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Incidence of hepatitis C virus is low among HIV-infected women and usually is linked to drug use

The incidence of hepatitis C virus (HCV) is low among women infected with the human immunodeficiency virus (HIV) that causes AIDS and among women at risk of HIV infection. For the majority of women, HCV infection is linked to drug use, according to a new study from the Women's Interagency HIV Study (WIHS). WIHS is a multicenter study of the natural history of HIV infection in women, which is jointly funded by the Agency for Healthcare Research and Quality, the National Institutes of Health, and the Centers for Disease Control and Prevention.

For this study, the investigators studied HCV antibody and viremia (presence of virus) in blood samples obtained during 1994-1999 from two groups: initially HIV-infected HCV-uninfected women and HIV-HCV-uninfected women. Over a mean of 3.5 years, 22 (1.5 percent) of 1,517 women seroconverted (developed HCV antibodies in their blood). Of these, 14 (64 percent) truly acquired a new infection as indicated by HCV antibodies and new-onset viremia. The incidence rate in HIV-infected women was 2.7 cases per 1,000 person-years, and among HIV-negative women, it was 3.3 cases per 1,000 person-years.

For the majority of women in the study who became HCV seropositive, acquisition of HCV infection was associated with any history of drug use, distant or current, injection or not. For example, 86 percent of women who acquired HCV infection reported a history of or current drug use compared with 22 percent of HCV-seronegative women.

This supports the contention that, with the screening of the blood supply, the use of drugs, primarily via injection, is the single most important risk factor for HCV infection. Sexual transmission of HCV is plausible, but the association is weak. Although most HCV exposed individuals will predictably develop HCV antibodies, a certain proportion may not do so for quite some time. Also, many will clear infection, particularly if they are not immunosuppressed, and for those who do so, it will happen soon after infection. Thus, clinicians should maintain a high index of suspicion of HCV infection among individuals at risk and consider repeated antibody testing, as well as HCV RNA testing, when such individuals have negative results of a single antibody study.

See "Incident hepatitis C virus in women with human immunodeficiency virus infection," by Michael Augenbraun, M.D., James J., Goedert, David Thomas, and others, in the November 15, 2003, Clinical Infectious Diseases 37, pp. 1357-1364.

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