Injection drug use (IDU) is a known risk factor for hepatitis C virus (HCV) infection, but the strength of other parenteral and sexual risk factors is unclear. In 1997, we performed a case-control study of 2,316 HCV-seropositive blood donors and 2,316 seronegative donors matched on age, sex, race/ethnicity, blood center, and first-time versus repeat-donor status. Odds ratios (OR) and 95% confidence intervals (CIs) were calculated using conditional logistic regression. Questionnaires were returned by 758 (33%) HCV ؉ and 1,039 (45%) control subjects (P ‫؍‬ .001). The final multivariate model included only the following independent HCV risk factors: IDU (OR ‫؍‬ 49.6; 95% CI: 20.3-121.1), blood transfusion in non-IDU (OR ‫؍‬ 10.9; 95% CI: 6.5-18.2), sex with an IDU (OR ‫؍‬ 6.3; 95% CI: 3.3-12.0), having been in jail more than 3 days (OR ‫؍‬ 2.9; 95% CI: 1.3-6.6), religious scarification (OR ‫؍‬ 2.8; 95% CI: 1.2-7.0), having been stuck or cut with a bloody object (OR ‫؍‬ 2.1; 95% CI: 1.1-4.1), pierced ears or body parts (OR ‫؍‬ 2.0; 95% CI: 1.1-3.7), and immunoglobulin injection (OR ‫؍‬ 1.6; 95% CI: 1.0-2.6). Although drug inhalation and a high number of lifetime sex partners were significantly more common among HCV seropositives, they were not associated with HCV after controlling for IDU and other risk factors. IDU, blood transfusion among non-IDU, and sex with an IDU are strong risk factors for HCV among United States blood donors. Weaker associations with incarceration, religious scarification, being stuck or cut with a bloody object, pierced ears or body parts, and immunoglobulin injection must be interpreted with caution. (HEPATOLOGY 2000;31:756-762.)Since the discovery of hepatitis C virus (HCV) was reported in 1989, much has been learned about its epidemiology and pathogenesis. HCV seroprevalence in the general population ranges from 1% to 2% in a number of countries including the United States 1-3 to 12.6% in parts of Italy, 4 and 14.1% in areas of Japan. 5 As a result of selection for those at low risk of infectious disease, HCV prevalence is lower among blood donors, ranging from 0.06% to 1.3% in several countries, and 0.4% in the United States. [6][7][8][9][10] It is hyperendemic among injection drug users (IDUs) in industrialized countries, with infection rates of up to 90%, 11,12 consistent with the high frequency of parenteral blood exposures in this subgroup. Most HCV seropositives have persistent viremia, more than half have chronic hepatitis, and cirrhosis may occur in up to 20%. 13 Other investigators have implied that up to 40% of HCV seropositives do not have recognized parenteral risk factors, 14 leading to speculation that other as-yet-undiscovered modes of transmission may exist. Whether heterosexual transmission occurs at more than a negligible rate is also controversial. [15][16][17][18] Furthermore, a recent study reported that intranasal inhalation of cocaine appeared to be a risk factor for HCV infection in United States blood donors. 19 Clarification of the risk factors for and transmiss...

Acute illness alone, in the absence of HIV infection, can be associated with profound decreases of T-lymphocyte populations. This problem is unpredictable and does not correlate with severity of illness, predicted mortality rate, or actual mortality rate. No conclusions regarding HIV serostatus or survival can be made based on single measurements of T-cell concentrations in acutely ill hospitalized patients.

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