Editorial note from Jules Levin: For a while I have been trying to draw attention to the underappreciated risk of sexual transmission of HCV in other than monogamous HIV-, STD-negative relationships. Without knowing further details of this study it adds to a growing body of evidence suggesting there is a risk of HCV sexual transmission under certain circumstances: when HIV, STDs & risky sexual behavior which may draw blood unknowingly.
 
Filippini P, Coppola N, Scolastico C, Rossi G, Onofrio M, Sagnelli E, Piccinino F.
 
Institute of Infectious Diseases, Second University of Naples, Naples, Italy.
 
BACKGROUND: There are widely discrepant findings on the sexual transmission of hepatitis C virus (HCV), commonly transmitted by the parenteral route. Coinfection with HCV is common in subjects infected with HIV.
 
GOAL: This case-control study evaluated the prevalence of anti-HCV in subjects with hetero- or homosexual contact and no history of intravenous drug abuse or blood transfusion, according to the presence or absence of HIV infection.
 
STUDY DESIGN: In this case-control study, the cases considered were 106 consecutive patients who showed positive anti-HIV test results. For each case, two control subjects were selected who had been screened for HIV infection at the authors' center and found to have anti-HIV-negative test results, and who matched the case in terms age (+/- 5 years), gender, and risk factor for parenterally transmitted infections.
 
RESULTS: The prevalence of subjects with positive test results for hepatitis B surface antigen (HBsAg) was similar between cases and control subjects (4.7% versus 2.4%). Positivity for anti-hepatitis B core antigen in connection with negative test results for HBsAg was observed more frequently in the 106 cases than in the 212 control subjects (33.9% versus 15.6%; P =0.0003). Anti-HCV positivity was more frequent in the cases than in the control subjects (15.1% versus 5.2%; P = 0.005). In particular, among subjects who had hetero- or homosexual intercourse with a steady partner who had positive anti-HIV test results, anti-HCV positivity was observed in 18.7% of the 32 cases and 1.6% of the 64 control subjects (P = 0.008).
 
CONCLUSION: This study demonstrated that in subjects who had only a sexual risk factor for parenterally transmitted infections, HIV may enhance the sexual transmission of HCV.