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

Detection of Hepatitis C Virus-RNA in Saliva from Chronically HCV-Infected Patients

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.

Saliva specimen sampling: a noninvasive method for diagnosis and basic investigation of viral hepatitis A, B and C

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.

Hepatitis C virus quantification in serum and saliva of HCV-infected patients

The hepatitis C virus (HCV) can be detected in blood and other bodily fluids, such as saliva, semen and gastric juices. The aim of this study was to compare the HCV viral loads in the serum and saliva of infected patients. Twenty-nine patients with detectable HCV RNA in their serum and saliva were included in this study. The HCV viral loads were determined through quantitative real-time polymerase chain reactions. The median viral RNA levels were 5.78 log10 copies in the serum and 3.32 log10 copies in the saliva. We observed that the salivary HCV viral load was significantly lower than the viral load in the serum. Further studies are required to understand the role of saliva in the diagnosis, management and potential transmission of HCV.

Health care-associated transmission of hepatitis B & C viruses in dental care (dentistry)

Hepatitis B virus (HBV) infection rates are declining, but infection with this virus or hepatitis C virus (HCV) remains a risk for dental health care personnel (DHCP). This article describes the epidemiology of HBV and HCV and their particular risks to DHCP. Hepatitis B vaccination is discussed, as is postexposure management recommendations for both HBV and HCV.

Correlation of hepatitis C antibody levels in gingival crevicular fluid and saliva of hepatitis C seropositive hemodialysis patients

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.

[Successful elimination of hepatitis C virus after hepatic lobectomy in a patient with hepatocellular carcinoma]

Hepatocellular carcinoma develops frequently after chronic hepatitis C and B virus infections. Hepatitis B virus has a direct, while hepatitis C virus an indirect role in hepatocarcinogenesis.

THE AIM OF OUR WORK

To demonstrate a very unique and interesting case where after the elimination of early detected duplex hepatocellular carcinoma with a combined therapy of PEG-interferon and ribavirin, hepatitis C virus could be eliminated.

CASE PRESENTATION

A 53-year-old male patient had chronic hepatitis C infection in his anamnesis. In 1995 histological examination confirmed cirrhosis in his liver. One year later he was non-responder for conventional interferon therapy. In 2002 CT examination confirmed a process with multiple plexus in the liver. With cytologic proof of hepatocellular carcinoma, a resection of the tumor by left-lobectomy of the liver was carried out. Four years after the operation a one-year PEG-interferon-alfa-2a and ribavirin combined therapy was instituted. The patient became virologically negative.

CONCLUSION

In chronic liver diseases carcinoma can develop from multiple center at the same time. PEG-interferon and ribavirin combined therapy can be effective in chronic liver disease, as well as after resection of established hepatocellular carcinoma.

Changing prevalence of hepatitis C virus infection among teenagers in an endemic area in Taiwan

Tzukuan Township in Taiwan has been reported to be an endemic area for hepatitis C virus (HCV) infection both in adults and adolescents. The maritime part of the township carries a higher prevalence than the non-maritime part and, as a consequence, several public education strategies have been introduced during the past decade. The current follow-up study aimed to clarify the changing prevalence of HCV infection among teenagers in the endemic maritime part of Tzukuan. In addition to viral hepatitis markers and biochemical profiles, we compared the epidemiological characteristics of 887 and 394 teenagers (aged 13-16 years) from the maritime part enrolled in 1995 and 2005, respectively. Compared with the results of surveillance in 1995, the prevalence of anti-HCV seropositivity (1.0% vs. 2.8%; P=0.045) and HCV RNA (0.5% vs. 2.3%; P=0.026) had decreased significantly by 2005. Transfusions and anti-HCV-positive families were the main risk factors amongst the 25 anti-HCV-positive teenagers in 1995, and became non-significant amongst the four anti-HCV-positive teenagers in 2005. In conclusion, the seroprevalence of HCV infection has significantly decreased after one decade of intervention among the teenage population in this endemic area.

Intrafamilial hepatitis C virus infection

A vér és a szövetnedvek hepatitis C-vírus-fertőzést terjesztő szerepe bizonyított. Elsősorban ellenőrizetlen vérkészítmények transzfúziójával, kontaminált eszközökkel történő perkután inokulációval, fertőzött anyáról csecsemőre, valamint szexuális úton terjed. A családon belüli mindennapos kontaktus révén akvirált fertőződés igen ritka, de a szakirodalomban találhatunk ilyen adatokat. Célkitűzés: A Semmelweis Egyetem II. Belgyógyászati Klinika hepatológiai ambulanciáján megjelent betegek között is találtunk olyan esetet, melyben felmerül a hepatitis C-vírus családon belüli átvitele. Munkánkban ezt mutatjuk be. Esetbemutatás: 47 éves krónikus C-hepatitisben szenvedő nő lányának szérumában hepatitis C-vírus-ellenes antitest jelenléte volt kimutatható. Megbeszélés: A hepatitis C-vírus hosszú lappangási ideje, az akut C-hepatitis enyhe, kevéssé jellegzetes tünettana és a nagy százalékban kialakuló tünetmentes betegség miatt a hordozó személy és családja hosszú ideig nincs tudatában a fertőződés lehetőségének, amelynek esélyét a nem megfelelő személyi higiéné növelheti. Konklúzió: A hepatitis C-vírus-fertőzés ritkán halmozódhat családon belül. Minden esetben ajánlott felhívni a C-vírust hordozó személy és családtagjainak figyelmét a személyi higiéné fontosságára.

Sexual transmission of hepatitis C

It is generally agreed that the hepatitis C virus (HCV) can be efficiently transmitted parenterally, although data on viral transmission by sexual or non-sexual intrafamilial contact are conflicting. Since data collection began in 1989, the first study dealt with the risk of sexual transmission among multiple sex partners. Other investigations followed, emphasizing that risk increases in specific groups such as patients co-infected with HIV and HBV, sex workers, homosexuals, illicit drug users and patients attended at sexually transmittable disease clinics. The question arises as to what might be the risk for monogamous heterosexuals in the general population, in which one of the partners has HCV? The literature provides overall rates that vary from zero to 27%; however, most studies affirm that the chances of sexual transmission are low or almost null, with rates for this mode fluctuating from zero to 3%. Intrafamilial transmission is strongly considered but inconclusive, since when mentioning transmission between sex partners within the same household, specific situations also should be considered, such as the sharing of personal hygiene items, like razorblades, toothbrushes, nail clippers and manicure pliers, which are important risk factors in HCV transmission. In this review, we discuss the hypotheses of sexual and/or intrafamilial transmission.

Oral transmission of HIV, reality or fiction? An update

Human immunodeficiency virus (HIV) and many other viruses can be isolated in blood and body fluids, including saliva, and can be transmitted by genital-genital and especially anal-genital sexual activity. The risk of transmission of HIV via oral sexual practices is very low. Unlike other mucosal areas of the body, the oral cavity appears to be an extremely uncommon transmission route for HIV. We present a review of available evidence on the oral-genital transmission of HIV and analyse the factors that act to protect oral tissues from infection, thereby reducing the risk of HIV transmission by oral sex. Among these factors we highlight the levels of HIV RNA in saliva, presence of fewer CD4+ target cells, presence of IgA antibodies in saliva, presence of other infections in the oral cavity and the endogenous salivary antiviral factors lysozyme, defensins, thrombospondin and secretory leucocyte protease inhibitor (SLPI).

Detection of HCV-RNA in saliva of HIV-HCV coinfected patients

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.

Quantitative detection of hepatitis C virus (HCV) RNA in saliva and gingival crevicular fluid of HCV-infected patients

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.

Transmission of hepatitis C virus by saliva?

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.

HCV clearance patterns in saliva and serum of patients with chronic HCV infection under interferon plus ribavirin therapy

STATEMENTS OF THE PROBLEM

Hepatitis C virus (HCV)-RNA is often present in saliva of HCV-infected patients, with plasma viral load being the only known predictable factor. Interferon plus ribavirin therapy yields a sustained reduction in HCV viremia. This study aimed to assess the presence of HCV in saliva and serum specimens from patients undergoing this combination therapy (CT).

METHOD OF STUDY

Paired serum and saliva specimens were collected from 44 chronic HCV-infected patients at basal time, 4 and 12 weeks after CT onset, at the end of treatment and 6 months latter. Serum HCV-RNA levels were determined by the polymerase chain reaction (PCR) Amplicor system. Presence of HCV-RNA in saliva was tested by a highly sensitive non-commercialized nested-PCR.

RESULTS

The HCV-RNA was detected in 26 saliva specimens at basal time (59.1%). In 34.1% of cases, a concordance viral clearance pattern in serum and saliva was observed in both responders (pattern 1a) and non-responders (pattern 1b). In pattern 2 (13.6% of cases), HCV was detected longer during CT in serum than in saliva (pattern 2a) or in saliva than in serum (pattern 2b). In 11.3% of patients, viral clearance was corroborated either in their serum (pattern 3a) or in their saliva (pattern 3b), but not in both fluids. Of the eight primary responders with 1a clearance pattern, seven were sustained responders. None of the patients with 2a clearance pattern was a sustained responder. Of the two primary responders showing the 3b salivary pattern, one had already relapsed in the first 6 months of follow up.

CONCLUSIONS

The present results suggest that the monitoring of salivary levels of HCV would be a helpful means of determining sustained antiviral effects of interferon and ribavirin in the treatment of HCV disease.

Detection of HCV-RNA in Cerumen of Chronically HCV-Infected Patients

OBJECTIVES/HYPOTHESIS

Viral hepatitis C is a worldwide public health problem. Hepatitis C virus is mainly transmitted by parenteral or percutaneous route. Nonparenteral transmission, such as through sexual activity, household contact, and vertical or perinatal exposure to body fluids or secretions, can occur, which has been studied before. Cerumen, however, has not been investigated for its ability to transmit hepatitis C virus. The aim of this study is to evaluate the importance of cerumen in transmission of hepatitis C virus infection.

STUDY DESIGN

This study was performed on 35 patients with confirmed chronic hepatitis C virus infection.

METHODS

Thirty-five cerumen specimens collected from the patients with hepatitis C virus RNA in their sera were prospectively analyzed for the presence of hepatitis C virus RNA by polymerase chain reaction.

RESULTS

None of the 35 cerumen specimens were positive for hepatitis C virus RNA.

CONCLUSION

This study showed that cerumen has no risk for transmission of hepatitis C virus infection, even in patients with high hepatitis C virus RNA serum levels; however, standard infection control precautions should be applied carefully in all examinations and surgical operations of the ears.

[Sporadic transmission of hepatitis C in dental practice]

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.

Mucosal humoral immune response to hepatitis C virus E1/E2 surface glycoproteins and HCV shedding in saliva and cervicovaginal fluids from chronically HCV-infected patients

BACKGROUND/AIMS

We herein focused on identifying biological factors possibly involved in non-parenteral transmission of hepatitis C virus (HCV), such as HCV excretion patterns and antibody-based immunity to the virus in saliva and/or cervicovaginal secretions (CVS).

METHODS

Paired blood, saliva and cervicovaginal lavage samples were obtained from HCV-RNA plasma-positive hemoglobin (Hb) antigen and HIV-seronegative, HCV-seropositive males (n=13) and females (n=21). HCV-specific antibodies were detected by ELISA in paired samples, and HCV-RNA was detected in cell-free and cell-associated body fluids.

RESULTS

Antibodies to E1 HCV surface glycoprotein of the IgG and IgA isotypes showed similar, but less pronounced, profiles as IgG and IgA to E2. HCV-specific IgG and IgA in mucosal fluids likely originated predominantly from the systemic compartment, because HCV-specific mucosal immunoglobulins involved primarily monomeric antibodies, including monomeric IgA, and because their specific activities for HCV antigens in corporeal fluids were similar to those in paired serum (Se). Viral shedding in saliva or CVS was restricted to cell-associated, non-replicating strand((+)) HCV-RNA in 42% (12 out of 28) of saliva and in 19% (four out of 21) of cervicovaginal fluids.

CONCLUSIONS

The association in body fluids of HCV-specific IgG, and to a lesser extent IgA, directed to E1/E2 surface glycoproteins (which may block critical steps of virus-cell interactions), of undetectable free viral RNA, and of occasional non-replicating cell-associated HCV, suggests a resulting poor infectivity of saliva or cervicovaginal fluid in chronically HCV-infected individuals. Taken together, these observations provide the basis for the low risk of non-parenteral transmission of HCV infection.

Detection of HCV RNA in saliva of patients with hepatitis C virus infection by using a highly sensitive test

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.

Evaluation of hepatitis C antibody testing in saliva specimens collected by two different systems in comparison with HCV antibody and HCV RNA in serum

Two different ELISA assays, the Ortho HCV 3.0 ELISA (Ortho Diagnostics Systems) and the Mono-Lisa anti-HCV Plus (Sanofi Diagnostics Pasteur) were evaluated for the detection of hepatitis C virus (HCV) antibody in saliva samples. Specimens were collected from 152 individuals who participated in a longitudinal cohort study on HIV infection, and who used illicit drugs. Saliva specimens were collected using two different systems: Salivette (Sarstedt) and Omni-Sal (Saliva Diagnostic Systems). Saliva specimens were tested following modified protocols by both ELISAs, and the results were compared with serum specimens that were tested according to the instructions of the manufacturer. Serum samples of 102 (67%) participants were positive by both assays, and 50 persons were negative for HCV antibody. A total of 99 of the 102 serum specimens were confirmed as positive using Ortho Riba HCV 3.0 (Ortho Diagnostics System) and Deciscan HCV (Sanofi Diagnostics Pasteur), and 3 yielded discrepant results. As no cut-off level is known for testing saliva samples by ELISA, 3 different levels were chosen: mean (M) + 1 standard deviation (SD), M + 2 SD, and M + 3 SD of the optical densities of saliva tests of the 50 HCV serum antibody negative persons. At a level of M + 1 SD and M + 2 SD the Salivette/Mono-Lisa combination gave the greatest proportion of HCV antibody positive saliva specimens obtained from the 102 HCV serum antibody positive participants, 88% and 79%, respectively. Differences between the various collection systems and assay combinations were not significant statistically. In 76 of the 102 persons with HCV antibodies in serum, HCV RNA was detected in serum. Salivary presence of HCV RNA, however, could not be demonstrated. The results show that the assays compared are unsuitable for diagnostic use, but the sensitivities of the assays are acceptable for use in epidemiological studies.

Detection of hepatitis C virus RNA from gingival crevicular fluid and its relation to virus presence in saliva

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.

HIV topic update: oro-genital transmission of HIV

Several viruses, including the human immunodeficiency virus (HIV), can be found in blood and many body fluids including saliva, and are transmissible sexually across genital and particularly anal mucosae. A persisting concern has been the question of transmission of HIV by oral sexual practices. This review discusses the evidence for oro-genital transmission of HIV, detailing the presence and infectivity of HIV in genital fluids and saliva, the case reports and epidemiology of oro-genital HIV transmission, and the evidence from animal studies. Oral intercourse is not risk-free. The evidence suggests that the risk of HIV transmission from oro-genital sexual practices is substantially lower than that from penile-vaginal or penile-anal intercourse, that exposure to saliva presents a considerably lower risk than exposure to semen, and that oral trauma and ulcerative conditions might increase the risk of HIV transmission.