A population-based study of the epidemiology of hepatitis C in a North American population

Screening for hepatitis C in an outpatient endoscopy unit

BACKGROUND: The Canadian Liver Foundation recommends routine hepatitis C (HCV) screening for Canadians born between 1945 and 1975. This study aimed to determine the feasibility and outcomes of targeted birth cohort HCV screening during routine outpatient endoscopic procedures in a tertiary care hospital. METHODS: We conducted a prospective cohort study of individuals born between 1945 and 1975 who attended outpatient endoscopy procedures at Kingston Health Sciences Centre from 2017 to 2019. Patients who consented received the HCV OraSure point-of-care test for the HCV antibody (HCV Ab). If positive, serum for HCV RNA was sent, and patients were linked to care with a hepatologist. RESULTS: 2,179 patients met birth cohort criteria for HCV screening. Of those, 1,079 (49.5%) were approached for study inclusion, and 160 (15.0%) declined participation, leaving 912 patients who provided consent. The median age was 62 years (IQR 55–67). Overall, 6/912 (0.7%) of participants were HCV Ab positive and 5/912 (0.6%) were HCV RNA positive. Four were linked to care for consideration of direct-acting antiviral (DAA) therapy, 3 received DAA treatment, and all 3 achieved sustained virologic response (SVR). CONCLUSIONS: Birth cohort screening for HCV in an outpatient endoscopy unit identified an HCV prevalence similar to population estimates. In this model, however, 50% of eligible patients were not approached for screening. Linkage to care for assessment of treatment was high at 80%, and of those who received therapy, all achieved SVR. These results suggest this cohort is a suitable population for HCV screening; however, we need strategies to increase recruitment of all eligible individuals.

Large Disparity between Prevalence and Treatment Rates for Hepatitis C in Western China

Background and Aims: Recently, the World Health Organization adopted the first-ever global hepatitis strategy with the dream of eliminating viral hepatitis as a public health threat by 2030. However, the epidemiology and treatment rates of hepatitis C virus (HCV) infection in Western China are still unknown. Methods: A total of 111,916 adult individuals (15-96 years) who underwent the HCV-antibody (HCV-Ab) test in the Second Affiliated Hospital of Chongqing Medical University between 2013 and 2015 were included in this study. We retrospectively analyzed the electronic medical records' data for each, and the positivity of HCV-Ab and the treatment of HCV RNA-positive patients were evaluated. Results: During 2013-2015, the crude prevalence of HCV-Ab was 1.4% (95%CI: 1.4-1.5; 1,611/111,916) and the adjusted prevalence of HCV-Ab was 1.7% (95%CI: 1.6-1.8), which was higher than in the 2006 national study (0.43%). The prevalence was 2-times higher in males than females (2.0% vs. 1.1%, p < 0.01). Notably, only 46% (434/951) of the HCV RNA-positive patients received standard peg-interferon plus ribavirin treatment, with 370 (82%) that completed treatment, of whom 272 (74%) achieved sustained virologic response (SVR). Particularly, 11% (32/292) of HCV RNA-positive patients were HBsAg-positive, and the SVR rate for them was lower than for the HBsAg-negative patients, but no significant difference was observed. Conclusions: HCV infection may have increased since 2006 in Western China. The SVR rate of peg-interferon plus ribavirin treatment was high, but the proportion of untreated HCV patients was large. Thus, more efforts need to be made by the government to create a scientific-based policy for HCV treatment and prevention.

Descriptive epidemiology of hepatitis C in individuals referred for specialized HCV care in Newfoundland and Labrador, 1996–2014

BACKGROUND: Despite growing awareness of the significant burden of disease caused by hepatitis C virus (HCV) infection worldwide, understanding of the epidemiology and demographic distribution of HCV infection in Canada, specifically in Atlantic Canada, is limited. Currently, data on the demographic and clinical profile of HCV-infected individuals in Newfoundland and Labrador is limited. The aim of this study is to address this knowledge gap. Methods: A retrospective cohort study of HCV-positive individuals referred for specialized care in St. John’s, Newfoundland, between 1996 and 2014, was conducted. Descriptive data were obtained through chart review and access to a database consisting of individuals referred for specialized HCV care in St. John’s. Results: During the study period, 767 individuals were referred for specialized HCV care, of whom 714 were included in our analysis. These individuals represent 57.5% of HCV-positive cases identified by the province’s public health department during the same time frame. HCV infection was more common among men (68.2%) and urban dwellers (74.8%). The majority of cases were HCV genotype 1 (52.1%). Intravenous and intranasal drug use were the most common self-reported risk factors for HCV transmission. High loss-to-follow-up rates were found among those referred from the province’s correctional system. Conclusions: This study provides important insights into the demographic and clinical profile of individuals referred for HCV-related care in Newfoundland and Labrador and fills a gap in the current understanding of HCV-positive individuals in this Atlantic province. These findings can help inform future directions for HCV-related health policy, resource allocation, and clinical care initiatives in Newfoundland and Labrador and across Canada.

Increased HCV Screening Yields Discordant Gains in Diagnoses Among Urban and Rural Veteran Populations in Texas: Results of a Statewide Quality Improvement Initiative

BACKGROUND

Chronic hepatitis C virus (HCV) infection is a significant health burden among military veterans. Our goals were to increase monthly HCV screenings, diagnoses, and sustained virologic responses (SVR) among 88,652 unscreened birth cohort Veterans in Texas.

METHODS

The interventions were enabled within six of the eight healthcare systems (HCSs) that compose Veteran's Integrated Service Network 17. The remaining two HCSs served as controls. The HCSs were separated into two groups: urban and rural; each composed of a control and three interventional HCSs. Decision support programming was embedded within the Computerized Patient Record System that prompted HCV screening among previously unscreened birth cohort patients. Clinical process design and educational efforts were enacted to enhance treatment capacity.

RESULTS

Monthly screenings increased 4.89 times (p < 0.001) and 2.97 times (p < 0.001) during the postinterventional period relative to control for urban and rural HCSs, respectively. For urban HCSs, diagnoses increased 1.58 (p < 0.001) times more than the control group during the postinterventional period, but there was no difference in number of diagnoses in the rural HCSs (p = 0.86). Monthly SVR increased 2.69 times more than the control group during the postinterventional period (p < 0.001).

CONCLUSION

Decision support improved HCV screening among birth cohort patients in both urban and rural HCSs. Increased screening boosted the monthly number of diagnoses in the urban HCSs, but not in the rural HCSs; which rebuts the utility of birth cohort screening among rurally residing veterans. These interventions significantly improved the rate of SVR achievement relative to control.

Hepatitis C virus-related complications are increasing in women veterans: A national cohort study

There are gender-specific variations in the epidemiology and clinical course of hepatitis C virus (HCV) infection. However, few long-term longitudinal studies have examined trends in the incidence and prevalence of serious liver complications among women compared with men with HCV infection. We used the Veterans Administration Corporate Data Warehouse to identify all veterans with positive HCV viraemia from January 2000 to December 2013. We calculated gender-specific annual incidence and prevalence rates of cirrhosis, decompensated cirrhosis and hepatocellular cancer (HCC) adjusting for age, diabetes, HIV and alcohol use. We also calculated the average annual per cent change (AAPC) for each outcome by gender using piecewise linear regression in the Joinpoint software. We identified 264 409 HCV-infected veterans during 2000-2013, of whom 7162 (2.7%) were women. There were statistically significant increases over time in the incidence rates of cirrhosis, decompensated cirrhosis and HCC for both men and women. The annual-adjusted incidence rates of cirrhosis, decompensated cirrhosis and HCC were higher in men than women for all study years. However, these complications increased at a similar rate in both groups. Specifically, the AAPC for cirrhosis was 13.1 and 15.2, while it was 15.6 and 16.9 for decompensated cirrhosis and 21.0 and 25.3 for HCC in men and women, respectively (all test of parallelism not significant). The results were similar in the prevalence analyses, although AAPCs were slightly smaller for each outcome. In conclusion, we found an ongoing upward trend in the incidence and prevalence of HCV complications in this cohort of HCV-infected women. This increase in cirrhosis complications in women with active HCV infection is similar to those in men. With cure from HCV now becoming a reality, most of the projected burden of HCV is potentially preventable. However, benefits of HCV treatment will need to extend to all patients in order to stem the rising tide of HCV complications.

Dual sexual and drug-related predictors of hepatitis C incidence among sex workers in a Canadian setting: gaps and opportunities for scale-up of hepatitis C virus prevention, treatment, and care

BACKGROUND

Hepatitis C virus (HCV) represents a significant cause of morbidity and mortality globally. While sex workers may face elevated HCV risks through both drug and sexual pathways, incidence data among sex workers are severely lacking. HCV incidence and predictors of HCV seroconversion among women sex workers in Vancouver, BC were characterized in this study.

METHODS

Questionnaire and serological data were drawn from a community-based cohort of women sex workers (2010-2014). Kaplan-Meier methods and Cox regression were used to model HCV incidence and predictors of time to HCV seroconversion.

RESULTS

Among 759 sex workers, HCV prevalence was 42.7%. Among 292 baseline-seronegative sex workers, HCV incidence density was 3.84/100 person-years (PY), with higher rates among women using injection drugs (23.30/100 PY) and non-injection crack (6.27/100 PY), and those living with HIV (13.27/100 PY) or acute sexually transmitted infections (STIs) (5.10/100 PY). In Cox analyses adjusted for injection drug use, age (hazard ratio (HR) 0.94, 95% confidence interval (CI) 0.86-1.01), acute STI (HR 2.49, 95% CI 1.02-6.06), and non-injection crack use (HR 2.71, 95% CI 1.18-6.25) predicted time to HCV seroconversion.

DISCUSSION

While HCV incidence was highest among women who inject drugs, STIs and the use of non-injection stimulants appear to be pathways to HCV infection, suggesting potential dual sexual/drug transmission. Integrated HCV services within sexual health and HIV/STI programs are recommended.

Congenital and perinatally-acquired infections in resource-constrained settings

INTRODUCTION

Congenital and perinatal infections are a leading cause of neonatal and infant morbidity and mortality. Maternal screening, vaccines or treatment where available, constitute effective prevention strategies to reduce the burden of these diseases. Data on the burden of congenital and perinatal infections are very limited for low and middle-income regions.

AREAS COVERED

This review aims to summarize the burden of congenital and perinatal infections and the main challenges for their control in resource-limited settings. Articles were identified through the main electronic databases and cover the period 1971-2016. Expert commentary: Estimates from low and middle-income countries indicate that the burden of congenital infections may be higher in these regions than in industrialized countries. As preventive and curative strategies are available to tackle some of these infections, efforts at the international and national levels must be made to implement those and thus reduce their burden in resource-limited countries.

Hepatitis C virus infection in the general population: A large community-based study in Mianyang, West China

Hepatitis C virus (HCV) infection remains a major public health problem. The objective of the current study was to reveal the seroepidemiology of HCV in the general population in Mianyang City. This study collected 438,575 blood samples from participants who had enrolled in the National Science and Technology Development Project and their demographic information, and then evaluated HCV antibody and alanine aminotransferase (ALT) levels. The overall anti-HCV positive rate was 0.80% (3,491/438,575) in the Mianyang general population, and it was 1.19% in rural population and 0.20% in urban. Anti-HCV positive rate increased with age, peaked at 45-54 years (2.01%), and then decreased. Anti-HCV prevalence was higher in males (0.89%) than that in females (0.73%). The prevalence of anti-HCV in participants with a history of blood transfusion, surgery, or with a previous diagnosis of hypertension was higher. The abnormal ALT levels (> 40 IU/L) were observed in 50.11% and 7.74% of anti-HCV positive and negative groups, respectively. In anti-HCV positive groups, the rate of abnormal ALT levels was higher in 55-64 age groups, male, and rural population. Though Mianyang was a low endemic area for HCV infection, the alarming fact was the large number of abnormal ALT levels in patients related to hepatitis C. This revealed delayed diagnosis and treatment of HCV infections. It is a necessity to promote early diagnosis and timely treatment of HCV infections.

Seroprevalences of hepatitis B virus and hepatitis C virus among participants of an Asian health fair in the Lower Mainland, British Columbia

In Canada, the seroprevalences of the hepatitis B virus (HBV) and the hepatitis C virus (HCV) are believed to vary significantly among different ethnic groups and at-risk populations. Data regarding the prevalence of HBV and HCV in Southeast Asian Canadians may vary significantly from the general population. Because this population may be less likely to participate in epidemiological studies, it is possible that HBV and HCV seroprevalences are under-reported. The authors of this study correlated questionnaire answers regarding vaccination status to serological profiles collected from an Asian health fair in British Columbia to assess the seroprevalences of HBV and HBC in this population.

BACKGROUND:

The seroprevalences of hepatitis B virus (HBV) and hepatitis C virus (HCV) are 0.4% and 0.8%, respectively, in Canada, but varying rates have been reported in different populations.

OBJECTIVES:

To determine the seroprevalences of HBV and HCV among attendees of an Asian health fair in the Lower Mainland, British Columbia, as well as to correlate questionnaire answers regarding vaccination status to serological profiles.

METHODS:

Attendees at an Asian health fair were invited to participate in the present study on a voluntary basis. They provided answers to a questionnaire including ethnicity and vaccination status. Blood was then drawn for HBV and HCV serology. Active HBV was defined as HBV surface antigen (HBsAg) positive while HCV seroprevalence was defined as HCV antibody reactive. Previous exposure to HBV was defined as HBV core antibody (anti-HBc) positive and HBsAg negative. Nonimmunity was defined as anti-HBc negative and HBV surface antibody negative. Only those with correct demographic information matched to serological results were included in the study.

RESULTS:

There were 192 consenting attendees of the fair, of whom 112 were included in the study. Of the participants, 91% were Chinese. Active HBV infection was found in three participants (2.7% [95% CI 0.6% to 7.6%]) and HCV infection was found in two participants (1.8% [95% CI 0.2% to 6.3%]). More than 40% of participants had been previously exposed to HBV (42% [95% CI 33% to 51%]). Almost 20% demonstrated nonimmunity to HBV (19% [95% CI 12% to 27%]). There was significant discordance when questionnaire answers regarding vaccination status were compared with serological profiles.

CONCLUSION:

The seroprevalences of HBV and HCV in this cohort were 2.7% and 1.8%, respectively – higher than nationally reported rates. Our results highlight that the lack of knowledge of HBV infection and vaccination status remains a significant clinical issue in the Asian community of British Columbia.

Gaps in the hepatitis C continuum of care among sex workers in Vancouver, British Columbia: Implications for voluntary hepatitis C virus testing, treatment and care

BACKGROUND

Hepatitis C virus (HCV) eradication leads to reduced morbidity, mortality and transmission. Despite the disproportionate burden of HCV among sex workers, data regarding the HCV care continuum in this population remain negligible.

METHODS

Using baseline data from an ongoing cohort of women sex workers in Vancouver (An Evaluation of Sex Workers' Health Access, January 2010 to August 2013), the authors assessed HCV prevalence and engagement in the HCV care continuum within the past year. Multivariable logistic regression analyses were used to evaluate associations with recent (ie, in the past year) HCV testing.

RESULTS

Among 705 sex workers, 302 (42.8%) were HCV seropositive. Of these, 22.5% were previously unaware of their HCV status, 41.7% had accessed HCV-related care, 13.9% were offered treatment and only 1.0% received treatment. Among 552 HCV-seronegative sex workers, only one-half (52.9%) reported a recent HCV test. In multivariable analysis, women who self-identified as a sexual⁄gender minority (adjusted OR [aOR] 1.89 [95% CI 1.11 to 3.24]), resided in the inner city drug use epicentre (aOR 3.19 [95%CI 1.78 to 5.73]) and used injection (aOR 2.00 [95% CI 1.19 to 3.34]) or noninjection drugs (aOR 1.95 [95% CI 1.00 to 3.78]) had increased odds of undergoing a recent HCV test, while immigrant participants (aOR 0.24 [95% CI 0.12 to 0.48]) had decreased odds.

CONCLUSIONS

Despite a high burden of HCV among sex workers, large gaps in the HCV care continuum remain. Particularly concerning are the low access to HCV testing, with one-fifth of women living with HCV being previously unaware of their status, and the exceptionally low prevalence of HCV treatment. There is a critical need for further research to better understand and address barriers to engage in the HCV continuum for sex workers.

Identifying and describing a cohort effect in the national database of reported cases of hepatitis C virus infection in Canada (1991-2010): an age-period-cohort analysis

BACKGROUND

Hepatitis C virus (HCV) infection has a high likelihood of becoming chronic and lead to a range of conditions with poor health outcomes. Identifying birth groups highly affected by HCV infection may better focus public health interventions and ensure their cost-effectiveness. Our analysis focused on studying the association of the birth year and reporting period with rates of cases of HCV infection reported in Canada over a 20-year period.

METHODS

Laboratory-confirmed acute or chronic HCV cases with information on sex, age and year of report from 6 provinces and territories that reported line-listed data to the Canadian Notifiable Diseases Surveillance System from 1991 to 2010 were used. Sex-specific infection rates for 5-year birth groups born between 1921 and 1990 were calculated. Rates of HCV infection were log-logit transformed and underwent mean polish analysis and panel linear regression. Rate ratios of HCV infection in the 5-year age groups and their 95% confidence intervals were calculated, with rates in males and females born in 1941-1945 used as references.

RESULTS

Males born between 1946 and 1970 had 21%-40% higher reported rates of HCV infection, whereas females born between 1946 and 1975 had 12%-43% higher reported rates compared with rates in the respective sexes who were born in 1941-1945.

INTERPRETATION

Individuals born between 1946 and 1965 contributed the most to the rates of HCV infection reported in Canada between 1991 and 2010. The cohort effect was present in male and female cases of HCV infection with birth year up to 1970 and 1975, respectively. Our findings will support the development of HCV prevention programs and policies in Canada.

The epidemiology of hepatitis C in a Canadian Indigenous population

BACKGROUND

An estimated 1% to 1.9% of North Americans are infected with the hepatitis C virus (HCV). Although Indigenous peoples are considered to bear the highest burden, there are only limited data regarding the demographic features and epidemiology of hepatitis C in this population.

OBJECTIVES

To document the demographic characteristics, rates of newly diagnosed hepatitis C cases and prevalence of HCV infection in a Canadian First Nations population, and to compare the findings with an infected non-First Nations population.

METHODS

A research database spanning 1991 to 2002 was developed, linking records from multiple clinical and administrative sources. Over a 12-year period, 671 First Nations and 4347 non-First Nations HCV-positive Canadians were identified in the province of Manitoba. Demographics, residence and time trends were compared between infected First Nations and non-First Nations persons.

RESULTS

HCV-infected First Nations individuals were younger (mean [± SD] age 33.0±0.4 years versus 39.7±0.2 years; P<0.0001), more often female (60% versus 40%; P<0.0001) and more often resided in urban centres (73% versus 27%; P<0.001). The rate of newly diagnosed HCV cases was 2.5-fold (91.1 per 100,000 versus 36.6 per 100,000; P<0.000) and prevalence 2.4-fold (801.7 per 100,000 versus 334.8 per 100,000; P<0.000) higher among the First Nations relative to non-First Nations populations.

CONCLUSIONS

The results of the present large population-based study indicate that the First Nations population with hepatitis C is characteristically different from infected non-First Nations persons. The results also describe higher rates of newly diagnosed cases and prevalence of HCV infection in the First Nations population. These findings should serve as an important baseline for future primary prevention and therapeutic intervention strategies in this high-risk population.

Prevalence of hepatitis B and hepatitis C infection in Libya: results from a national population based survey

Background

Libya is one of the largest countries in Africa and has the longest coast in the Mediterranean basin facing southern Europe. High rates of prevalence of viral hepatitis have been observed in various regions in Africa, but the prevalence in Libya is not well documented. We report on a large-scale nationwide study that evaluated the epidemiology of hepatitis B and hepatitis C in Libya and assessed the risk factors involved.

Methods

A cross-sectional study was carried out in 2008 on 65,761 individuals all over Libya. The country was divided into 12 regions according to the population density and sampling within each region was carried out under the supervision of the National Centre for Prevention of Infectious Diseases. Serum samples were collected from both males and females of all ages in both urban and rural areas and tested for HBsAg for hepatitis B and anti-HCV antibody for hepatitis C. Prevalence rates were determined in regions and in different groups and correlated with different demographic and risk factors involved in the spread of these viruses.

Results

The prevalence of hepatitis B and hepatitis C viruses varied regionally across the country. The overall prevalence of hepatitis B was 2.2% (95% CI 2.1%-2.3%) and was higher among males than females (1.4:1.0). Hepatitis C virus (HCV) prevalence was 1.2% (95% CI 1.1-1.3) and it increased gradually after the age of 30 years (0.7-0.9% for < 30 years; 3.6% for ≥ 60 years). Prevalence of HBsAg was 0.8-0.9% below the age of 10 years, and higher but similar in older age groups (2.3-2.7%). There was an association between literacy and prevalence of hepatitis, particularly for HCV. Hospital admission, surgical operation, blood transfusion, and intravenous drug use were the main risk factors, and they were associated independently with a higher prevalence rate of viral hepatitis.

Conclusions

Libya may be considered an area of low-intermediate endemicity for hepatitis B virus infection, with lower rates in young age groups, and an area of low endemicity for hepatitis C. The prevalence of hepatitis B and C across Libya is not homogeneous, with indications of the effect of the higher rates in some neighbouring countries. Libya should adopt full coverage national plans and guidelines to face the future consequences of viral hepatitis, particularly hepatitis C virus.

Burden of pediatric hepatitis C

Hepatitis C virus (HCV) is a major health burden infecting 170-210 million people worldwide. Additional 3-4 millions are newly-infected annually. Prevalence of pediatric infection varies from 0.05%-0.36% in the United States and Europe; up to 1.8%-5.8% in some developing countries. The highest prevalence occurs in Egypt, sub-Saharan Africa, Amazon basin and Mongolia. HCV has been present in some populations for several centuries, notably genotypes 1 and 2 in West Africa. Parenteral anti-schistosomal therapy practiced in the 1960s until the early 1980s had spread HCV infection throughout Egypt. Parenteral acquisition of HCV remains a major route for infection among Egyptian children. Insufficient screening of transfusions, unsterilized injection equipment and re-used needles and syringes continue to be major routes of HCV transmission in developing countries, whereas vertical transmission and adolescent high-risk behaviors (e.g., injection drug abuse) are the major routes in developed countries. The risk of vertical transmission from an infected mother to her unborn/newborn infant is approximately 5%. Early stages of HCV infection in children do not lead to marked impairment in the quality of life nor to cognitive, behavioral or emotional dysfunction; however, caregiver stress and family system strain may occur. HCV slowly progresses to serious complications as cirrhosis (1%-2%) and hepatocellular carcinoma (HCC) especially in the presence of risk factors as hemolytic anemias, obesity, treated malignancy, and concomitant human immune deficiency and/or hepatitis B virus co-infection. HCV vaccine remains elusive to date. Understanding the immune mechanisms in patients who successfully cleared the infection is essential for vaccine development. The pediatric standard of care treatment consists of pegylated interferon-α 2a or b plus ribavirin for 24-48 wk. The new oral direct acting antivirals, approved for adults, need further evaluation in children. Sustained virologic response varies depending on the viral load, genotype, duration of infection, degree of aminotransferase elevation, adiposity and single nucleotide polymorphisms of interleukin (IL)-28B locus. The goals of treatment in individual patients are virus eradication, prevention of cirrhosis and HCC, and removing stigmatization; meanwhile the overall goal is decreasing the global burden of HCV. IL-28B polymorphisms have been also associated with spontaneous clearance of vertically acquired HCV infection. The worldwide economic burden of HCV for children, families and countries is estimated to be hundreds of millions of US dollars per year. The United States, alone, is estimated to spend 199-336 million dollars in screening, monitoring and treatment during one decade. The emotional burden of having an HCV infected child in a family is more difficult to estimate.

Epidemiology of hepatitis C virus infection and risk factor analysis in the Hebei Province, China

Background

In 1985, a hepatitis C virus (HCV) outbreak caused by plasmapheresis donation was reported in the Hebei Province, China. However, studies assessing the epidemic features and risk factors of HCV in the general population of Hebei have been limited until now.

Methods

The multicenter cluster sampling method was used to collect samples. The participants were interviewed. Relevant information was obtained from the general population using a standardized questionnaire, and association and logistic regression analyses were conducted. Serum samples were taken to test anti-HCV by enzyme immunoassays.

Results

A total of 4562 participants from 11 cities of the Hebei Province were enrolled. The average anti-HCV positive rate was 0.62% (29/4562), which was 1.07% in the rural population, compared with 0.22% in the urban population. The anti-HCV positive rate in the 40–59-year age group was higher than in those aged <40 years. History of blood transfusion and transmission in families were the main risk factors for HCV infection in this area.

Conclusion

The anti-HCV positive rate in Hebei has decreased significantly from that two decades ago. Safety of blood products and health education about HCV still need to be improved.

Role of antiviral therapy in the management of hepatocellular carcinoma

Globally, hepatitis B virus (HBV) and/or hepatitis C virus (HCV) infection leads to liver fibrosis and cirrhosis, which in turn causes resultant hepatocellular carcinoma (HCC). Frequently, HCC recurs very soon even after a potentially curative treatment such as surgical interference or locoregional ablative therapies. Chronic HBV/HCV infection is often responsible for this recurrence, through secondary carcinogenesis. Antiviral therapy after a curative treatment of HCC plays an important role in preventing or delaying recurrence and improves survival in patients with HBV/HCV infection-related HCC. This article reviews the worldwide epidemiology of HBV/HCV infection, the association of viral infection with HCC, the mechanism of hepatitis virus-related hepatocarcinogenesis, and the paramount importance of antiviral therapy in the management of HCC.

Epidemiology of hepatitis C virus infection in highly endemic HBV areas in China

Background

Wuwei City has the highest prevalence of hepatitis B virus (HBV) in China. From 2007 to 2011, the average reported incidence rate of hepatitis B was 634.56/100,000 people. However, studies assessing the epidemic features and risk factors of HCV in the general population of Wuwei City are limited.

Methods

A total of 7189 people were interviewed and screened for HCV antibodies. HCV RNA and HCV genotypes were analyzed by PCR. Relevant information was obtained from the general population using a standardized questionnaire, and association and logistic regression analyses were conducted.

Results

The anti-HCV prevalence was 1.64% (118/7189), and HCV-RNA was detected in 37.29% (44/118) of the anti-HCV positive samples. The current HCV infection rate was 0.61% (44/7189) in the Wuwei general population. Hepatitis C infection rate was generally higher in the plains regions (χ² = 27.54,P<0.05), and the most predominant HCV genotypes were 2a (59.1%) and 1b (34.1%). The concurrent HCV and HBV infection rate was 1.37%, and a history of blood transfusion (OR = 17.9, 95% CI: 6.1 to 52.6, p<0.001) was an independent risk factor for HCV positivity.

Conclusions

Although Wuwei is a highly endemic area for HBV, the anti-HCV positive rate in the general population is low. More than one-third of HCV-infected people were unaware of their infection; this may become an important risk factor for hepatitis C prevalence in the general population. Maintaining blood safety is important in order to help reduce the burden of HCV infection in developing regions of China.