丙型肝炎病毒感染的性传播
Sexual transmission of hepatitis C virus infection.
作者信息
Rooney G, Gilson R J
机构信息
Department of Genitourinary Medicine, Camden and Islington Community Health Services NHS Trust, Mortimer Market Centre, London.
出版信息
Sex Transm Infect. 1998 Dec;74(6):399-404. doi: 10.1136/sti.74.6.399.
BACKGROUND
Hepatitis C virus (HCV) is the cause of almost all cases of parenterally transmitted non-A, non-B viral hepatitis (NANBH). HCV is an RNA virus, unrelated to the hepatitis viruses, A, B, D, or E; it was first identified in 1989. Although most infections become chronic, and it may lead to chronic liver disease, most patients with HCV infection are asymptomatic. The predominant modes of transmission are by blood, blood products, or other parenteral exposure, particularly injecting drug use. More contentious is the role of sexual transmission, although evidence for this was provided by studies of NANBH.
OBJECTIVE
This review considers the evidence for sexual transmission, and the types of studies used to estimate the rate of transmission and the factors that may influence it.
METHOD
A Medline search using the keywords hepatitis C, sex, transmission, and prevalence in MeSH and free text. References in papers were searched, and some unpublished data identified. References were further selected to illustrate different methodologies.
FINDINGS
Evidence for sexual transmission is provided by several types of study including prevalence studies in groups at risk of other STDs, investigation of cases identified from surveillance reports, and cross sectional and longitudinal partner studies. Many studies are limited by their small size, the sensitivity and specificity of early assays, lack of controls, or the difficulty of excluding other routes of transmission. One prospective cohort study reported an incidence of 12 per 1000 person years in the sexual partners of HCV infected patients. 1-3% of partners of HCV infected patients are found to be infected in cross sectional studies. Co-infection with HIV, duration of the relationship, or chronic liver disease may be independent cofactors increasing the risk of transmission. A meta-analysis of selected studies may be informative, and further larger prospective studies are required. There is a small but definite risk of sexual transmission of hepatitis C.
背景
丙型肝炎病毒（HCV）是几乎所有经肠道外传播的非甲非乙型病毒性肝炎（NANBH）的病因。HCV是一种RNA病毒，与甲型、乙型、丁型或戊型肝炎病毒无关；它于1989年首次被发现。虽然大多数感染会转为慢性，且可能导致慢性肝病，但大多数HCV感染患者并无症状。主要传播途径是通过血液、血液制品或其他肠道外接触，尤其是注射吸毒。性传播的作用更具争议性，尽管NANBH的研究提供了这方面的证据。
目的
本综述探讨性传播的证据，以及用于估计传播率的研究类型和可能影响传播率的因素。
方法
使用医学主题词表（MeSH）中的关键词丙型肝炎、性、传播和患病率以及自由文本在Medline数据库中进行检索。检索论文中的参考文献，并识别一些未发表的数据。进一步筛选参考文献以说明不同的方法。
结果
多种类型的研究提供了性传播的证据，包括对其他性传播疾病高危人群的患病率研究、对监测报告中确诊病例的调查以及横断面和纵向性伴侣研究。许多研究存在局限性，如样本量小、早期检测方法的敏感性和特异性不足、缺乏对照或难以排除其他传播途径。一项前瞻性队列研究报告称，HCV感染患者的性伴侣中每1000人年的发病率为12例。在横断面研究中，发现HCV感染患者的性伴侣中有1% - 3%被感染。与HIV合并感染、性关系持续时间或慢性肝病可能是增加传播风险的独立协同因素。对选定研究进行荟萃分析可能会提供有用信息，还需要进一步开展更大规模的前瞻性研究。丙型肝炎存在虽小但确定的性传播风险。
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