Hepatitis C Virus Intranasal Transmission: Pilot Study

慢性活动性丙型肝炎是美国和世界范围内的一个主要健康问题。丙型肝炎病毒(丙型肝炎病毒)主要通过接触受感染的血液传播，已知的危险因素包括注射毒品、1992年前接受血液或血液制品、纹身和身体穿孔以及医院暴露。尽管人们对丙型肝炎病毒的传播有很多了解，但相当大比例的感染者报告说没有可识别的接触来源。原因不明的丙型肝炎病毒感染病例在非注射吸毒者中特别高，这表明这一群体中存在潜在的潜在感染源。解释这些无法解释的病例的一个假设是，丙型肝炎病毒可能通过吸毒者共用的吸管或勺子等受污染的嗅探/鼻塞工具传播。吸入可卡因和其他粉末药物会刺激鼻膜，导致鼻腔恶化、渗漏和出血。当插入鼻腔时，嗅探器可能会接触到感染了丙型肝炎病毒的鼻分泌物或血液，然后这些分泌物或血液可能会传播给共用同一器械的未受感染的人。虽然一些研究表明，鼻腔用药是丙型肝炎病毒感染的重要危险因素，但几乎完全缺乏与这种潜在的丙型肝炎病毒传播方式有关的病毒学、临床和行为数据。拟议的试点研究将通过实现以下具体目标来帮助填补这些研究空白：(I)制定可靠的方法和进行实验室分析，以检测血浆阳性的鼻吸毒者鼻腔分泌物和药物嗅探器表面的丙型肝炎病毒RNA；(Ii)制定方法和进行化验，以测试鼻分泌物和嗅探器中是否存在血液，(Iii)制定措施，收集初步数据，并评估仪器的心理测量学特性，以评估可能与鼻内传播丙型肝炎病毒有关的风险因素；以及(Iv)制定和评估慢性吸毒者的临床检查和鼻腔病理评估方案。虽然这些目标侧重于新技术的开发和为未来研究收集初步数据，但拟议的研究将解决有关经鼻传播丙型肝炎病毒所需前提条件的几个基本问题。

Chronic active hepatitis C is a major health concern in the United States and worldwide. Hepatitis C virus (HCV) is primarily transmitted through contact with infected blood, with known risk factors including injection drug use, receipt of blood or blood products prior to 1992, tattoo and body piercing, and nosocomial exposure. Although much is known about HCV transmission, a substantial proportion of infected individuals report no identifiable source of exposure. Unexplained cases of HCV are particularly high among noninjection drug users, indicating a potential hidden source of infection within this group. One hypothesis to account for these unexplained cases is that HCV may be transmitted through contaminated sniffing/snorting implements, such as straws or spoons, shared by intranasal drug users. Snorted cocaine and other powdered drugs can irritate the nasal membranes causing deterioration, leakage and bleeding. When inserted into the nasal cavity, a sniffing implement may come into contact with HCV-infected nasal secretions or blood, which may then be transmitted to an uninfected individual sharing the same implement. Although several studies have shown intranasal drug use to be a significant risk factor for HCV infection, there is nearly a complete absence of virological, clinical, and behavioral data pertaining to this potential mode of HCV transmission. The proposed pilot study will help fill these research gaps by achieving the following specific aims: (i) develop reliable methods and perform laboratory assays to detect HCV RNA in the nasal secretions of plasma-positive intranasal drug users and on the surfaces of drug-sniffing implements; (ii) develop methods and perform assays to test for the presence of blood in nasal secretions and sniffing-implements, (iii) develop measures, collect preliminary data, and evaluate the psychometric properties of an instrument to assess risk factors that may be associate with intranasal HCV transmission; and (iv) develop and evaluate protocols for clinical examination and assessment of nasal cavity pathology among chronic drug-sniffers. While these aims focus on the development of new technologies and the collection of preliminary data for future research, the proposed study will, nonetheless, resolve several fundamental questions regarding the preconditions necessary for intranasal HCV transmission.