Are you HIV-positive? Are you living with hepatitis C? Or maybe you’re unsure of your HIV or hepatitis C status and are looking for information about testing and preventing infection?
Whatever brings you here, we want to make sure you find the information and the tools you need to be as healthy as you can.
You can find more information about our programs and services, including individual case management, counseling, and peer support here.
Below you’ll find information on HIV and hepatitis C, including risk, prevention, testing, and treatment options to help you live life on your terms.
For over 30 years, AIDS Action has been a leader in HIV prevention. We educate people about HIV, working directly with those most at risk to make sure they have the tools to avoid infection. We also work with people who are HIV-positive to make sure they know their HIV status, get connected to care, and understand how they can keep from passing the virus onto others.
In recent years, our work has expanded to include STI and hepatitis C prevention, as well. Sexually transmitted diseases like herpes and syphilis can increase a person’s risk of contracting HIV, and certain activities, like injection drug use, can put people at risk for hepatitis C and HIV.
To help you avoid infection, AIDS Action can work with you to:
- Educate yourself, your friends, and your community about HIV, STDs, and hepatitis C
- Access condoms, clean needles, and other prevention tools
- Understand testing options and find places to get tested that work for you
- Connect with people who understand what you’re going through and can give you support
Looking for basic information about HIV/AIDS? We’ve got answers to the most commonly asked questions. Our answers are based in scientific research, so you can trust what you read here.
HIV stands for “human immunodeficiency virus.” HIV was given this name because it infects humans and, over time, causes a deficiency (weakness) in the body’s immune system. The immune system helps us stay healthy by fighting germs and destroying abnormal cells that cause illness.
The term AIDS stands for “acquired immune deficiency syndrome” or “acquired immunodeficiency syndrome.” AIDS is “acquired” in the sense that people develop it as the result of an infection, specifically with HIV. The word “syndrome” refers to a group of health problems that make up a disease. In the case of AIDS, these health problems are a result of HIV-related weakening of important parts of the immune system.
You can see from these descriptions that, while HIV and AIDS are related, they are not the same thing. HIV is a virus, and AIDS is a condition caused by infection with HIV.
The immune system is the body’s protection against bacteria, viruses, and other disease-causing germs. When a person becomes infected with HIV, the virus damages and kills different types of cells, including CD4 T-cells—often called “T-cells” or “CD4s” for short. The body’s immune system needs to have both enough CD4 cells and the right balance of CD4s and other cells to fight germs and abnormal cells effectively.
In most cases, if a person’s HIV infection is not treated, then both the number of CD4 cells (their “CD4 T-cell count”) and the proportion of CD4 cells in their blood (their “CD4 percentage” or “CD4%”) will gradually drop. Without treatment, the CD4 count and CD4% will often, over a period of years, reach dangerously low levels.
If people do not get any treatment for HIV, it takes an average of about 8 to 10 years to progress from first being infected with the virus to having an AIDS diagnosis. An HIV-infected person is given an AIDS diagnosis if any one of the following three things happens:
- Their CD4 count falls below 200—a level at which, generally speaking, a person’s immune deficiency makes them highly vulnerable to some serious illnesses.
- Their CD4% falls below 14%; such a low CD4% is another indication of poor immune function.
- They develop certain serious infections or cancers that have been confirmed by tests; the U.S. Centers for Disease Control and Prevention (CDC) has published a list of more than two dozen conditions that are considered “AIDS-defining.” In other words, if a person is infected with HIV and they develop one of these conditions, they are automatically given an AIDS diagnosis.
AIDS-defining conditions include many so-called opportunistic illnesses. Opportunistic illnesses, sometimes called “OIs” for short, are a group of infections and cancers that are uncommon in people with a healthy immune system. In some cases, these illnesses are caused by germs that our bodies are exposed to on a regular basis and that the immune system can usually fight off without difficulty.
However, these germs can take advantage of a weakened immune system to cause illness. In other words, you can think of opportunistic illnesses as germs or abnormal cells that “take the opportunity” to cause trouble when the immune system is weakened.
HIV is transmitted through four body fluids: blood, semen (and precum), vaginal fluids, and breast milk.
In order to pass HIV from one person to another, HIV-infected fluid from one person needs to get into the bloodstream of another person. Activities like sharing needles or having unprotected anal or vaginal sex are the most common ways to transmit HIV from one person to another. Using clean needles and condoms during anal and vaginal sex are VERY effective ways to prevent transmission. Recent studies have shown that other approaches can also keep people from becoming infected with the virus. Pre-exposure prophylaxis (PrEP) refers to any form of treatment that can be taken before exposure to a disease in an attempt to prevent infection. Currently, in PrEP for HIV infection, a person who is at risk for HIV infection takes a daily dose of the antiretroviral combination pill Truvada to greatly reduce their risk of becoming infected with the virus.
HIV can be passed from mother to infant before or during delivery or while breastfeeding. However, good medical care before, during, and after birth can prevent nearly all mother-to-child HIV infections.
While there is still no cure or vaccine for HIV, there are highly effective treatment options if someone is infected with HIV. These treatments are medically safe and have allowed many people living with HIV to lead longer and healthier lives.
Because HIV is a type of germ called a retrovirus, the drugs used to treat HIV are often called “antiretrovirals” or “ARVs.” These drugs work by interfering with—inhibiting—different steps in HIV’s life cycle; that is, the way HIV infects cells and then uses cells to make more HIV viruses. Most HIV-infected persons need to take three or more ARVs to gain lasting control of their HIV infection. The approach of using a combination of ARVs to treat HIV infection is often called antiretroviral therapy (ART) or combination therapy. Although ARVs may be taken one at a time, it is common for two or more ARVs to be combined in a single pill for convenience.
ARVs are often grouped into different drug classes, based mostly on the ways the drugs disrupt HIV’s life cycle and the chemicals they are made of. The main ARV drug classes are:
- Entry inhibitors (sometimes further divided into attachment inhibitors and fusion inhibitors);
- Nucleoside or nucleotide reverse transcriptase inhibitors (often called “nukes” for short);
- Non-nucleoside reverse transcriptase inhibitors (often called “non-nukes” for short);
- Integrase inhibitors; and
- Protease Inhibitors (PIs)
There are many ways to protect yourself from contracting HIV and from spreading the virus on to others. Here are some common questions about HIV prevention:
Becoming educated about HIV and understanding how it is transmitted is the first and perhaps most important way to prevent the spread of HIV. It is essential for people to make informed decisions about the level of risk they are willing to take, based on what is realistic for them.
Abstaining from sex and not sharing needles are the most effective ways for people to protect themselves from HIV and other sexually transmitted infections (STIs). However, abstinence is not a realistic option for everyone.
When abstinence is not an option, the proper use of barrier protection, such as latex or polyurethane condom (external or internal, also known as “male” or “female”) with a water based lubricant, can be the next best thing for preventing HIV transmission during vaginal or anal sex. Barrier methods can also provide protection from some other STIs. For more information on barrier methods, see the section below, “How Do I Use External and Internal Condoms?”
PrEP: Taking HIV Drugs to Prevent Infection
Pre-exposure prophylaxis—often called PrEP for short—refers to any form of treatment that can be taken before exposure to a disease-causing germ in order to prevent infection. For persons who want to avoid being infected with HIV, PrEP involves taking antiretroviral drugs (ARVs) consistently.
The ARVs that have undergone the most testing for PrEP treatment are tenofovir and emtricitabine, taken in a once-a-day combination pill called Truvada. Several studies have shown that, when taken as directed, Truvada is very effective in preventing HIV transmission and usually has few, if any, major side effects.
It is important to note, however, that taking Truvada prevents only HIV infection. It does not protect a person from other STIs or blood-borne infections.
HIV Treatment as Prevention
Large studies have also shown that when an HIV-infected person is being treated effectively for HIV, their chance of transmitting HIV to an uninfected partner is dramatically reduced. This is sometimes called “HIV treatment as prevention.”
To keep their risk of HIV transmission to a minimum, it is important that HIV-infected persons take their medications consistently as directed and maintain a very low (“undetectable”) viral load. As with PrEP, described above, HIV treatment as prevention prevents only HIV infection. It does not stop transmission of other STIs or blood-borne infections.
The best way to reduce the risk of becoming infected with HIV while performing oral sex is to maintain good oral hygiene. That, in addition to not flossing or brushing your teeth right before or after performing oral sex, will also reduce the risk of transmission.
Performing Oral Sex on a Woman (“Go Down”, “Eat Pussy”)
When performing oral sex on a woman, a dental dam or common kitchen plastic wrap can be used as a barrier to protect from HIV transmission. It covers the area you are performing oral sex on (vagina or anus). If you do not have a dental dam, you can also use a new, unused, non-lubricated or flavored condom by stretching it out and cutting it down the side, then stretching it out in the same way you would a dental dam or plastic wrap.
Performing Oral Sex on a Man (“Blowjob”, “Giving Head”)
In addition to good oral hygiene, proper use of a non-lubricated or flavored condom on a man can significantly decrease risk of HIV transmission. If a condom is not available or an option, not accepting semen into the mouth or spitting rather than swallowing will reduce the risk. You can also use the “harmonica method” by focusing on the shaft of the penis while avoiding the head.
Performing Oral Sex on the Anus (“Rimming”, “Eating Ass”)
For oral to anal contact, or rimming, a dental dam, plastic wrap, or a condom can be used in the same way described above under the heading “Performing Oral Sex on a Woman.” This can be a great barrier against not only HIV, but possible hepatitis A exposure.
Receiving Oral Sex
Since HIV is not transmitted by saliva, there is generally no risk in receiving oral sex unless there is a lot of blood in the mouth of the person performing oral sex.
Most external (also known as male) condoms are made of latex. For people who are allergic to latex, polyurethane condoms can be used instead. If you’ve ever experienced irritation from latex, ask your doctor to test you for a latex allergy. When used properly, both latex and polyurethane condoms are effective ways of significantly reducing the risk of HIV transmission.
When using either latex or polyurethane condoms for vaginal or anal sex, water-based lubricants on the outside of the condom will help to reduce friction that could cause the condom to tear. If desired, a small amount can be placed inside the tip of the condom as well.
Important Notes: The use of oil-based lubricants such as Vaseline can deteriorate latex condoms and significantly increase their chance of breaking. Oil-based lubricants should only be used with polyurethane condoms. It is also worth noting that Lambskin (a.k.a. “natural”) condoms will not protect against HIV or STIs.
When Using an External Condom:
Keep it fresh! Always store condoms in a cool dry place (not a wallet) and check the expiration date.
- Check it! Squeeze the package gently to make sure there are no punctures and be sure not to use your teeth to open the package. Your teeth could rip the condom!
- Heads Up! Unroll the condom a little before putting it on and make sure it’s able to roll easily down the penis. Squeeze the tip (so semen can collect) and roll the condom from the tip of the penis all the way to the base. If uncircumcised, pull the foreskin back before putting the condom on.
- Don’t Double Up! Be sure to never use more than one condom at a time. Doubling up can lead to friction and possibly the condom breaking. One condom is sufficient.
- Lube it Up! Apply lots of water based lubricant to the condom to prevent friction which could cause breakage.
- Take It Easy! After ejaculation (cumming), remove the penis from the vagina, anus, or mouth while still erect and carefully unroll and remove the condom. Be careful to not spill any semen on your partner.
Never use a condom more than once. Always use a new condom each time you have sex, or when you switch from oral to vaginal or anal sex. This will reduce the risk of the condom breaking.
Using an Internal or Reality Condom (Also Known as a Female Condom)
Although it is sometimes referred to as the female condom, the Reality condom can be used by both men and women. When using the internal condom, make sure to put it into place before your partner’s penis comes into contact with the vagina or anus. Once in place, carefully guide the penis into the condom, making sure to enter the condom and not outside of the condom’s external rim.
For Vaginal Sex:
- Press the inner ring between your fingers to narrow it and make it easier to insert.
- Hold the condom with its open end pointing down, and insert the closed end into the vagina, letting the wider end remain around the opening of the vagina (it’s easier to insert if the knees are spread apart). You can also place the internal condom on an erect penis or dildo to insert it.
- Push the condom up into the vagina, until it is just past the pubic bone (you can tell where the pubic bone is by curving the index finger when it has gone a couple inches into the vagina).
- When removing the internal condom, squeeze the end, twist the condom to keep the semen inside, and pull out. DO NOT FLUSH.
For Anal Sex:
- Remove the internal ring and place the condom on the partner’s erect penis or a dildo.
- Use the penis or dildo to carefully insert the condom into the anus of the receptive partner.
- To remove, squeeze the end of the condom, twist to hold the semen inside, and remove.
While certain sexual activities, such as mutual masturbation, barrier-protected oral sex, and oral to anal contact (rimming, fingering) have little or no risk of HIV transmission, some of these activities may have the potential for transmitting other STIs. While HIV is transmitted only by blood, semen, vaginal fluid, and breast milk, other STIs can be transmitted by simple genital skin-to-skin contact or oral sex.
Since HIV and hepatitis C are blood-borne viruses (viruses that exist in and are transported via the bloodstream), any direct blood-to-blood contact is a risk for HIV and hepatitis C transmission.
Sharing needles or works (cotton, cookers, water, and so forth) presents a significant risk for transmitting these blood-borne viruses. Whenever possible, it is best for each person to use their own needles and works.
Needle exchange sites have been set up to trade in used needles and get new ones. There are five state-funded Needle Exchange Sites in the following Massachusetts cities and towns: Boston, Cambridge, Holyoke, Northampton, and Provincetown.
If you are not near a Needle Exchange site, or cannot get to one, there is another way to get clean syringes. The Massachusetts Pharmacy Access Bill allows individuals 18 and older to purchase needles at a pharmacy without a doctor’s prescription.
Proper disposal of used needles is important as well. Used needles should not be disposed of in the garbage since this creates a risk for anyone handling the trash who may get stuck by an infected needle. Sharps containers are heavy-duty containers used for disposal of needles, and can be acquired through some pharmacies. If a sharps container is not available, an empty plastic liquid detergent or bleach bottle can be used as well. These should then be turned into a designated needle disposal site.
The only way to completely avoid potential transmission of blood-borne illnesses when injecting drugs is by not sharing needles. If people do share needles, cleaning the needles and works properly with bleach and water before and after each person uses them will help reduce the risk.
How Do I Clean My Used Needles?
The most effective way to sterilize used syringes is the 3x3x3 method:
- Fill your syringe with water, shake it, and push out the water. Do it three times.
- Fill your syringe with bleach, shake it, and push out the bleach. Do it three times.
- Fill your syringe again with clean water, shake it, and push out the water. Do it three times.
If bleach isn’t available, you can use soap and clean water, or even just water to clean your works. ANY steps you take to clean syringes before use will reduce your risk of HIV and hepatitis C transmission.
Where can I get clean needles/syringes?
Prior to September 2006 the only way to acquire clean needles in Massachusetts was via a prescription or through a needle exchange programs. As a result of the Pharmacy Access Bill, it is now legal for pharmacies to sell medical syringes over the counter without a prescription. Anyone 18 or older (with proof of age) can purchase clean needles at many pharmacies in Massachusetts. They are relatively inexpensive. Although pharmacies are allowed to sell syringes, they are not required to do so. A phone call to the pharmacy in advance can save a trip to the drug store.
Here are some common questions and answers about HIV testing. AIDS Action delivers HIV testing and counseling services within our targeted prevention programs.
Testing is the only way to know your status when it comes to HIV. Many people who are infected with HIV don’t have symptoms. While testing may sound and feel scary—so does not knowing! These days, it’s pretty simple to get an HIV test at your doctor’s office or at a specialized HIV counseling and testing location. If you don’t know where to go for a test you can find updated testing sites at hivtest.cdc.gov.
When HIV enters the body, the immune system responds by producing antibodies—substances that recognize germs (such as viruses or bacteria) or cancer cells and mobilize the body to fight them. HIV antibody tests are designed to detect HIV antibodies rather than the HIV virus itself. In contrast, HIV antigen tests detect parts of the virus that trigger the body to produce antibodies. Polymerase chain reaction tests, typically called PCR tests for short, detect the genetic material of HIV itself.
The most common HIV tests detect HIV infection in a sample of blood. Some tests can also detect HIV in urine, fluid from the mouth, or a scraping from inside the cheek. Although it takes a few days to get the results of some HIV tests, rapid HIV tests can give results within an hour—sometimes as little as 10 to 20 minutes.
A positive (reactive) test result means that the test has found some evidence of HIV infection—HIV antibodies, antigens, or viral genetic material, depending on the type of test. A negative (nonreactive) test result means that no evidence of HIV infection has been found.
Occasionally, a person will get an indeterminate or inconclusive test result, which means that the test result is unclear. When a person gets an indeterminate result, the test should be repeated. If the second test also has an indeterminate result, than other types of tests may be performed to provide a clearer result.
Any positive HIV test result must be followed up by another test—called a confirmatory test—to confirm the positive result. It can take a few days to a few weeks to get the results of a confirmatory test.
Before considering different HIV tests in more detail, it is useful to define several important testing terms.
The window period of an HIV test is the amount of time from when a person is first infected with the virus to the appearance of detectable evidence of their HIV infection, such as HIV antibodies, antigens, or viral genetic material. Most people develop detectable HIV antibodies within 9 to 14 days after becoming infected. According to CDC, 97% of persons develop antibodies in the first 3 months after becoming infected with HIV, although in very rare cases, it may take up to 6 months to develop HIV antibodies.
The sensitivity of an HIV test refers to the test’s ability to detect what it is looking for, such as HIV antibodies. For example, a highly sensitive HIV antibody test will nearly always detect HIV antibodies if they are present. Such a test will have very few false-negative results.
The specificity of an HIV test refers to the test’s ability to eliminate findings that are similar to, but not, what it is looking for. For example, a highly specific HIV antibody test does a very good job distinguishing HIV antibodies from other substances that are somewhat similar to HIV antibodies. Such a test will have very few false-positive results.
The accuracy of an HIV test reflects both the test’s sensitivity and specificity. For example, a highly accurate HIV antibody test is one that has both high sensitivity and specificity in detecting HIV antibodies. Such a test will have very few false-positive and very few false-negative results.
As mentioned earlier, there are a number of different types of HIV tests. These include:
4th Generation HIV EIA Test
The 4th generation test can detect p24 antigen (an HIV protein), HIV-1 antibodies, and HIV-2 antibodies, but it cannot tell them apart. A positive result on the 4th generation test is followed up with a Multispot confirmatory test to detect whether antibodies to HIV-1 or HIV-2 are present. If no antibodies are detected, the NAAT test is used to detect HIV RNA. (You can read more about these tests below.) The 4th generation test has a window period of 2 weeks, compared to 2 to 8 weeks for a standard or rapid HIV antibody test. Testing sites in Massachusetts commonly use the 4th generation test because of its shorter window period.
A rapid HIV antibody test provides results within an hour, and sometimes substantially less. This test is done by a trained counselor through a finger prick or, in some places, an oral swab.
In the OraSure test, a swab is rubbed between the cheek and lower gum to collect a small sample of the tissue lining the inside of the mouth, which is then sent out for testing. It is recommended that people taking the OraSure test not eat, drink, or smoke within 20 minutes before the test is administered. At the lab, an EIA (and, if necessary, a confirmatory test) is performed on the sample to detect HIV antibodies. Results are typically available in 5 to 10 business days.
The U.S. Food and Drug Administration (FDA) has approved two home HIV antibody tests: the Home Access HIV-1 Test System and the OraQuick In-Home HIV Test. In the Home Access test, a person extracts a few drops of blood through a finger prick and collects the drops on a special card that is mailed in for testing. The OraQuick home test is designed to detect HIV in a sample of oral fluid. It can provide results in 20 minutes. A positive test result on these home HIV tests should be followed up with a confirmatory test.
Standard (Conventional) HIV Antibody Test
This is also often called ELISA (short for “enzyme-linked immunosorbant assay”) or EIA (short for “enzyme immunoassay”). In the standard HIV antibody test, a blood sample is drawn and then sent to a laboratory for testing. Results are usually available in 2 to 10 business days.
Western Blot Test
This antibody test may be used to confirm HIV infection in persons who have a positive result on an EIA. The Western blot can rule out false-positive results by distinguishing HIV antibodies from other antibodies that may react to the EIA. Results of Western blot tests are usually available in a few days to a few weeks. Antibody tests using an EIA, followed up with a Western blot, as needed, have about a 99.5% accuracy.
This antibody test may also be used to confirm HIV infection in persons who have a positive result on an EIA. It is more sensitive, more specific, faster, and less expensive than the Western blot. It can also distinguish between the two types of HIV—HIV-1 and HIV-2.
p24 Antigen Test
This test detects an HIV protein called p24. The p24 antigen can be detected 2 weeks after a person is infected.
Nucleic Acid Amplification Test (NAAT)
This is a highly sensitive PCR test that can detect HIV RNA—the virus’s genetic material. The NAAT test can detect the virus during acute HIV infection.
Other Types of HIV Tests
It is worth noting that some other types of HIV tests—viral load tests and resistance tests—are also available, but they are not used for diagnosing HIV infection. These tests are used instead for monitoring HIV disease and guiding HIV treatment decisions in persons who are already known to be infected with the virus.
According to the U.S. Preventive Services Task Force (USPSTF) 2013 HIV screening recommendations, healthcare providers should offer routine HIV screening to all adolescents and adults between 15 and 65 years old. The USPSTF also recommends HIV screening for all pregnant women, including women in labor who do not know their HIV status, as well as for teens younger than age 15 and adults older than 65 who are at increased risk for HIV infection.
Persons that the USPSTF considers to be at increased risk for HIV infection include: men who have sex with men (MSM); active injection drug users; persons who engage in unprotected vaginal or anal intercourse; persons with sexual partners who are HIV-infected, bisexual, or injection drug users; and persons who exchange sex for drugs or money.
Other persons considered at high risk include those who have acquired other sexually transmitted infections (STIs) or have requested testing for STIs. In addition, persons under age 15 or older than 65 with new sexual partners may also be considered to be at increased risk for infection and candidates for HIV screening.
The Massachusetts Department of Public Health also strongly endorses routine HIV screening in primary and urgent care “due to the significant individual and public health benefits associated with knowledge of HIV status and prompt linkage to medical care and preventive services.”
Routine HIV Screening
If a person is a candidate for routine HIV screening (see section above) and has had no potential exposure to HIV—such as through unprotected sex or needle-sharing—within the previous 8 weeks, then they can undergo testing without waiting.
HIV Testing Following a Recent Potential Exposure to HIV
If a person is being tested following a recent potential exposure to HIV, then they should typically wait until the window period for their particular HIV test has elapsed before undergoing testing. As described earlier, the window period is the time after a person is infected when there may not yet be enough evidence—such as HIV antibodies, antigens, or viral genetic material—for the test to produce an accurate result. So if for example, a person wanted to use a home antibody test, they would wait at least 8 weeks after their most recent potential HIV exposure to take the test, because it takes up to 8 weeks for most people to develop detectable HIV antibodies.
Repeat HIV Testing
In its 2013 HIV screening recommendations, the USPSTF notes there is not yet enough evidence to determine the best frequency for repeated HIV testing among persons who may have a higher-than-usual risk of HIV infection. In the meantime, “One reasonable approach would be one-time screening of adolescent and adult patients to identify persons who are already HIV-positive, with repeated screening of those who are known to be at risk for HIV infection, those who are actively engaged in risky behaviors, and those who live or receive medical care in a high-prevalence setting.” According to the Centers for Disease Control and Prevention (CDC), a high-prevalence setting is a geographic location or community in which at least 1% of the population is infected with HIV. These settings include STI clinics, correctional facilities, homeless shelters, tuberculosis clinics, clinics serving gay, bisexual, and other men who have sex with men (MSM), and adolescent health clinics with a high prevalence of STIs.
The word hepatitis essentially means inflammation of the liver. Viruses, alcohol, drugs, and various chemicals can cause hepatitis.
Hepatitis C is a blood-borne virus that causes damage to the liver.
Although hepatitis A, B, and C are all viruses that damage the liver, they differ in some important ways.
The hepatitis A virus (HAV) is spread through ingesting fecal matter (such as, through changing diapers and not washing hands, performing oral to anal sex, or eating contaminated food or drinking contaminated water). HAV causes an acute infection that can make people very sick within weeks after contracting the infection. Once people clear the virus, they cannot be reinfected. There is a vaccine to prevent HAV infection.
The hepatitis B virus (HBV) is spread through blood and other body fluids, including semen, vaginal fluids, and saliva. The virus is extremely easy to spread through sharing needles and also quite infectious through anal and vaginal sex. It can also be passed from mother to child. About one-third to half of HBV-infected adults develop symptoms of acute illness, and about 6% to 10% go on to develop chronic disease. Although the rates of acute illness from HBV infection are substantially lower among infants and young children, they have a much greater chance of developing chronic disease than older children or adults. There is a vaccine to prevent HBV infection.
The hepatitis C virus (HCV) is spread through blood. It is spread mainly through sharing needles and, before 1992, it was spread frequently through blood transfusions or other blood products. HCV is not often spread through sex, unless blood is involved. Although HCV can lead to cirrhosis and liver cancer in some people, in most cases it does not. There is no HCV vaccine.
In most cases, people infected with HCV experience no symptoms. Since HCV infection typically progresses slowly, no symptoms may occur for 20 years or more. The symptoms of hepatitis C include fatigue, nausea, vomiting, abdominal pain, joint pain, and jaundice (a yellowing of the eyes, skin, and mucous membranes).
Doctors and scientists recognized a type of hepatitis in the early 1970s that they called non-A, non-B hepatitis. In 1989, they discovered that it was a unique virus and named it hepatitis C virus.
There are six main subtypes—called “genotypes”—of HCV, which have been given the numbers 1 through 6. Some researchers believe there may be as many as 11 genotypes altogether.
In the United States:
- Genotype 1 accounts for about 70% of all HCV cases;
- Genotypes 2 and 3 together account for about 30% of HCV cases;
- Genotypes 4, 5, and 6 account for less than 1% of U.S. cases.
A person’s HCV genotype can affect how likely they are to respond to different HCV treatments and, as such, can influence their course of treatment (which drugs are used for how long).
Yes. Because HIV and HCV are both spread by contact with infected blood, many people are coinfected with both viruses. HIV can increase liver damage from HCV. Coinfected people are more likely to have liver problems from anti-HIV drugs, but it is possible to choose drugs that are easier on the liver.
Coinfection is linked to faster HCV disease progression and a greater risk of severe liver damage. On the other hand, HCV does not seem to speed up HIV disease progression.
High Rates of Depression
People with both infections are more likely to be depressed. Depression is a symptom of chronic HCV infection. Depression can lead to missed doses of medications (poor adherence) and problems thinking.
Greater Risk of Liver Damage
HIV-infected people with a CD4 T-cell count below 200 are at highest risk for serious liver damage from HCV infection.
Yes. Nearly all cases of HCV infection could be cured if appropriate treatment was started very soon after infection. However, because most people don’t have any symptoms of acute HCV infection, they are generally not diagnosed until years after they are infected—too late to benefit from early treatment. Fortunately, chronic HCV infection can also be cured. Current HCV treatments have much higher cure rates and fewer side effects than older treatment options.
HCV Treatments: Past, Present, and Future
Early HCV treatments typically involved the drugs interferon and ribavirin, which cured chronic infection in some persons. However, interferon and ribavirin often required nearly a year of treatment, were difficult to take (interferon requires periodic injections), and often had unpleasant to intolerable side effects.
An important breakthrough in HCV treatment occurred in 2011 with the approval of the first direct-acting antiviral (DAA) drugs targeting the virus. Unlike interferon and ribavirin, DAAs are designed to interfere with specific stages in the life cycle of HCV. Since 2011, several additional single- and multi-drug DAA pills have been approved, and many more are in the later stages of development and testing.
Fortunately, there are now a growing number of all-DAA drug regimens that completely avoid the side effects and inconvenience of interferon and ribavirin.
However, the high costs of the DAAs may be a major barrier to their use in people living with chronic HCV infection. Many drug companies offer patient assistance programs to help defray the cost of HCV medications. Patients can also work with their healthcare providers, insurers, and case managers to help them gain access to these medications.
Hepatitis C is a bloodborne virus and is transmitted through direct blood-to-blood contact. The most common ways for hepatitis C to be transmitted is through sharing needles or injection equipment with an infected person, having had a blood transfusion prior to 1992, sharing personal care items such as razors that could have infected blood on them, and from mother to child during childbirth. In rare cases, hepatitis C can be transmitted through sex.
It is possible to transmit hepatitis C through sex, but it is not an efficient transmission method. It is much more likely to get hepatitis C through sharing needles or “works,” or having had a blood transfusion before 1992. According to the Hepatitis C Support Project, if someone is in a long-term relationship with a person who has hepatitis C, there is only a small chance (up to 3% over 20 years) that they could get hepatitis C from their sexual partner. (This assumes that neither partner is having sex outside the relationship.) However, the chances of getting infected with hepatitis C through sexual activity is higher among people who have many sexual partners or are in so called high-risk groups (men who have sex with men, sex workers, people with sexually transmitted infections, and people who practice rough sex).
The risk of hepatitis C transmission from mother to child averages 5% (about a 1 in 20 chance) or less. There is no known way to reduce the risk.
Not necessarily. About 15% to 25% of the people who get infected with hepatitis C clear the virus completely out of their bodies naturally. This means that those people are no longer infected and can no longer spread the virus to other people.
However, the remaining 75% to 85% of people infected with hepatitis C become chronically infected. These people have the potential to transmit the virus to others through blood. Nobody knows why some people clear the virus and some people don’t. There is no way to know in advance who would naturally clear it and who would not. However, a test can be done to determine whether or not a person still has hepatitis C.
Fortunately, a growing number of antiviral medications are now available and under development to treat chronic hepatitis C infection. When used in combination, these medications have the potential to cure chronic hepatitis C in a large proportion of those infected. For more information about hepatitis C treatment, please see the “How Is Chronic HCV Infection Treated?” section on The Basics of Hepatitis C tab.
Yes. People who have cleared the virus either naturally or through medication can become infected again. Also, people who have active hepatitis C can become infected with additional genotypes (strains) of hepatitis C.
Some people who are infected with hepatitis C do get very sick and may die as a result of liver disease or other health conditions that are worsened by chronic hepatitis C infection. The number of HCV-related deaths in the U.S. has been rising in recent years and now exceeds the deaths from HIV and AIDS.
Interestingly, the relatively small proportion of people who develop acute illness symptoms as a result of hepatitis C infection tend to recover from their illness and have no lasting liver damage. About 60% to 70% of persons who are chronically infected with hepatitis C develop chronic liver disease. About 5% to 20% develop cirrhosis over a period of 20 to 30 years after being infected, and about 1% to 5% ultimately die from cirrhosis or liver cancer. Most people with hepatitis C will live for more than 20 years without having any serious symptoms. However, people who are coinfected with HIV may progress to liver disease more quickly.
Fortunately, the development of new hepatitis C treatments that are highly effective in curing chronic hepatitis C – even in persons coinfected with HIV – has the potential to substantially reduce the rates of HCV-related deaths and illnesses in the years ahead. For more information about hepatitis C treatment, see The Basics of Hepatitis C tab.
Yes. If someone has hepatitis C, there are several things that can increase the likelihood that the virus will cause liver damage.
Drinking alcohol (any amount) is very dangerous to a person who has hepatitis C since alcohol also causes liver damage.
In HIV and hepatitis C coinfected people, the risk of developing liver damage is much higher than in those people who only have hepatitis C. When people are coinfected with HIV and hepatitis C, they tend to get sick from hepatitis C sooner than if they only had hepatitis C.
Some medications are hard on the liver and generally should not be taken when people have hepatitis C. However, sometimes an urgent medical need for a particular medication overrides the possibility of liver damage. This is something for people to talk about with their doctors.
Avoiding alcohol (even small amounts) is very important. Tylenol and other over-the-counter and prescription drugs can sometimes cause liver damage. High iron diets may also cause problems. Good nutrition, regular exercise, and adequate sleep are helpful in keeping the liver healthy. We recommend speaking with your doctor or hepatitis specialist about all the medications and supplements you are taking to see whether they are safe for the liver.
Before answering this question, it may be helpful to review some of the things that happen after a person is infected with HCV. Shortly after a person is infected with HCV, the virus spreads through their body, and their immune system produces substances called antibodies in response to the infection. Some HCV-infected persons are able to clear the virus from the body naturally, while others go on to develop chronic (long-lasting) HCV infection. In either case, they will continue to have HCV antibodies.
Typically, a person who undergoes HCV testing first gets a test that looks for HCV antibodies. Although a positive (reactive) antibody test result indicates that a person has been infected with HCV in the past, it does not show whether they cleared the virus or remain chronically infected. Consequently, when a person has a positive result on an HCV antibody test, it is recommended that they have an HCV RNA test. This test looks for HCV viral genetic material (RNA), which is evidence that the person has an active HCV infection.
Persons who have a negative (nonreactive) result on an HCV antibody test are considered not infected with HCV. They generally do not need to undergo further HCV testing, unless they have a known risk factor for a false-negative test result. Factors that may lead to a false-negative HCV antibody test result include a recent HCV infection, chronic hemodialysis, or an immune compromising condition.
People who have a positive HCV antibody test and a positive HCV RNA are considered to have current (active) HCV infection. In contrast, if a person has a positive HCV antibody test result and a negative HCV RNA result, they are considered to have no evidence of current HCV infection. In such cases, additional testing can help determine whether the positive antibody test result is a false-positive or is an indication of a past HCV infection that the body has cleared.
The window period for an HCV test is the amount of time from when a person is first infected with the virus and the appearance of detectable evidence of their HCV infection, such as HCV antibodies or viral genetic material. Most people develop detectable HIV antibodies within 8 to 12 weeks after becoming infected. For most people who would like to get tested for HCV, it is generally a good idea to wait until after this window period before having an HCV antibody test.
However, if someone has had many risks over a long period of time—for example, a person who injects drugs and shares needles—they may want to have an HCV antibody test even if it has been less than 12 weeks since their last potential exposure to the virus. If this initial test is negative, they might want to get retested later.
The Centers for Disease Control and Prevention (CDC) estimates that as many as three out of four people who are infected with HCV don’t know that they are infected.
CDC recommends testing for:
- “Baby Boomers” (persons born between 1945 and 1965), who have HCV infection rates 5 times higher than in other age groups;
- People living with HIV;
- People with known exposures to HCV;
- People who have ever injected illegal drugs; and
- People who received blood transfusions or solid organ transplants before July 1992.
HCV testing is also recommended for:
- Recipients of clotting factor concentrates made before 1987;
- Patients who have ever received long-term hemodialysis treatment;
- Patients with signs or symptoms of liver disease, such as abnormal liver enzyme test results; and
- Children born to mothers who test positive for HCV.
Yes. As mentioned earlier, if a person has a positive antibody test, they should then have an HCV RNA test. This type of test looks for evidence of the virus itself, rather than antibodies. If this RNA test has a negative result, it indicates that the person has cleared the virus and is no longer infected. If the RNA test result is positive, it indicates that the person still has active HCV infection.
Once it has been determined that someone has chronic HCV infection, other tests will likely be performed on a regular basis. These tests, which include liver enzyme (ALT and AST) and viral load tests, are done periodically to monitor how that person’s liver is functioning and how quickly the HCV is making more copies of itself (replicating). However, these blood tests do not clearly show whether HCV is causing significant liver damage. Sometimes an ultrasound and/or a liver biopsy is performed to get a clearer picture of the liver’s health.
Until recently, liver biopsies were considered the best way to determine whether, and to what extent, liver damage occurred in persons infected with HCV. However, in 2013, the U.S. Food and Drug Administration approved FibroScan, a device that uses ultrasound to provide a noninvasive assessment of liver fibrosis (scarring). Recent studies have shown that FibroScan assessments of liver fibrosis are comparable with those provided by liver biopsies. This is good news, because it means that a noninvasive, outpatient, 15-minute procedure can often take the place of a liver biopsy, which is painful and carries the risk of bleeding and infection.
AIDS Action Committee of MA (AAC) and the Massachusetts Viral Hepatitis Coalition (MVHC) created this guide to help residents locate hepatitis C services in our state, including testing sites, treatment specialists, and support groups.
May marks Hepatitis Awareness Month and May 19 marks National Hepatitis Testing Day. This month provides an opportunity for concentrated messaging around hepatitis prevention, testing, and treatment. Help raise awareness about hepatitis prevention, testing, and treatment through Facebook and Twitter.
Many people in Massachusetts don’t know about hepatitis. Leading an education session is a great way to get the information out into the community. Here are some ideas for strengthening your session:
- Use or adapt an existing, tested curriculum.
- Include short videos
- AIDS Action has a downloadable infographic with basic information about hepatitis C in MA. Click here to download it.
- CDC has several hepatitis campaign posters and graphics that are free to download or order. Go to: https://wwwn.cdc.gov/pubs/CDCInfoOnDemand.aspx?ProgramID=48
Fenway Health is a Safe and Respectful Place to Receive Testing and Counseling for HIV/AIDS and Other STIs
Our Sexual Health Clinic is open to men who have sex with men, transgender and gender-diverse people, and their partners.
Call us at 617.267.0159 to book an appointment.
First things first—don’t panic. Treatment for HIV/AIDS is far more advanced than it was even a few years ago. Chances are there are treatment options available to you that will improve your health.
That said—treatment paths are different for everyone. The most important thing you can do now is to arm yourself with information that will help you decide the best course of action.
You can find more information about our programs and services, including individual case management, counseling, and peer support here.
Whatever you do, don’t avoid taking action. HIV is treatable, and there are many things you can do in addition to accessing medical care to improve your health and well-being. For people living in Massachusetts, AIDS Action is here to help. If you’re visiting our website from someplace else, there are many similar organizations and services available in other locations.
Getting medical care that’s right for you is essential for your long-term health. AIDS Action staff and volunteers can help you connect with healthcare providers and services that fit your needs. Here are a few suggestions on how to create a medical care plan that works for you:
- Choose a provider—a doctor, for instance—with experience in treating your condition, whether it’s HIV, hepatitis C, or something else.
- Explore the different methods and medications available to treat your condition. Develop questions, and make sure the people involved in your care can answer them.
- Consider reaching out to family or friends who are facing the same or similar health challenges. Ask them for advice. Think about joining a group of people who are undergoing similar treatments. Peer support may provide you with some relief. You could learn from others, and share your own knowledge to improve others’ health.
The Affordable Care Act and HIV/AIDS
(reprinted from the AIDS.gov website)
On March 23, 2010, President Obama signed the Affordable Care Act (ACA) into law and set into place a national effort to help ensure Americans have secure, stable, and affordable health insurance. The ACA is one of the most important pieces of legislation in the fight against HIV/AIDS in our history.
Here’s some of the many ways the Affordable Care Act Helps People Living with HIV/AIDS:
- Ensuring coverage for people with pre-existing conditions
- Expanding Medicaid coverage
- Providing more affordable private health coverage
- Lowering prescription drug costs for Medicare recipients
- Ensuring coverage of preventive services, including HIV testing
- Ensuring coverage of essential health benefits
- Increasing coordinated care for people with chronic health conditions
Have questions? Need more ideas? Contact Malinda Ellwood, Center for Health Law and Policy Innovation of Harvard Law School and Treatment Access Expansion Project, firstname.lastname@example.org, or John Peller, AIDS Foundation of Chicago, email@example.com.
- The Affordable Care Act and HIV/AIDS – summary information from the Federal government’s AIDS.gov website
- Healthcare.gov – Federal website with easy-to-understand information on health care reform
- Kaiser Family Foundation Health Reform Central – fact sheets, charts, maps, and tools for understanding Health Reform and its impacts; includes 14-page Summary of the Affordable Care Act
- The Affordable Care Act’s Health Insurance Marketplace: Consumer education resources for public health practitioners – 4-page fact sheet from the American Public Health Association