Think Before You Ink: Tattoos and the Risk of Hepatitis C

I can identify with Ishmael's dismay at his first sighting of Queequeg's tattoos in Melville's Moby Dick. Call me old-fashioned, but I have never been a fan of body art. Many others, however, especially those far younger than I, do not share my artistic tastes. Apparently, as many as 30% of persons in the United States under age 30 have tattoos. In Canada, 8% of high school students have at least 1 tattoo. Among those without tattoos, about one-fifth want to get one.¹

In the past, I have had only one caveat for those considering a tattoo: "Once it's on, you can't get it off. You may hate it later." Well, there may be more to that story; it appears that tattoos may increase the risk of hepatitis C.

RISKS ARE MORE THAN SKIN DEEP

This month's Top Paper is a systematic review and meta-analysis of 124 studies from 30 countries—including the United States, Italy, Canada, Iran, and Brazil.2 Its express purpose was to determine whether tattooing is associated with a greater risk of acquiring hepatitis C virus. For the meta-analysis portion of the paper, 83 studies were evaluated. Overall, the pooled odds ratio for hepatitis C, in those with and without tattoos, was 2.74 (95% confidence interval [CI], 2.38 to 3.15).

Since some of the persons included in these studies may have had more than 1 risk factor for hepatitis C virus acquisition (intravenous drug abuse, for instance), the authors proceeded further. They did subgroup analyses on specific groups. Let's look at some of them. The odds ratio of finding hepatitis C virus antibody in persons with tattoos, compared with those who did not have body art, was 3.73 in a cohort of blood donors, 3.06 in injection drug users, and 2.56 in prisoners. In samples obtained from those who did not use injection drugs, the odds ratio was 5.74 (95% CI, 1.98 to 16.66).

Note that this was an analysis of many observational studies, which may not be the best research design for answering the question at hand. As in any meta-analysis, since negative studies may not have been published as readily as positive ones, the odds ratio conclusion may represent only the positive studies that actually made the literature. The confidence intervals were rather wide too. But when you consider the blood and body fluid that tattooers and their instruments come in contact with, is this particular association that much of a surprise?

POSSIBLE PREVENTION STRATEGIES

The authors of the study suggest better infection control guidelines as well as better enforcement for tattoo parlors. Maybe sober reflection on the progression of hepatitis C virus infection to cirrhosis would be a better deterrent. Is a tattoo worth the risk of acquiring this nasty little virus? Ishmael and I don't think so.