Prevalence and risk factors of Hepatitis C virus infection in Brazil, 2005 through 2009: a cross-sectional study

Abstract

BackgroundHepatitis C chronic liver disease is a major cause of liver transplant in developed countries. This article reports the first nationwide population-based survey conducted to estimate the seroprevalence of HCV antibodies and associated risk factors in the urban population of Brazil.MethodsThe cross sectional study was conducted in all Brazilian macro-regions from 2005 to 2009, as a stratified multistage cluster sample of 19,503 inhabitants aged between 10 and 69 years, representing individuals living in all 26 State capitals and the Federal District. Hepatitis C antibodies were detected by a third-generation enzyme immunoassay. Seropositive individuals were retested by Polymerase Chain Reaction and genotyped. Adjusted prevalence was estimated by macro-regions. Potential risk factors associated with HCV infection were assessed by calculating the crude and adjusted odds ratios, 95% confidence intervals (95% CI) and p values. Population attributable risk was estimated for multiple factors using a case–control approach.ResultsThe overall weighted prevalence of hepatitis C antibodies was 1.38% (95% CI: 1.12%–1.64%). Prevalence of infection increased in older groups but was similar for both sexes. The multivariate model showed the following to be predictors of HCV infection: age, injected drug use (OR = 6.65), sniffed drug use (OR = 2.59), hospitalization (OR = 1.90), groups socially deprived by the lack of sewage disposal (OR = 2.53), and injection with glass syringe (OR = 1.52, with a borderline p value). The genotypes 1 (subtypes 1a, 1b), 2b and 3a were identified. The estimated population attributable risk for the ensemble of risk factors was 40%. Approximately 1.3 million individuals would be expected to be anti-HCV-positive in the country.ConclusionsThe large estimated absolute numbers of infected individuals reveals the burden of the disease in the near future, giving rise to costs for the health care system and society at large. The known risk factors explain less than 50% of the infected cases, limiting the prevention strategies. Our findings regarding risk behaviors associated with HCV infection showed that there is still room for improving strategies for reducing transmission among drug users and nosocomial infection, as well as a need for specific prevention and control strategies targeting individuals living in poverty.

Hepatitis C Virus (HCV) Prevalence and Risk of Unsafe Parenteral Practices in Derqui, Argentine

“…The study shows remarkably similar results to the main LAC study on hepatitis prevalence, the Brazilian National Prevalence Study [24], which shows lower than usually reported prevalence, wide regional heterogeneity, injected and sniffed drug abuse, and a major role for hospitalizations and glass syringe injections, among other risk factors related to social circumstances (such as lack of sewage disposal). Brazil national study concludes that known risk factors explain only 50% of hepatitis C cases.…”

Incidence of hepatitis C in Brazil

“…The opposite situation occurred in Brazil, as our fi ndings revealed an increase in the incidence rates of hepatitis C during our analysis period. This may be due to the underreporting of hepatitis C by some surveillance systems, which has been a topic of discussion in Europe and the United States (20) . A study developed in Poland sought to assess the epidemiological situation of hepatitis C in 2011 and compare it to previous years.…”

“…These fi ndings are consistent with our study. The burden of infection in Brazil, in absolute terms, shows an unequal geographical distribution, with the highest concentrations in the South and Southeast, compared to lower rates in the North, Northeast, and Midwest, between 2003 and 2009 (20) . A likely explanation for the higher incidence rates in the South and Southeast may be better access to the health care systems in these regions, which are more organized (21) .…”

Hepatitis C Virus and Hepatitis C-Infection

“…In a population-based study conducted in 1998 in Salvador, the capital of the northeastern State of Bahia, the HCV prevalence was 1.5%. (12) Several studies in Brazil have reported that HCV genotype 1 is more prevalent than genotype 3 among patients who had received a blood transfusion. (13) The first report on the HCV genotype distribution in Salvador -Bahia in intravenous drug users (IDU´s) showed a high prevalence in genotype 1, followed by genotype 3.…”