Genotyping of hepatitis C virus performed by type-specific PCR in comparison to nucleotide sequencing of NS5 and core regions

Intrafamilial transmission of hepatitis C virus in patients with hepatitis C and human immunodeficiency virus coinfection

OBJECTIVE

The aim of this study was to determine whether hepatitis C virus (HCV)/HIV coinfection of index cases increases intrafamilial transmission (sexual and nonsexual contacts) of HCV.

METHODS

We prospectively enrolled 347 subjects, including 87 family members of 53 HCV/HIV-coinfected index cases and 134 family members of 73 HCV-monoinfected index cases, which served as a control group. All index cases and family members were interviewed, and a screening for HCV and HIV using enzyme-linked immunosorbent assays was performed. Positive samples were confirmed by polymerase chain reaction and tested for genotype and HCV RNA viral load. A meta-analysis designed to assess the pooled risk of sexual transmission of HCV among HCV/HIV-coinfected patients was performed.

RESULTS

Anti-HCV was detected in 2.2% of family members of HCV-monoinfected index cases and 2.3% of family members of HCV/HIV-coinfected index cases. Viral load was higher in coinfected index cases (7.2 x 10(6) mEq/ml) compared with HCV alone (1.9 x 10(6) mEq/ml), p = 0.01. HCV genotype concordance was observed in three family members of HCV-monoinfected index cases and in two family members of HCV/HIV-coinfected index cases. The pooled OR of the meta-analysis evaluating HIV as a cofactor of sexual transmission of HCV was 1.54 (95% CI = 0.76-3.12).

CONCLUSIONS

Our data demonstrate a low prevalence of intrafamilial transmission of HCV, independent of the presence of HCV/HIV coinfection. This finding is supported by meta-analysis, which failed to identify HIV as an important cofactor of sexual transmission in HCV/HIV-coinfected patients.

Nosocomial transmission of hepatitis C virus

The nosocomial transmission of hepatitis C involving three subjects participating in a research project in a Swedish hospital is described. One person contracted acute hepatitis C and another participant had an asymptomatic seroconversion. A temporal relationship between participation in the experiments and seroconversion for hepatitis C, and virology with phylogenetic analyses, suggest that they most probably contracted hepatitis C from a third subject who unknowingly had chronic hepatitis C. Faulty nursing and procedural routines were identified as the probable cause of the transmission. Our findings reinforce the need for medical personnel to strictly adhere to universal precautions worked out to prevent the transmission of blood-borne viruses and underline the importance of a continuous supervision of nursing and procedural routines, even in hospitals with well-educated staff and presumably high standards.