Sexual activity as a risk factor for hepatitis C

Abstract

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...

Prevalence of hepatitis C virus infection among recyclable waste collectors in Central-West Brazil

“…In addition, unprotected sex with multiple partners was associated with HCV infection according to the univariate analysis of data obtained from the study population. These sexually risky behaviours have been reported by other authors (Terrault 2002, Wang et al 2007, Alter 2011) and appear to be common in this population (Rozman et al 2007, 2008). It should be stressed that most preventative policies related to STIs are aimed at groups with higher exposure risks and do not include recyclable waste collectors.…”

Hepatitis C Worldwide and in Brazil: Silent Epidemic—Data on Disease including Incidence, Transmission, Prevention, and Treatment

“…There are defined risk factors for hepatitis C virus infection, such as transfusions of HCV-infected blood, contaminated injections during medical procedures, and injection drug use. However, the risk for HCV transmission by sexual or interfamilial contact is not well established [1–3]. …”

Trouble with Bleeding: Risk Factors for Acute Hepatitis C among HIV-Positive Gay Men from Germany—A Case-Control Study

“…Certain sexual practices involving trauma of the rectal mucosa have been discussed as relevant risk factors among MSM [13], [39]. Co-infections with bacterial sexually transmitted infections (STIs), especially ulcerative STIs such as syphilis or lymphogranuloma venereum (LGV) have also been proposed as risk factors for HCV transmission among HIV-positive MSM [7], [9], [10], [24], [32], [40]. Furthermore, HIV infection might increase susceptibility towards HCV infection through weakened immunological defence mechanisms [2], [8], [21], [41].…”