivery (C-Section) prior to 1992 (when testing for HCV began) and received blood transfusions during the process faced a greater risk of exposure during the process. As such, it is suggested that women who underwent this procedure be screened for HCV infection.

Ribavirin, one of the primary drugs used to treat HCV infection, has a common side effect: Anemia – low red blood cell count. Women are naturally more likely than men to develop Anemia, specifically because, unlike men, they experience menstruation causing a heavy loss of blood in the process. It is recommended that women who are prescribed Ribavirin frequently monitored their blood cell levels, as a result.

As women age, Hormone Replacement Therapy (HRT) is often used to increase the levels of estrogen to counteract the decreased production levels caused by menopause. Estrogen replacement pills, including oral contraception, are generally fine for women with HCV; however, women with significant or severe liver damage should not take these pills, because their livers may not be able to break down these hormones, and should consult with their physicians before beginning any estrogen replacement regimens.

HCV infection is a serious issue for both men and women, alike, but recognizing the differences in how HCV affects the sexes is an important step in addressing the looming crisis that faces our nation.

Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates.

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Behind the Numbers

By: Marcus Hopkins, Blogger

In the eight months that I’ve been writing for HEAL Blog, I have often advocated the position that everyone should be tested for HCV or that testing should be offered to every patient whenever they visit a doctor. On several occasions, after the publication of a piece in which I proposed this scope of testing, I have been challenged by colleagues, healthcare professionals, and former professors on the matter, their arguments being that such broad screening without any known risk factors poses a significant risk of returning “false positives” – tests that mistakenly come back positive for HCV without a patient actually being infected – and also that screening on such a broad level would place too great a strain on already limited resources, both financial and human.

As someone who grew up in the midst of the initial HIV/AIDS outbreak in the 1980s and 90s, I have always operated from a position where I suggest, “Knowing is better than not knowing.” When scientists finally discovered a way to screen for HIV, this theme became common amongst those of us who saw firsthand the devastation wrought at the hands of AIDS. Even today, I always suggest in every guest lecture that everyone get tested for HIV every six months, whether or not there is a “scare” (a broken condom, a poor decision, or a thought out decision). I make no judgments about the circumstances; I simply care that, if there is an ill, there is a will to treat it.

But, every time I am challenged on this stance as it relates to HCV, I am taken aback – not because I believe that my colleagues are incorrect in their assertions, nor out of any sense of ego – it is truly because I have to wonder if, at this stage in our technological and scientific history, “false positives” are really an issue, and also if resources are truly so scare that we cannot offer screening on a broader scale.

In order to allay my own fears that I may be advocating a position that is untenable, I decided to look into how we test for HCV to see if the process was as simple as I assumed it to be. I know it sounds silly to think of this at this late stage in the game, but in all of my lectures and outreach, I only ever really talked about testing for HIV, and the ease with which those tests are administered. Never once did it occur to me that the process could be different for HCV, as they are both blood borne pathogens that produce antibodies that are relatively easy to identify. Much to my relief, I discovered that the processes are, in fact, virtually identical for the two viruses.

For both diseases, OraSure Technologies, Inc. offers a quick testing device called “OraQuick.” While the name is the same for both viruses, the process is slightly different:

For HIV testing, the OraQuick device is an orally administered swab that collects oral fluid (similar to, but slightly different than saliva) collected from the gumline to test for HIV antibodies. Once the sample is collected, results can be returned within twenty minutes, making the process quick and easy. If the result comes back “Reactive,” a secondary confirmatory test is required to check to ensure that the results are accurate. The secondary testing is an RNA test, usually the Western blot test, which requires a blood sample being drawn and sent to a laboratory for screening.

OraQuick HVC Test KitThe FDA approved a similar OraQuick device in February of 2011 for use in testing for HCV. Unlike the HIV device, the OraQuick HCV requires a fingerstick collection method, whereby the patient’s finger is pricked and a blood sample is collected. The sample is then mixed in a buffer, the device is inserted into the buffer, and within 20 to 40 minutes, a result should show up as “Reactive” or “Non-Reactive.” If the test returns a “Reactive” result, once again, a secondary confirmatory test is needed to confirm whether or not a patient tests positive for HCV.

The OraQuick HIV testing device boasts greater than 99% agreement with the Western blot confirmatory test, while the OraQuick HCV boasts 98% accuracy with confirmatory tests. This level of accuracy for testing is something that we in the healthcare profession can rely on for accurate testing, and should provide us with the confidence we need to assure our patients and clients that the tests are reliable enough for widespread testing.

Given the ease and accuracy with which HCV testing can be administered, there really is little reason that screening should not be conducted (or at least offered) on a broader basis. Of course, as each state and institution generally procures contracts for purchasing devices in bulk, the issue of financial resources would have to be hammered out in the negotiation process. That said, I’m not certain that the risk of “false positives” is high enough to warrant any real concerns that testing should be limited to a specific set of risk factors.

Part of why I embarked on this discovery mission was that I wanted to ensure that I was giving timely, accurate, and credible information as an advocate and educator. Whenever I encounter a question about why I advocate a specific position, I like to educate myself in order to provide an answer that can address any concerns that may arise. I always appreciate it when my colleagues provide me with an opportunity to expand my knowledge base, and in this case, I leave the process feeling much more confident that I am advocating for something that is both tenable and sound advice.

Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates.

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