Long-Married Couples Share Hepatitis

NEW YORK (Reuters) -- Researchers in Taiwan have come up with new support for the old saying that a hand held over a flame long enough is bound to get burned.

According to their report in The American Journal of Gastroenterology this month, a spouse whose partner of 20 years or more is infected with hepatitis C is more likely to also catch the virus than spouses of infected partners in marriages of shorter duration.

Dr. Jia-Horng Kao and his colleagues at Taipei's National Taiwan University Hospital say frequent sexual contact and sharing toothbrushes make infection with the hepatitis C virus (HCV) even more likely.

These findings suggest that spouses of people who test positive for HCV should also be checked periodically for infection and "be educated [as to] how to prevent contraction of HCV infection from their spouses."

The researchers note that prevention techniques may include using condoms, and avoiding shared toothbrushes and other personal hygiene products -- razors, dental products -- that might transfer blood from one spouse to the other.

"I think it's reasonable to say that we've always suspected this about hepatitis C transmission. The information is not that new. It confirms our suspicions," says Dr. Alan I. Leibowitz, department of medicine chief at Good Samaritan Hospital and Medical Center in Phoenix.

Leibowitz points out that HCV is the most common form of post-transfusion hepatitis. "Blood units can be tested for hepatitis C, but the screening test could have false negatives [erroneous negative results], so there still are occasional cases of hepatitis C transmission from blood transfusions," he says, adding that about 35% to 40% of people who have hepatitis C have no known source of exposure to the virus.

The Phoenix hepatitis expert also notes that an estimated 3.9 million people in the U.S. might test positive for hepatitis C, and 90% or more become chronic carriers of the virus.

"But people should not become alarmed about this because it takes a long time for the infection to hurt the liver, that could be 20-plus years," Leibowitz points out. "This is not HIV."

In terms of cure, Leibowitz explains that the use of interferon to clear out the virus is about 12% to 25% successful.

SOURCE: The American Journal of Gastroenterology (1996;91(10):2087-2090)

HepC BC

Lymphocyte reactivity to hepatitis C virus (HCV) antigens shows evidence for exposure to HCV in HCV-seronegative spouses of HCV-infected patients.

Lymphocyte reactivity against hepatitis C virus (HCV) antigens was studied in 20 couples in which 1 member had chronic hepatitis C. This was done to investigate the possibility of HCV transmission between spouses that was not followed by seroconversion. Twenty healthy subjects without any risk factors for HCV transmission served as negative controls. All the patients' spouses and the healthy controls were negative for HCV RNA and for anti-HCV antibody. Lymphocytes were cultured with recombinant HCV core and nonstructural antigens (c22, c33, c100, c200, and NS5) and with control antigens (sperm whale myoglobin, chicken lysozyme, and superoxide dismutase). Lymphocytes from 10 patients and 4 seronegative spouses proliferated in the presence of at least one HCV antigen. No proliferation was shown with nonspecific antigens or in the control group. This study gives evidence for possible in vivo priming with HCV antigens that did not lead to seroconversion in spouses of HCV-positive patients.

Author: Bronowicki JP, Vetter D, Uhl G, Hudziak H, Uhrlacher A, Vetter JM, Doffoel M, Laboratoire d'Histo-compatibilitie, and Institut de Pathologie, Hopitaux Universitaires et Faculte de Medecine de Strasbourg, France.

Source: J Infect Dis 1997 Aug;176(2):518-522

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Heterosexual transmission of hepatitis C virus among married couples in southwestern Japan.

Tanaka K, Stuver SO, Ikematsu H, Okayama A, Tachibana N, Hirohata T, Kashiwagi S, Tsubouchi H, Mueller NE

Department of Public Health, School of Medicine, Kyushu University, Higashi-ku, Fukuoka, Japan.

The heterosexual transmission of hepatitis C virus (HCV) remains controversial, and data from general populations are scanty. In this cross-sectional study, we assessed the seroprevalence of antibodies to hepatitis C virus (anti-HCV) and the presence and genotype of HCV-RNA among 109 married couples within an endemic, community-based Japanese population. Overall, 25% of the husbands and 32% of the wives had anti-HCV. Spouses with anti-HCV-positive partners were around 2 times more likely to have anti-HCV than spouses with anti-HCV-negative partners (p = 0.01). Of 6 couples in which both spouses had HCV-RNA, however, 3 presented discordant HCV genotypes (type 1b vs. 2b). The couples' anti-HCV concordance status was not significantly influenced by the presence or absence of HCV-RNA among anti-HCV-positive partners (odds ratio [OR]: 0.8 for wives, 0.6 for husbands), nor by the length of marriage, the number of pregnancies or the use of contraceptives. No significant associations with anti-HCV were observed for serum markers of sexually transmitted agents, including human T-lymphotropic virus (OR = 1.1, 95% confidence interval [CI] 0.5-2.3), Treponema pallidum (OR = 0.7; CI 0.1-6.1) and hepatitis B virus (OR = 1.6; CI 0.9-3.0). Our results suggest that the clustering of HCV infection among specific couples within this endemic population may not be attributable to heterosexual transmission. Follow-up studies are necessary to determine the risk of heterosexual transmission of HCV in endemic areas.

PMID: 9212222, MUID: 97355741

HepC BC

Spouses of Hepatitis C Virus Patients At Increased Risk For Infection

WESTPORT, Oct 17 (Reuters) - Spouses of patients with chronic hepatitis C virus (HCV) are at increased risk of acquiring the virus, and the risk goes up as time goes by, Taiwanese researchers report.

Dr. Ding-Shinn Chen and colleagues of the National Taiwan University Hospital, Taipei, studied 100 anti-HCV-positive index patients and their spouses. "Chronic HCV infection was defined by a positive reaction for second-generation anti-HCV assay...for at least 6 months," Dr. Chen said.

Seventeen spouses (17%) were anti-HCV positive, and 15 of them were also positive for hepatitis C virus RNA. In addition, 11 couples were infected with the same genotype.

Couples married longer than 20 years had a 22% rate of infection, compared to 6% for couples married less than 20 years. Dr. Chen found that "the infected couples had more frequent sexual contacts and more commonly shared toothbrushes than those with uninfected spouses."

Because risk of transmission increases over time, Dr. Chen's team concludes that spouses of chronic hepatitis C virus patients should be "...followed regularly for HCV markers and...educated about how to prevent contraction of HCV infection."

In a related editorial, Drs. Timothy M. McCashland and Daniel F. Schafer of the University of Nebraska in Omaha, spell out those prevention measures. Sharing of personal hygiene items that could be contaminated with blood should be avoided; sexual activity should be restricted if bleeding (menstruation, hematuria) is present; routine condom use is not recommended, although couples should weigh the consequences of HCV infection "...to decide if the risk is sufficient to consider use of condoms."

Am J Gastroenterol 1996;91:2069-2070,2087-2090.

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