Hepatitis C virus in various human body fluids: A systematic review

Hepatitis C virus (HCV) is transmitted mainly by parenteral routes. However, 15-40% of patients infected with HCV have no obvious parenteral risk factors. In these patients perinatal, intrafamilial and/or sexual transmission of the virus is suspected. It is assumed that viral transmission in these patients occurs through various body fluids. Studies of human secretions for the presence of HCV-genome have yielded conflicting results. The objective of this analysis is to review existing published data in an attempt to determine whether body fluids contain HCV-genome and if so, to estimate the level of risk. We reviewed all published studies (controlled and uncontrolled) reporting the prevalence of HCV-genome in human body fluids of patients infected with HCV. Most studies did not include control groups. The pooled prevalence of HCV-genome in the saliva (as reported in the seven controlled studies) of HCV-RNA plasma positive patients was 47.0% while in HCV-RNA plasma negative patients it was 7.4%. HCV-genome was reported to be present in controlled studies in semen, breast milk, vaginal fluids, urine and ascites of HCV-RNA plasma positive patients but not in the fluids of HCV- RNA plasma negative patients. The pooled prevalence of HCV-genome was 18.5% in semen (two studies), 9.5% in breast milk (two studies), 63.6% in vaginal fluids (one study), 28.3% in urine (two studies) and 100% in ascites (one study). Pooled unweighted odds ratios (OR) for the presence of HCV-RNA in the various body fluids of HCV-RNA plasma positive patients was high for urine (OR 14.9, P<0.013), saliva (OR 11.1, P<0.0001) and ascites (OR 75.0, P<0.03). The controlled studies reported included small numbers of patients. Human body fluids of HCV-RNA plasma positive patients, especially saliva, urine and ascites, should be regarded as potential sources for spreading of HCV infection.