Hepatitis C in Sub-Saharan Africa: Urgent Need for Attention

Abstract

The hepatitis C virus (HCV), which was not recognized as an infectious agent until the 1980s, is responsible for a worldwide epidemic. The World Health Organization estimates global prevalence at 2.8%, with 185 million persons infected. In contrast to hepatitis B, where successful vaccine campaigns have reduced the disease burden, much less progress has been made toward the control of HCV. Phylogenetic studies suggest that HCV originated in Africa and has been endemic in some regions for at least 500–600 years. However, little is known about the epidemiology, transmission, and clinical course of HCV in Africa. With the advent of highly effective anti-HCV agents, there exists great potential to at least curb the global epidemic. For regions such as sub-Saharan Africa, however, this will require a thorough understanding of the regional population-level epidemiology, risk factors, and transmission mechanisms. Only then can effective treatment and prevention strategies be introduced.

Hepatitis C genotype distribution in patient and blood donor samples in South Africa for the period 2008–2012

“…In the past, unscreened blood and blood products and unhygienic injection practices did contribute to the spread of hepatitis C in Africa . Practices such as scarifications, tribal scrapings, traditional circumcision and home births are postulated as possible transmission risks and may be associated with different genotypes circulating in Africa. The blood donor population in this study is a low‐risk cohort (0.0073% HCV prevalence) in South Africa and does not reflect the general population, as stringent screening takes place before donation.…”

“…1,2 Of global HCV infections, sub-Saharan Africa accounts for ±20% of the burden of infections although the reported prevalences are disparate and the epidemiological data uneven or sparse. 3 There are no systematic surveillance studies in South Africa, and the data for hepatitis C prevalence are varied and depend on the setting. The seroprevalence of hepatitis C virus was 0.01% in the low-risk blood donor population 4 by contrast to a prevalence of 13.4% in an HIV-positive setting.…”

“…Estimates indicate that about 3% of the world's population is infected with HCV, with about 70%–90% of infected people becoming chronic carriers . Of global HCV infections, sub‐Saharan Africa accounts for ±20% of the burden of infections although the reported prevalences are disparate and the epidemiological data uneven or sparse . There are no systematic surveillance studies in South Africa, and the data for hepatitis C prevalence are varied and depend on the setting.…”

“Waiting for DAAs”: A retrospective chart review of patients with untreated hepatitis C in Rwanda

“…Approximately 20% of these infections are estimated to occur in sub-Saharan Africa (SSA) [4], and this accounts for the second greatest number of infected individuals after the Eastern European region [5]. Seroprevalence for HCV in SSA has been reported to be 2.7% overall, ranging from 0.7% in southern and eastern Africa to 6.9% in central Africa [6].…”

Incidence of hepatitis C in Brazil

“…It is estimated that 3% of the global population is infected by the virus, corresponding to approximately 200 million people (1) (2) . This is 5 times the rate of infection with human immunodefi ciency virus (HIV) (3) . In Brazil, it is estimated between 2.5% and 4.9% of the population is infected with hepatitis C virus (4) .…”