異性伴侶之間的C型肝炎傳染很罕見


  【24drs.com】根據一篇橫斷面研究,一夫一妻的異性伴侶之間,C型肝炎病毒(HCV)傳染很罕見。
  
  加州大學舊金山分校的Norah A Terrault醫師等人在3月版Hepatology期刊發表研究結果。
  
  作者們指出,性行為和HCV傳染之間的關聯以前也被研究過,不過,那些資料缺乏可應用到美國夫妻的量化風險資訊,因為那些研究在其他國家進行。
  
  作者們寫道,一夫一妻異性伴侶的少數前瞻世代研究指出,在慢性HCV感染者的血清陰性伴侶中,每年HCV感染率為0%-0.6%。在橫斷面研究中,伴侶的HCV盛行率差異很大(0%-27%),但是,排除已知為針扎感染之伴侶的研究中,盛行率小於5%。
  
  這次的研究,作者們在2000年1月至2003年5月間,招募了已知為抗HCV陽性者及其異性伴侶,這些伴侶都是維持一夫一妻關係至少36個月,且在過去6個月內有過至少3次性行為;排除規範包括:缺乏性生活、曾有器官移植、同時感染B型肝炎病毒或HIV。
  
  納入研究之抗HCV陽性參與者的500名伴侶中,20人(4%)被發現也是抗HCV陽性,其中13人也是HCV RNA陽性;這20對抗HCV陽性伴侶包括了9對是一致的基因型/血清型,8對是不一致的基因型/血清型,3對是不確定。
  
  基因型/血清型一致的9對中,3對有高度相關的病毒株,表示是伴侶之間傳染。在該研究追蹤的8,377人-年中,伴侶之間的HCV傳染發生率為3.6/10,000人-年(95%信心區間[CI]為0.0 - 7.7)。
  
  另外,作者們指出,每次性行為的估計風險值為1/380,000 (95% CI,1/600,000 - 1/280,000)到1/190,000 (95% CI,1/1,030,000 - 1/100,000)。研究限制包括,橫斷面研究的本質、可能有回憶偏差、研究對象少。
  
  作者們寫道,總而言之,在一夫一妻伴侶的長期研究中,已感染者於性行為間將HCV傳染給異性伴侶是可能發生但很罕見的。我們的結果讓醫師們有特定的諮商訊息可提供給他們的病患。這些訊息因為樣本數少而受限,但是,他們支持目前的全國建議:一夫一妻關係者無須因此即改變他們的性生活。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=6994&x_classno=0&x_chkdelpoint=Y
  

Hepatitis C Transmission Rare Among Heterosexual Couples

By Joe Barber Jr, PhD
Medscape Medical News

Hepatitis C virus (HCV) transmission appears to be rare among monogamous heterosexual couples, according to the findings of a cross-sectional study.

Norah A Terrault, MD, MPH, from the University of California San Francisco and colleagues published their findings in the March issue of Hepatology.

The authors note that the relationship between sexual activity and HCV transmission has been investigated previously. However, those data lack quantitative risk information that applies to couples in the United States because the studies were performed elsewhere.

"The few prospective cohort studies of monogamous heterosexual couples have reported incidence rates of HCV infection of 0%-0.6% per year in seronegative partners of subjects with chronic HCV infection," the authors write. "In cross-sectional studies, HCV prevalences among partners vary widely (0%-27%) but are < 5% in studies excluding partners with known percutaneous exposures."

In the current study, the authors recruited known anti-HCV–positive individuals and their heterosexual partners between January 2000 and May 2003. All couples had had a monogamous relationship for at least 36 months and at least 3 sexual encounters in the preceding 6 months. The exclusion criteria included a lack of sexual activity, prior organ transplantation, and hepatitis B virus or HIV co-infection.

Among the 500 partners of anti-HCV–positive participants included in the study, 20 (4%) were found to also be anti-HCV positive, 13 of whom were also HCV RNA positive. The 20 anti-HCV–positive couples included 9 couples with concordant genotypes/serotypes, 8 couples with discordant genotypes/serotypes, and 3 couples with indeterminate statuses.

Among the 9 couples with concordant genotypes/serotypes, 3 couples had highly related viral isolates, suggesting viral transmission between the couple. During 8377 person-years of follow-up in this study, the incidence of HCV transmission among couples was 3.6 per 10,000 person-years (95% confidence interval [CI], 0.0 - 7.7).

Additionally, the authors reported an estimated risk per sexual encounter of 1 per 380,000 (95% CI, 1/600,000 - 1/280,000) to 1 per 190,000 (95% CI, 1/1.03 million - 1/100,000).

The limitations of the study included its cross-sectional nature, potential recall bias, and low number of participants.

"In conclusion, HCV transmission by sex from chronically infected persons to their heterosexual partners in a long-term monogamous relationship likely occurs, but is a rare event," the authors write. "Our results provide a basis for specific counseling messages that clinicians can use with their patients. These messages should be qualified given the limitations of the sample size, but they support the current national recommendations that couples not change their sexual practices if they are in a monogamous heterosexual relationship."

The authors have disclosed no relevant financial relationships.

    
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