Non-parenteral transmission of hepatitis C

描述（由申请人提供）：本提案将为申请人Chia Wang提供病毒传播流行病学研究方面的培训。王医生是一名委员会认证的ID医生，拥有流行病学硕士学位。在华盛顿大学学习期间，她研究了非洲的异性恋艾滋病毒传播。该项目形成了对传播和获得感染的流行病学的长期兴趣的基础。该提案描述了她在丙型肝炎病毒（HCV）非肠道传播领域的研究兴趣。 在目标1中，我们将对慢性感染者进行一项纵向研究，研究唾液和生殖道液中HCV RNA的流行率和脱落模式。此外，还将收集有关口腔和生殖道炎症的信息，以研究此类疾病可能增加脱落的假设。在目标2中，我们探讨了在HCV感染的急性期传播可能更有效的假设。我们将在从当地HCV阴性注射吸毒者队列中确定的HCV事件病例中建立早期血清病毒载量动态和粘膜脱落模式。最后，在目标3中，我们将通过结合音频计算机辅助调查工具（ACASI）技术来减少漏报偏倚和特定调查技术来减少回忆偏倚，从而检查否认胃肠外传播方式的个体的潜在风险因素。将在传统面对面访谈中否认此类风险因素的受试者中确定静脉注射毒品等污名化行为的漏报率。其他潜在的丙型肝炎非肠外风险因素的报告，如鼻内可卡因使用，将与来自普通医学诊所的对照人群进行比较。20-30%的丙型肝炎感染者的感染模式仍然知之甚少。拟议的研究结果可能证实性接触等疑似传播途径，或可能反驳目前的数字，即相当大比例的感染可能发生在非肠道。此外，拟议的项目将为王博士提供病毒传播研究方面的培训，超出她相当集中的奖学金项目，目的是建立她在这一领域的专业知识，并为她提供进一步独立研究丙型肝炎和其他病毒传播的技能。

DESCRIPTION (provided by applicant): This proposal will provide the applicant, Chia Wang, with training in the epidemiologic study of viral transmission. Dr. Wang is a board certified ID physician with a MS in Epidemiology. During her fellowship at the University of Washington, she studied heterosexual HIV transmission in Africa. This project formed the foundation of a long term interest in the epidemiology of transmission and acquisition of infection. This proposal describes her research interests in the area of non-parenteral transmission of hepatitis C virus (HCV). In Aim 1, we will study individuals with chronic infection in a longitudinal study of the prevalence and pattern of shedding of HCV RNA in saliva and genital tract fluids. Furthermore, information about oral and genital tract inflammatory conditions will be collected to investigate the hypothesis that such conditions may increase shedding. In Aim 2, we explore the hypothesis that transmission may occur more efficiently during the acute phases of HCV infection. We will establish early serum viral load dynamics and mucosal shedding patterns in incident cases of HCV identified from a local cohort of HCV negative current IDUs. Finally, in Aim 3, we will examine potential risk factors in individuals who deny parenteral modes of transmission by incorporating audio computer-assisted survey instrument (ACASI) technology to reduce under-reporting bias and specific survey techniques to reduce recall bias. The under-reporting rate of stigmatized behaviors such as intravenous drug use will be determined in subjects who deny such risk factors in traditional face-to-face interviews. Reporting of other potential non-parenteral risk factors for hepatitis C, such as intranasal cocaine use, will be compared to that of a control population derived from general medicine clinic. The mode of infection in 20-30% of hepatitis C-infected individuals remains poorly understood. The findings of the proposed research study may confirm suspected transmission routes such as sexual exposure, or may refute current figures suggesting that a substantial proportion of infections may occur non- parenterally. In addition, the proposed project will provide Dr. Wang with training in viral transmission research beyond her rather focused fellowship project, with the goal of establishing her expertise in this field and providing her with skills to pursue further independent studies in the transmission of hepatitis C and other viruses.