HCV exposure in spouses of the index cases

To study the exposure of HCV in the spouses of patients suffering from chronic hepatitis C virus infection attending the outpatients department of medical research center running a liver clinic.

Index patients were defined as patients suffering from hepatitis C related chronic liver disease. HCV infection was confirmed by a 3rd generation kit, chronic liver disease by raised alanine amino transferase for over 6 months. PCR was done in a selected group who could afford the test. Serum albumin, endoscopic confirmation of varices and ultrasonography were done to evaluate any evidence of decompensation. Spouses were checked for anti HCV and ALT, those found positive were considered as exposed. Those with negative HCV were defined as not exposed.

A total of 153 index cases, 127 chronic liver disease compensated liver disease and 26 with cirrhosis (signs of decompensation) and their spouses entered the study, of whom 58 spouses were anti HCV positive (38%). Of 153 patients with chronic HCV infection, 127 patients had raised ALT and fulfilled the criteria of chronic liver disease (CLD). One hundred and three of 127 (81%) cases were PCR positive and 69 (67%) were candidates on interferon therapy. Of 26 cirrhotics 7 were PCR positive with advanced, disease. Out of 127 patients with CLD, 50 spouses were HCV positive, 21 of whom had raised ALT. Sixteen spouses (76%) were PCR positive. Spouses of 8 cirrhotic patients were found to be PCR positive.

An overall HCV positivity of 38% in the spouses of index cases with 42% showing raised ALT indicates a high disease transmission. With a 5% exposure of the virus in general population, reasons for this high intra-spousal transmission needs to studied further.