Endemic hepatitis C virus infection in a Sicilian town: Further evidence for iatrogenic transmission

Abstract

The prevalence of and risk factors for HCV and HBV infections in the general population and the predictive value of ALT screening in identifying anti-HCV positive subjects have been evaluated in a small Sicilian town. A random 1:4 sampling from the census of the general population was performed. Anti-HCV, HCV-RNA, HCV genotype, HBsAg, and anti-HBc were tested. The linkage between HCV infection and potential risk factors was evaluated by multiple logistic regression analysis. Among 721 subjects studied, 75 (10.4%) were anti-HCV positive. The HCV infection rate increased from 0.4% in subjects 10-29 years of age to 34% in those > 60 years of age. Among the 75 anti-HCV positive subjects, 66.7% were HCV-RNA positive and 36% had abnormal ALT, in contrast abnormal ALT levels were found in 4.3% of the 646 anti-HCV negative subjects (P < 0.01). HCV genotype 1b infected the majority (88.0%) of viremic subjects. Exposure to HBV infection (anti-HBc positivity) was found in 11.2% of subjects; HBsAg positivity was 0.7%. At multivariate analysis, two variables were associated with HCV infection: age > or = 45 years (OR 27.8; CI 95% = 11.0-70.2) and previous hospitalization (OR 2.5; CI 95% = 1.3-4.7). ALT testing had low positive predictive value (PPV = 49.1%) for HCV infection. The positive predictive value was good (88%) in people > or = 60 years of age, but minimal (16.7%) in those below 60. These findings indicate that HCV infection is common in the elderly, perhaps as a result of past iatrogenic transmission. The present low rate of HCV infection among the younger generations coupled with the low progression of the viral related liver damage does not support the projection of a future increasing incidence in the next decades of the burden of HCV-related chronic disease. HBV infection, formerly common in this area, is already in sharp decline. In an area of high HCV endemicity, screening of the general population by ALT cannot be used a surrogate marker to detect HCV infection in those susceptible to treatment.

Prevalence of Hepatitis C Virus and its genotypes among a cohort of drug users in Kenya

“…the low prevalence of anti-Hcv antibodies among older persons in the united states is most likely due to a cohort effect and the risk of acquiring Hcv infection lower in the distant past rather than the recent past. in Kenya, the risk was the same, higher in the recent past than the distant an observation that is different from that observed and reported in cameroon (4) and italy (5).…”

Prevalence and risk factors for hepatitis C infection in rural north Vietnam

“…Healthcare settings have several potential parenteral contributors to HCV transmission, with blood transfusion, surgery, dental treatment, acupuncture and therapeutic injections (especially with nondisposable syringes), and high frequency of injection documented as independent predictors of HCV infection [18,20,23,[26][27][28][29][30]. Those who had ever been in a hospital were 2.1 to 3.7 times more likely to have acquired HCV [20,26,[28][29][30][31][32]. In our study, participants who had more than one hospital admission were found to be 7.2 times more likely to have HCV than those who had never been admitted.…”

Current practice of hepatitis C treatment in Southern Italy

“…In our experience the majority (nearly half of cases) of untreated patients were older that 65 years of age, with 75% over 70 years and thus likely not suitable for treatment. This is a serious treatment barrier to overcome even at a national level, because it reflects the epidemiological pattern of HCV infection common in all Italian areas as shown by several population-based surveys [10][11][12][13]. However, it should be considered that we are treating the patient and not the virus, in order to prevent HCV-related morbidity and mortality.…”