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Conference Summary
Prevention of Hepatitis C
in Women1
Beth P. Bell,*
Eric E. Mast,* Norah Terrault,† and Yvan J.F. Hutin‡
*Centers for Disease Control and Prevention, Atlanta, Georgia, USA; †University
of California at San Francisco, San Francisco, California, USA; and ‡World
Health Organization, Geneva, Switzerland
Suggested
citation for this article
Hepatitis C is a major public health problem in the United States. Although
the incidence of new infections declined substantially in the past decade,
approximately 25,000 persons are infected each year. In total, an estimated
2.7 million Americans have chronic hepatitis C virus (HCV) infection and
are at risk for HCV-related chronic liver disease and hepatocellular carcinoma
(HCC).
The most common exposure associated with HCV infection is use of injection
drugs. Other less commonly identified risk factors include sexual contact;
transfusions before blood screening was implemented; and occupational,
nosocomial, and perinatal exposures. Although sources of HCV infection
are the same for men and women, the overall prevalence of HCV infection
is lower among women than men, which is likely related to the lower prevalence
of injection-drug use among women.
The risk for HCV transmission from mother to infant is about 5%–6%; transmission
occurs only from women who are HCV RNA positive and is higher among those
coinfected with HIV (≈18.7%) than among women not infected with
HIV (≈5.4%). The influence of factors such as maternal viral titer
and interventions at the time of delivery is unclear. Studies indicate
that breastfeeding is not a risk factor for perinatal transmission.
Most hepatitis C prevention strategies are gender neutral and include
screening and testing donors of blood, plasma, organ, tissue, and semen;
virus inactivation of plasma-derived products; effective infection control
practices; identification, counseling, and testing of at-risk persons;
and medical management of infected persons. Pregnant women with risk factors
for infection should be identified, screened, and counseled regarding
the risk for perinatal transmission.
Clinical
Reports
Although risk factors for HCV acquisition are similar among men and women,
women are at higher risk of acquiring HCV from sexual contact with an
HCV-infected partner and more likely to be initiated into drug use, share
needles, or be injected by a sexual partner. Among HCV-infected women,
pregnancy may lead to worsening of histologic disease. Other gender differences
in the natural history of hepatitis C are that the rate of spontaneous
HCV clearance may be higher among women than men, the risk for fibrosis
progression and HCC are lower in women than men, and alcohol use by women
with hepatitis C is likely to have more pronounced negative effects on
the liver than is observed among HCV-infected men. There do not appear
to be substantial gender differences in response to currently available
therapy.
Hepatitis
C Epidemiology and Prevention: the International Perspective
Approximately 2.2% of the world's population, 130 million people, are
infected with HCV. Worldwide, an estimated 325,000 deaths from HCV-attributable
HCC and cirrhosis occur annually. In industrialized countries, most HCV-infected
persons have prevalent, chronic infections, attributable to past exposures
such as injection drug use, blood transfusions, and sexual contact. Primary
prevention strategies include reducing harm and preventing nosocomial
transmission. In developing countries, many incident, new infections are
due to health care-related exposures such as unsafe injections, and prevention
strategies focus on safe health care as well as reducing harm.
1The following comments were made in presentations
by the above authors at the International Conference on Women and Infectious
Disease.
Suggested citation
for this article:
Bell BP, Mast EE, Terrault
N, Hutin YJF. Prevention of hepatitis C in women [conference summary].
Emerg Infect Dis [serial on the Internet]. 2004 Nov [date cited].
Available from http://www.cdc.gov/ncidod/EID/vol10no11/04-0624_04.htm
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