Clinical

Hepatitis C virus persists in genital tract of HIV+ women

Last Updated: 2005-11-16 16:38:44 -0400 (Reuters Health)

By Will Boggs, MD

NEW YORK (Reuters Health) - Hepatitis C virus (HCV) RNA is often present in the genital tracts of women coinfected with HCV and HIV, according to a report in the November 1st issue of The Journal of Infectious Diseases.

"Perinatal and sexual transmission of HCV may be related to the presence of HCV in the genital tract," Dr. Andrea Kovacs from the University of Southern California, Los Angeles, told Reuters Health. "Thus, it would be important to counsel co-infected patients in regards to potential transmission to a partner or a newborn."

Dr. Kovacs and colleagues analyzed cervicovaginal lavage fluid from 71 women, 58 of whom were coinfected with HCV and HIV, participating in the Women's Interagency HIV Study.

Nearly one third of the samples from HCV/HIV-coinfected women (18/58, 31%) contained HCV RNA, the researchers report, although the viral loads were relatively low (median, 1500 copies/mL).

None of the women who were infected with HCV but not with HIV had detectable HCV RNA in their cervicovaginal lavage fluid when tested by a commercial HCV RNA assay, the results indicate, but two of these women had detectable HCV RNA by the researchers' in-house qualitative assay.

The only statistically significant predictors of HCV RNA in cervicovaginal lavage fluid were the presence of HCV RNA in plasma and the presence of HIV RNA in lavage fluid, the researchers note.

Careful analysis of HCV from five women suggested the presence of differing quasispecies variants in these compartments. In three women, cervicovaginal-derived HCV contained sequences that were not present in HCV derived from plasma or peripheral blood mononuclear cells, the report indicates.

"To our knowledge," the investigators write, "our study is the first to demonstrate compartmentalization of HCV in the genital tracts of HCV/HIV-coinfected women and possible local replication in a large proportion of HCV/HIV-coinfected women."

"HCV appears to infect cells in compartments other than hepatic and blood," Dr. Kovacs said. "Thus, further study will be needed to assess the impact of such reservoirs on reactivation of HCV."

"Additionally, with treatment of HCV and HIV it would be important to assess for reservoirs, such as the genital tract, to assure that there are no sanctuaries where HCV can replicate independently from the blood compartment," Dr. Kovacs concluded.

J Infect Dis 2005;192:1557-1565.