Intrafamilial Transmission Of Hepatitis Research Articles

Intrafamilial transmission risk factors and preventive measures followed by household contacts of hepatitis C patients

Background Hepatitis C virus (HCV) infection is the most challenging public health problem in Egypt where the prevalence is the highest in the world. Intrafamilial transmission of hepatitis C occurring between patients infected with HCV and their household members sharing the same house and living conditions. Preventive measures of hepatitis C are considered the first line of defense against HCV infection. Aim assess the intrafamilial transmission risk factors and preventive measures followed by household contacts of hepatitis C patients. Design A descriptive cross sectional research design was utilized. Setting The study was conducted at outpatient clinics of Liver Institute at Kafer-Elsheikh Governorate. Sample A simple random sample of 365 household contacts of hepatitis C patients was recruited for the current study. Tool Data was collected through one tool: A structured Interviewing Questionnaire for household contacts of hepatitis C patients which included three parts; part I-(a) Demographic data, (b) Medical history of household contacts, Part II (a) Household contacts knowledge about HCV (b) Hepatitis C risk factors, Part III: Preventive measures followed by household contact of hepatitis C patient: This part is self-reported practices. Results The study revealed that;56.7% of household contacts were males, 72.1% of them were living in rural areas, 75.60% were married, with a mean age ±SD 36.73±9.18 years old.44.1% obtained secondary education, 30.7% were employees, among this group hypertension and diabetes were the main chronic illness. 49.90% had moderate level of general knowledge about HCV infection, 71.50% had low level of knowledge about hepatitis C risk factors and 90.00% had a low level of preventive measures (self-reported practices) regarding HCV. There was no correlation between household contacts knowledge about HCV risk factors and their preventive measures(r=0.031 and P=0.549). Conclusion Almost half of household contacts mentioned that they knew intrafamilial risk factors while about half of this group have a misconception about intrafamilial risk factors, while majority of them stated that they knew sharing scissors and clippers as the main intrafamilial risk factors and less than one-fourth of them knew direct contact with infected blood and sharing of special equitoothbrushesth brushes. Household contacts applied some preventive measures such as; Cover the wound with a piece of cloth or gauze, disinfect the site with alcohol or antiseptic solution and frequent and proper hand washing. Recommendations Routine health assessment of household contacts knowledge regarding intrafamilial risk factors and preventive measures therefore health education sessions should be conducted to raise their awareness regarding HCV infection and further research should be conducted on larger samples of contacts.

Intrafamilial Transmission of Hepatitis C Virus among Household Members of Hepatitis C Virus Patients

Background:Egypt is considered one of the highly endemic countries with Hepatitis C Virus (HCV) infection. Since we are moving into the HCV-free era, it is necessary to acknowledge the most common methods of HCV transmission. Intrafamilial transmission is one important method that hugely contributed to that endemicity. Aim:Our aim is to identify the prevalence of intrafamilial transmission of HCV among household contacts of chronic HCV patients, risk factors, and methods of transmission. Subjects and Methods:In this study, we recruited 807 Household members of 228 chronic HCV patients. Eligible participants were subjected to history taking, clinical examination, and blood testing for HCV antibodies and PCR. Results:We found that HCV infection was more prevalent among older age groups; married; who live in rural residence; and having high crowding index. Among relatives with HCV, parents were the most affected, followed by siblings, then husbands or wives. The longer the duration of contact, the higher the risk of infection. The incidence of HCV infection was significantly higher among patients who did the following activities: Sharing shaving machine and sugar measurement device with HCV-infected family members, sharing towels with family members, and Handshaking/kissing HCV-infected relatives.Conclusions:Intrafamilial transmission of HCV is an undeniable risk factor, which amplified the burden of HCV. Recognition of remarkable modes of intrafamilial transmission would facilitate suppression of infectivity, as a result achieving the ambition of an HCV-free Egypt.

Intra-familial transmission of hepatitis B affecting all household members - A case report

Intra-familial transmission of hepatitis B is well documented and is the rationale for screening of household members. However, reports on transmission of infection to all household members are sparse. We report a case of intra-familial transmission of hepatitis B affecting all household members. The index case was a lady diagnosed with chronic liver cell disease, who was later found to have chronic hepatitis B viral infection. All household contacts were screened, which included five persons. All showed evidence of exposure and two were chronically infected, of which one was a pregnant lady. The risk of familial transmission of hepatitis B could be higher than expected. This case highlights the importance of active efforts to screen all family members at diagnosis of each new case of hepatitis B.

A genome-wide association study on chronic HBV infection and its clinical progression in male Han-Taiwanese.

It is common to observe the clustering of chronic hepatitis B surface antigen (HBsAg) carriers in families. Intra-familial transmission of hepatitis B virus (HBV) could be the reason for the familial clustering of HBsAg carriers. Additionally, genetic and gender factors have been reported to be involved. We conducted a three-stage genome-wide association study to identify genetic factors associated with chronic HBV susceptibility. A total of 1,065 male controls and 1,623 male HBsAg carriers were included. The whole-genome genotyping was done on Illumina HumanHap550 beadchips in 304 healthy controls and HumanHap610 beadchips in 321 cases. We found that rs9277535 (HLA-DPB1, P = 4.87×10−14), rs9276370 (HLA-DQA2, P = 1.9×10−12), rs7756516 and rs7453920 (HLA-DQB2, P = 1.48×10−11 and P = 6.66×10−15 respectively) were significantly associated with persistent HBV infection. A novel SNP rs9366816 near HLA-DPA3 also showed significant association (P = 2.58×10−10). The “T-T-G-G-T” haplotype of the five SNPs further signified their association with the disease (P = 1.48×10−12; OR = 1.49). The “T-T” haplotype composed of rs7756516 and rs9276370 was more prevalent in severe disease subgroups and associated with non-sustained therapeutic response (P = 0.0262). The “G-C” haplotype was associated with sustained therapeutic response (P = 0.0132; OR = 2.49). We confirmed that HLA-DPB1, HLA-DQA2 and HLA-DQB2 loci were associated with persistent HBV infection in male Taiwan Han-Chinese. In addition, the HLA-DQA2 and -DQB2 complex was associated with clinical progression and therapeutic response.

Intrafamilial transmission of hepatitis C virus in Menoufia Governorate

ObjectiveThis study was conducted to focus on the intrafamilial transmission of hepatitis C virus (HCV) infection and to determine the impact of a suggested health education program on the knowledge, the attitude and the practice of the participants regarding the prevention of intrafamilial transmission of HCV.BackgroundThe HCV is one of the most important causes of chronic liver disease in Egypt . Information on the current magnitude and the rate of intrafamilial transmission of HCV and its risk factors in Egypt is scarce.Patients and methodsThis study was a cross-sectional analytic study with an intervention (health education program) that was conducted in both the Monshaat Sultan University Hospital and the Menouf General Hospital on all previously diagnosed HCV-positive patients and their spouses as well as their family members with corresponding control groups.ResultsHCV-positive patients were significantly higher among family members of HCV-positive spouses compared with HCV-negative ones, 19.1 versus 15.4%, which indicates that HCV may be transmitted through social relations among different family members.ConclusionThe data of this study provide evidence that there is a greater probability of intrafamilial transmission of HCV infection, especially wife-to-husband transmission rather than husband-to-wife transmission of HCV, in Egypt. The data also support the plausible hypothesis that the probability of transmission is greater if the spouse is positive for HCV RNA.

Hepatitis B virus depicts a high degree of conservation during the immune-tolerant phase in familiarly transmitted chronic hepatitis B infection: deep-sequencing and phylogenetic analysis.

When intrafamilial transmission of hepatitis B virus (HBV) occurs, a virus with the same characteristics interacts with diverse hosts' immune systems and may thus result in different mutations to escape immune pressure. In this study, the HBV genomic characterization was assessed longitudinally after intrafamilial transmission using nucleotide sequence data of phylogenetic and mutational analyses, including those obtained by deep-sequencing for the first time. Furthermore, HBeAg-anti-HBe profile and variability of HBV core-derived epitopes were also evaluated. Strong evidence was obtained from intrafamilial transmission of HBV genotype D1 by phylogenetic inferences. HBV isolates exhibited high degree (~99%) of genomic conservation for almost 20 years, when patients were persistently HBeAg positive with normal amino transferase levels. This identity remained high among immune-tolerant siblings. In contrast, it diminished significantly (P = 0.02) when the mother cleared HBeAg (immune clearance phase). By deep-sequencing, the quantitative analysis of the dynamics of basal core promoter (BCP) (A1762T, G1764A; A1766C; T1773C; 8-bp deletion; and other) and precore (G1896A) variants among HBV isolates from family members exhibited differences during the follow-up. However, only those from the mother showed amino acid variations at core protein that would impair their MHC-II binding. Hence, when intrafamilial transmission occurs, HBV was highly conserved under the immune-tolerant phase, but it exhibited mutations more frequently during the immune clearance phase. The analysis of the HBV BCP and precore mutants after intrafamilial HBV transmission contributes to a better understanding of how they evolve over time.

Intrafamilial transmission of hepatitis C virus

HCV infection is a major public health problem worldwide. Several studies reported that HCV infection might cluster in families or households. Horizontal intrafamilial transmission of the virus has been demonstrated previously. Whether horizontal transmission makes any significant contribution to the global burden of HCV infection is still controversial and data about epidemiology and routes of transmission are uncertain. The certain diagnosis of horizontal intrafamilial transmission of HCV is based on the simultaneous presence of specific laboratory criteria, the temporal association between intrafamilial exposure and infection and the exclusion of all the potential extrafamilial routes of transmission of the infection. This review summarizes the current knowledge of epidemiology, risk factors and molecular biology of horizontal intrafamilial transmission of HCV infection.

Intrafamilial transmission of hepatitis C virus in patients with severe haemophilia A

The history behind the production of clotting factor concentrates produced differences in the prevalence of Hepatitis C Virus (HCV) and other blood-borne infections in haemophilic patients. Prevalence rates of HCV infection up to 100% were reported in patients treated with concentrates before 1985. Conversely, nowadays, viral inactivation and recombinant technologies have effectively prevented transfusion-transmitted viral pathogens. Recently, new HCV infections in three young brothers were observed. In the absence of any other risk of transmission, their HIV/HCV coinfected uncle, who was living in the same house, was subject to study. Plasma samples of the four relatives were investigated in order to test whether the infections have a common source. A phylogenetic approach using the most variable (E2) viral sequences was carried out using samples from the four family members. The HCV sequences from the study resulted highly related, being those obtained from the uncle the most ancestral ones. Because of the chronological order in which the infections occurred and the relatedness of the sequences, an infection from the uncle to his nephews is the most likely explanation. Special cares must be applied in the case of household contact among members of a family with inherited bleeding disorders.

Impact of universal vaccination on intrafamilial transmission of hepatitis B virus

To control hepatitis B virus (HBV) infection, a nationwide vaccination program was launched in 1984 and resulted in a significant reduction in the rate of persistent infection of children. However, the relative contribution of vaccination to the intrafamilial clustering of HBV infection remains unclear. The rate of intrafamilial HBV transmission in vaccinated children was investigated. Eighty-four sera from vaccinated children were enrolled and HBV serum markers were determined. The modes of intrafamilial HBV transmission were investigated by history taking and serological assay, and confirmed by genotyping and phylogenetic analysis. The results showed 66 (78.6%) vaccinated children born to hepatitis B surface antigen (HBsAg)-negative parents were HBsAg-negative. Eighteen vaccinees were born to HBsAg-positive parents; four (21.4%) of the children were HBsAg-positive. According to the parents' HBsAg status, three patterns of HBsAg-positive parents were identified. Serological analysis showed that three of 15 children born to HBsAg-positive mother (pattern I) and one of two children born to HBsAg-positive father became infected (pattern II). The remaining one child was HBsAg negative with both parents positive for HBsAg (pattern III). Genotyping and phyogenetic analysis confirmed the mode of intrafamilial transmissions. Sequence analysis of S and pre-S genes showed that HBV isolates of HBsAg-positive vaccinees were variants; no G145R but G145A and other substitutions were found. In conclusion, this small study showed that both maternal and paternal transmissions are important of the intrafamilial spread of HBV infection. In addition, the introduction of HBV vaccination has resulted in a reduction of intrafamilial transmission, but a study of a large population is needed.

Changes in the intrafamilial transmission of hepatitis B virus after introduction of a hepatitis B vaccination programme in Korea

Hepatitis B virus (HBV) infections are endemic in Korea. The aims of this study were to determine the prevalence of HBsAg positivity in Korea and to evaluate the changes in intrafamilial transmission after introduction of HBV vaccination in 1983. This study was based on the 2001 Korea National Health and Nutrition Examination Survey. A total of 2512 study subjects, aged 10-29 years, were selected from across Korea using a stratified multi-stage probability sampling design. To identify the changes in intrafamilial transmission after the introduction of the HBV vaccination programme, 1850 subjects with parental serological markers were selected. These subjects were then grouped into two birth cohorts (cohort 1: born before 1983; cohort 2: born after 1983). Appropriate sampling weights were used for all analyses. The weighted age-specific prevalence of HBsAg was 4.9% in participants in their 20s and 1.9% in adolescents; the combined weighted prevalence was 3.2%. Of subjects with HBsAg positivity in either parent, 17.5% were HBsAg-seropositive. Of subjects with two HBsAg-negative parents, 1.5% were HBsAg-seropositive. The HBsAg positivity rate of offspring with HBsAg-positive mothers was higher than those with HBsAg-positive fathers (27.3% vs. 4.8%, P<0.001). The weighted HBsAg positivity rate of offspring with HBsAg-negative mothers was 2.3% for cohort 1 and 0.4% for cohort 2 (P<0.01), and for those offspring with HBsAg-positive mothers it was also significantly decreased compared to cohorts 1 and 2 (40.2% vs. 16.4%, P<0.01). However, the weighted HBsAg positivity rate of offspring with HBsAg-positive mothers was still high. Our results showed that introduction of HBV vaccination has resulted in a decline in the overall HBsAg positivity rate and a reduction in intrafamilial transmission in Korea, but further preventive measures for maternal intrafamilial transmission are needed.

Intrafamilial transmission of hepatitis C virus in Italy: a systematic review

BackgroundHepatitis C virus (HCV) transmission is mainly due to parenteral exposure; however, in absence of such risk factor, there are reports of intrafamilial spread of HCV and observational studies suggest...

Molecular analysis of transmission of hepatitis C virus in a nurse who acquired acute hepatitis C after caring for a viremic patient with epistaxis

A 23-year-old nurse (HC-IP) developed acute hepatitis C. Intrafamilial transmission of hepatitis C virus (HCV) was suspected initially because her parents were carriers of HCV of the same genotype (1b) as that of Patient HC-IP. However, the HCV isolate from Patient HC-IP and those from her parents shared identities of only 92.4-92.7% in the 1,087-nucleotide (nt) sequence within the NS5B region. It was then suspected that she contracted HCV infection during medical practice. Sixteen patients with antibodies to HCV (anti-HCV) were hospitalized 1-3 months before she became positive for anti-HCV. Upon analysis of stored serum samples, 14 of the 16 patients were found to be positive for HCV RNA, and 9 of the 14 viremic patients had genotype 1b HCV. Although the shared identities between the HCV isolate from Patient HC-IP and those from eight of the nine patients were merely 90.6-93.9% within the 1,087-nt NS5B sequence, the HCV isolate from the remaining one patient (HC-P12) was 99.7% identical to that from Patient HC-IP. Upon analysis of the E1 and E2 junctional region including hypervariable region 1 (283 nt), there was a close relationship (99.3-100%) between clones obtained from Patients HC-IP and HC-P12. Although the nurse HC-IP had a finger injury, she took care of Patient HC-P12, a 70-year-old man with HCV-related cirrhosis and recurrent epistaxis, occasionally without wearing protective gloves. This study indicates the occurrence of HCV transmission by exposure of nonintact skin to blood in health care settings.

Hepatitis C: sexual or intrafamilial transmission? Epidemiological and phylogenetic analysis of hepatitis C virus in 24 infected couples

The role of sexual or intrafamilial transmission of hepatitis C is controversial. A phylogenetic analysis was performed on the non-structural region 5B of the hepatitis C virus (NS5B-HCV). High percentages of homology (mean of 98.3%) were shown between the couples. Twenty (83.3%) of the 24 men but only two of the women (8.3%) reported having had sexually transmitted diseases during their lives. The risk factors for HCV acquisition were blood transfusion (10 couples), use of illegal injected drugs (17), use of inhalants (15), acupuncture (5) and tattoos (5). The shared use of personal hygiene items included toothbrushes between six couples (25%), razor blades between 16 (66.7%), nail clippers between 21 (87.5%) and manicure pliers between 14 (58.3%). The high degree of similarity of the hepatitis C virus genome supports the hypothesis of hepatitis C virus transmission between these couples. The shared use of personal hygiene items suggests the possibility of intrafamilial transmission of infection.

Intrafamilial Transmission of Hepatitis C Virus Infection in Iran (Markazi Province)

Objectives: The role of Intrafamilial Hcv transmission is still controversial, the aim of the present study is to determine intrafamilial transmission (Sexual and non sexual contacts) of Hcv in Iran. Methods: In this historical cohort study, we enerolled 270 first degree relatives of hepatits c patients as the exposed group and 270 first degree relative of normal subjects (with negative Hcv) compared as the unexposed group. Positive Hcv and negative Hcv subjects were selected of blood donors reffered to the Regional Blood transfusion organization in Arak from August 2001 to August 2007. First degree relatives were who lived with the index case at least for one year in the same house. Subjects were interviewed using a standard questionnaire acquiring demographic and risk factor information. Then serum samples were obtained from each subject. Antibodies to Hcv were detected employing by commercially available second generation enzyme immunoassay. Positive serum specimens were retested using a second generation recombinant immunoblot assay. Data analysis was carried out with spss for intra-hous hold clustering. We used fisher exact test in order to detect association between the exposure and out come of the study Results: The mean age of exposed group was 27.11± 19.84 years and 38.1% were male. The mean age of unexposed group was 29.38± 16.70 years and 51.9% were male. There was not any significant difference about sex, age, familial relation and candom use between exposed and unexposed subjects. sexual partner subjects formed 24.8% of first degree relatives in the case group. In exposed group, there is no Hcv positive but in unexposed group we had 2 cases of Hcv positive who were intravenous drug abuser. The prevalence of positive Hcv antibody among household contacts of two groups was not significantly different. (P value = 0.25) Conclusion: The results of this study demonstrate that intrafamilial transmission of Hcv is not the significant transmission route and sexual transmission does not seem to play a role in the intrafamilial spread of Hcv infection.

Intrafamilial transmission of hepatitis C virus: Infection of the father predicts the risk of perinatal transmission

The aims of the present study were to evaluate in a cohort of mothers infected with hepatitis C virus (HCV) the prevalence of HCV infection of their sexual partners, the influence of infection of the partners on perinatal transmission, and whether this influence is mediated by other well known risk factors for perinatal transmission. Forty-nine consecutive mothers infected with HCV who transmitted infection to their offspring and, as a control group, 557 consecutive mothers infected with HCV who did not transmit infection, together with their children and the fathers of the children who were also the sexual partners of the mothers were evaluated. History of intravenous drug use was significantly more frequent in women with partners infected with HCV than in women with partners not infected [115/180 (63.9%) vs. 87/401 (21.7%); relative risk (RR): 6.38, 95% confidence intervals (CI): 4.34-9.39, P < 10(-3)]. HCV infection was more frequent in the partners of mothers who transmitted perinatally HCV [23/49 (46.9%) vs. 174/557 (31.2%); RR: 1.95, 95%CI: 1.08-3.51, P = 0.03]. Multivariate analysis demonstrated that paternal HCV infection is not a risk factor per se for perinatal HCV transmission, but its role is dependent on maternal intravenous drug use [adjusted RR: 1.23 (95%CI: 0.44-3.39, P = 0.6)]. In conclusion, the present study shows that partners of mothers infected with HCV with a history of intravenous drug use were at a higher risk of HCV infection. HCV infection of the father seems to be associated with perinatal transmission but this relationship is dependent on maternal history of intravenous drug use.

Intrafamilial transmission of hepatitis B in Tuzla region of Bosnia and Herzegovina

To determine (i) the prevalence of HBV infection in families of confirmed chronic carriers, (ii) possible routes of transmission and risk factors for the intrafamilial transmission, (iii) vaccination rate among family members of chronic carriers and (iv) family members with highest risk for infection. A total of 172 family members of 67 hepatitis B surface antigen chronic carriers were tested for hepatitis B markers; 716 first-time blood donors from the same area were used as controls. Prevalence of hepatitis B surface antigen was higher (P<0.001) among family members of index cases (12.2%; 21/172) than among controls (3.6%; 26/716) with relative risk of 3.3 (95% confidence Intervals=1.9-5.8; P<0.05). Rate of exposure among family members was 37.8% (65/172); only 8.7% (15/172) had been vaccinated for hepatitis B virus. Difference (P<0.001) in exposure existed among family members; exposure increased with age (rhos=0.34; P<0.001). Prevalences of hepatitis B surface antigen positivity and hepatitis B virus exposure were higher among parents of index cases (P<0.005) and among offspring of female index cases (P<0.001). There were more (P<0.001) hepatitis B surface antigen-positive family members among those with mother-children relationship with index case (13/31; 41.9%) than among those with father-children (19/85; 22.4%) and horizontal (siblings and spouses) relationship (2/56; 3.6%). Significantly more (P<0.001) hepatitis B surface antigen-positive and hepatitis B virus-exposed offspring were found in families where only mother was hepatitis B surface antigen positive. Among family members of HBeAg-positive cases more hepatitis B surface antigen-positive cases and hepatitis B virus-exposed cases have been found (P<0.001). Combination of HBeAg positivity and female sex of index case significantly increased risk for chronic carriage among family members (relative risk=24.06; 95% confidence interval=8.88-65.21; P<0.05). In the area studied, both horizontal and vertical transmission exists, but maternal route is predominant. Female sex, HBeAg positivity of index carrier and presence of hepatitis B surface antigen-positive mother inside family increased risk for hepatitis B surface antigen positivity and exposure among family members. Vaccination rate of family members of index cases is alarmingly low.

Intrafamilial transmission of hepatitis C virus

Intrafamilial transmission of hepatitis C virus

Hepatitis B virus infections in families in which the mothers are negative but the fathers are positive for HBsAg

We studied a total of 37 families, in which HBsAg was positive in either or both of father and mother, to assess intra-familial transmission of hepatitis B virus (HBV). The HBsAg positive rate for children with HBsAg-negative mothers was significantly lower than that with positive mothers (4 of 31, 12.9% versus 18 of 32, 56.3%, p<0.01) of course. However, there were three families in which the infection source for children was thought to be fathers, not mothers, i.e., of eight children in these three families with HBsAg +/- father/mother pairs, 4 (50%) were positive for both HBsAg and HBV DNA of genotypes identical to those of their fathers, and another child was positive for HBcAb despite being negative for HBsAg. Interestingly, moreover, all the mothers in these three families were HBcAb-positive even though HBsAg-negative, suggesting that not only father-to-child but also inter-spouse HBV transmission might have occurred. With these findings we would suggest that all the family members with HBsAg-positive fathers should receive HBV vaccine, let alone for those with HBsAg-positive mothers.

Intrafamilial Transmission of Hepatitis C in Egypt *

The incidence of hepatitis C (HCV) infection and associated risk factors were prospectively assessed in a cohort of 6,734 Egyptians from 2 rural villages who were negative for antibodies to HCV (anti-HCV). Initial and follow-up sera were tested for anti-HCV by enzyme immunoassay (EIA), and possible incident cases were confirmed by using the microparticle enzyme immunoassay (MEIA) and tested for HCV RNA. All follow-up serum samples converting from negative to positive without detectable HCV-RNA were further tested by recombinant immunoblot assay. Over an average of 1.6 years, asymptomatic anti-HCV seroconversion occurred in 33 people (3.1/1,000 person-years [PY]), including 28 (6.8/1,000 PY) in the Nile Delta village (AES), where prevalence was 24% and 5 (0.8/1,000 PY) in the Upper Egypt village (baseline prevalence of 9%). The strongest predictor of incident HCV was having an anti-HCV-positive family member. Among those that did, incidence was 5.8/1,000 PY, compared (P < .001) with 1.0/1,000 PY; 27 of 33 incident cases had an anti-HCV-positive family member. Parenteral exposures increased the risk of HCV but were not statistically significant; 67% of seroconverters were younger than 20 years of age, and the highest incidence rate (14.1/1,000 PY) was in children younger than 10 who were living in AES households with an anti-HCV-positive parent. In conclusion, young children would especially benefit from measures reducing exposures or preventing infection with HCV.

Intrafamilial transmission of hepatitis C virus in patients with hepatitis C and human immunodeficiency virus coinfection.

The aim of this study was to determine whether hepatitis C virus (HCV)/HIV coinfection of index cases increases intrafamilial transmission (sexual and nonsexual contacts) of HCV. We prospectively enrolled 347 subjects, including 87 family members of 53 HCV/HIV-coinfected index cases and 134 family members of 73 HCV-monoinfected index cases, which served as a control group. All index cases and family members were interviewed, and a screening for HCV and HIV using enzyme-linked immunosorbent assays was performed. Positive samples were confirmed by polymerase chain reaction and tested for genotype and HCV RNA viral load. A meta-analysis designed to assess the pooled risk of sexual transmission of HCV among HCV/HIV-coinfected patients was performed. Anti-HCV was detected in 2.2% of family members of HCV-monoinfected index cases and 2.3% of family members of HCV/HIV-coinfected index cases. Viral load was higher in coinfected index cases (7.2 x 10(6) mEq/ml) compared with HCV alone (1.9 x 10(6) mEq/ml), p = 0.01. HCV genotype concordance was observed in three family members of HCV-monoinfected index cases and in two family members of HCV/HIV-coinfected index cases. The pooled OR of the meta-analysis evaluating HIV as a cofactor of sexual transmission of HCV was 1.54 (95% CI = 0.76-3.12). Our data demonstrate a low prevalence of intrafamilial transmission of HCV, independent of the presence of HCV/HIV coinfection. This finding is supported by meta-analysis, which failed to identify HIV as an important cofactor of sexual transmission in HCV/HIV-coinfected patients.