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Pastore L, Fiore J, Tateo M, Benedittis MDE, Petruzzi M, Casalino C, Genchi C, Muzio LLO, Angarano G, Serpico R. Detection of Hepatitis C Virus-RNA in Saliva from Chronically HCV-Infected Patients. Int J Immunopathol Pharmacol 2018. [DOI: 10.1177/205873920601900122] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The possibility of the non-parenteral Hepatitis C Virus (HCV) transmission is supported by the demonstration that the actual virus is present in several body fluids, including saliva. From a review of the literature many investigators have found the presence of HCV-RNA in saliva, however, widely contrasting results emerge, with detection rates ranging from 0–100%. To further examine HCV salivary shedding, saliva samples were collected from 46 chronically HCV-infected patients and tested for HCV-RNA and occult blood. Quantification and genotyping of serum HCV-RNA were also carried out for each patient. HCV-RNA was detected in 39.13% of the saliva samples. The viral salivary shedding was significantly related to viraemia levels, serum viral genotype and the presence of salivary occult blood. Our findings indicate that the HCV salivary shedding occurs in about one third of HCV-infected patients, but seem to suggest that it is unlikely when the serum viral genotype is 3a. Moreover, blood leakage into the oral cavity is possibly the main source of the salivary HCV-RNA. Although the occurrence of the viral salivary shedding does not necessarily mean that HCV trasmission occurs by saliva, our results suggest the need for further investigations into the biological factors possibly involved in HCV mucosal transmission related to both the source and the exposed subjects.
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Affiliation(s)
- L. Pastore
- Department of Odontostomatology and Surgery, University of Bari
| | - J.R. Fiore
- Department of Clinical Medicine, Immunology and Infectious Diseases, University of Bari
- Department of Medical Sciences, University of Foggia
| | - M. Tateo
- Department of Clinical Medicine, Immunology and Infectious Diseases, University of Bari
| | | | - M. Petruzzi
- Department of Odontostomatology and Surgery, University of Bari
| | - C. Casalino
- Clinic of Infectious Diseases, Polyclinic of Bari
| | - C. Genchi
- Clinic of Infectious Diseases, Polyclinic of Bari
| | - L. LO Muzio
- Department of Surgical Sciences, University of Foggia, Italy
| | - G. Angarano
- Department of Medical Sciences, University of Foggia
| | - R. Serpico
- Department of Odontostomatology and Surgery, University of Bari
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2
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Hooshmand B, Alavian SM, Kouhestani F, Firouzmandi M, Motamedian SR. Detection of Hepatitis C Virus RNA in Blood and Saliva of Transfusion-Dependent Thalassemia Patients Diagnosed with Hepatitis C. Contemp Clin Dent 2018; 9:5-9. [PMID: 29599575 PMCID: PMC5863410 DOI: 10.4103/ccd.ccd_297_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background: The aim of the current study was to detect hepatitis C virus (HCV) RNA in blood and saliva of a population of patients with thalassemia who have HCV antibody in their serum. Materials and Methods: In this cross-sectional study, blood and saliva samples were collected and were analyzed with quantitative reverse transcription polymerase chain reaction (RT-PCR) for the detection of HCV RNA. In addition, liver-related blood tests were performed, and patients’ medical history was recorded. Data were analyzed by independent samples t-test and Chi-square with a significant level of 0.05. Results: Overall, 62 adult patients (29 males and 33 females) were included. Most (87%) of the patients had major thalassemia and genotype 1a was the most common (42%) type. HCV RNA was detected in 71 and 16% of blood and saliva samples, respectively. HCV RNA was detected more in female patients (31%) (P = 0.003) and in intermediate thalassemia (50%) (P < 0.005). The mean age of the patients with positive saliva was almost 10 years older (P < 0.001), and the mean number of blood transfusion was fewer in positive saliva group (P = 0.037). The sensitivity, specificity, and positive and negative predictive values of saliva PCR was calculated to be 18%, 88%, 80%, and 69%, respectively. Conclusion: Saliva contained HCV RNA in 16% of the assessed population. The probability of detection of HCV RNA in saliva increased in older patients, less number of blood transfusions, females and intermediate thalassemia. Saliva RT-PCR demonstrated low sensitivity and high specificity with high positive predictive value in the assessed population.
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Affiliation(s)
- Behzad Hooshmand
- Department of Periodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Moayed Alavian
- Baqiyatallah Research Center for Gastroenterology and Liver Disease, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Farnaz Kouhestani
- Department of Periodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Firouzmandi
- School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeed Reza Motamedian
- Department of Orthodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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3
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Pfaender S, Helfritz FA, Siddharta A, Todt D, Behrendt P, Heyden J, Riebesehl N, Willmann W, Steinmann J, Münch J, Ciesek S, Steinmann E. Environmental Stability and Infectivity of Hepatitis C Virus (HCV) in Different Human Body Fluids. Front Microbiol 2018; 9:504. [PMID: 29636728 PMCID: PMC5881408 DOI: 10.3389/fmicb.2018.00504] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 03/05/2018] [Indexed: 12/11/2022] Open
Abstract
Background: Hepatitis C virus (HCV) is a hepatotropic, blood-borne virus, but in up to one-third of infections of the transmission route remained unidentified. Viral genome copies of HCV have been identified in several body fluids, however, non-parental transmission upon exposure to contaminated body fluids seems to be rare. Several body fluids, e.g., tears and saliva, are renowned for their antimicrobial and antiviral properties, nevertheless, HCV stability has never been systematically analyzed in those fluids. Methods: We used state of the art infectious HCV cell culture techniques to investigate the stability of HCV in different body fluids to estimate the potential risk of transmission via patient body fluid material. In addition, we mimicked a potential contamination of HCV in tear fluid and analyzed which impact commercially available contact lens solutions might have in such a scenario. Results: We could demonstrate that HCV remains infectious over several days in body fluids like tears, saliva, semen, and cerebrospinal fluid. Only hydrogen-peroxide contact lens solutions were able to efficiently inactivate HCV in a suspension test. Conclusion: These results indicate that HCV, once it is present in various body fluids of infected patients, remains infective and could potentially contribute to transmission upon direct contact.
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Affiliation(s)
- Stephanie Pfaender
- Institute of Virology and Immunology, Mittelhäusern, Switzerland.,Department of Infectious Diseases and Pathobiology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Fabian A Helfritz
- Department of General, Visceral and Transplantation Surgery, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Anindya Siddharta
- Institute of Experimental Virology, TWINCORE-Centre for Experimental and Clinical Infections Research, a joint venture between the Hannover Medical School and the Helmholtz Centre for Infection Research, Hanover, Germany
| | - Daniel Todt
- Institute of Experimental Virology, TWINCORE-Centre for Experimental and Clinical Infections Research, a joint venture between the Hannover Medical School and the Helmholtz Centre for Infection Research, Hanover, Germany.,Department of Molecular and Medical Virology, Ruhr-University Bochum, Bochum, Germany
| | - Patrick Behrendt
- Institute of Experimental Virology, TWINCORE-Centre for Experimental and Clinical Infections Research, a joint venture between the Hannover Medical School and the Helmholtz Centre for Infection Research, Hanover, Germany.,Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hanover, Germany
| | - Julia Heyden
- Institute of Experimental Virology, TWINCORE-Centre for Experimental and Clinical Infections Research, a joint venture between the Hannover Medical School and the Helmholtz Centre for Infection Research, Hanover, Germany
| | - Nina Riebesehl
- Institute of Experimental Virology, TWINCORE-Centre for Experimental and Clinical Infections Research, a joint venture between the Hannover Medical School and the Helmholtz Centre for Infection Research, Hanover, Germany
| | - Wiebke Willmann
- Institute of Experimental Virology, TWINCORE-Centre for Experimental and Clinical Infections Research, a joint venture between the Hannover Medical School and the Helmholtz Centre for Infection Research, Hanover, Germany
| | - Joerg Steinmann
- Institute of Medical Microbiology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany.,Institute for Clinical Hygiene, Medical Microbiology and Clinical Infectiology, Paracelsus Medical Private University, Nürnberg Hospital, Nürnberg, Germany
| | - Jan Münch
- Institute of Molecular Virology, Ulm University Medical Center, Ulm, Germany
| | - Sandra Ciesek
- Institute for Virology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Eike Steinmann
- Institute of Experimental Virology, TWINCORE-Centre for Experimental and Clinical Infections Research, a joint venture between the Hannover Medical School and the Helmholtz Centre for Infection Research, Hanover, Germany.,Department of Molecular and Medical Virology, Ruhr-University Bochum, Bochum, Germany
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4
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Amado Leon LA. Saliva specimen sampling: a noninvasive method for diagnosis and basic investigation of viral hepatitis A, B and C. Future Virol 2013. [DOI: 10.2217/fvl.13.41] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Saliva is a biological fluid that is easy to collect and manipulate. Collection of saliva samples is less expensive, noninvasive and painless compared with blood collection. Due to these advantages, saliva has been investigated as an alternative fluid to serum for diagnostic and epidemiological purposes. The aim of this article was to the review research on salivary biomarkers of viral hepatitis A, B and C, highlighting their current use, collection devices, and potential applications for diagnosis and epidemiological studies. This paper also explores recent findings of saliva as a possible source of viral hepatitis transmission.
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Affiliation(s)
- Luciane Almeida Amado Leon
- Laboratory of Technological Development in Virology, Institute Oswaldo Cruz – Fiocruz, Av. Brasil 4365, Rio de Janeiro, 21045-900, Brazil
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5
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Correlation of hepatitis C antibody levels in gingival crevicular fluid and saliva of hepatitis C seropositive hemodialysis patients. Int J Dent 2009; 2009:247121. [PMID: 20309410 PMCID: PMC2837414 DOI: 10.1155/2009/247121] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2009] [Revised: 07/04/2009] [Accepted: 08/03/2009] [Indexed: 01/21/2023] Open
Abstract
Search for hepatitis C virus (HCV) in body fluids other than blood is important when assessing possible nonparenteral routes of viral transmission. However, the role of oral fluids in HCV transmission remains controversial. Our aim was to compare the prevalence of HCV antibody (HCV Ab) levels in saliva, and gingival crevicular fluid (GCF) of HCV seropositive hemodialysis patients. Serum, saliva and GCF samples were collected from thirty-nine patients. Samples were analyzed for HCV Ab using the Ortho HCV 3.0 SAVe enzyme-linked immunosorbent assay (ELISA). HCH Ab levels in saliva and GCF of all HCV-seropositive patients were statistically compared. Reported here are the results of the study designed to determine the correlation between HCV-RNA positivity in serum and the detection of antibodies in GCF and saliva. One hundred percent (100%) of the 39 patients have antibodies to HCV in their serum, 15.4% have antibodies to HCV in GCF, and saliva found out. HCV Ab seropositivity in GCF and saliva was significantly correlated (kappa = 0.462; P < .001). This study supports the concept that GCF may be a significant source of HCV in saliva.
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6
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Aykin N, Cevik F, Demirturk N, Demirdal T, Orhan S, Naz H. Anti-HCV positivity in sexual partners and offspring of patient with chronic hepatitis C. ACTA ACUST UNITED AC 2008; 40:533-7. [PMID: 18584543 DOI: 10.1080/00365540701867313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We investigated the seroprevalence of HCV in stable sexual partners and offspring of chronic hepatitis C patients, and aimed to determine the risk factors involved. 191 anti-HCV and HCV RNA positive subjects who coinhabited with their spouse and/or offspring were included. Risk factors of index cases for disease transmission, liver biopsy results, anti-HCV and HCV-RNA in spouses and/or offspring were evaluated. Together with index cases, a total of 404 family members including 174 stable sexual partners and 230 offspring were included. The most common risk factors among index cases were dental procedures (73.8%), history of surgery (64.9%), and blood transfusions (24.1%). Anti-HCV positivity was established in 11 (2.7%) of the total 404 family contacts--6 sexual partners and 5 offspring. HCV seropositivity was significantly higher in the spouses of index cases with severe hepatitis C compared to those with mild to moderate hepatitis C (p=0.008), but there was no statistically significant correlation between the severity of liver disease in index cases and anti-HCV positivity in their offspring. In conclusion, anti-HCV seropositivity in the spouses and children of patients who are HCV-RNA positive HCV carriers does not appear to be higher than the HCV seroprevalence in our country.
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Affiliation(s)
- Nevil Aykin
- Yunus Emre State Hospital, Clinics of Infectious Diseases, Eskisehir, Turkey.
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7
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Hajiani E, Masjedizadeh R, Hashemi J, Azmi M, Rajabi T. Hepatitis C virus transmission and its risk factors within families of patients infected with hepatitis C virus in southern Iran: Khuzestan. World J Gastroenterol 2006; 12:7025-8. [PMID: 17109499 PMCID: PMC4087348 DOI: 10.3748/wjg.v12.i43.7025] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine whether hepatitis C virus (HCV) infection of index cases increases intrafamilial transmission (sexual and nonsexual contacts) of HCV.
METHODS: In a case-control descriptive study we enrolled 300-household contacts of 60 index cases (40 males and 20 females) of HCV infection and 360 pair-matched controls in Ahwaz JundiShapour University Hospitals from August 1, 1998 to September 1, 2003. The control group consisted of first time blood donors referred to the Regional Blood Transfusion Organization. Serum samples and demographic data and a medical history including the existence of risk factors for HCV (after a questionnaire on the risk factors for parenteral exposure) were obtained from each subject. Antibodies to HCV were detected employing a commercially available second-generation enzyme immunoassay (EIA, Abbott II). Positive serum specimens were retested using a second-generation recombinant immunoblot assay (RIBA-2) and a polymerase chain reaction for HCV RNA. Data analysis was carried out for intra-household clustering.
RESULTS: Only 4 of 300 (1.33%) cases of household contacts without percutaneous risk factors were positive for HCV Ab while the remaining 296 family contacts were negative for anti-HCV. The mean age of the index cases was 28.4 (Std 15.22) years. The anti-HCV prevalences in parents, spouses, children of the index cases were 0.87% (1/115), 3.39% (2/59)) and 0.79% (1/126), respectively. Among couple partners negative for anti-HCV antibodies, the mean duration of the sexual relationship was 6 years. The two-couple partners positive for anti-HCV antibodies married the index cases for longer than 15 years. The prevalence of positive HCV Ab among household contacts (1.33%) was not significantly higher than that in the controls (1%) (P > 0.06).
CONCLUSION: Intrafamilial transmission of HCV is not the significant transmission route and sexual transmission does not seem to play a role in the intrafamilial spread of HCV infection. Intrafamilial transmission of HCV is possible but occurs at a low rate.
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Affiliation(s)
- Eskandar Hajiani
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Golestan Hospital, Ahwaz Jundishapur University of Medical Sciences, PO Box 89, Ahwaz, Iran.
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8
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Eirea M, Dios PD, Hermida M, Rodríguez I, Castro A, Ocampo A. Detection of HCV-RNA in saliva of HIV-HCV coinfected patients. AIDS Res Hum Retroviruses 2005; 21:1011-5. [PMID: 16379604 DOI: 10.1089/aid.2005.21.1011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The presence of HCV-RNA in saliva of patients with chronic hepatitis C provides a biological basis for the potential transmission of this virus. HCV viremia is particularly high in HCV-HIV-coinfected patients, which could favor the presence of HCV in their saliva. This study was designed to evaluate the prevalence of HCV in saliva of HCV-HIV-coinfected patients. Stimulated whole saliva was collected from 75 HCV-HIV-coinfected patients and 75 HCV controls. The presence of HCV-RNA in saliva was tested by a highly sensitive noncommercialized nested PCR, and analyzed in relation to demographic, clinical, and analytical variables. HCVRNA was detected in the saliva of 49 (65%) HCV-HIV-coinfected patients and 39 (52%) HCV controls. The presence of HCV in saliva was not related to any of the analyzed variables in HCV-HIV-coinfected patients. In the HCV control group a statistically significant relationship was demonstrated only between the detection of HCV-RNA in saliva and the viral load in peripheral blood (p < 0.001). Our results indicate that there is a trend toward a higher HCV-RNA prevalence in the saliva of HCV-HIV-coinfected patients.
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Affiliation(s)
- M Eirea
- School of Medicine and Dentistry, Santiago de Compostela University, Santiago, Spain
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9
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Suzuki T, Omata K, Satoh T, Miyasaka T, Arai C, Maeda M, Matsuno T, Miyamura T. Quantitative detection of hepatitis C virus (HCV) RNA in saliva and gingival crevicular fluid of HCV-infected patients. J Clin Microbiol 2005; 43:4413-7. [PMID: 16145085 PMCID: PMC1234063 DOI: 10.1128/jcm.43.9.4413-4417.2005] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The search for hepatitis C virus (HCV) in body fluids other than blood is important when assessing possible nonparenteral routes of viral transmission. However, the role of oral fluids in HCV transmission remains controversial. Here we quantitatively determined HCV RNA in saliva and gingival crevicular fluid (GCF) of anti-HCV-positive patients. Most patients (14 of 18; 78%) whose saliva specimens were negative had HCV RNA in their GCF. Most patients (20 of 26; 77%) had higher HCV RNA levels in their GCF than in their saliva. Although there was not a statistically significant correlation between the serum viral load and HCV level in saliva or GCF, patients with low serum HCV loads were less likely to have detectable HCV in their saliva. These findings have important implications for medical personnel and suggest that epidemiological studies designed to understand the significance of the oral route of transmission of HCV are warranted.
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Affiliation(s)
- Tetsuro Suzuki
- Department of Virology II, National Institute of Infectious Diseases, Shinjuku-ku, Tokyo, Japan.
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10
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Abstract
Saliva can contain a range of infectious agents and, despite several antimicrobial mechanisms, transmission of these can occur. Hepatitis C virus (HCV) is of increasing importance, and HCV is transmitted by unknown routes as well as by the percutaneous route and sexual contact. Contact with blood or other body fluids may be responsible, as may be receipt of unscreened blood or blood product transfusions. HCV-RNA can be detected by the polymerase chain reaction which also shows that HCV may be present in the saliva of HCV-infected patients. This might provide an argument for the possible transmission of HCV via contaminated saliva. Epidemiological studies however, suggest that the infective capacity of HCV viral particles in saliva is low, but it has not been possible to determine their infective potential. Moreover, HCV-specific receptors have not been defined on oral epithelial cells, nor has the role of host defence mechanisms been determined. New experimental animal models and the recently described infectious HCV pseudoparticles, capable of simulating HCV replication in vitro, could be useful in establishing any role of saliva in the transmission of HCV infection.
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Affiliation(s)
- M C Ferreiro
- School of Medicine and Dentistry, University of Santiago de Compostela, Spain
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11
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Castro Ferreiro M, Hermida Prieto M, Diz Dios P. [Sporadic transmission of hepatitis C in dental practice]. Med Clin (Barc) 2004; 123:271-5. [PMID: 15482736 DOI: 10.1016/s0025-7753(04)74485-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Percutaneous contact with contaminated blood is the principal mode of transmission of the hepatitis C virus (HCV). However, the diagnosis of infection in patients in whom no parenteral risk factor can be identified allows speculation on the existence of other routes of transmission. In the field of dentistry, the role of saliva has still not been defined as a potential vehicle for infection nor the role of dental treatment as a possible occult factor in the sporadic transmission of hepatitis C. HVC-RNA is detectable in the saliva of over 50% of patients with chronic hepatitis C. The infectivity of the HVC particles detected in the saliva has not been determined, though it may be deduced from epidemiological studies that their potential for transmission, if it exists, is extremely limited. There has been no documented case of HVC transmission in a dental clinic. Studies which propose a history of dental treatment as a risk factor for HVC infection have not achieved conclusive results. The age distribution of the prevalence of HVC could indicate that a risk of iatrogenic transmission existed in the past, before the systematic application of universal barriers. The transmission of HVC in dental clinics may be considered a very infrequent occurrence as long as the norms for the control of cross-infection are respected.
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Affiliation(s)
- Miguel Castro Ferreiro
- Departamento de Estomatología, Facultad de Medicina y Odontología, Universidad de Santiago de Compostela, Santiago de Compostela, A Coruña, España
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12
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Akhtar S, Moatter T, Azam SI, Rahbar MH, Adil S. Prevalence and risk factors for intrafamilial transmission of hepatitis C virus in Karachi, Pakistan. J Viral Hepat 2002; 9:309-14. [PMID: 12081609 DOI: 10.1046/j.1365-2893.2002.00350.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Household contacts of hepatitis C virus (HCV)-positive patients are considered at increased risk of HCV infection. This cross-sectional study during April through June 1999 assessed the prevalence and risk behaviours associated with HCV seropositivity among the household contacts of HCV seropositive thalassaemic children in Karachi, Pakistan. Among the 341 household contacts of 86 thalassaemic HCV seropositive children who were tested, 70 (20.5%) were positive for anti-HCV antibodies. The stratified analysis showed that HCV seroprevalence among the contacts did not differ significantly by the gender of the index patient and the type of relationship of contact with the index patient. However, HCV seroprevalences among the fathers and mothers of male index patients was substantially higher compared to those of female index patients. HCV RNA was recovered and genotyped from nine index patients and corresponding nine HCV-seropositive household contacts. HCV genotype 3a and 3b were found in 89% (8/9) and 11% (1/9) of the pairs, respectively. The final multivariable conditional logistic regression model revealed that after adjusting for the effect of ethnicity and past hospital admission history, the HCV-seropositive household contacts were more likely than HCV seronegative household contacts to have been bitten by the carrier [adjusted matched odds ratio (mOR)=2.6, 95% CI 1.3-5.2] or have shared a toothbrush with the carrier (adjusted mOR=8.2; 95% CI 1.56-43.5). Control efforts should focus on the risk behaviours.
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Affiliation(s)
- S Akhtar
- Department of Community Health Sciences, The Aga Khan University, Stadium Road, Karachi, Pakistan, Department of Pathology, The Aga Khan University, Stadium Road, Karachi, Pakistan.
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13
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Hermida M, Ferreiro MC, Barral S, Laredo R, Castro A, Diz Dios P. Detection of HCV RNA in saliva of patients with hepatitis C virus infection by using a highly sensitive test. J Virol Methods 2002; 101:29-35. [PMID: 11849681 DOI: 10.1016/s0166-0934(01)00417-7] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Hepatitis C virus (HCV) is transmitted primarily by direct percutaneous exposures to blood. Since HCV RNA has been found in saliva, it has been suggested that saliva might also be a source of infection. HCV RNA in saliva from plasma HCV RNA positive patients was tested by a highly sensitive PCR method. HCV RNA was detected in 32 out of 61 saliva specimens (52.4%). No correlation was found between the presence of HCV in saliva and age, sex, identified risk factors for HCV infection, time lapsed since the diagnosis, transaminases and alkaline phosphatase values and stimulated salivary flow. A statistically significant relation between plasma HCV RNA viral load and saliva HCV RNA detection was observed (P<0.001). In conclusion, HCV RNA is often present in saliva of HCV infected patients, with plasma viral load being the only known predictable factor. Further studies on salivary HCV RNA are needed.
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Affiliation(s)
- M Hermida
- Institute of Health Sciences, Juan Canalejo Hospital, La Coruña, Spain
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14
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Affiliation(s)
- W. Keith Paver
- PHLS North West, Public Health Laboratory, Withington Hospital, Manchester, UK; and
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15
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Abstract
Although many aspects of the transmission of HCV have been clarified, some important issues remain controversial, and the conventional wisdom may be based more on opinion than data (Table 2). HCV is transmitted by percutaneous exposure to contaminated blood, uncommonly from a mother to her infant and between sexual partners, and rarely during the provision of medical care in developed nations. Improved behavioral research instruments are needed to further the understanding of the practices that actually transmit infection. In addition, large, prospective studies are necessary to characterize the frequency [table: see text] of transmission between sexual partners and the potential role of cesarian section in reducing HCV transmission to infants.
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Affiliation(s)
- D L Thomas
- Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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16
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Maticic M, Poljak M, Kramar B, Seme K, Brinovec V, Meglic-Volkar J, Zakotnik B, Skaleric U. Detection of hepatitis C virus RNA from gingival crevicular fluid and its relation to virus presence in saliva. J Periodontol 2001; 72:11-6. [PMID: 11210067 DOI: 10.1902/jop.2001.72.1.11] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND To search for a possible source of hepatitis C virus (HCV) in saliva, the presence and shedding patterns of HCV in gingival crevicular fluid (GCF) and saliva of HCV viremic patients were assessed based on clinical, biochemical, histological, virological, and oral health parameters. METHODS Saliva and GCF samples of 50 HCV viremic patients were collected to detect HCV RNA by a modified commercial polymerase chain reaction (PCR) assay. Clinical oral examination was performed and periodontal status at the collection sites was monitored. The results were correlated to specified parameters. RESULTS HCV RNA was detected in 59% (29/49) of the GCF specimens and in 35% (17/48) of the saliva specimens. In saliva specimens, HCV RNA was detected only in cases which also had detectable HCV RNA in the GCF samples (P=0.00002) and was significantly related to the presence of blood in saliva (P=0.03). Higher, but not significant, values of oral clinical parameters at the sites of fluid collection were found in GCF specimens harboring HCV RNA. In GCF specimens with no blood detected, HCV RNA was more often present in cases with higher plasma viral load (P=0.05). CONCLUSIONS The results suggest that besides blood, the other most probable source of HCV in saliva is GCF. Unknown endogenous HCV inhibitory mechanisms in the oral cavity may explain the discrepancies in HCV appearance between saliva and GCF. The results provide a biologic basis for further investigation of the role of HCV in the pathogenesis of periodontal disease.
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Affiliation(s)
- M Maticic
- Department of Infectious Diseases, University Medical Centre, Ljubljana, Slovenia
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17
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Rey D, Fritsch S, Schmitt C, Meyer P, Lang J, Stoll-Keller F. Quantitation of hepatitis C virus RNA in saliva and serum of patients coinfected with HCV and human immunodeficiency virus. J Med Virol 2001. [DOI: 10.1002/1096-9071(20000201)63:2<117::aid-jmv1005>3.0.co;2-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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19
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Abstract
Hepatitis C virus infection occurs in all parts of the world. Infection is generally due to percutaneous exposures, though sexual and perinatal transmission may occur. While further study is needed to elucidate the biology of HCV transmission and develop vaccines for prevention, new HCV infections can be reduced by economic development and education regarding blood-borne infections.
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Affiliation(s)
- D L Thomas
- Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
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20
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Abstract
Hepatitis C virus (HCV) infection is widespread with an estimated 3% of the world population being infected. Acute infection is usually mild but chronicity develops in as many as 70% of patients, of whom at least 20% will eventually develop cirrhosis. A further 1-4% of cirrhotic individuals will develop hepatocellular carcinoma. Infection with HCV may have effects on various organs other than the liver. HCV has been causally associated with a remarkable array of extrahepatic manifestations, some of which remain unproven. This review discusses the evidence implicating HCV in the aetiology of two important oral conditions, namely Sjögren's syndrome and lichen planus.
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Affiliation(s)
- K Roy
- Infection Research Group, University of Glasgow Dental School, Glasgow, Scotland
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21
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Roy KM, Bagg J, McCarron B. The effect of saliva specimen collection, handling and storage protocols on hepatitis C virus (HCV) RNA detection by PCR. Oral Dis 1999; 5:123-7. [PMID: 10522208 DOI: 10.1111/j.1601-0825.1999.tb00076.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Commercial assays can now be adapted to detect salivary anti-hepatitis C virus (HCV) antibodies, increasing the potential of saliva as a non-invasive diagnostic specimen suited to surveillance and epidemiological studies. However, current diagnostic algorithms involve confirmation of HCV infection by RT-PCR. Manipulation and storage conditions of serum can influence the stability of viral RNA. This study examined whether varying specimen collection, handling and storage protocols also affected subsequent HCV RNA detection by RT-PCR applied to saliva specimens. METHODS Whole unstimulated saliva, together with saliva samples collected in two commercially available devices (Salivette and Omnisal) were obtained from 50 HCV seropositive intravenous drug users. The specimens were subjected to a number of handling and storage conditions, including heat treatment and prolonged storage, then examined for HCV RNA by RT-PCR using primers derived from the 5' non-coding region (5'NCR). RESULTS HCV RNA was detected in saliva samples from 25 (50%) of the patients. No single collection device or handling procedure identified all the subjects with HCV RNA positive saliva though whole saliva yielded the greatest number of positive results. CONCLUSIONS Collection and processing of saliva specimens for RT-PCR analysis is complex. At present, detection of salivary HCV RNA by PCR is not sufficiently sensitive for use as a diagnostic tool in epidemiological studies.
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Affiliation(s)
- K M Roy
- Infection Research Group, University of Glasgow Dental School, Scotland
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22
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Fabris P, Infantolino D, Biasin MR, Marchelle G, Venza E, Terribile Wiel Marin V, Benedetti P, Tositti G, Manfrin V, de Lalla F. High prevalence of HCV-RNA in the saliva cell fraction of patients with chronic hepatitis C but no evidence of HCV transmission among sexual partners. Infection 1999; 27:86-91. [PMID: 10219636 DOI: 10.1007/bf02560503] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The aims of this study were to evaluate the prevalence of HCV-RNA in different fractions of saliva taken from patients with chronic hepatitis C, to establish whether virologic parameters or disease severity exert any influence on the detectability of HCV-RNA in saliva, and to evaluate the prevalence of HCV infection in partners of HCV-infected subjects with respect to the presence of HCV-RNA in saliva. Sera samples and different fractions of saliva (whole saliva, surnatant, and cell fraction) from 48 subjects (45 with chronic hepatitis C and three healthy anti-HCV+ carriers) were examined for HCV-RNA by RT nested PCR and DEIA hybridization. HCV-RNA-positive sera were also tested for genotype and viral titer (bDNA2 method). Twenty-seven stable sexual partners (25 females and 2 males) were screened for anti-HCV antibodies at least twice over a minimum of 12 months. HCV-RNA was detected in the sera of 39/45 patients and of 22/39 viremic patients. In all of the latter, the presence of HCV-RNA was restricted to the cell fraction. Viral titer was significantly higher in patients with HCV-RNA in saliva than in those without (12.3 x 10(6) versus 4.6 x 10(6) eq/ml, P < 0.01). HCV-RNA positivity was unrelated to genotype, duration of disease, Hepatitis Activity Index scores or transaminase levels. Anti-HCV was positive in one of 13 sexual partners of patients with HCV-RNA in saliva and in 1/14 of those without (P = NS). In conclusion, HCV-RNA is detectable in the cell fraction of saliva in a high proportion of highly viremic patients with chronic hepatitis C, but its presence does not seem to be associated with an increased risk of HCV transmission among sexual partners.
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Affiliation(s)
- P Fabris
- Dept. of Infectious Diseases, Ospedale S. Bortolo, Vicenza, Italy
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23
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Abstract
The identification of hepatitis A and hepatitis B led to the recognition that a third virus was capable of causing blood-borne hepatitis. The pathogen responsible for this nonA, nonB hepatitis was identified in the late 1980s and subsequently named hepatitis C. Since the discovery of hepatitis C there has been a pandemic of research publications describing the natural history of the infection and it is now known that this virus can cause serious liver damage in a proportion of infected patients. It is now clear that the effects of infection with hepatitis C and alcohol misuse are additive and that there is an increased risk of hepatic complications in infected patients who abuse alcohol.
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Affiliation(s)
- J C Booth
- Department of Gastroenterology, Chelsea and Westminster Hospital, London, UK
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24
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Giuliani M, Caprilli F, Gentili G, Maini A, Lepri AC, Prignano G, Palamara G, Giglio A, Crescimbeni E, Rezza G. Incidence and determinants of hepatitis C virus infection among individuals at risk of sexually transmitted diseases attending a human immunodeficiency virus type 1 testing program. Sex Transm Dis 1997; 24:533-7. [PMID: 9339972 DOI: 10.1097/00007435-199710000-00007] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The role of sexual transmission of hepatitis C virus (HCV) infection is still not completely understood, partly because of the lack of longitudinal studies among cohorts of HCV-negative individuals who engage in at-risk sexual behavior. GOALS To evaluate the incidence of HCV infection in a population at risk for human immunodeficiency virus type 1 (HIV-1) infection and other sexually transmitted diseases (STD) and to identify factors associated with HCV seroconversion. STUDY DESIGN A retrospective longitudinal study was carried out on a cohort of consecutive attendees of a voluntary HIV-1 testing and counseling program in a large STD center in Rome. All individuals undergoing at least two consecutive tests for HCV antibodies were enrolled. Clinical data and information on individual behavior were collected for all study participants. RESULTS Between June, 1992 and December, 1994, a total of 709 individuals (12 intravenous drug users [IDU], 244 homosexuals, and 453 heterosexual non-IDUs), initially negative for HCV antibody, were tested more than once. Among these individuals, 15 HCV seroconversions occurred. The average follow-up time was 1.25 person/years (p/y) for an incidence rate of 1.69 per 100 p/y. The incidence rates by exposure category were 39.30 per 100 p/y among IDUs, 1.37 per 100 p/y among homosexual men, and 0.97 per 100 p/y among heterosexual non-IDUs. Excluding IDUs, of the 697 STD clinic attendees engaging in at-risk sexual behavior, HIV-1-positive status tended to be associated with HCV seroconversion (relative hazard = 5.48; 95% confidence interval = 0.85-35.40). The HCV crude incidence rates among HIV-1-infected patients at enrollment was 11.5%, 4.2%, and 2.4% in those with severe, moderate, and mild levels of immunosuppression, respectively (chi-square for trend = 2.38, P = 0.1). CONCLUSIONS In this cohort, HCV infection was confirmed to be strongly associated with intravenous drug use. Nonetheless, the occurrence of two thirds of the total HCV seroconversions in non-IDU individuals engaging in at-risk behavior suggests a role of sexual practices in the transmission of the infection. Among non-IDU individuals, the risk for development of HCV infection tended to increase in those who were HIV-1 infected.
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Affiliation(s)
- M Giuliani
- Centro Operativo AIDS, Istituto Superiore di Sanità, Rome, Italy
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25
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Kage M, Ogasawara S, Kosai K, Nakashima E, Shimamatsu K, Kojiro M, Kimura A, Fujisawa T, Matsukuma Y, Ito Y, Kondo S, Kawano K, Sata M. Hepatitis C virus RNA present in saliva but absent in breast-milk of the hepatitis C carrier mother. J Gastroenterol Hepatol 1997; 12:518-21. [PMID: 9257243 DOI: 10.1111/j.1440-1746.1997.tb00476.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In order to examine whether saliva and breast-milk are mediators of the vertical transmission of hepatitis C virus (HCV) from an HCV carrier mother, serum, saliva, and breast-milk samples from 11 HCV carrier mothers were collected at the time of delivery, and at approximately 1- to 3-months intervals for as long as 30 months postpartum. Serum was also sampled from their children. All samples were analysed for the presence of HCV RNA, using the nested polymerase chain reaction method. No HCV RNA was detected in any breast-milk samples. In saliva, HCV RNA was detected in four of the 11 mothers (36%). These four mothers also had liver function abnormalities. Hepatitis C virus RNA was not detected in any serum samples of the children, and all children had normal liver function. The children were monitored for periods from 2 to 44 months. During this period, there was no evidence of virus transmission. Breast-milk is not likely to be a source of mother-to-child transmission of HCV. Maternal saliva may harbour HCV, but it may not result in infant infection.
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Affiliation(s)
- M Kage
- First Department of Pathology, Kurume University School of Medicine, Japan
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26
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Bellini R, Casali B, Carrieri M, Zambonelli C, Rivasi P, Rivasi F. Aedes albopictus (Diptera:Culicidae) is incompetent as a vector of hepatitis C virus. APMIS 1997; 105:299-302. [PMID: 9164472 DOI: 10.1111/j.1699-0463.1997.tb00572.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In laboratory experiments, Aedes albopictus females were fed hepatitis C virus (HCV)-infected human blood with a unit-feeding apparatus. Pools of engorged females were tested at various time intervals after their blood meal for the presence of HCV RNA using two methods in parallel: reverse transcription-nested polymerase chain reaction (PCR) and PCR with the Amplicor HCV system. Comparable results were obtained with both methods. Mosquitoes were found to be positive only immediately and 24 h after feeding. Moreover, female progeny produced negative results. Our results indicate that the Ae.albopictus strain used is incompetent as a vector of HCV.
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Affiliation(s)
- R Bellini
- Centro Agricoltura Ambiente, Crevalcore, Italy
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27
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Abstract
Infection with hepatitis C virus (HCV) may affect not only the liver but also various nonhepatic tissues and organs and may combine with many etiologically unrelated diseases and morbid conditions. Numerous nonhepatic manifestations in HCV infection have been previously reported. For some (eg, cryoglobulinemia), the association is well established. For others, such as sialadenitis and lichen planus, the association is probable (but not completely documented) and, for the remainder, the associations are weak. Extrahepatic manifestations may result from immunological mechanisms as well as virus invasion and replication in the affected extrahepatic tissues and organs. Thyroid abnormalities, primarily Hashimoto's disease, and isolated increases of anti-thyroid antibodies (ATPO) appear to be more frequent in chronic hepatitis C than B or D, with high ATPO titers clustering mainly among females. Interferon-alpha (IFN-alpha) therapy is associated with development of thyroid dysfunction in 5.5-12.9% of patients, usually exposing preexisting subclinical thyroid abnormalities. Mixed cryoglobulinemia (MC) is commonly found (36-45%) in patients with chronic HCV infection; however, only in a minority of cases does it become clinically manifested as systemic vasculitis with purpura, neuropathy, or Raynaud's phenomenon. In a number of patients, MC may terminate in non-Hodgkin's B-cell lymphoma. Treatment of these lymphoproliferative disorders with IFN-alpha is advocated. Idiopathic thrombocytopenia is now recognized more frequently in association with chronic HCV infection and is usually aggravated by IFN-alpha therapy. Patients with porphyria cutanea tarda (PCT) have demonstrated serological markers of HCV infection in 62-82% of cases. The usefulness of IFN-alpha in PCT remains to be demonstrated. Lichen planus has also been found in association with chronic HCV infection, particularly when severe or affecting the oral cavity. Other nonhepatic manifestations have also been reported in HCV infection such as diabetes, corneal ulceration, uveitis, and sialadenitis. These manifestations deserve further study and documentation. Finally, markers of autoimmunity occur with high frequency in chronic HCV infection; however, combination with the classical syndrome of autoimmune hepatitis is rare. In the presence of various autoantibodies, the clinical features of chronic hepatitis C do not appear to be modified and, contrary to general perception, IFN-alpha therapy within randomized controlled trials should not be withheld since the response rate to IFN-alpha does not appear to differ in the presence or absence of low titers of these markers.
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Affiliation(s)
- S J Hadziyannis
- Academic Department of Medicine, Hippokration General Hospital, Athens, Greece
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28
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29
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Roy KM, Bagg J, Follett EA, Brewer A, Lowe GD. Hepatitis C virus in saliva of haemophiliac patients attending an oral surgery unit. Br J Oral Maxillofac Surg 1996; 34:162-5. [PMID: 8861292 DOI: 10.1016/s0266-4356(96)90371-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This study determined the frequency with which hepatitis C virus (HCV) could be detected in the saliva of 21 HCV-seropositive haemophiliac patients attending an Oral Surgery Unit. All sera were positive for HCV RNA by the polymerase chain reaction (PCR). Six of the patients were also HIV antibody positive. Saliva was collected both by spitting into a Universal container (whole saliva), and by means of Salivettes. Following RNA extraction from saliva specimens and synthesis of cDNA, nested PCR was performed. Amplified DNA was detected by agarose gel electrophoresis and ethidium bromide staining. Overall, HCV was detected in saliva from 10 of the subjects (8 HIV seronegative and 2 HIV seropositive) but there was not complete concordance between the Salivette specimens and normal whole saliva. Analysis of pellet and supernate fractions from whole saliva produced similar discrepancies. Repeat runs of PCR for HCV following freezing and thawing of the initially positive saliva specimens were unsuccessful. It was concluded that HCV is present in the saliva of some haemophiliac patients. However, careful optimisation of sample handling and storage methods and of PCR technique are required before the true prevalence of HCV shedding in saliva can be determined.
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Affiliation(s)
- K M Roy
- Department of Oral Sciences, University of Glasgow Dental School, Glasgow, UK
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30
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Caldwell SH, Sue M, Bowden JH, Dickson RC, Driscoll CJ, Yeaton P, Stevenson WC, Ishitani MB, McCullough CS, Pruett TL, Lovell MA. Hepatitis C virus in body fluids after liver transplantation. LIVER TRANSPLANTATION AND SURGERY : OFFICIAL PUBLICATION OF THE AMERICAN ASSOCIATION FOR THE STUDY OF LIVER DISEASES AND THE INTERNATIONAL LIVER TRANSPLANTATION SOCIETY 1996; 2:124-9. [PMID: 9346637 DOI: 10.1002/lt.500020207] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Recurrence of hepatitis C virus (HCV) after liver transplantation is common and is associated with high blood levels of HCV RNA. Higher blood levels of HCV may promote body fluid expression of the virus. We tested 152 body fluid specimens from 33 patients with chronic hepatitis C, 21 of whom had undergone prior liver transplantation. All patients had hepatitis C viremia, as determined by a reverse-transcription polymerase chain reaction (PCR) to the 5' noncoding region. The virus was quantitated in serum by the branched chain DNA assay (bDNA). Body fluids (33 sputum, 33 saliva, 33 urine, 32 tear, 9 vaginal, and 12 semen samples) were analyzed using PCR for HCV RNA. Serum HCV RNA by bDNA in the posttransplantation group was 255 +/- 229 x 10(5) compared with 50 +/- 56 x 10(5) eq/mL in the patients who did not undergo transplantation (P = .01). All urine, tear, and semen specimens were negative for HCV RNA. Five of 21 (24%) posttransplantation patients had detectable HCV RNA using PCR in oral secretions compared with 0 of 12 patients who did not undergo transplantation (not statistically significant). However, 5 of 11 patients with serum HCV RNA by bDNA results greater than 150 x 10(5) eq/mL had positive RNA in oral secretions compared to 0 of 22 patients with bDNA less than 150 x 10(5) eq/mL (P = .01). Posttransplantation patients were more likely to have bDNA levels exceeding 150 x 10(5) eq/mL (11 of 21 v 1 of 12, P = .03). Patients within the first year of transplantation were particularly prone to viral RNA levels exceeding 150 x 10(5) eq/mL (8 of 9 v 3 of 12, P = .01). We conclude that HCV RNA can occasionally be detected using PCR in oral secretions after liver transplantation. This is more likely during the first year posttransplantation when blood levels of HCV RNA often exceed 150 x 10(5) eq/mL by the branched chain DNA assay. Whether or not these observations represent an increased risk of transmission of infection during the early posttransplantation period is not certain.
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Affiliation(s)
- S H Caldwell
- University of Virginia Medical Center, Department of Internal Medicine, Charlottesville, USA
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31
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Demelia L, Vallebona E, Poma R, Sanna G, Masia G, Coppola RC. HCV transmission in family members of subjects with HCV related chronic liver disease. Eur J Epidemiol 1996; 12:45-50. [PMID: 8817177 DOI: 10.1007/bf00144427] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
To investigate the risk of sexual and intrafamilial transmission of HCV, 220 family members of 76 patients (index cases) with chronic type C viral liver disease were tested for serological markers of HCV. Of the family members, 129 were offspring, 64 sexual partners, 15 parents and 12 siblings of the index cases. Anti-HCV was tested in all the household contacts; HCV-RNA was tested in antibody positive samples. The serologic markers of HCV were tested in a control group of 168 family members of 81 patients with chronic hepatitis unrelated to HCV. The overall prevalence of anti-HCV was 8.2% compared to 0.6% in the control group (p < 0.001). Sexual partners were anti-HCV positive more frequently than the other contacts (20% vs 2.2%; p < 0.001), without any difference in males or females. No correlation was observed between the occurrence of HCV infection in contacts and age, severity of liver disease or risk factor for the acquisition of HCV in the index cases. Seven of the 18 (39%) anti-HCV positive family contacts had bio-chemical evidence of chronic liver disease, histologically confirmed in the 6 patients who underwent a liver biopsy. Liver chemistry was normal in all the HCV-negative contacts. Ten of the 18 anti-HCV positive contacts (55%) were HCV-RNA positive, Genotypes were the same (1b) in 4 of the 7 viremic couples of subjects: in 3 of the 6 couples of sexual partners and in the only mother/son couple. These data suggest the occurrence of intraspousal transmission of HCV, while intrafamiliar acquisition of HCV in non-sexual contacts seems to be rare.
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Affiliation(s)
- L Demelia
- Institute of Clinical Medicine, University of Cagliari, Italy
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32
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Hou CH, Chen WY, Kao JH, Chen DS, Yang Y, Chen JJ, Lee SH, Wu DJ, Yang SC. Intrafamilial transmission of hepatitis C virus in hemodialysis patients. J Med Virol 1995; 45:381-5. [PMID: 7545208 DOI: 10.1002/jmv.1890450405] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The prevalence of hepatitis C virus (HCV) infection in chronic hemodialysis patients ranges from 20 to 50% and these patients may serve as a reservoir of infection for their household contacts. The aim of this study was to investigate the prevalence of anti-HCV in hemodialysis patients and their families, and to evaluate possible routes of infection. One hundred eighty-six family members of 84 hemodialysis patients and 529 healthy adults were enrolled. The family members consisted of 50 spouses, 96 children, 11 parents, 29 siblings, and other relatives living together with the patients. Serum samples were collected for testing anti-HCV. Exposure to risk factors was obtained by a questionnaire and an interview. The results showed that prevalence of anti-HCV in hemodialysis patients was 44%, whereas in family members it was 5.4%, not significantly different from that of age-matched healthy adults (standardized morbidity rate = 1.51, P = 0.390). The anti-HCV rate in family members tended to increase with age, and a spouse of an infected hemodialysis patient had a higher risk of HCV infection than other family members (15% vs. 2.6%, odds ratio 6.6, P = 0.058). Except for the age factor, no difference was found between seropositive and seronegative family members with respect to risk factors such as blood transfusion, surgery, frequent injections, dental procedures, or acupuncture. It was concluded that, although the anti-HCV positivity of hemodialysis patients is high, the risk of HCV infection for their family members is not higher than that of the general population. Among family members, spouses of seropositive hemodialysis patients have the highest risk of HCV infection.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- C H Hou
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Republic of China
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33
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Chen M, Yun ZB, Sällberg M, Schvarcz R, Bergquist I, Berglund HB, Sönnerborg A. Detection of hepatitis C virus RNA in the cell fraction of saliva before and after oral surgery. J Med Virol 1995; 45:223-6. [PMID: 7775943 DOI: 10.1002/jmv.1890450219] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The presence of hepatitis C virus (HCV) RNA in serum, whole saliva, and saliva from the submaxillary glands was investigated before and after oral surgery. The presence of HCV RNA (positive and negative-strand RNA) was determined in serum and saliva by a nested polymerase chain reaction in 26 anti-HCV positive patients, of whom 11 were coinfected with human immunodeficiency virus-1. Oral surgery was carried out on five occasions on four of the patients. HCV RNA was detected in the sera of 23 of 26 (88%) patients, and in the saliva of 4 of the 23 (17%) of the viremic patients. In all four cases, HCV RNA was detected only in the cell fraction derived from centrifugation of whole saliva. Negative-stranded HCV RNA was not detected. At one of five occasions of oral surgery, HCV RNA was detected in saliva sampled immediately after surgery, but not before or 24 hours after surgery. The results suggest that HCV is present in saliva in less than 25% of HCV viremic persons. The presence of the virus in saliva is restricted to the cell fraction. Thus, saliva may serve as a possible, but low, nonparenteral transmission route of HCV. Contamination of saliva by blood during and after oral surgery may result in an increased risk of viral exposure. Except for trauma caused by sharp instruments during surgery, this might contribute to the higher HCV seropositivity found among dentists.
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Affiliation(s)
- M Chen
- Division of Clinical Virology, Karolinska Institute, Huddinge Hospital, Sweden
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34
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Shev S, Hermodsson S, Lindholm A, Malm E, Widell A, Norkrans G. Risk factor exposure among hepatitis C virus RNA positive Swedish blood donors--the role of parenteral and sexual transmission. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 1995; 27:99-104. [PMID: 7544914 DOI: 10.3109/00365549509018987] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The potential modes of transmission for hepatitis C virus (HCV) infections were studied using a multivariate analysis of risk factor exposure among 51 2nd generation anti-HCV and HCV-RNA positive and matched anti-HCV negative blood donors. The following variables were found to be independently associated with anti-HCV and HCV-RNA positivity: intravenous drug use (IVDU) (p < 0.001), blood transfusion (p < 0.01), tattoos (p < 0.001), previous hospitalization (p < 0.05), history of sexually transmitted disease (STD) (p < 0.001) and lack of travels outside of Europe (p < 0.05). Among the 23 HCV-RNA positive donors without a history of IVDU or blood transfusion, an increased frequency of hospitalization (p = 0.017) and history of STD (p = 0.023) were found. Five of 22 sexual partners of the 51 index blood donors were HCV-RNA positive and in one of these couples sexual transmission was suspected. Anti-HCV and HCV-RNA positive donors were more often seropositive for herpes simplex virus type 2 (HSV-2) antibodies than were HCV-negative controls (p = 0.015). Sexual transmission of HCV may occur, but the possible role of HSV-2 requires further investigation.
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Affiliation(s)
- S Shev
- Department of Infectious Diseases, East Hospital, Göteborg, Sweden
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35
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Porter S, Scully C, Samaranayake L. Viral hepatitis. Current concepts for dental practice. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1994; 78:682-95. [PMID: 7898904 DOI: 10.1016/0030-4220(94)90082-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The transmission of blood-borne viruses in the dental office is a potential hazard to patients and dental staff, particularly to oral and maxillofacial surgeons. Hepatitis B virus has been a recognized hazard for several years, and in the past oral surgeons and other dental health care staff have been infected as a result of occupational exposure. Hepatitis C virus in contrast does not appear to be a major occupational hazard to dental staff, nevertheless, infection with this virus can lead to significant morbidity and may have oral manifestations. Hepatitis D virus can be nosocomally transmitted, but vaccination against the hepatitis B virus minimizes this problem. Hepatitis E virus is not of clinical relevance to dentistry, although dental staff who are in areas of endemic infection can become infected as a result of enteric transmission. A number of other putative viral agents may also cause hepatitis, but additional data is awaited, and their significance to dental practice is unknown. This article summarizes current data on hepatitis viruses A, B, C, D, and E.
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Affiliation(s)
- S Porter
- Joint Department of Oral Medicine, Eastman Dental Institute, London, U.K
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36
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Martins RM, Vanderborght BO, Rouzere CD, Almeida VC, Cardoso DD, Yoshida CF. Low intrafamilial transmission of hepatitis C virus in central Brazil. Rev Inst Med Trop Sao Paulo 1994; 36:547-9. [PMID: 7569630 DOI: 10.1590/s0036-46651994000600012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Affiliation(s)
- R M Martins
- Lab. de Virologia, IPTEST, Universidade Federal de Goiás, Goiânia, GO, Brazil
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37
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Abstract
The hepatitis C virus (HCV), a single-stranded RNA virus, is the major cause of posttransfusion hepatitis. HCV isolates differ in nucleotide and amino acid sequences. Nucleotide changes are concentrated in hypervariable regions and may be related to immune selection. In most immunocompetent persons, HCV infection is diagnosed serologically, using antigens from conserved regions. Amplification of RNA may be necessary to detect infection in immunosuppressed patients. Transmission by known parenteral routes is frequent; other means of spread are less common and may represent inapparent, percutaneous dissemination. Infection can lead to classical acute hepatitis, but most infected persons have no history of acute disease. Once infected, most individuals apparently remain carriers of the virus, with varying degrees of hepatocyte damage and fibrosis ensuing. Chronic hepatitis may lead to cirrhosis and hepatocellular carcinoma. However, disease progression varies widely, from less than 2 years to cirrhosis in some patients to more than 30 years with only chronic hepatitis in others. Determinants important in deciding outcome are unknown. Alpha interferon, which results in sustained remission in selected patients, is the only available therapy. Long-term benefits from such therapy have not been demonstrated. Prevention of HCV infection by vaccination is likely to be challenging if ongoing viral mutation results in escape from neutralization and clearance.
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Affiliation(s)
- J A Cuthbert
- Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas 75235-8887
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Stewart CM, Jones AC, Bates RE, Boeff D, Migliorati C, Bentrup K. Percutaneous and mucous membrane exposure protocol in a southeastern dental school. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1994; 78:401-7. [PMID: 7970606 DOI: 10.1016/0030-4220(94)90076-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A southeastern dental educational institution formalized a Percutaneous and Mucous Membrane Exposure Protocol in 1990. This article outlines the development, implementation, and administration of the protocol including risk assessment and rationale for testing health care workers and source persons. Pretest and posttest counseling for HIV testing is also discussed.
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Affiliation(s)
- C M Stewart
- Department of Oral Diagnostic Sciences, University of Florida, College of Dentistry, Gainesville
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39
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Crippin JS. Viral Hepatitis: 1994 Update. Proc (Bayl Univ Med Cent) 1994. [DOI: 10.1080/08998280.1994.11929868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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40
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Affiliation(s)
- S J Skidmore
- Regional Virus Laboratory/PHLS Birmingham, United Kingdom
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41
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Goto M, Fujiyama S, Kawano S, Taura Y, Sato S, Sato T, Akahoshi M. Intrafamilial transmission of hepatitis C virus. J Gastroenterol Hepatol 1994; 9:13-8. [PMID: 7512389 DOI: 10.1111/j.1440-1746.1994.tb01209.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The intrafamilial transmission pattern of hepatitis C virus (HCV) was examined in 118 family members of 61 index patients with type C chronic liver disease using anti-HCV antibodies and HCV RNA assay. The study subjects consisted of eight parents, 49 spouses, 50 children, eight siblings and three other relatives. The positivity rates of anti-C100, anti-JCC, second-generation anti-HCV and HCV RNA were 6.8, 12.7, 12.7 and 11.0%, respectively. Positivity in one or more anti-HCV antibody assay was detected in 3/24 (12.5%) father-child pairs, 3/17 (17.6%) mother-child pairs, 2/8 (25%) sibling pairs, 6/38 (15.8%) husband-wife pairs and 2/13 (15.4%) wife-husband pairs. In spouses, positivity for anti-HCV antibody or HCV RNA was observed after 40 years of age. None of 11 spouses married < 15 years was positive for any anti-HCV assay or HCV RNA. In spouses whose age was > 50 years and duration of marriage was > 25 years, anti-HCV or HCV RNA was frequently detected (32.0%). However, when seven pairs involving four spouses, one mother-daughter pair and two sibling pairs were subtyped, the same HCV subtypes were found in only four pairs (type II in three pairs and type III in one pair). Further, the agreement rate between anti-HCV and HCV RNA was > 90%. These results suggest that intrafamilial transmission of HCV, revealed by the subtyping method, is considered lower than the percentage of positivity for anti-HCV antibodies or HCV RNA in family members of patients with type C chronic liver disease.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- M Goto
- Third Department of Internal Medicine, Kumamoto University School of Medicine, Japan
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42
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Camps J, García N, Riezu-Boj JI, Civeira MP, Prieto J. Ribavirin in the treatment of chronic hepatitis C unresponsive to alfa interferon. J Hepatol 1993; 19:408-12. [PMID: 8151102 DOI: 10.1016/s0168-8278(05)80550-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
For the 30-50% of patients with chronic hepatitis C who do not respond to alpha-interferon therapy there is no alternative treatment. Some previously untreated patients have shown a biochemical response to ribavirin, but the antiviral effects of this substance on alpha-interferon-resistant cases is largely unknown. Twelve patients with chronic hepatitis C who had not responded to a 6-12 month course of alpha-interferon were included in this study. Oral ribavirin was administered at a dose of 16 mg/kg per day for 6 or 9 months. Aminotransferase levels had not significantly changed during interferon therapy but decreased significantly during ribavirin treatment (mean alanine aminotransferase at baseline, 102 +/- 18 IU/l vs. 55 +/- 14 IU/l at 6 months; P = 0.0001). Aminotransferase levels became normal in 6 cases (50%), significantly decreased in 3 patients (25%), and did not significantly change in the remaining 3 cases (25%). All patients with normalized aminotransferase values relapsed after ribavirin was discontinued and aminotransferase activity returned to pretreatment levels. Before therapy serum hepatitis C virus RNA was detected by polymerase chain reaction in 10 cases. None of them had cleared viral RNA when tested following 3, 6 and 9 months of ribavirin therapy. Side-effects were mild and reversible. In conclusion, about half of the patients with chronic hepatitis C who are unresponsive to alpha-interferon show a clear-cut biochemical response after 6-9 months of ribavirin administration. However, ribavirin does not clear circulating hepatitis C virus RNA and relapses occur after withdrawal.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- J Camps
- Department of Medicine, Clínica Universitaria, Pamplona, Spain
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43
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Abstract
The hepatotropic viruses currently include hepatitis A, B, C, D, and E, and are associated with a spectrum of acute and chronic liver disease syndromes. The epidemiology and natural history of each are discussed, with emphasis on uncommon or newly recognized clinical presentations. The serodiagnosis of hepatitis A, B, and D is well established; the serodiagnosis of hepatitis C and E continues to evolve as serologic and virologic assays become refined. Hepatitis A and E only cause acute liver injury; current medical approaches therefore focus on vaccination strategies. Hepatitis B, C, and D can cause both acute and chronic liver injury. Sequelae of chronic liver disease, including portal hypertension and hepatocellular carcinoma, are not uncommon. Medical therapy of resulting chronic liver disease currently consists of interferon, though other anti-viral strategies are being explored. Advanced chronic liver disease due to hepatitis B, C, or D can be treated by orthotopic liver transplantation, but viral recurrence is near uniform and can be problematic. Further study of the hepatotropic viruses at the molecular biologic, epidemiologic, and clinical levels will continue to provide greater insight into the diagnosis and management of their associated clinical syndromes.
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Affiliation(s)
- P K Kiyasu
- Department of Internal Medicine, University of Virginia, Charlottesville
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44
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Numata N, Ohori H, Hayakawa Y, Saitoh Y, Tsunoda A, Kanno A. Demonstration of hepatitis C virus genome in saliva and urine of patients with type C hepatitis: usefulness of the single round polymerase chain reaction method for detection of the HCV genome. J Med Virol 1993; 41:120-8. [PMID: 8283173 DOI: 10.1002/jmv.1890410207] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The possible transmission routes of hepatitis C virus (HCV) in patients without overt parenteral exposure (sporadic or community acquired form) were examined. Saliva and urine specimens obtained from type C hepatitis patients, whose sera were positive for the HCV genome, were examined by reverse transcription and polymerase chain reaction (RT-PCR). By analyzing the factors that influenced the detection of the HCV genome by PCR, we developed a single round method which enabled semiquantitative detection with higher sensitivity than that obtained with nested PCR. Single round PCR revealed that 34.8% (8 of 23) of saliva and 56.5% (13 of 23) of urine specimens from patients with type C hepatitis contained the HCV genome. The amounts of HCV genome in saliva and urine specimens correlated with those in serum. The relative amounts of HCV genome in serum, saliva, and urine from a chronic type C hepatitis patient were determined by comparing the reciprocal of the smallest volume of the specimens in which the PCR products were visualized in agarose gels (PCR units/ml), and the values were 1 x 10(5), 5 x 10(1), and 3 x 10(1) PCR units/ml for serum, saliva, and urine specimens, respectively.
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Affiliation(s)
- N Numata
- Department of Microbiology, Sendai Municipal Institute of Public Health, Japan
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45
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Hallam NF, Fletcher ML, Read SJ, Majid AM, Kurtz JB, Rizza CR. Low risk of sexual transmission of hepatitis C virus. J Med Virol 1993; 40:251-3. [PMID: 7689092 DOI: 10.1002/jmv.1890400315] [Citation(s) in RCA: 53] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Sexual transmission of hepatitis C virus (HCV) was studied between 104 anti-HCV positive index cases (99 haemophilic men, five women) who have attended the Oxford Haemophilia Centre and 104 (98 female, 6 male) longstanding sexual partners. Ninety-one percent of the index cases were HCV RNA positive by the polymerase chain reaction (PCR) and 56% were anti-human immunodeficiency virus (HIV) positive. Three (2.9%) sexual partners (each a female partner of a different HCV RNA positive haemophilic man) were anti-HCV, and HCV RNA, positive. All had other risk factors for HCV infection. Of 59 partners who were tested for anti-HIV four (7%) were positive and only one of these was also anti-HCV positive. There was no association between HIV positivity in the index cases and HCV positivity in their partners. Our results confirm a low risk of sexual transmission of HCV.
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Affiliation(s)
- N F Hallam
- Virology Department, Public Health Laboratory, John Radcliffe Hospital, Oxford, England
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46
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Wu JC, Lin HC, Jeng FS, Ma GY, Lee SD, Sheng WY. Prevalence, infectivity, and risk factor analysis of hepatitis C virus infection in prostitutes. J Med Virol 1993; 39:312-7. [PMID: 8492103 DOI: 10.1002/jmv.1890390410] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A population of 622 prostitutes in Taiwan was tested for antibodies to the hepatitis C virus (anti-HCV) using a synthetic peptide assay composed of representative determinants from capsid and nonstructural (NS) viral proteins. Seventy-four (12%) were positive and the remaining 548 (88%) were negative. Seventy-nine samples were retested by a second-generation anti-HCV assay composed of recombinant capsid and NS proteins of HCV. Both assays had a nearly perfect agreement (Kappa value = 0.91). Of the positive cases, 31% were positive for reactivity to capsid only. Most (60/74, 81%) of the cases positive for synthetic peptide assay were HCV RNA positive, indicating potential infectivity. On the basis of the results of synthetic peptide assay, univariate analysis showed that history of paid sex for longer than 6 months, blood transfusion, acupuncture, intravenous drug abuse, and age over 20 years were significant risk factors of HCV infection (P < 0.01). Elevated alanine aminotransferase levels (> 40 U/L) were positively associated with anti-HCV, while the presence of serum hepatitis B surface antigen was a negatively associated factor. Multivariate analysis revealed that history of paid sex for longer than 6 months and blood transfusion were positively associated with anti-HCV (P < 0.001). The latter only accounted for less than one fifth of the HCV-infected prostitutes. This study indicates strongly that sexual transmission is an important route for HCV infection in prostitutes. This risk group may spread HCV to other populations as a sexually transmitted disease.
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Affiliation(s)
- J C Wu
- Division of Gastroenterology, Veterans General Hospital, National Yang-Ming Medical College, Taipei, Taiwan, Republic of China
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47
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Affiliation(s)
- J B Mahony
- McMaster University Regional Virology and Chlamydiology Laboratory, St. Joseph's Hospital, Hamilton, Ontario, Canada
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48
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Ogasawara S, Kage M, Kosai K, Shimamatsu K, Kojiro M. Hepatitis C virus RNA in saliva and breastmilk of hepatitis C carrier mothers. Lancet 1993; 341:561. [PMID: 8094800 DOI: 10.1016/0140-6736(93)90324-a] [Citation(s) in RCA: 59] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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49
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Affiliation(s)
- N Bach
- Department of Medicine, Mount Sinai Medical Center, New York, New York 10029
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50
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