Study: PrEP can reduce your risk of contracting Hepatitis C

The pre-exposure prophylaxis (PrEP) used by people at risk to prevent HIV infection can as well be used by individuals with Hepatitis C, according to a new study.

The study found that individuals with hepatitis C virus (HCV) represent a population that may benefit from PrEP, given the overlapping risk factors and transmission networks of HCV and HIV.

HIV and HCV share some transmission routes such as shared drug injection equipment and unprotected sex.

Although a third of the people with HCV surveyed in Washington, DC, and Baltimore were potentially eligible for HIV prevention pills or long-acting injections, most had not heard of the drug and few were using it. This applies to Kenya as well, where only those at risk are eligible for PrEP.

HCV is blood-borne and transmitted through the reuse or inadequate sterilisation of medical equipment, especially syringes and needles in healthcare settings, transfusion of unscreened blood and blood products, and injection drug use through the sharing of equipment.

PrEP reduces the risk of getting HIV from sex by about 99 per cent. Two pills are taken 2–24 hours before sex, one pill 24 hours after the first dose, and another pill 24 hours after the second dose. 

The study published in Open Forum Infectious Diseases on September 14 this year enrolled 314 people with hepatitis alone—two-thirds (207) were cisgender men, and a third were cisgender women. Most (88 per cent) were black, and 78 per cent self-identified as heterosexual.

Dr Kristi Hill of Harvard Medical School and colleagues assessed PrEP awareness and use among participants in Gravity (Geomapping resistance and viral transmission in risky populations), an observational study conducted between March 2016 and November 2020 that collected epidemiologic data and blood samples from people with HIV or HCV.

Most participants were recruited from a harm reduction organisation that provides services to sex workers, people who inject drugs and gender and sexual minorities. Some 191 (61 per cent) individuals had a high school degree or higher, and 180 (57 per cent) reported having a source of money or income, with the government being the most common income source (46 per cent).

The researchers found that 109 of the 314 participants surveyed had an indication of PrEP. Within this group, 48 people (44 per cent) reported HIV risk due to injection drug use, defined as sharing needles or other injection equipment during the past year.

Forty people (37 per cent) were at risk of HIV via sexual transmission, defined as more than one partner and inconsistent condom use, sex work or other transactional sex, or having a HIV-positive partner. Another 21 people (19 per cent) had both drug use and sexual risk factors.

However, just 85 of the 314 participants (27 per cent) had ever heard of the drug, a provider had offered only 32 people (10 per cent) and only six people were currently taking the medication.

More encouragingly, 114 survey participants overall and 47 of those with a PrEP indication said they were interested or may be interested in PrEP, suggesting people may be receptive to efforts to increase its uptake.

“Though PrEP indications were prevalent among individuals with HCV in this cohort, most patients were unaware and had never been offered the drug. These data support the need for improved implementation of the drug among people with HCV.”

The study found that the progress in PrEP implementation for people with HCV will be limited if they are not included in the testing and implementation of new PrEP technologies.

“People with HCV antibodies have been systematically excluded from the drug clinical trials and major studies investigating long-acting injectable PrEP. Equitable drug implementation will require investigations into novel strategies to engage individuals with HCV in care and inclusion in landmark clinical trials,” says the study.

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