Study Finds Strong Association Between Hepatitis C and Tattooing; HCV Testing Recommended for All People with Tattoos

By Liz Highleyman

Hepatitis C virus (HCV) is transmitted through direct contact with blood, which many occur when needles or other items that penetrate the skin are shared or used by more than 1 person.

Tattooing is a potential method of HCV transmission if needles or other equipment are used on more than 1 person without adequate sterilization. Some cities once banned tattooing due to its link with hepatitis B virus (HBV) infection, which is transmitted in similar ways. However, the connection between tattoos and HCV infection has never been fully proven using optimal scientific methods.

Edmund Bini, MD, and colleagues from New York University Medical Center conducted a study to clarify the association between tattooing and HCV, carefully controlling for other potential risk factors including injection drug use.

Results were released by the American Association for the Study of Liver Diseases (AASLD) in advance of the organization's 58th annual meeting, which starts today in Boston.

The researchers studied 3871 people in New York City (80% men, average age 55 years), about half with HCV infection and half uninfected control subjects. Participants completed detailed questionnaires about demographics and HCV risk factors.

The investigators found that individuals with HCV were (as expected) more likely to have a history of injection drug use and to have had a blood transfusion before 1992. However, people with HCV were also more likely to have had 1 or more tattoos (35% vs 13%), an association that remained highly significant after adjusting for age, sex, and race/ethnicity.

Patients with tattoos who also had other risk factors for HCV -- injection drug use or blood transfusion -- were excluded from the final analysis. Among the remaining 1887 people with no known traditional HCV risk factors, individuals with hepatitis C were still approximately 3 times more likely to have tattoos compared with HCV negative participants after adjusting for demographic factors (34% vs 12%).

"Tattoos are strongly associated with HCV infection, even among those without traditional HCV risk factors such as injection drug use and blood transfusions," the researchers concluded.

"Other studies did not exclude patients with other risk factors for hepatitis C, which made it difficult to assess the association between HCV and tattoos," Dr. Bini stated in a press release announcing the findings. "The strength of that association surprised us."
Based on these findings, the investigators recommended that all people who have tattoos should be offered testing for HCV.

"It helps to be able to identify patients early who are eligible for treatment," Dr. Bini said.

The researchers are conducting further analyses to assess whether having multiple tattoos is associated with increased risk, and whether there is a difference between people who received tattoos in the U.S. or abroad.

Most professional tattooists today practice universal precautions including wearing gloves, autoclaving instruments used on more than 1 person, and using disposable needles and ink pots. However, amateur tattoos, such as those done in prison, may not be applied under safe conditions. The Hepatitis C Support Project provides more information about tattooing and HCV .
11/02/07

Sources
American Association for the Study of Liver Diseases. Hepatitis C Testing Recommended for Anyone with a Tattoo. Press release. October 19, 2007.

S Dhalla, T Tenner, A Aytaman, and others. Strong association between tattoos and hepatitis C virus infection: A multicenter study of 3,871 patients. 58th Annual Meeting of the American Association for the Study of Liver Diseases. Boston. November 2-6, 2007. Abstract 136.