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Revista da Sociedade Brasileira de Medicina Tropical
Print version ISSN 0037-8682
Rev. Soc. Bras. Med. Trop. vol.42 no.3 Uberaba May/June 2009
http://dx.doi.org/10.1590/S0037-86822009000300001 
ARTICLE ARTIGO
Hepatitis C: sexual or intrafamilial transmission? Epidemiological and phylogenetic analysis of hepatitis C virus in 24 infected couples
Hepatite C: transmissão sexual ouintrafamiliar? Análise epidemiológica e filogenética do vírus da hepatite C em 24 casais infectados
Norma de Paula CavalheiroI; Abel De La RosaII; Slava ElaginIII; Fátima Mitiko TenganI; Evaldo Stanislau Affonso de AraújoI; Antonio Alci BaroneI
IHepatitis Laboratory, Medical School, University of São Paulo, SP, Brazil 
IIPharmasset Inc, Atlanta, Georgia, USA 
IIIThird Wave Molecular Diagnostics, Madison,Wisconsin, USA
Address to
ABSTRACT
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 sexuallytransmitted 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%). Thehigh 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.
Key-words: Intrafamilial. Hepatitis C virus. Sexual transmission. Heterosexual. Phylogeny.

RESUMO
O papel da transmissão sexual ou intrafamiliarda hepatite C é controverso. Foi feita análise filogenética, região não estrutural 5B do vírus da hepatite C (NS5B-HCV). Altas percentagens de homologia com média de 98,3% foi revelada entre os casais. Vinte (83,3%) de 24 homens, contra apenas duas (8,3%) mulheres reportaram doença sexualmente transmisível durante suas vidas. Os fatores de risco para aquisição da doença foram: transfusão de sanguepara 10 casais, uso de drogas ilícitas injetáveis para 17, inalatórias para 15, acupuntura em 5 e tatuagens para 5. O compartilhamento de utensílios de higiene pessoal incluem: escova de dente para seis (25%) dos casais, lâmina de barbear para 16 (66,7%), cortador de unhas para 21 (87,5%) e alicate de manicure para 14 (58,3%). O alto grau de similaridade genômica entre os vírus da hepatite Csuporta a hipótese de transmissão entre os casais. O uso compartilhado de utensílios de higiene pessoal sugere a possibilidade de transmissão intrafamiliar.
Palavras-chaves: Intrafamiliar. Vírus da hepatite C. Transmissão sexual. Heterosexual. Filogenia.
 Alter et al1 were the first to discuss the possibility of sexual transmission of the hepatitis C virus (HCV), and they suggested that multiplesexual partners were a risk factor. However, the importance of sexual transmission of HCV remains controversial, with transmission rates ranging from 0.5 to 2% per year of relationship reported in the literature. These low rates, associated with the scarcity of risk factors, suggest that there may be little or no risk of sexual transmission1 2. On the other hand, Tengan et al25 analyzed the sexualtransmission of HCV in a Brazilian population and found prevalence of 11.8%25.
The intrafamilial transmission rates are significantly higher between sexual partners than among other household members who do not have sexual contact. Transmission to children is significantly low23. The findings from investigations involving specific populations such as patients at sexually transmitted disease (STD)...
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