Hep C: Have men who have sex with men (MSM) reached a turning point?

2nd May 2018

Last year, 9940 people living with Hep C were treated with the new direct acting antiviral medications in the UK. Treatments typically last 12 weeks and are close to 100 percent effective. Many of those treated were gay men living in London.

In London and across the UK waiting lists are down. In most places there are no longer waiting lists at all. Those diagnosed with Hep C can now expect to start treatment shortly after diagnosis. The goal of health professionals, charities and campaigners is that patients will soon be able to start treatment on the day they are diagnosed.

The treatment situation around Hep C has changed dramatically over the last few years. I was treated for my Hep C between December 2016 and March 2017, having lived with the virus since 2010. I had a rollercoaster journey, as new medications became available in a constantly changing treatment landscape.

At first the NHS refused to give me the new drugs, treating only those with advanced liver damage (fibrosis or cirrhosis). In December 2016, my specialist explained that policy had changed and there were treatment slots available. I had three gay friends who were also co-infected with HIV and Hep C, all living in London. One commenced treatment at the same time as me, another in the summer of 2017 and a third in October 2017. All responded positively to the new medications, clearing the virus. I do not know anyone who is still on a waiting list in London.

As men who have sex with men (MSM) are treated for their Hep C, a treatment as prevention approach becomes possible. Once a patient has cleared their Hep C, they cannot pass it on. MSM are one of the most active groups in terms of STI testing. The NHS recommends that MSM get tested at least once a year and every three months if having sex with new or casual partners.

Hep C diagnoses in MSM are often picked up early. Informally, one London HIV specialist told me that he was already seeing the impact of the Hep C treatment backlog falling. As the number of MSM living with the virus in London drops, he is encountering fewer new Hep C diagnoses. This trend is very much in its nascent stages though.

Amongst MSM and beyond, there still remains a lack of awareness around Hep C. And much stigma. Most gay men who are Hep C positive are also HIV positive, although there are a few HIV negative gay men who are diagnosed with Hep C. The viruses share a number of transmission routes. Within the gay community, I found the stigma of Hep C to be worse of that of HIV. Now that Hep C is easier to treat, perhaps some of the stigma will subside.

It is worth being aware that when you request an HIV test at an STI clinic, not all clinics will automatically screen for Hep C. Similarly, on-the-spot HIV testing is great, but MSM should get screened for other STIs as well. There are a number of ways in which you can get tested for Hep C.

At the STI clinic, for most people, remains the easiest option. On-the-spot Hep C testing is only available in limited locations. This is called dry blood spot testing. A pinprick of blood is taken and then blotted onto a piece of paper. This will not be as familiar to MSM as the on-the-spot tests for HIV. It would be helpful to co-locate on-the-spot testing facilities, such as mobile testing vans and street testing teams, for HIV and Hep C.

For MSM the most important campaigning point around Hep C is ensuring that the new medications are made available to those who are reinfected with the virus, in line with a treatment as prevention approach. At the moment the NHS is refusing to treat people a second time.

Data collected between 2004 and 2012 by the Chelsea and Westminster Hospital found that just under 25 % of MSM who cleared Hep C were subsequently reinfected. Several individuals in this group cleared the virus twice and were reinfected a third time.

Similarly, a 2016 study covering Western Europe found that around 25 % of MSM who cleared the virus were reinfected. The NHS must change its policy, so that the provision for re-treatment is made regardless of the level of liver damage or re-infection route.

No one should have to live with the health consequences or stigma of Hep C, as the virus is now 100 % curable. No one should be denied treatment because of cost. And no one should be denied treatment because people have made assumptions about their lifestyle.