Hepatitis B and Delta virus infection among heterosexuals,homosexuals and bisexual men

The hepatitis B virus (HBV) and hepatitis Delta virus (HDV) infection rates were estimated in patients attending a venereal disease outpatient clinic: 759 heterosexuals and 154 homosexual-bisexual men. The anti-HBC prevalence was higher in homo-bisexual men (68.8 per 100) than in heterosexuals (41.8 per 100), whereas HBsAg was roughly the same in the two groups (about 6 per 100). The anti-HBc prevalence rate among heterosexuals was higher than that estimated in hospital personnel from the same geographical area. A positive association between anti-HBc prevalence and present or past sexually transmitted diseases (STD) was found among homo-bisexual men. Anti-HBc was also positively associated with herpes simplex type 2 antibodies in both heterosexuals and homo-bisexual men. These data are consistent with the hypothesis that sexual behavior also plays a role in the spread of infection among heterosexuals. Ten of the 46 HBsAg-positive subjects were anti-HDV positive: 6 of the 36 heterosexuals and 4 of the 10 homosexuals. All HDV-positive subjects had present or past STDs. These findings suggest sexual transmission of HDV infection.     

贵阳地区性乱者血清抗HCV的调查

对208例性乱、107例献血员作血清丙型肝炎病毒抗体(抗HCV)、部分乙肝病毒标志(HBVM)检测。结果献血员抗HCV阳性率1.87%,性乱者8.65%,其中伴性病者为12.7%,不伴性病者4.1%。性乱者抗HCV阳性率在男、女各年龄组间无明显差异,HCV合并HBV感染率达72.2%。结果提示,性乱者中有着不可忽视的HCV感染率,感染率高低与伴发性病或HBV感染有关。     

Age-specific seroprevalence of HIV, hepatitis B virus, and hepatitis C virus infection among injection drug users admitted to drug treatment in 6 US cities

OBJECTIVES: This study measured age-specific seroprevalence of HIV, hepatitis B virus, and hepatitis C virus (HCV) infection among injection drug users (IDUs) admitted to drug treatment programs in 6 US cities. METHODS: Remnant sera collected from persons entering treatment with a history of illicit drug injection were tested for antibodies to HIV, hepatitis C (anti-HCV), and hepatitis B core antigen (anti-HBc). RESULTS: Prevalence of anti-HBc and anti-HCV increased with age and reached 80% to 100% among older IDUs in all 6 cities. Although overall age-specific HIV prevalence was lower than anti-HCV or anti-HBc, this prevalence was greater in the Northeast than in the Midwest and West. CONCLUSIONS: The need continues for effective primary prevention programs among IDUs specifically targeting young persons who have recently started to inject drugs.     

Texas statewide hepatitis C counseling and testing, 2000-2005

In 1999, the Texas legislature funded a statewide hepatitis C education and prevention program. Hepatitis training was incorporated into training for all human immunodeficiency virus (HIV), sexually transmitted disease (STD), and substance abuse counselors. Hepatitis C virus (HCV) counseling and HCV-antibody (anti-HCV) testing services were integrated into 20 HIV/STD service provider programs. Hepatitis C counseling and testing became available in 2000. Through 2005, 38,717 tests were administered, with 8,964 (23.2%) anti-HCV positive. Injection drug use was reported by 7,105 people (79.3%) who tested positive. In Texas, a state-initiated and almost entirely state-funded program supported statewide HCV counseling and anti-HCV testing among high-risk adults.     

Human immunodeficiency virus and hepatitis C virus infections among patients attending sexually transmitted disease clinics, Regional 2, Thailand

A cross-sectional study of 400 patients attending sexually transmitted disease (STD) clinics at The Venereal Diseases and AIDS Centers, Regional 2, Thailand, was conducted from January to December 1996 in order to investigate the antibody prevalence to human immunodeficiency virus (HIV) and hepatitis C virus (HCV) and to describe some epidemiological characteristics among HIV and HCV co-infected individuals. The studied patients were interviewed and their blood specimens were collected for determining anti-HIV and anti-HCV antibodies. The results revealed that the prevalence of anti-HIV among studied patients was 25%, while 7.5% were positive for anti-HCV. The positivity of both antibodies present in the same individuals was 3.3% (13/400 cases). The highest prevalences of anti-HIV, anti-HCV and both antibodies were found in studied patients aged 20 years or less. Patients with primary education, or lower, had relatively higher prevalence of anti-HIV and/or anti-HCV than those with higher level education. A relatively higher prevalence was found among commercial sex workers and labourers. Among 13 HIV and HCV co-infected individuals, there were four cases who had histories of sexual contact without condom use, but no history of parenteral contact. The rest (9/13) had histories of both parenteral contact and sexual contact without condom use.     

Sexual transmission of hepatitis C virus infection

The role of sexual transmission in the diffusion of HCV infection, was studied through the seroprevalence of anti-HCV antibodies in the heterosexual habitual partners of 83 anti-HCV positive subjects. The index cases were represented by 10 dialysed subjects, 31 patients with chronic liver disease and 42 healthy carriers. Seroprevalence of anti-HCV positivity reported in partners was 8.43%, with a higher rate in cohabitants of patients with chronic liver disease (16.12% vs 4.76% of carriers); no case was found among partners of dialysed subjects. Laboratory and ultrasonograph signs of chronic hepatitis were reported in 3 cases (3.61%). Control on 70% of the cohabitants' relatives, was negative for HCV infections. These data suggest a possible sexual transmission of HCV infection, even if its prevalence resulted modest, undoubtedly lower than in other disease sexually transmitted.     

Sexual transmission of hepatitis C virus among female prostitutes and patients with sexually transmitted diseases in Fukuoka, Kyushu, Japan.

The authors investigated the prevalence of antibody to hepatitis C virus (anti-HCV) in 404 female prostitutes, 428 clinic patients with a history of at least one episode of sexually transmitted disease, and 8,944 blood donors who served as the controls. All subjects were Japanese, and all studies were carried out in Fukuoka, Kyushu, Japan, in 1989. The prevalence of anti-HCV was significantly higher in the prostitutes (6.2%), in the female patients with sexually transmitted diseases (6.1%), and in the male patients with sexually transmitted diseases (2.9%) than in the controls (1.5%). Prevalence of anti-HCV increased with age in prostitutes and in the controls. The prevalence of anti-HCV in those who had been involved in prostitution for 1 year or more (8.1%) was higher than in those who had been involved in prostitution for less than 1 year (1.4%), but the difference was not statistically significant. One of the 152 anti-HCV negative prostitutes seroconverted between 1 and 2 years later. Among the subjects with sexually transmitted diseases, patients with a history of at least one episode of syphilis had a significantly higher prevalence of anti-HCV (4.4%) than the controls. Patients with acute urethritis and cervicitis also showed a high prevalence of anti-HCV (3.6% and 6.7%, respectively). These data support the possibility of sexual transmission of hepatitis C virus.     

Prevalence and risk factors of hepatitis B virus, hepatitis C virus, and human immunodeficiency virus infections among drug addicts in Bangladesh

This cross-sectional study investigated the prevalence and risk factors of hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) infections among 266 drug users attending a drug-addiction treatment centre in Dhaka, Bangladesh, from November 1996 to April 1997. Of the 266 addicts, 129 were injectable drug users (IDUs), and 137 were non-injectable drug users (non-IDUs). The seroprevalences of hepatitis B virus surface antigen (HBsAg), anti-HBc, anti-HBs, and anti-HCV antibodies among the IDUs were 8 (6.2%), 41 (31.8%), 15 (11.6%), and 32 (24.8%), and among the non-IDUs were 6 (4.4%), 33 (24.1%), 9 (6.6%), and 8 (5.8%) respectively. None of the drug users were positive for anti-HIV antibody. Although the prevalence of HBV infection did not significantly differ between the IDUs and the non-IDUs, the prevalence of HCV infection was significantly higher among the IDUs. Among the IDUs, the prevalence of both HBV and HCV infections was associated with sharing of needles and longer duration of injectable drugs used. The seroprevalence of HBV infection in both IDUs and non-IDUs was significantly higher among those who had a history of extramarital and premarital sex. The prevalence of HCV infection was not associated with sexual promiscuity. There was no association between the seroprevalence of HBV and HCV infections and age. Active preventive programmes focusing on educational campaigns among the youths against substance abuse should be undertaken.     

Infection by hepatitis B and C virus in non-intravenous drug using female prostitutes in Spain

We have studied the prevalence of hepatitis B (HBV) and hepatitis C virus (HCV) serologic markers in female blood donors and in female prostitutes and the relationship of antibodies to hepatitis B core antigen (anti-HBc) and of antibodies to HCV (anti-HCV) with the presence of treponemal antibodies (FTA-ABS) in non-intravenous drug using female prostitutes. Hepatitis B surface antigen (HBsAg) was found in 1.0% of the female blood donors, anti-HBc in 15.6% and anti-HCV in 0.7%. In the prostitutes, the prevalence of HBsAg was 6.1%, anti-HBc was positive in 29.0% and anti-HCV in 8.8%. No significant statistical association between the prevalence of anti-HBc or anti-HCV and the age of prostitutes (p = 0.9111 and p = 0.8254 respectively) or the length of time as prostitutes (p = 0.3583 and p = 0.5770) was found. FTA-ABS positive prostitutes had a significantly higher prevalence of anti-HCV than FTA-ABS negative prostitutes (p < 0.001). No statistical association was found between anti-HBc antibodies and positive FTA-ABS prostitutes (p = 0.336).Corresponding author.     

Sexual transmission of hepatitis C virus and HIV-1 infection in female intravenous drug users

We examined the relationship between the presence of antibody to HCV and sexually transmitted diseases in 151 female, intravenous drug users aged 17–43 years. Anti-HCV was present in 49 of 66 HIV-1-negative women (74.2%), and 63 of 85 HIV-1-positive women (74.1%). Anti-HCV seropositivity was significantly related to sexually transmitted infections (Ureaplasma urealyticum infections excluded) in HIV-1-seronegative women, but not in HIV-1-positive women. Also, in HIV-1-negative subjects, Trichomonas vaginalis infections (and infections with M. hominis) were significantly related to anti-HCV seropositivity, and a positive relation between the number of sexual partners and the presence of anti-HCV was demonstrated. In HIV-1-positive subjects a shared use of needles and syringes was more likely, and an increased parenteral exposure to HCV may decrease the relative contribution by sexual transmission. However, in HIV-1-negative subjects, sexual transmission of HCV appears to be both a possible and important means of transmission.     

Prevalence of HIV, hepatitis B, and hepatitis C antibodies in prisoners in England and Wales: a national survey

Prisoners in eight of the 135 prisons in England and Wales were surveyed in 1997 and 1998 to study the prevalence of and risk factors for transmission of bloodborne viruses in prison. Subjects voluntarily completed a risk factor questionnaire and provided oral fluid specimens for unlinked anonymous testing for the presence of antibodies to HIV, hepatitis C virus (HCV), and the core antigen of hepatitis B virus (HBc). Almost 8% (4778) of the total of 60,561 prisoners were eligible and four fifths (3942) of those eligible took part. Among all those tested (3930) 0.4% (14) were positive for anti-HIV, 8% (308) for anti-HBc, and 7% (293) for anti-HCV (the anti-HBc and anti-HCV prevalences were not adjusted for assay sensitivities of 82% and 80%, respectively). Twenty-four per cent (777/3176) of adult prisoners reported ever having injected drugs, 30% of whom (224/747) reported having injected in prison. Three quarters of those who injected in prison (167/224) shared needles or syringes. Among adult injecting drug users, 0.5% (4/775) had anti-HIV, 31% (240/775) anti-HCV, and 20% (158/775) anti-HBc. The presence of anti-HCV and anti-HBc was associated with injecting inside prison and number of previous times in prison. The results suggest that hepatitis viruses are probably being transmitted in prisons through sharing non-sterile injecting equipment and that a risk of HIV transmission exists. Harm minimisation measures for the 6% of prisoners who continue to inject while in prison should be strengthened.     

Integrating viral hepatitis prevention services into an urban STD clinic: Denver, Colorado

The Centers for Disease Control and Prevention recommends integrating viral hepatitis prevention services with services for adults evaluated for sexually transmitted diseases (STDs). The Denver Public Health STD clinic began hepatitis B vaccination in 1999, hepatitis C virus (HCV) antibody (anti-HCV) testing in 2000, and hepatitis A vaccination in 2002. Rapid human immunodeficiency virus (HIV) testing began in late 2004. Hepatitis B vaccinations peaked in 2003 (31/100 client visits) when a full-time nurse was hired to vaccinate and eligibility was expanded. The proportion of clients documented to have received their anti-HCV test results declined from an average of 71% in 2000-2003 to 22% in 2004-2005, coinciding with the introduction of rapid HIV testing. Viral hepatitis prevention services can be incorporated into a busy STD clinic if staff and resources are available. Rapid HIV testing may be associated with lower receipt of anti-HCV test results.     

Risk factors for hepatitis C virus infection among blood donors in an HIV-epidemic area in Thailand.

OBJECTIVE: The role of sexual transmission in hepatitis C virus (HCV) infection has not yet been completely elucidated. This study aimed to compare the risk factors for HCV and human immunodeficiency virus (HIV) infection in an HIV epidemic area of Thailand where HIV is mainly transmitted heterosexually. DESIGN AND SUBJECTS: Sera from 3053 blood donors were collected and tested for HCV and HIV between January and March 1994. Altogether 1756 (57.5%) of the donors were interviewed about demographics and several risk factors. RESULTS: The prevalence rates of HIV and HCV infections determined by antibody assays were 2.3% and 2.2%, respectively. Sexual risk factors were clearly shown among anti-HIV positive donors. These clear associations were not found, however, among anti-HCV positive donors. In contrast, previous histories of injecting drug use and being tattooed were found in some anti-HCV positive donors but less frequently in anti-HIV positive donors. CONCLUSIONS: Sexual transmission may play a relatively minor role in HCV transmission compared with HIV, in this area.     

Seroepidemiological survey of hepatitis C virus among commercial sex workers and pregnant women in Kinshasa, Democratic Republic of Congo

BACKGROUND: Studies conducted mainly in industrialized countries have shown that the transmission of hepatitis C virus (HCV) is mainly parenteral, and have emphasized the role of nosocomial transmission. In Equatorial Africa, the respective contributions of parenteral and non-parenteral routes of transmission are unknown. The potential role of sexual transmission in this area of high HCV endemicity, where sexually transmitted infections (STI) are frequent, is suggested by the fact that HCV infection is rare in infants and young adolescents, but increases thereafter with age. The present study, conducted in Democratic Republic of Congo, was designed to determine the prevalence of HCV infection and associated sexual risk factors in two female populations with different sexual behaviour. METHODS: Cross-sectional studies conducted among commercial sex workers (CSW; n = 1144) and pregnant women (n = 1092) in the late 1980s in Kinshasa showed a high frequency of at-risk sexual behaviour, STI and human immunodeficiency virus (HIV) infection, particularly among CSW. We screened samples collected during these epidemiological studies for antibodies to HCV using a second-generation ELISA with confirmation by a third-generation LIA. We also assessed sociodemographic variables, medical history, STI markers and sexual behaviour, and their potential association with HCV infection. RESULTS: The overall prevalence of anti-HCV was 6.6% (95% CI : 5.2-8.2) among CSW and 4.3% (95% CI : 3.2-5.7) among pregnant women (age-adjusted OR = 1.5, 95% CI : 1.0-2.1, P = 0.05). Multivariate analysis showed that the presence of anti-HCV among CSW was independently associated with a previous history of blood transfusion (P < 0.001), age >30 years (P < 0.001) and the presence of at least one biological marker of STI (P < 0.03). No such links were found among pregnant women (although the history of blood transfusions was not investigated in this group). Anti-HCV was not associated with sociodemographic variables or sexual behaviour in either group, or with individual markers of STI. Despite the high-risk sexual behaviour and the higher prevalence of STI in CSW, the difference in HCV seroprevalence between CSW and pregnant women (6.6% versus 4.3%) was small, particularly when compared with the difference in the seroprevalence of HIV (34.1% versus 2.8%). CONCLUSION: The role of sexual transmission in the spread of HCV seems to be limited. Parenteral transmission (including blood transfusion and injections), possibly related to the treatment of STI, probably plays a major role.     

Sexual Activity and Hepatitis B and C Virus Infection Among Young Adults After Introduction of a Vaccination Program in an Area of High Endemicity

Background

In areas where hepatitis is endemic, little is known about the sexual transmission of HBV after introduction of an HBV vaccination program.

Methods

We used a self-administered questionnaire and serological tests for HBsAg, anti-HBs, anti-HBc, and anti-HCV to examine the role of sexual activity, as well as sociodemographic status, lifestyle habits, and a history of vaccinations, transfusions, and surgery, in the transmission of HBV and HCV in Korea. The subjects were 865 female and 541 male university students (median age, 19 years; age range, 16–25).

Results

Overall seropositivity was 8.1% for HBsAg, 69.3% for anti-HBs, 21.3% for anti-HBc, and 0.4% for anti-HCV. Regarding HBV, 8% of the subjects were chronic carriers or had recently been infected, 22.8% were never exposed and nonvaccinated, 16.6% were exposed noncarriers, and 52.7% had most likely been vaccinated. We found a significant association between HBsAg seropositivity and history of sexual intercourse (Odds Ratio, 1.8; 95% CI, 1.1–2.8). Students without serologic evidence of immunization against HBV were more likely to have become HBsAg-positive after becoming sexually active.

Conclusions

Our findings suggest that sexual transmission does occur among adolescents and young adults who have not been vaccinated, whereas vaccination protects individuals from becoming an HBV carrier after becoming sexually active.Key words: hepatitis B virus, hepatitis C virus, sexual transmission, vaccination, endemic area     

Prevalence of hepatitis B,hepatitis C and syphilis in female sex workers in Venezuela

OBJECTIVE: In Venezuela, female sex workers are submitted to a preventive control of syphilis and human immunodeficiency virus (HIV). However, other very important sexually transmitted infections are not evaluated. A study was carried out to identify the sociocultural background of a group of sex workers and its association with the seroprevalence of hepatitis B and C markers, in addition to routine evaluation. METHOD: A total of 212 female sex workers who attended the control center of sexually transmitted infections (STI) in the city of Los Teques, Venezuela, were evaluated. Women were asked their age, educational background, use of contraceptive methods and condoms. Blood was drawn to determine the prevalence of syphilis, hepatitis B surface antigen (HBsAg), antibodies to hepatitis B core (anti-HBc), hepatitis C (anti-HCV) and HIV. RESULTS: The prevalence of syphilis was 2.4%, seroprevalence of anti-HCV was 0.5%, HBsAg 3.8% and anti-HBc 13.8%. No cases of HIV were observed. Higher prevalence of hepatitis B markers was associated with a lower level of education (p<0.05) and higher age (p<0.05). It was found that 38.5% of participant women never used condoms and 25.6% did not use any contraceptive method. CONCLUSION: It could be necessary to implement preventive programs to immunize sex workers against hepatitis B virus as well as education programs on condom use for their protection against sexually transmitted infections.     

Prevalence,risk factors and evaluation of a screening strategy for chronic hepatitis C and B virus infections in healthy company employees

A cross-sectional study was carried out in employees of 17 Greek companies with the aim of assessing the prevalence of hepatitis B (HBV) and hepatitis C (HCV) virus, identifying associated prognostic/risk factors and evaluating the effectiveness of a questionnaire as a pre-screening tool. All participants were asked to complete a questionnaire and a random sample of them was asked to provide a blood sample for hepatitis B core antibody (anti-HBc), hepatitis B surface antigen (HBsAg) and antibodies to hepatitis C (anti-HCV) testing. Individual questions or combinations of them were evaluated in terms of their ability to detect HBV or HCV(+) cases. Of 9085 eligible employees, 6074 (67%) completed the questionnaire. Of 990 samples obtained, 19.9% were anti-HBc(+), 2.6% HBsAg(+) and 0.5% anti-HCV(+). All anti-HCV(+) cases had multiple parenteral risk factors. Multiple logistic regression identified associations between anti-HBc and older age, family members with chronic hepatitis, job category and history of transfusion before 1992. HBsAg(+) was associated with older age and history of transfusion before 1992. None of the risk/prognostic factors had sufficient sensitivity and specificity for HBV but report of at least one risk factor identified all HCV(+) cases. Anti-HCV screening of those with at least two parenteral risk factors not only identified all anti-HCV(+) cases but also resulted in 86% decrease in the screening cost. Under the light of recent treatment advances, targeted questionnaire-based screening of asymptomatic people may prove to be a cost-effective way to face hepatitis C.     

Prevalence and risk factors of HIV,hepatitis B and hepatitis C in a forensic population of rapists and child molesters

The aim of the present study was to assess the prevalence as well as the possible risk factors of HIV, hepatitis B and hepatitis C, in 194 male prisoners who had been convicted for rape (n = 105) or child molestation (n = 89). HBsAg, HBeAg, anti-HBc, anti-HBs, anti-HCV and anti-HIV-1/2 were tested for. The participants also completed a standard sociodemographic questionnaire, indicating possible risk factors, the Barratt Impulsiveness Scale, and the life-time history of aggression. Anti-HIV antibodies were not found in any of the prisoners. HBsAg was found in 25 (13%), anti-HBc in 94 (49%), anti-HBs in 40 (21%) and anti-HCV in 13 (6.5%) subjects. Logistic regression analysis showed that anti-HCV positivity was associated with intravenous drug use (OR 20.7, 95% CI 1.1-4.9, P<0.001), while HBsAg positivity was associated separately with being foreign (OR 4.0, 95% CI 0.2-2.5, P<0.1), as well as with impulsiveness score (OR 1.06, 95% CI 0.01-0.11, P<0.02). The prevalence of HBV and HCV infection in this sex offender sample was highly increased in relation to the general population. Since it has been proved that sex offenders are a high-risk group for reoffending, monitoring their health is a necessary step towards prevention of sexually transmitted diseases being spread.     

Association of hepatitis C virus with liver cirrhosis and hepatocellular carcinoma compared with hepatitis B virus in Egyptian patients

Hepatocellular carcinoma (HCC) is an aggressive malignancy and carries a poor prognosis. Documentation of the wide geographical variation in its incidence has led to clear identification of several risk factors. These include hepatitis B virus (HBV) and hepatitis C virus (HCV) infections in endemic areas. The present study investigated the association of HBV with HCV and cirrhosis, the latter is regarded as a premalignant lesion and underlies most cases with HCC. Serum samples from 94 patients with HCC (n=25) and cirrhosis (n=69) were tested for hepatitis C virus antibody (anti-HCV), hepatitis B surface antigen (HBsAg), hepatitis B core antibody (anti-HBc) and serum alphafetoprotein (AFP). Of the 94 patients, 71 (75.5%) had anti-HCV, 6 (6.4%) were positive to HBsAg, while 64 (68.1%) were positive to anti-HBc. These viral markers were more prevalent among HCC patients, 19 (76.0%) had hepatitis C antibody, 3 (12.0%) were positive to HBsAg and 22 (88.0%) were positive to anti-HBc compared with 52 (75.4%), 3 (4.3%) and 42 (60.9%), respectively in patients with cirrhosis. Regarding serum AFP measurement, 14 (56%) of patients with carcinoma and 35 (50.7%) of patients with cirrhosis demonstrated levels above 7 ng/ml. In patients with cirrhosis, elevated serum AFP and presence of anti-HCV in serum were significantly associated. In conclusion, this study shows that viral hepatitis is strongly associated with the development of cirrhosis and HCC in Egyptian patients. Hepatitis C virus seems to play a predominant role compared with hepatitis B virus.     

The role of sexual transmission in the epidemiology of hepatitis C virus in black South Africans.

The role of sexual transmission of hepatitis C virus in Black South Africans was evaluated by a seroprevalence study of sentinel populations at varying risk for sexually transmitted diseases (STD). Prevalence of anti-hepatitis C virus antibodies was found to be 1.8% in an STD clinic sample of 272, 0.7% in a family planning sample of 148, 3.3% in a sample of 246 'blue collar' workers (81% of rural origin), and 0.9 in a sample of 117 new blood donors. All samples were from Black adults. The differences between them were not significant (P = 0.2348). In contrast, the prevalence of anti-human immunodeficiency virus antibodies in the STD sample (5.5%) was statistically significantly different (P = 0.00095) from the family planning clinic sample (1.4%) and the blue collar sample (0.8%) as well as from the reported prevalence for black blood donors in the Johannesburg area (0.7%). No evidence supporting a role for sexual transmission of hepatitis C virus was found, while the prevalence of infection appeared to be higher in rural populations and in males. These features are similar to hepatitis B in this population.