Host-Related Predictors of Persistence of Hepatitis C Virus Infection

Abstract

Background: Spontaneous clearance occurs in varying proportions in individuals infected by hepatitis C virus (HCV). However, the factors associated with this clearance are debatable. Their recognition may lead to a better understanding of HCV natural history and eventually improve associated prediction and management models. Aim: This study was conducted to determine the host-related factors associated with persistence of HCV infection. Methods: Among 1059 HCV-antibody-positive individuals who denied receiving HCV antiviral treatment, 257 (24.3%) spontaneously cleared the virus. Patient groups with persistent infection and clearance were compared in terms of potential HCV risk factors; host socio-demographic data, medical history, and behavioral factors. Results: Females (27.7%) and individuals below 45 years of age (31%) showed significantly higher clearance rates than males (20.3%) and older individuals (22.2%). Individuals who had a history of schistosomiasis and those who were receiving parenteral antischistosomal therapy had odds ratios (ORs) of 1.43 and 1.41 and confidence intervals of 1.08-1.9 and 1.06-1.87, p = 0.01 and 0.02 respectively. A history of incarceration was associated with a zero clearance rate. Low educational levels, high-risk occupations, frequent dentist visits, circumcision, and oral ulcers were associated with persistence of infection. Independent predictors associated with persistence of infection were frequent dentist visits, incarceration, fatigue, and jaundice (OR = 1.17, 3.67, 1.42, and 1.54, p = 0.04, 0.02, 0.03, 0.08 respectively), whereas the factor associated with clearance of infection was previous blood sampling (OR = 0.4). Conclusion: The host-related predictors of HCV persistence of infection are related to either risk factors associated with repeated infection or symptoms of chronic infection, particularly fatigue with undetermined causes.