RSS Feeds
Spousal Transmission of the Hepatitis C Virus?
- Leonard B. Seeff, MD; and
- Harvey J. Alter, MD
- Georgetown University School of Medicine, Department of Veterans Affairs Medical Center, Washington, DC 20422. National Institutes of Health, Bethesda, MD 20892. Requests for Reprints: Leonard B. Seeff, MD, Gastroenterology Section (151W), Department of Veterans Affairs Medical Center, 50 Irving Street, N.W., Washington, DC 20422.
A vast amount has been learned about hepatitis C virus (HCV) in the short time since its discovery through molecular cloning [1]. Much still remains to be defined, however, particularly in regard to clinical outcome, pathogenesis, and modes of transmission. Our discussion focuses on the last item.
When first identified, non-A, non-B (C) hepatitis was believed to be acquired almost exclusively through percutaneous exposure. This early view derived naturally from the fact that the virus was first recognized in the context of blood transfusion studies. Subsequent investigations moved from the transfusion setting to that of community-acquired hepatitis, focusing on an analysis of risk factors for viral acquisition. An early study involving five Baltimore hospitals described 295 patients, 42% of whom fulfilled the then-existing criteria for non-A, non-B hepatitis [2]. Risk factors associated with the illness included previous receipt of blood transfusions, parenteral drug use, and hospital employment. Also showing a strong correlation, however, was “personal contact with other persons with hepatitis.” Investigators at the Centers for Disease Control and Prevention enlarged on these observations with a series of epidemiologic “sentinel county” surveys and also concluded that sexual contact was a factor in transmission, although a small one [3-5]. Of these, the most compelling involved a comparison between 52 patients with non-A, non-B hepatitis and 104 matched controls [5]. Multivariate analysis showed a significant association between sexual contact with two or more partners in the preceding 6 months and the presence of HCV infection and a near-significant association between general household exposure to hepatitis and HCV infection.
Although these epidemiologic studies seemed to support the concept of sexual transmission of HCV, in none of them did heterosexual contact represent more than 6% to 8% of all identifiable risk factors. Most perplexing in these surveys was the fact …
