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.
Highlights
Hepatitis C chronic liver disease is a major cause of liver transplant in developed countries
In Brazil, the overall weighted prevalence of Hepatitis C virus (HCV) antibodies was 1.38% in the state capitals of the five macro-regions and the Federal District taken as a whole (Table 1)
The large estimated absolute numbers of infected individuals indicate the burden of the disease in the near future
Summary
Hepatitis C chronic liver disease is a major cause of liver transplant in developed countries. The sequential population-based studies conducted in the USA are among the few nationwide surveys to estimate the prevalence of HCV [3,4,5,6]. In the USA, a 1.6% nationwide prevalence of anti-HCV was found by the National Health and Nutrition Examination Survey Continuous (NHANES Continuous) between 1999 and 2002 [5]. These surveys showed a decline in the prevalence of hepatitis C from NHANES III (1988–1994) to NHANES Continuous (2003–2006), but this figure remained stable between the NHANES 1999–2002 and NHANES 2003–2006 [6]. IDU, nasal drug use, blood transfusion prior to 1992, having a tattoo, being older than 29 years, social deprivation, and being born on a continent with endemic levels higher than 2.5% were the risk factors associated with HCV infection [8]
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