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HCV in Semen
  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.
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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