There is currently some uncertainty about the exact

There is currently some uncertainty about the exact mode of hepatitis C transmission in HIV-positive gay men. However, the following risk-reduction recommendations are made:

1. Advice should include discussions of hepatitis C transmission and fisting, recreational drug use, group sex, use of sex toys, unprotected sex, traumatic sex, sharing injecting equipment, and risks from blood-to-blood contact.

2. Information about hepatitis C risk reduction should be given to all HIV-positive individuals after their diagnosis and then at regular intervals. Patients with newly diagnosed hepatitis C should also be counselled about risk reduction.

A proportion of individuals naturally clear hepatitis C infection without the need for treatment. The consensus recommendations made the following observations about the natural history of the infection:

1. HIV-positive patients are at greater risk of developing chronic hepatitis C infection.

2. Studies suggest that between 0% and 40% of HIV-positive patients spontaneously clear hepatitis C during the acute phase.

3. Factors associated with spontaneous clearance include female sex; sexual transmission; infection with hepatitis B; jaundice; and higher peak ALT levels.

4. An early decline in hepatitis C viral load, four to eight weeks after infection is also associated with spontaneous clearance.

Good response rates to hepatitis C therapy have been seen in HIV-positive patients who start such treatment within a year of contracting the virus. Therefore recommendations are offered regarding the monitoring of the infection and test results that should act as a prompt to initiate treatment.

1. Hepatitis C viral load should be measured when a patient is first diagnosed and then four weeks later.

2. Treatment should be offered if viral load has not fallen by 2 log₁₀ copies/ml at the four week monitoring interval, or if a patient still has a detectable hepatitis viral load twelve weeks after acute infection was diagnosed.