Risk Factors for Hepatitis C Virus Seropositivity in Heterosexual Couples

Osmond, Dennis; Padian, Nancy; Sheppard, Haynes W.; Glass, Sarah; Shiboski, Stephen; Reingold, Arthur

doi:10.1001/jama.1993.03500030059033

Cited by 122 publications

(40 citation statements)

References 29 publications

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“…In those studies limited to individuals without a history of injection drug use, factors predictive of anti-HCV positivity included the number of recent and lifetime partners, high risk sexual practices (variably defined), other STDs, and anti-HIV positivity. [7][8][9][10][11][12] These factors are consistent with a sexual route of transmission.…”

Section: What Is the Prevalence Of Hcv In Persons At Risk For Stds?supporting

confidence: 65%

Sexual activity as a risk factor for hepatitis C

Terrault

2002

Hepatology

134

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The accumulated evidence indicates that hepatitis C virus (HCV) can be transmitted by sexual contact but much less efficiently than other sexually transmitted viruses, including hepatitis B virus and human immunodeficiency virus (HIV). However, because sex is such a common behavior and the reservoir of HCV-infected individuals is sizable, sexual transmission of HCV likely contributes to the total burden of infection in the United States. Risk of HCV transmission by sexual contact differs by the type of sexual relationship. Persons in long-term monogamous partnerships are at lower risk of HCV acquisition (0% to 0.6% per year) than persons with multiple partners or those at risk for sexually transmitted diseases (0.4% to 1.8% per year). This difference may reflect differences in sexual risk behaviors or differences in rates of exposure to nonsexual sources of HCV, such as injection drug use or shared razors and toothbrushes. In seroprevalence studies in monogamous, heterosexual partners of HCV-infected, HIV-negative persons, the frequency of antibody-positive and genotype-concordant couples is 2.8% to 11% in Southeast Asia, 0% to 6.3% in Northern Europe, and 2.7% in the United States. Among individuals at risk for sexually transmitted diseases ( P ercutaneous exposures, such as blood transfusion and injection drug use, are well-established risk factors for hepatitis C virus (HCV) infection. The risk of HCV transmission by sexual contact, however, is less well defined. The accumulated epidemiologic evidence indicates that HCV can be transmitted by sexual contact but much less efficiently than other sexuallytransmitted viruses, including hepatitis B virus and human immunodeficiency virus (HIV).There are several case reports of acute hepatitis C occurring in persons whose only risk factor appeared to be a HCV-infected sexual partner. 1,2 The strength of these reports lay in their ability to document seroconversion in an individual at risk in temporal relationship to sexual activity with an HCV-infected partner. The mode of transmission was ascertained by carefully questioning the infected individual to exclude nonsexual sources of HCV. A high degree of sequence homology between the viral strains in the sexual partners provided virological confirmation that a transmission event had occurred.While there is sufficient evidence to support the conclusion that sexual transmission of HCV occurs, quantifying the magnitude of an individual's risk of HCV acquisition by sexual contact is more difficult. Epidemiologic studies have had several methodological shortcomings that tend to overestimate the proportion of HCV infections attributed to sexual contact. Early studies used first-generation antibody to HCV (anti-HCV) assays which have a higher false positive rate than second-and third-generation assays. Studies varied in the completeness of risk ascertainment in partners, and many failed to carefully exclude HCV acquisition from nonsexual sources (Fig. 1). Nondisclosure of injection drug use is particularly important because a...

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Section: What Is the Prevalence Of Hcv In Persons At Risk For Stds?supporting

confidence: 65%

Sexual activity as a risk factor for hepatitis C

Terrault

2002

Hepatology

134

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“…Multiple studies have reported that HCV is inefficiently transmitted sexually. [14][15][16][17] We cannot exclude the possibility that a more established risk factor (e.g., syringe sharing) or frequency of injection may be indirectly responsible for this association.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with prevalent hepatitis C: differences among young adult injection drug users in lower and upper Manhattan, New York City

2001

Am J Public Health

164

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OBJECTIVES: This study examined correlates of prevalent hepatitis C virus (HCV) infection among young adult injection drug users in 2 neighborhoods in New York City. METHODS: Injection drug users aged 18 to 29 years were street recruited from the Lower East Side and Harlem. Participants were interviewed about drug use and sex practices; venipuncture was performed for hepatitis B virus (HBV), HCV, and HIV serologies. RESULTS: In both sites, testing positive for HCV antibody (anti-HCV) was associated with having injected for more than 3 years. Additionally, HCV infection was positively associated with injecting with someone known to have had hepatitis (but the association was significant only in the Lower East Side) and with sharing cotton (but the association was statistically significant only in Harlem). Being in drug treatment and older than 24 years were associated with HCV in the Lower East Side but not in Harlem. Receiving money for sex was associated with anti-HCV positivity in Harlem but not in the Lower East Side. CONCLUSIONS: Several differences in factors associated with prevalent HCV infection existed among 2 populations of young injection drug users from the same city. Indirect transmission of HCV may occur.

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“…These results suggest the possibility that some of the individuals in the drug users group who selfreported as non-IDUs may have injected drugs in the past. However, the risk of sexual transmission of an HCV infection is associated with a history of multiple sexual partners and a lack of condom usage (Alter, 1990;Osmond, 1993;Rauch, 2005). Thus, the high prevalence of HCV infection in both risk groups in this study could be explained by the large number of subjects who said that they never use condoms.…”

Section: Resultsmentioning

confidence: 74%