1. Hepatitis C and Sexual & Reproductive Health Graham Mackintosh, Training & Capacity Officer Lesley Bon, Patient Involvement Officer

2. Overview Hepatitis C - key points Health inequalities People who inject drugs HIV Co-Infection Contraception Mother to child transmission

3. Hepatitis C – Key points Blood borne virus 6 Genotypes: Genotypes 1 & 3 most common No vaccination, treatment available 33,595 diagnosed anti-body positive 2:1 ratio males Approx 90% acquired - injecting drugs 69% diagnosed between age 20-39 yrs 0.8% of 15-59yrs diagnosed HCV antibody positive Health Protection Scotland

5. Comparison of HCV diagnosed population with other conditions – Health Protection Scotland

6. Socio-Economic Deprivation Peri-natal outcomes – peri-natal mortality, premature birth, low birth weight Risk factors during pregnancy – substance misuse, domestic abuse, smoking, diet Poorer outcomes for women who don’t seek/delay/have intermittent antenatal care

7. People who use drugs Vast majority of infections occur amongst PWID Sharing needles and other paraphernalia Complex issues associated with sharing Injection Equipment Provision Challenges around prevention, testing, treatment and support Do sexual health services ask about drug use?

8. HCV/HIV co-infection HCV transmission risk increases if HIV Positive or other STI 9% of HIV positive people in UK are co-infected with HCV 2006 – 6% of deaths in HIV positive patients attributed to HCV or HBV 83% of HIV positive injecting drug users are co- infected with HCV 7% of HIV positive gay men are co-infected with HCV

9. Treatment & Contraception Standard of Care Treatment: Pegylated Interferon and Ribavirin. Those undergoing HCV treatment should use 2 forms of contraception > 6 months after treatment. Ribavirin – teratogenic/embryocidal effects Females & males undergoing treatment must avoid pregnancy Negative pregnancy test required before beginning treatment

10. Contraception Scenario A woman called our office, after reading the patient guide to her contraception, and read it was not to be used by people with liver disease and/or hepatitis infection. The health care worker who prescribed the contraception knew of hep c infection – but did not discuss. What do we do in this situation?

11. Mother to child transmission No routine antenatal screening for HCV Low risk of vertical transmission < 5% No interventions to prevent MTCT No modification of obstetric management Treatment contra-indicated in pregnancy No treatment for babies/young children Breastfeeding: No documented evidence of HCV transmission HCV infection not a contraindication to breastfeeding Dr Mary Hepburn

12. Discussion Points What do you advise patients diagnosed with Hep C about sexual transmission risks? Do you enquire about risk factors associated with Hep C? Full sexual health screen – does it include hep c testing?

13. Hepatitis Scotland 1 st Floor, 91 Mitchell Street, Glasgow, G1 3LN phone: 0300 343 0250 www.hepatitisscotland.org.uk email: info@hepatitisscotland.org.uk twitter: @hepscotland facebook: Hepatitis-Scotland Any questions or comments?