| | HCV
Transmission: Sex, Violence, Alcohol and Drug Use
Principal
Investigator: Marcia Russell, Ph.D.
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Disproportionate
numbers of alcohol and drug users are infected with Hepatitis
C virus (HCV). Although the majority of new cases appear to
result from sharing contaminated drug paraphernalia, approximately
20% are attributed to sexual contact with an infected person.
However, the HCV infectivity of semen and saliva is controversial.
Based on evidence that alcohol and drug use are associated
with high-risk sexual behavior (e.g., multiple sexual partners,
a history of sexually transmitted diseases, and anal sex),
violent behavior, and accidental injuries, we postulate that:
1) heavy drinking and other drug use increase HCV transmission
via blood-to-blood contact in the context of sexual and other
intimate interactions by promoting exposure to menstrual blood
and bleeding caused by minor and major trauma and 2) heavy
alcohol consumption may promote HCV transmission by depressing
the immune system, increasing serum HCV RNA levels.
We
propose to assess lifetime and current drinking patterns,
other drug use, and alcohol/drug-related behavior associated
with possible blood-to-blood contact in the context of sexual,
intimate situations in 1600 STD clinic clients, 400 positive
for anti-HCV and 1200 negative. Serum levels of HCV RNA will
be assessed in anti-HCV+ clients by polymerase chain reaction.
The
relations between alcohol/drug use and HCV status, and the
potential mediating effects of blood-to-blood contact related
to high-risk sexual behavior, sexual victimization, domestic
and other violence, accidental injuries, and unsafe drug use
will be investigated using hierarchical regression analytic
techniques; interaction terms will be used to investigate
gender and racial differences in these relations. Cluster
analysis will be employed to identify behavioral typologies
associated with HCV status. Finally, the influence of lifetime
and current drinking patterns on serum HCV RNA levels will
be investigated, taking into account the effects of diet,
smoking, and concomitant infections.
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