Hepatitis C Virus Epidemiology in Lithuania: Situation before Introduction of the National Screening Programme

Abstract

In 2022, the Lithuanian health authorities decided to pay general practitioners a fee for performing serological tests for hepatitis C virus (HCV) antibodies in the population born from 1945 to 1994 once per life and annual HCV testing for PWID and HIV infected patients. This study aimed to assess trends in HCV-related mortality in the country and the prevalence of HCV infection among patients with liver diseases and evaluate possibilities of screening for HCV infection at a primary health care center. Age-standardized mortality rates in 2010–2020 were calculated for deaths caused by chronic hepatitis C and some liver diseases. Data on HCV infection among patients with liver cirrhosis, cancer and transplant patients were collected from the tertiary care hospital Kauno Klinikos. The prevalence of anti-HCV and risk factors of HCV infection was assessed among patients registered with the health care center in Klaipeda, where a pilot study of screening was performed. No steady trend in mortality was observed. Analysis of medical documentation showed that 40.5% of patients with liver cirrhosis, 49.7% with cancers and 36.9% of transplant patients were HCV infected. Over the year, 4867 patients were screened in the primary health care center. Positive anti-HCV prevalence was 1.7% (2.1% in men and 1.3% in women). Blood transfusion and being a blood donor before 1993 also having tattoos were associated with higher odds of HCV infection. The study revealed the active participation of individuals in HCV screening.

Hepatitis C screening in Lithuania: first-year results and scenarios for achieving WHO elimination targets

“…The seroprevalence of anti-HCV was consistent across all Lithuanian counties, ranging from 1.2 to 1.9%, with the highest prevalence observed in Klaipėda county. These findings align with our prior pilot study conducted in a single primary healthcare centre in Klaipėda city [ 18 ].…”

“…Before screening assays became available, most HCV infections were iatrogenic, resulting from transfusions with infected blood or unsafe invasive medical and surgical procedures. A significant proportion of the older HCV-infected population in Lithuania likely acquired the infection through blood transfusions and blood donation before 1993 [ 18 ]. The majority of new HCV infections occur among PWID, and elimination strategies require particular focus on this population.…”

“…The first attempt to assess the prevalence of anti-HCV in the Lithuanian population was made in 2011 when a study outlined a prevalence of 2.78% in 1528 adults from 5 cities of the country [ 17 ]. To expand upon this effort, in 2020–2022, a pilot study was carried out in a primary healthcare centre in Klaipėda, aiming to assess the seroprevalence of HCV antibodies (anti-HCV) and to evaluate the possibility of a HCV screening program in a primary healthcare setting in Lithuania [ 18 ]. After screening 4867 individuals, an anti-HCV seroprevalence of 1.7% was observed.…”

“…Individuals who underwent blood transfusions or donated blood before 1993, those with tattoos, illicit injection drug users, and former prisoners showed higher anti-HCV seroprevalence. This study helped demonstrate how individuals would participate in a screening program conducted by GPs in similar settings across the country [ 18 ]. This framework further became the basis for creating a national screening program.…”

Genotype Distribution and Characteristics of Chronic Hepatitis C Infection in Estonia, Latvia, Lithuania, and Ukraine: The RESPOND-C Study

“…The prevalence of HCV infection is relatively high in the Baltic countries. In Estonia, it affects 1.5% to 2.0% of the population [ 10 ], in Latvia, 2.4% [ 11 ], and in Lithuania, 1.7% [ 12 ]. In Ukraine, official statistics or registries for HCV infection are scarce; however, the estimated prevalence of infection is assessed as very high—3.5% [ 13 ].…”