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HCV in Semen
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It is generally considered today that rates of sexual
HCV transmission are low, about 5%. There is much controversy about how
and if HCV is transmitted sexually. Although HCV has been found in
semen, there does not appear to be evidence yet that the exchange of
semen transmits HCV. But I think further research is needed to examine
if there are circumstances or conditions in which HCV can be
transmitted by semen. How can HCV be transmitted sexually? The CDC says
risk for sexual transmission increases if a person has multiple sex
partners and is active sexually. Remember HCV is transmitted by
blood-to-blood contact. Studies show that risk for sexual transmission
may be increased when the following circumstances are present during
sexual contact: STDs, open sores, anal sex, and sex during
menstruation; several studies show increased risk for sexual
transmission among men who have sex when risky sexual behaviors which
may draw blood are used such as fisting. Here are some selected study
abstracts of interest. Two of these abstracts are from recent
presentation and publication, but do not necessarily present new
information. Studies suggest that a high HCV viral load may promote
sexual transmission. Since higher HCV viral load in HIV-infected
individuals has been observed at times it raises the question whether
HCV sexual transmission is a greater risk for HIV-infected individuals.
I don't think this has been adequately studied. Studies do show that
among pregnant women HIV increases the risk for HCv transmission
several times.
Intermittent detection of hepatitis C virus (HCV) in semen from men with human immunodeficiency virus type 1 (HIV-1) and HCV
HCV is usually transmitted via the blood, but HCV RNA has been detected
recently in seminal fluid. This study was done to study HCV seminal
shedding and factors that could influence the presence of HCV in the
seminal fluid of men coinfected with HCV and HIV-1. HCV and HIV-1
genomes were assayed in multiple paired blood and semen samples
obtained from 35 men enrolled in an assisted medical procreation
protocol. HCV RNA was found intermittently in semen samples from 9
patients (25.7%). Samples from 9 men with HCV RNA in their semen and 26
men without were compared to further analyze these parameters. No
correlation was found between HCV RNA in the seminal fluid and age, HCV
virus load, the duration of HIV-1 infection, HIV treatment, the CD4+
cell count, HIV-1 virus load or HIV-1 detection in the semen. The
intermittent detection of HCV RNA in semen samples support the
systematic search for HCV RNA in semen and the use of processed
spermatozoa in assisted medical procreation of infertile HCV
serodiscordant couples. J. Med. Virol. 69:344-349, 2003.
A STUDY OF THE PRESENCE OF HCV RNA IN SEMEN OF PATIENTS WITH CHRONIC HCV INFECTION
El Guinaidy and researchers at the Ain Shams University in Cairo, Egypt
were reporteing this study at the 28th Meeting of the European
Association for the Study of the Liver. But the Conference was
cancelled due to war, and here is the abstract. Introduction: HCV is a
worldwide problem. The prevalence in Egypt approximates 12%. The role
of sexual route in transmitting HCV remains controversial. The aim of
the study was to detect HCV RNA in semen of chronic HCV infected
patients. Patients and methods: Seminal plasma was tested for HCV RNA
in 40 married patients with chronic HCV infection (all have positive
HCV RNA in their sera) using a nested reverse transcription PCR assay
with commercial kits for amplification and detection of HCV RNA
(Purescript, Gentra Systems, Minneapolis, USA). Semen was tested for
the presence of PCR inhibitors to identify patients with false negative
results. Results: 10 patients (25%) had HCV RNA in their semen (seminal
plasma was +ve while round cells and motile spermatozoa were Šve for
HCV RNA). Three out of the 10 wives of these 10 patients had HCV RNA in
serum. Duration of marriage was significantly longer in HCV positive
wives compared to non-infected wives. Serum HCV RNA levels were
significantly higher in patients with +ve semen samples than in
patients with Šve semen samples (mean±SD 1, 695, 539±1, 348, 002 vs
241, 860±338, 504 copies /ml, P<0.001). Conclusion: HCV RNA can be
detected in semen of patients with high blood viral load. They may
transmit the infection to their wives and the risk of transmission
increases proportionately with duration of marriage.
Sperm washing and virus nucleic acid detection to reduce HIV and
hepatitis C virus transmission in serodiscordant couples wishing to
have children.
BACKGROUND: Use of a motile spermatozoa isolation process was assessed
for reducing the transmission of HIV and hepatitis C virus (HCV) during
artificial insemination in HIV-serodiscordant couples in which the man
is infected. PATIENTS: Thirty-two HIV-1-infected clinically
asymptomatic men, having a median CD4 cell count of 396 x 10(6)/l and a
median blood plasma HIV-1 RNA content of 414 copies/ml. Of these, 16
were infected with both HIV and HCV. METHODS: Motile spermatozoa were
isolated from 51 semen samples by density gradient and 'swim-up'. HIV-1
and HCV genomes were detected and quantified in the blood plasma and
seminal plasma, and detected in seminal cell fractions obtained during
spermatozoa isolation. RESULTS: HIV-1 RNA was detected in 30% of
seminal plasma samples. HIV-1 genomes were found in 18% of seminal cell
samples, but in none of the motile spermatozoa fractions after
'swim-up'. There was no correlation between the HIV-1 RNA
concentrations in the blood and seminal plasma. HIV-1 genome was
detected intermittently in patients who gave more than one sample. HCV
RNA was detected in 20% of seminal plasma samples from HCV viraemic
patients, but in no seminal cells or motile spermatozoa fractions.
CONCLUSIONS: Purification of motile spermatozoa by density gradient
plus 'swim-up' reduced the HIV-1 and HCV genomes in the semen of
infected individuals to undetectable levels. This method, associated
with a standardized virus assay, could be useful for serodiscordant
couples (males infected) who wish to have children. AIDS 2000 Sep
29;14(14):2093-9
Presence and predictors of hepatitis C virus RNA in the semen of homeless men.
Although the possibility of sexual transmission of the hepatitis C
virus (HCV) remains controversial, little is known of the associations
of positive semen specimens with potential demographic and behavioral
risk factors. Knowledge of these predictors may suggest factors that
increase risk of HCV RNA in the semen. Semen and bloodfrom 80
HCV-infected homeless men were evaluatedfor the presence of HCVRNA by
means of branch DNA and transcription-mediated amplification analyses.
Associations of selected demographic and behavioral characteristics of
the participants with presence or absence of HCV in their semen were
also assessed. HCV RNA was detected in the semen of 36% of the sample.
Associations were found with HCV RNA in semen and older age, higher
viral loads of HCV in blood, current alcohol and lifetime
methamphetamine use, and having been vaccinated for the hepatitis B
virus. Findings suggest that sexual transmission of HCV is plausible
and shed light on the need to conduct more in-depth investigations.
Biol Res Nurs 2002 Jul;4(1):22-30
Detection and characterization of hepatitis C virus RNA in seminal
plasma and spermatozoon fractions of semen from patients attempting
medically assisted conception.
To investigate the risk of transmission of hepatitis C virus (HCV) via
semen in assisted reproduction techniques, semen samples from 32 men
chronically infected with HCV attending a center for assisted
procreation were tested for HCV RNA by a reverse transcription-PCR
protocol by using a modified version of the Cobas AMPLICOR HCV assay
(version 2.0; Roche Diagnostics). The sensitivity of the test was 40
copies/ml. Four of 32 seminal plasma samples (12.5%) were found to be
positive for the presence of HCV RNA. The median HCV load in blood was
significantly higher in patients who were found to be positive for the
presence of HCV RNA in semen than in those who tested negative (P =
0.02). In one man, seven consecutive seminal plasma samples tested
positive for HCV RNA, as did two consecutive motile spermatozoon
fractions; the corresponding fractions obtained after migration of the
spermatozoa remained negative. Despite the absence of the proven
infectivity of virus in semen samples that test positive for HCV RNA,
these findings highlight the fact that seminal fluid may exhibit
prolonged HCV RNA excretion. The usefulness of HCV RNA detection in
both seminal plasma and spermatozoon fractions before the start of a
program of medically assisted reproduction in couples in whom the male
partner is chronically infected with HCV would need to be evaluated
prospectively with a larger population of subjects exhibiting HCV RNA
in their
semen. J Clin Microbiol 2002 Sep;40(9):3252-5
Pregnancy after safe IVF with hepatitis C virus RNA-positive sperm.
In France, assisted reproductive technology (ART) for hepatitis C virus
(HCV)-infected patients is now subject to strict control after the
publication of recent guidelines. Infertile serodiscordant couples
(HCV-viraemic men and their seronegative female partners) require
special care to carried out in designated 'viral risk' laboratories.
Twelve sequential semen samples taken from an HCV chronically infected
patient were analysed within 22 months. HCV RNA was detected in all the
seminal plasma sampled before antiviral treatment with relatively high
viral loads, and in two of the corresponding fractions of motile sperm
obtained after a gradient selection, suggesting that a contamination
risk by HCV through ART cannot be excluded. When the selection of sperm
on a discontinuous gradient was followed by an additional swim-up step,
HCV RNA was never detected in the motile sperm suspension that was
frozen in highly secure straws. IVF was performed using cryopreserved
sperm that tested negative for HCV RNA, resulting in a pregnancy. One
month after embryo transfer, testing for HCV RNA and antibodies in the
woman gave negative results. Hum Reprod 2002 Oct;17(10):2650-3
Hepatitis C virus infection and genotypes among human immunodeficiency virus high-risk groups in Cameroon
Parenteral transmission (needles, Ivs) of HCV is well established but
other possible routes such as heterosexual transmission are still
questioned. The Central African region is characterised by a high HCV
endemicity without any evidence on the route of transmission. The
information on HCV genotypes that circulate in this area is also
limited and controversial. HIV infection is very frequent in this
region and mostly acquired via the heterosexual route. The aim of this
work was to investigate the trend of HCV infection and genotypes among
HIV high-risk groups from Cameroon. Four hundred eighty-two patients
including 229 tuberculosis clinic attendants, 184 sexually transmitted
disease clinic attendants, and 69 HIV clinical suspects from another
clinic were enrolled. All plasma samples were screened for antibodies
to HCV and HCV RNA. Genotypes were assigned by sequencing a 5UTR
amplified fragment. The overall prevalence of HCV markers was 11.6% and
a significant increasing trend with respect to age was observed. A
proportion of 64.1% (34/53) of HCV antibody positive samples was
viraemic. HCV RNA was found in 3 samples that were indeterminate in
RIBA 3.0. One was negative in the antibody screening test and the two
others were weakly positive. The data on HCV genotypes revealed that
genotype 1 was involved in 57% of viraemias, genotype 2 in 24%, while
genotypes 4 and 5a accounted for 16 and 3%, respectively. In contrary
to the predominance of genotype 4 reported in some African countries
and even the neighbouring countries, these data demonstrate clearly
that HCV infection in Cameroon is dominated by genotypes 1 and 2. No
association was found between the HCV markers and the presence of HIV
infection. It is concluded, therefore, that the heterosexual route
plays a minor role in HCV transmission in this country. J. Med. Virol.
66:179-186, 2002. |
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