Giuliani M, Caprilli F, Gentili G, Maini A, Lepri A C, Prignano G, Palamara G, Giglio A, Crescimbeni E, Rezza G
Centro Operativo AIDS, Istituto Superiore di Sanità, Rome, Italy.
Sex Transm Dis. 1997 Oct;24(9):533-7. doi: 10.1097/00007435-199710000-00007.
The role of sexual transmission of hepatitis C virus (HCV) infection is still not completely understood, partly because of the lack of longitudinal studies among cohorts of HCV-negative individuals who engage in at-risk sexual behavior.
To evaluate the incidence of HCV infection in a population at risk for human immunodeficiency virus type 1 (HIV-1) infection and other sexually transmitted diseases (STD) and to identify factors associated with HCV seroconversion.
A retrospective longitudinal study was carried out on a cohort of consecutive attendees of a voluntary HIV-1 testing and counseling program in a large STD center in Rome. All individuals undergoing at least two consecutive tests for HCV antibodies were enrolled. Clinical data and information on individual behavior were collected for all study participants.
Between June, 1992 and December, 1994, a total of 709 individuals (12 intravenous drug users [IDU], 244 homosexuals, and 453 heterosexual non-IDUs), initially negative for HCV antibody, were tested more than once. Among these individuals, 15 HCV seroconversions occurred. The average follow-up time was 1.25 person/years (p/y) for an incidence rate of 1.69 per 100 p/y. The incidence rates by exposure category were 39.30 per 100 p/y among IDUs, 1.37 per 100 p/y among homosexual men, and 0.97 per 100 p/y among heterosexual non-IDUs. Excluding IDUs, of the 697 STD clinic attendees engaging in at-risk sexual behavior, HIV-1-positive status tended to be associated with HCV seroconversion (relative hazard = 5.48; 95% confidence interval = 0.85-35.40). The HCV crude incidence rates among HIV-1-infected patients at enrollment was 11.5%, 4.2%, and 2.4% in those with severe, moderate, and mild levels of immunosuppression, respectively (chi-square for trend = 2.38, P = 0.1).
In this cohort, HCV infection was confirmed to be strongly associated with intravenous drug use. Nonetheless, the occurrence of two thirds of the total HCV seroconversions in non-IDU individuals engaging in at-risk behavior suggests a role of sexual practices in the transmission of the infection. Among non-IDU individuals, the risk for development of HCV infection tended to increase in those who were HIV-1 infected.
丙型肝炎病毒（HCV）感染的性传播作用仍未完全明确，部分原因是缺乏对有高危性行为的HCV阴性个体队列进行的纵向研究。
评估1型人类免疫缺陷病毒（HIV-1）感染及其他性传播疾病（STD）高危人群中HCV感染的发生率，并确定与HCV血清学转换相关的因素。
对罗马一家大型STD中心自愿参加HIV-1检测与咨询项目的连续就诊者队列进行了一项回顾性纵向研究。纳入所有至少连续进行两次HCV抗体检测的个体。收集了所有研究参与者的临床数据和个人行为信息。
在1992年6月至1994年12月期间，共有709名个体（12名静脉吸毒者[IDU]、244名同性恋者和453名异性恋非IDU者），最初HCV抗体呈阴性，接受了不止一次检测。在这些个体中，发生了15次HCV血清学转换。平均随访时间为1.25人年（p/y），发病率为每100人年1.69例。按暴露类别划分的发病率分别为：IDU者每100人年39.30例，男同性恋者每100人年1.37例，异性恋非IDU者每100人年0.97例。排除IDU者后，在697名有高危性行为的STD门诊就诊者中，HIV-1阳性状态往往与HCV血清学转换相关（相对风险=5.48；95%置信区间=0.85-35.40）。入组时HIV-1感染患者中HCV的粗发病率在免疫抑制严重、中度和轻度水平者中分别为11.5%、4.2%和2.4%（趋势卡方=2.38，P=0.1）。
在该队列中，HCV感染被证实与静脉吸毒密切相关。尽管如此，在有高危行为的非IDU个体中，三分之二的HCV血清学转换事件表明性行为在该感染传播中起一定作用。在非IDU个体中，HIV-1感染者发生HCV感染的风险往往增加。
