LETTER
Transmission of Hepatitis C Virus to Spouses
Eveline P. Mauser-Bunschoten;
Dorine Bresters; and
Henk W. Reesink
15 January 1995 | Volume 122 Issue 2 | Pages 154-155
TO THE EDITOR:
Akahane and colleagues [1] reported that 27% of spouses of patients with hepatitis C virus (HCV) infection had antibodies against HCV and that 18% of the spouses were positive for HCV RNA. Bresters and colleagues [2] observed no sexual transmission in 50 heterosexual partners of index patients positive for HCV RNA who had had unprotected sexual intercourse for a total of 713 person-years (mean duration per couple, 13 years). In this study [2], branched-chain DNA assay showed that index patients had an HCV RNA titer ranging from below the cutoff to 626 x 105 eq/mL, which is similar to titers found in Asia [3]. Unfortunately, no HCV RNA titers were determined in Akahane and colleagues' study and, therefore, no conclusions can be made about the importance of viral load in relation to sexual transmission.
Persons with HCV subtype II (1b) are more common in Asia than in Europe and the United States. Bresters and colleagues, however, found HCV type II in 59% of persons with hemophilia (n = 39) compared with 20% of those without hemophilia (Cuypers HT. Personal communication). Therefore, as indicated by Akahane and colleagues, subtype II may not be a substantial risk factor for HCV transmission. The possible cause of HCV infection in index patients was not stated in the report by Akahane and coworkers. In most index patients, if no source of infection is found, this result may suggest that the source of infection is the same for the spouse, which also explains the concordance of HCV subtypes in couples.
Polymerase chain reaction (PCR) assays at present have a low specificity [4]. It is remarkable that 2 of 27 (7.4%) spouses were positive for HCV RNA in the absence of HCV antibodies. This is an extremely rare finding and, so far, has only been observed in patients with acute HCV infection and in immunosuppressed patients. Therefore, one may question whether Akahane and coworkers' data are influenced by the specificity of their PCR assay. Future studies on sexual transmission of HCV should be done in low-endemic areas and should include well-characterized HCV-infected persons with a relatively short (<10 years) duration of sexual relationship.
1. Akahane Y, Kojima M, Sugai Y, Sakamoto M, Miyazaki Y, Tanaka T, et al. Hepatitis C virus infection in spouses of patients with type C chronic liver disease. Ann Intern Med. 1994; 120:748-52.
2. Bresters D, Mauser-Bunschoten EP, Reesink HW, Roosendaal G, van der Poel CL, Chamuleau RA, et al. Sexual transmission of hepatitis C. Lancet. 1993; 342:210-1.
3. Hsu HH, Wright TL, Luba D, Martin M, Feinstone SM, Garcia G, et al. Failure to detect hepatitis C virus genome in human secretions with the polymerase chain reaction. Hepatology. 1991; 14:763-7.
4. Zaayer HL, Cuypers HT, Reesink HW, Winkel IN, Gerken G, Lelie PN. Reliability of polymerase chain reaction for detection of hepatitis C virus. Lancet. 1992; 341:722-4.
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