Detection of HCV RNA in subjects with antibody to hepatitis C virus among the general population of Fukuoka,Japan

Volunteer blood donors and aged people who came to hospitals for a thorough physical checkup were surveyed to evaluated the exact prevalence of hepatitis C virus (HCV) infection in the general population of Fukuoka, Japan. We tested for antibody to HCV (anti-HCV) by second-generation assay and, to distinguish active HCV infection from past resolved infection, we tested for HCV RNA in reactive serum samples by polymerase chain reaction. The prevalence of anti-HCV was 286 (2.0%) of 14341 subjects, increasing with advancing age, from 0.4% in the under-29 age group to 12.0% in the over-70 age group. There were no differences between sexes. HCV RNA was detected in 170 of 286 (59.4%) anti-HCV-positive subjects. The ratio of HCV RNA-positive to anti-HCV-positive subjects was higher in males than in females (P<0.05) and decreased with advancing age, from 72.2% to 46.5%. The prevalence of elevated alanine aminotransferase (ALT) was only 15.9% in subjects with HCV RNA, higher in males (21.4%) than in females (8.3%) (P<0.05). This study revealed that the prevalence of anti-HCV was high in the aged population, but that the ratio of HCV RNA-positive to anti-HCV-positive subjects was low, and most of the HCV RNA-positive subjects had normal ALT levels.     

Hepatitis C virus: prevalence and routes of infection among blood donors of West Mexico

In Latin America few studies have explored frequency and risk factors predicting hepatitis C virus (HCV) infection in blood donors. In this study we determined the prevalence of HCV infection in blood donors from West Mexico. Potential risk factors, clinical, histological and virologic characteristics presented in this group were also evaluated. Methods: HCV antibodies were evaluated in 57 108 blood donors with commercial second-generation enzyme immunoassays. Positive results were confirmed by a recombinant immunoblot assay. Repeatedly seropositive donors were further studied for risk factors, history for hepatitis, hepatic enzymes (aspartate aminotransferase and alanine aminotransferase (AST and ALT)), liver histology and hepatitis C virus–ribonucleic acid (HCV–RNA) detection. Results: A total of 499 blood donors were initially tested positive doubtful for antibodies to HCV Ab (0.8%). While there was no difference in HCV prevalence with respect to age or gender, the most frequent risk factors identified were transfusion (42%), household exposure (14.8%), multiple sex partner (6.8%) and intranasal cocaine use (2.3%). Also, we found that from a subgroup of donors tested for histological analysis, 19% presented abnormal ALT levels and 90% showed abnormal liver histology. No correlation was found between abnormal ALT levels and the presence of HCV–RNA in serum. Conclusion: These results demonstrate a low prevalence (0.8%) of HCV infection among Western Mexican blood donors, which was comparable to those established for Western countries, but in contrast in our study the most frequent risk factor continues being transfusion followed by household exposure.     

HCV RNA in serum of asymptomatic blood donors involved in post-transfusion hepatitis (PTH).

A group of blood donors involved in post-transfusion hepatitis was investigated for the presence of the anti-HCV antibody and of HCV RNA as a more direct infection marker. RNA was extracted from serum, reverse transcribed and amplified using primers which belonged to the non structural region. The amplified product of the PCR reaction was 582 base pairs. Seven (25.9%) of the 27 blood donors examined were found anti-HCV-positive by ELISA; five (71.4%) of these were HCV RNA positive. Among the 20 anti-HCV-negative blood donors, four (20.0%) were HCV RNA positive. ALT levels were below 45 UI/l in 18 donors, while the other nine had ALTs over the limit accepted for transfusion. The anti-HCV-negative HCV RNA-positive blood donors had normal ALTs. Our study offers a direct explanation for the substantial proportion of residual cases of anti-HCV-positive post-transfusion hepatitis and suggests the necessity of creating a register of blood donors who have at some time presented blood enzyme abnormalities and for whom second level investigations such as HCV RNA should be used.     

输血后丙型肝炎病毒感染的血清病毒定量研究

目的 研究血清丙型肝炎病毒（ＨＣＶ）含量与ＨＣＶ致病的关系及ＨＣＶ含量与抗－ＨＣＶ和丙氨酸转氨酶（ＡＬＴ）的相关性。方法 以逆转录－聚合酶链反应（ＲＴ－ＰＣＲ）法对ＨＣＶ感染的受血及相关供血系列血清进行ＨＣＶ ＲＮＡ定量分析,同时检测ＡＬＴ与抗－ＨＣＶ。结果 致输血后ＨＣＶ感染的供血中,ＨＣＶ ＲＮＡ平均含量为１０＾８．６拷贝／Ｌ,抗－ＨＣＶ及ＡＬＴ的异常检出率随ＨＣＶ ＲＮＡ滴度升高而增加。结论     

Natural history of hepatitis C virus carriers with persistently normal aminotransferase levels

BACKGROUND & AIMS: Some patients with serum hepatitis C virus (HCV) have persistently normal aminotransferase (ALT) levels and are affected by cirrhosis. This study prospectively evaluated progression of the disease in a group of anti-HCV-positive patients with persistently normal ALT levels. METHODS: Thirty-seven subjects were studied. Each subject underwent liver biopsy at baseline and after 5 years of follow-up. At baseline, serum samples were tested for genotypes and HCV RNA load. ALT levels and serum HCV RNA were tested every other month and every 6 months, respectively. Patients with increased ALT were discharged from the study and treated with IFN. Five years after the end of IFN therapy, a liver biopsy was performed. RESULTS: Liver biopsy at baseline showed chronic hepatitis in 34 patients and normal histology in 3 patients, 2 of whom were negative for HCV RNA and 1 positive. HCV genotypes were distributed as follows: 2a, 56%; 1b, 41%; and 1a, 3%. At the end of 7-year follow-up, 73% of the patients still had normal ALT values. Liver histology after 5 years was comparable to that observed at entry to study. CONCLUSIONS: Most patients with persistently normal ALT serum levels have very mild chronic hepatitis. However, healthy anti-HCV-positive subjects exist. In patients with HCV-related chronic hepatitis associated with persistently normal ALT levels, the grade of disease activity does not increase over years and progression to cirrhosis is slow or absent.     

TT virus and hepatitis G virus infections in Korean blood donors and patients with chronic liver disease

AIM: To determine the prevalences of TTV and HGV infections among blood donors and patients with chronic liver disease in Korea, to investigate the association of TTV and HGV infections with blood transfusion, and to assess the correlation between TTV and HGV viremia and hepatic damage. METHODS: A total of 391 serum samples were examined in this study. Samples were obtained from healthy blood donors (n=110), hepatitis B surface antigen (HBsAg)-positive donors (n=112), anti-hepatitis C virus (anti-HCV)-positive donors (n=69), patients with type B chronic liver disease (n=81), and patients with type C chronic liver disease (n=19). TTV DNA was detected using the hemi-nested PCR. HGV RNA was tested using RT-PCR. A history of blood transfusion and serum levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were also determined. RESULTS: TTV DNA was detected in 8.2 % of healthy blood donors, 16.1 % of HBsAg-positive donors, 20.3 % of anti-HCV-positive donors, 21.0 % of patients with type B chronic liver disease, and 21.1 % of patients with type C chronic liver disease. HGV RNA was detected in 1.8 % of healthy blood donors, 1.8 % of HBsAg-positive donors, 17.4 % of anti-HCV-positive donors, 13.6 % of patients with type B chronic liver disease, and 10.5 % of patients with type C chronic liver disease. The prevalence of TTV and HGV infections in HBV- or HCV-positive donors and patients was significantly higher than in healthy blood donors (P<0.05), except for the detection rate of HGV in HBsAg-positive donors which was the same as for healthy donors. There was a history of transfusion in 66.7 % of TTV DNA-positive patients and 76.9 % of HGV RNA-positive patients (P<0.05). No significant increase in serum ALT and AST was detected in the TTV- or HGV-positive donors and patients. CONCLUSION: TTV and HGV infections are more frequently found in donors and patients infected with HBV or HCV than in healthy blood donors. However, there is no significant association between TTV or HGV infections and liver injury.     

Epidemiology,serological markers,and hepatic disease of anti-HCV ELISA-2-positive blood donors

The epidemiology associated with hepatitis C virus (HCV) infection, serologic reactivity, and hepatic disease related to anti-HCV-positive donors of Granada were researched. From 1990 through 1993, medical and epidemiological information and anti-HCV and HCV RNA testing were evaluated in 46,741 blood donors. Serum samples were obtained for anti-HCV ELISA and RIBA and HCV RNA determination. A liver biopsy was conducted in all anti-HCV positives by confirmatory second-generation RIBA to analyze the hepatic lesion and the presence of HCV RNA. The anti-HCV prevalence was 1.12%. A total of 228 anti-HCV second-generation ELISA positive blood donors were analyzed. Intrafamiliar transmission rate was 1.7%. Transfusion and intravenous drug abuse (IVDA) antecedents were associated with a higher risk of seroconversion. A RIBA-positive result was related to high second- and third-generation ELISA ratios (90%), HCV RNA positivity (89%), and elevated alanine aminotransferase (ALT) levels (88%). Approximately 50% of donors with normal ALT levels had high ELISA ratios and second-generation RIBA and HCV RNA positive results. Of the second-generation RIBA indeterminate results, 42% and 82% of the c22 and 33% and 100% of the c100 reactivities were third-generation RIBA and HCV RNA positive, respectively. Liver biopsy was conducted in 85 donors, 74% of whom had a chronic hepatitis and 83% had detectable HCV RNA levels. Chronic hepatitis was diagnosed in 88% vs 43% of donors with elevated and normal alanine aminotransferase levels, respectively. ELISA and confirmatory HCV RNA determinations should be routinely employed in donor screening. A liver biopsy should be conducted in patients with elevated ALT levels and normal ALT levels when viremic.     

Prevalence and genotypes of hepatitis C virus infection among drug addicts and blood donors in Thailand

Hepatitis C virus (HCV) is an infectious agent that has the potential to cause chronic liver disease, cirrhosis and hepatocellular carcinoma. We determined the prevalence and genotypes of HCV infection among groups of drug addicts: intravenous drug users (n = 134), methamphetamine users (n = 100), inhaled-drugs users (n = 19) and alcoholics (n = 50); a group of blood donors acted as a control. The control group consisted of 179 randomly-selected anti-HCV positive samples: these were subjected to HCV RNA screening and genotyping. The anti-HCV test was performed by ELISA: HCV RNA screening was by nested RT-PCR that employed primers from the 5' noncoding region. The genotype assay was based upon analysis of the 5' NCR amplified sequences and RFLP. Hepatitis C virus was highly prevalent among all groups of drug addicts (12-70%). In 2000. among the new blood donors (n = 66,340) at the National Blood Center, Thai Red Cross, anti-HCV prevalence amounted to 0.98%. The HCV genotype distribution showed that the most prevalent genotype was 3a, followed by 1b and 6a. Our data demonstrated the very high prevalence of HCV infection in IVDUs, a finding that is consistent with the blood-borne nature of the virus. In order to curb HCV infection, a determined effort to educate both the general population and high-risk groups is required; such a program of education would address both general and particular methods of transmission, especially the use of non-sterile needles etc.     

Prevalence of antibodies to hepatitis C (anti HCV) in blood donors in Rio de Janeiro, Brazil. Its relation to ALT and anti HBC]

We have studied 933 volunteer blood donors from May to July, 1990. After a interview and screening tests for syphilis, Chagas disease, malaria and HIV, they underwent an enzyme immunoassay for HBsAg, anti HBc and anti HCV antibodies. Alanine aminotransferase (ALT) serum levels were determined by auto analyser. Most blood donors were male with mean age of 33 years (19-65). Anti HCV prevalence was 3.1% (29 from 933 blood donors). Among anti HCV+, blood donors, 44.8% (13/29) had ALT 40 UI/L, 31% (9/29) were anti HBc+ and 17.2% (5/29) had both surrogate markers simultaneously. From 109 donors with ALT 40 UI/L, 13 (11.9%) were anti HCV+, while among 153 anti HBc+ donors, the anti HCV was 5.8%. Conclusions: 1) we found a higher anti HCV prevalence among our blood donors than previous published reports from other countries; 2) our data show that surrogate assays do not adequately identify anti HCV blood donors, 41.4% of them would not have been excluded by anti HBc and ALT tests alone; 3) there were a correlation between anti HCV positivity with a sample to cutoff optical density ratio equal or greater than 4 and elevated ALT serum levels.     

A Study of Hepatitis C Virus Antibodies and Serum Alanine Amino Transferase in Blood Donors in Hong Kong Chinese

The reference range of serum alanine amino transferase (ALT) for the local population was established by testing 5,000 random voluntary Chinese blood donors of various age groups of both sexes. In addition, 1,769 serum samples with elevated ALT levels were also collected for anti-HCV assays using both the Abbott and Ortho anti-hepatitis C virus (HCV) assay kits. The relationship between serum ALT and anti-HCV tests was studied and the performances of both kits used were compared. It was found that while the prevalence of serum anti-HCV was 0.4% among hepatitis B surface antigen-negative donors with normal ALT, subjects with ALT between 2 and 3 standard deviations (SD) and greater than 3 SD above the mean level had respective prevalence of anti-HCV 3 and 9.5 times that of the normal ALT subjects. Both anti-HCV kits were found to identify in majority the same positive population among the different groups of subjects studied. In addition, it was observed that for subjects who were anti-HCV-positive, the higher the serum ALT level, the higher the mean anti-HCV ELISA ratio and this observation was similar for both anti-HCV kits used. We conclude that: (1) there is a direct relationship between serum ALT level and anti-HCV positivity by EIA; (2) there is a direct correlation between serum ALT level and anti-HCV ELISA ratio, and (3) both Abbott and Ortho anti-HCV kits perform similarly in the identification of positive serum samples.     

Relationship between genotypes of hepatitis C virus and histopathological manifestations in chronic hepatitis C patients

OBJECTIVE: The aim of this study was to assess the relationship between HCV genotype and histological liver injury. DESIGN: Prospective study on a cohort of patients with biopsy proven chronic hepatitis C. SETTING: University medical centre. PARTICIPANTS: Enrolled were 324 consecutive patients (male 197, median age 52 years, range 19-68; chronic hepatitis, 224; cirrhosis, 100). METHODS: HCV genotype was determined by the INNO LiPA assay and HCV RNA levels by the bDNA assay. The histological features were scored according to the histology activity index. RESULTS: The distribution of HCV genotypes was 1a, 4.6%; 1b, 52.4%; 2a/c, 27%; 3a, 8%; 4, 2%; mixed, 6%. Serum HCV RNA levels were similar for all genotypes. There was no difference in the distribution of HCV genotypes between patients with chronic hepatitis and those with cirrhosis. Patients with genotype 1b and those with type 2a/c showed a similar prevalence of cases of cirrhosis (33% versus 31%, respectively). In addition, in a subgroup of 102 patients with an established date of infection, the progression to cirrhosis occurred with a similar length of time for HCV type 1b and 2a/c (median 16 versus 15 years, respectively). Patients with HCV genotype 2a/c or mixed genotype showed a higher histology activity index than those with type 1b (P< 0.01), whereas there was no difference in the fibrosis score for the different genotypes. Patients with genotype 3a showed a significantly higher prevalence of steatosis compared to those infected with other genotypes. Alanine aminotransferase (ALT) values were higher in patients with HCV type 2a/c, 3a and mixed genotype than those with type 1 (P < 0.002). CONCLUSIONS: The data indicate that there is no association between a particular HCV genotype and the progression to cirrhosis, and that specific genotypes are associated with distinct histopathological and biochemical manifestations although none of them is correlated with an increase of the fibrosis stage.     

慢性丙型肝炎患者病毒基因分型与血清HCV RNA水平的关系探讨

目的研究HCV基因型的分布,以探讨不同基因型感染者血清HCV RNA载量的差异。方法采用PCR法检测218例慢性丙型肝炎患者血清HCV RNA;采用ELISA法检测抗-HCV抗体;使用全自动生化分析仪测定丙氨酸氨基转移酶;采用化学发光免疫分析法测定血清肝纤维化指标;采用基因芯片法进行HCV基因分型。结果在218例HCV RNA阳性血清中共检出9种基因型,分别是lb、2a、3a、3b、6型单基因型共208例和lb+2a、lb+3b、lb+6型、2a+3a共10例四种混合基因型,其中以lb型168例(77.1%)、2a型19例(8.7%)为主;在208例HCV单基因型感染患者中发现不同基因型感染者血清HCV RNA载量无统计学差异(F=0.932,P>0.05);在168例1b基因型和40例非lb基因型感染者,性别差异无统计学意义(x2=0.857,P>0.05),两型感染者之间肝纤维化指标差别比较也无统计学意义。结论我国HCV基因型以lb型为主,基因型与HCV RNA载量及ALT水平之间无相关性。     

Hepatocellular carcinoma in Sweden: its association with viral hepatitis, especially with hepatitis C viral genotypes

Viral markers of chronic hepatitis were tested for in 95 frozen serum samples from 299 patients from Malm?, Sweden, with hepatocellular carcinoma (HCC), diagnosed between 1977 and 1994. Hepatitis B analysis included anti-HBc, HBsAg and, if anti-HBc positive, HBV DNA. Hepatitis C infection analysis included anti-HCV screening, RIBA, HCV RNA and HCV genotyping. HCV genotyping was also carried out in 9 HCV-viraemic HCC-patients from Gothenburg. HCV genotype distribution in HCC cases was compared with Swedish HCV-infected blood donors. Among the 95 patients from Malm?, 28 (29%) had anti-HBc, but only 5 (5%) were chronic HBV carriers, compared with 16 (17%) with chronic hepatitis C (p = 0.021). HCV-related HCC was more common among immigrants (8/16 vs. 8/79; p < 0.001). Genotyping of 25 HCV-infected cases showed genotype 1a in 6 (24%), genotype 1b in 13 (52%), genotype 2b in 4 (16%), and genotype 3a in 2 (8.0%) patients. Genotype 1b was more common among HCC patients than among blood donors (p < 0.001), but 8 of 13 genotype 1b-infected patients were from countries where genotype 1b is predominant. Among native Swedes there was no difference between the HCV genotypes infecting blood donors and those found in HCC patients.     

干扰素联合利巴韦林治疗慢性丙型肝炎患者的疗效

目的 研究昆明地区HCV感染者的病毒基因型分布,观察干扰素和利巴韦林联合治疗慢性丙型肝炎的疗效。 方法 采集60例慢性丙型肝炎患者的血液样品,采用特异性探针杂交法进行HCV基因分型,根据基因分型结果将患者分为HCV 1b型感染的长效干扰素治疗组（皮下注射聚乙二醇干扰素α-2a 180μg,1次/周）和非1b型感染的普通干扰素治疗组（皮下注射普通干扰素α-1b50μg,隔日1次）,两组患者均口服利巴韦林,剂量为900 ～ 1200 mg/d。治疗前后和随访中检测患者血浆HCV RNA和ALT水平作为疗效评价的指标。用x2检验比较治疗结束后HCV 1b基因型与HCV非1b基因型感染患者肝功能异常率的差异。结果 60例患者的血液样本中,HCV 1b基因型感染患者13例(21.7％),HCV 2a基因型3例(5.0％),HCV 3a基因型10例(16.7％),HCV 3b基因型29例(48.3％),HCV 6a基因型5例(8.3％);60例患者均完成治疗48周,长效干扰素治疗组和普通干扰素治疗组获得持续病毒学应答率分别为46.1％、74.5％;获得早期病毒学应答的患者全部获得持续病毒学应答。长效干扰素治疗组和普通干扰素治疗组在治疗后肝功能仍异常的患者分别占15.4％、14.9％,两组比较,x2=0.01,P＞0.05,差异无统计学意义。结论 (1)昆明地区HCV感染基因型以3b和1b为主;(2)聚乙二醇干扰素α-2a联合利巴韦林治疗HCV 1b型感染患者的疗效不理想;(3)早期病毒学应答是获得持续病毒学应答的重要预测因素。     

Genotype distribution in Nagoya and new genotype (genotype 3a) in Japanese patients with hepatitis C virus

We evaluated hepatitis C virus (HCV) genotype distribution among Japanese patients in the city of Nagoya and the possible existence of any other genotype not determined by Okamoto's method. Eighty-five of 93 (91.4%) anti-HCV-positive patients had detectable HCV RNA. The genotype of the HCV isolate was determined in 84 of 85 (98.8%) of these HCV RNA-positive patients by Okamoto's method but determination was not possible in one (1.2%). Genotype 1b was detected in 58 of the 85 patients (68.2%), genotype 2a in 20 (23.5%), genotype 2b in 3 (3.5%), and genotype 1b+2a in 3 (3.5%). In the remaining 1 patient in whom the genotype could not be determined, we determined the nucleotide sequence of the core region in HCV RNA extracted from this patient and evaluated it by molecular evolutionary analysis. This HCV isolate was then classified as genotype 3a. These results suggest that genotype 3a is rare among Japanese patients with HCV; thus, when classifying Japaneses isolates, we should take more care because genotype 3a is not determined by current typing systems.     

Prevalence of Anti-Hepatitis C Virus in the Blood Donor Population of Rio de Janeiro

The prevalence of hepatitis C virus (HCV) antibodies in 2,557 asymptomatic volunteer Brazilian blood donors is reported. Using the line immunoassay (Inno-LIA) as a confirmatory test on ELISA anti-HCV-positive reacting sera, a prevalence rate of 2.7% for anti-HCV positivity was found. By comparison, prevalences of 1.6% for hepatitis B surface antigen, 0.9% for Treponema pallidum , 0.4% for human immunodeficiency virus and 0,04% for Trypanosoma cruzi were observed. Only 57% of the HCV-positive donors had elevated alanine aminotransferase (ALT) levels. Using previous criteria, based on surrogate markers (ALT ≥ 50 IU/1 and for anti-hepatitis B core antibody), for HCV infection at that time, only 25% of the HCV-positive donations would have been eliminated. In view of the high prevalence of anti-HCV reactivity among the Brazilian blood donor population and the poor reliability of surrogate markers, it is recommended that routine screening for anti-HCV in Brazilian blood donors is introduced.     

Clinical characteristics and distribution of genotypes of TT virus infection in a hepatitis C virus-hyperendemic township of a hepatitis B virus-endemic country (Taiwan)

BACKGROUND: The prevalence of TT virus (TTV) viremia, without definite clinical significance, has been reported to be higher among chronic hepatitis C patients. The status and clinical characteristics of TT virus (TTV) infection and distribution of TTV genotypes in a hepatitis C virus (HCV) hyperendemic township (Masago community) in a hepatitis B virus (HBV) endemic country (Taiwan) were investigated. METHODS: Sera from 100 Masago residents were tested for alanine aminotransferase (ALT) and markers of HBV, HCV and GB virus C/hepatitis G virus (GBV-C/HGV) and TTV-DNA. Sera of 250 blood donors as a control group were tested for TTV-DNA. Sera of Masago residents and blood donors with positive TTV-DNA were directly sequenced, and phylogenetic analyses were performed subsequently. RESULTS: The prevalences of TTV viremia in different age groups among individuals from Masago were significantly higher than that among blood donors. In regard to the subtypes of TTV, 23, seven, two, eight, one, six and one isolate were related to the genotypes 1a, 1b, 2a, 2b, 3, 4 and 5, respectively, from Masago and 21, 14, one, nine and three isolates were related to the genotypes 1a, 1b, 2a, 2b, and 4, respectively, from donors. No clinical or virological factor was associated with TTV viremia or TTV genotypes. CONCLUSIONS: TT Virus prevalence was higher among HCV hyperendemic township residents than blood donors with similar genotype distributions (genotype 1 was the most prevalent) in Taiwan. Neither TTV viremia nor a particular genotype was associated with HBV, HCV or GBV-C/HGV infection and abnormal ALT levels.     

Prevalence of hepatitis C virus infection among female prostitutes in Fukuoka,Japan

To assess the risk of sexual transmission of hepatitis C virus (HCV), we surveyed female prostitutes to determine the prevalence of antibody to HCV (anti-HCV) and HCV RNA. Anti-HCV was examined with a second generation anti-HCV test employing a passive hemagglutination assay. HCV RNA was detected by two-stage polymerase chain reaction with primers deduced from the 5′-noncoding region of the HCV genome. All studies were performed in Fukuoka, Japan, from 1989 through 1992 and all subjects were Japanese and had no history of intravenous drug abuse. The prevalence of anti-HCV was significantly higher in the prostitutes (10.1%; 61/604) than in the controls (female blood donors; 0.8%; 52/6632) (P<0.001). HCV RNA was found in 73.2% of the anti-HCV-positive prostitutes. The prevalence of anti-HCV among prostitutes increased with the number of years spent in prostitution (P<0.05). Prostitutes with a history of syphilis had a higher prevalence of anti-HCV than those with no history of syphilis, irrespective of the number of years in prostitution. In a longitudinal study of 244 prostitutes, 2 of the 218 initially seronegative subjects showed anti-HCV and HCV RNA over the study period of 3 years. These two persons had no history of percutaneous exposure. Sexual transmission of HCV presents a risk for female prostitutes.