Risk factors for hepatitis C virus infection in United States blood donors

Abstract

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...

Prevalence of hepatitis C virus infection and associated factors among male illicit drug users in Cuiabá, Mato Grosso, Brazil

“…Oliveira et al (2009b) described a remarkable decline in HCV infection among intravenous drug users in Rio de Janeiro (Southeast Region) over the years. Some authors state that the use of non-intravenouslyinjected drugs also contributes to the transmission of HCV due to the exposure of nasal mucosa that comes from using shared equipment (Murphy et al 2000). In a systematic revision carried out by Scheinmann et al (2007), the prevalence of HCV in non-intravenous drug users varied between 2.3-35.3%.…”

Hepatitis C epidemiology: Injecting new tools in the field

“…In this regard it is important to note that in several studies the HCV prevalence of long-term sexual partners of HCV-infected persons is similar to that in the general population. 6,10 In addition, in the study by Murphy et al, 5 HCV-infected blood donors were not more likely to report high-risk sexual practices or intranasal cocaine use, after adjusting for other factors. However, in this and some other studies, neither were blood transfusions associated with HCV infection, indicating that failure to detect an association in one study does not exclude its role in another setting.…”

“…In the study by Murphy et al 5 in this issue of HEPATOLOGY, HCV antibody-positive volunteer blood donors were 50-fold more likely to acknowledge injection drug use than those without HCV infection. In this and a similar prior study by Conry-Cantilena et al, 6 almost half of HCV infections were attributed to injection drug use even among volunteer blood donors who initially denied the practice.…”

Hepatitis C virus quantification in serum and saliva of HCV-infected patients

“…It is transmitted mainly through the parenteral route and sexual and vertical transmissions are considered to be rare. However, epidemiological studies suggest that the transmission routes of a large number of HCV infections are unknown (Heintges & Wands 1997, Murphy et al 2000.…”