Hepatitis C Virus Antibody Prevalence Research Articles

HIV and HCV screening among trauma patients.

The purpose of this study was to develop a hepatitis C virus (HCV) and HIV screening program for patients evaluated by the trauma service and link to care. Patients were offered screening for HCV antibody and HIV. Demographics were collected on gender, race, age, and history of intravenous drug use. A navigator connected patients to treatment. In total, 1160 trauma patients were screened for HCV and/or HIV. There were 162 (14%) patients with HCV antibodies. Patients who inject drugs comprised 39.5% (64) of the HCV antibody positive group. Forty-six (68.7%) patients received linkage to care services and 55 (34%) patients were actively engaged in treatment. There were 155 (10.5%) of all eligible patients screened for HIV. Twenty-one (13.5%) patients were living with HIV (PLWH) and there were two (1.3%) new HIV infections. All new PLWH were linked to care and a total of 14 (73.7%) PLWH were on antiretroviral therapy. This is the first HCV and HIV screening and linkage to care program of trauma surgery patients. In this interim program evaluation, we found high prevalence of HCV antibody and HIV prevalence and high linkage to care rates. Trauma service HCV and HIV screening is an opportunity to diagnose, link, and re-engage a vulnerable population.

Hepatitis C prevalence among the migrant population in Spain: A systematic review and meta-analysis

IntroductionSpain, which has one of the largest migrant populations in Europe, has committed to eliminating the hepatitis C virus (HCV). The aim of this study was to estimate the prevalence of HCV among migrant groups in Spain, a country of 46 million people, with an estimated HCV-antibody prevalence of 1.7%. MethodsStudies on HCV and migration in Spain were identified by systematically searching three databases from the first records to 30 November 2017, and consulting experts at the Ministry of Health and in the 17 Spanish autonomous communities. A meta-analysis was conducted to determine pooled HCV prevalence for the general migrant population. Prevalences were also calculated for high-risk migrant populations and populations who had undergone hospital screening, stratified by region of origin. ResultsOut of 243 studies identified, 26 met the eligibility criteria. The meta-analysis of the general migrant population found HCV antibody prevalence to be 1.6%. Migrants originating from European countries, including those at high or moderate risk for HCV, had the highest pooled prevalence (7.1%). In the general migrant population, prevalence was highest among sub-Saharan African migrants (3.1%) and lowest among Latin American migrants (0.2%). ConclusionBased on the limited available data, the prevalence among the general migrant population was found to be the same as the general Spanish population. Further research is needed to more accurately determine HCV prevalence for the overall migrant population and specific migrant subpopulations with a higher risk in the country as a whole and in each of Spain's 17 autonomous communities.

Who to Test for Hepatitis C Virus in the Middle East and North Africa?: Pooled Analyses of 2,500 Prevalence Measures, Including 49 Million Tests.

Expanding hepatitis C virus (HCV) treatment coverage is challenged by limited testing and diagnosis. This study assessed the risk of exposure, for the Middle East and North Africa, by population, yields of testing, and program efficiency of testing strategies. A standardized and systematically assembled database of 2,542 HCV antibody prevalence studies on 49 million individuals was analyzed. Random effects meta‐analyses were conducted to estimate pooled measures for risk of exposure, risk ratio (RR) of exposure, and yields of testing. Program expansion path curves were calculated to assess program efficiency. Countries clustered into two patterns: generalized versus concentrated epidemics. In generalized epidemics (Egypt and Pakistan) relative to general populations, RR of exposure was 6.8 for people who inject drugs (PWID), 6.7 for populations with liver conditions, and 5.0 for populations with high‐risk health care exposures. In concentrated epidemics (remaining countries), corresponding RRs were 97.2, 45.1, and 22.2, respectively. In generalized epidemics, the number of tests needed to identify a chronic infection was 2.5 for PWID, 2.4 for populations with liver conditions, 2.7 for populations with high‐risk health care exposures, and 14.2 for general populations. In concentrated epidemics, corresponding numbers were 2.8, 8.6, 5.1, and 222.2, respectively. Program expansion path curves demonstrated major gains in program efficiency by targeting specific populations. Risk of exposure varies immensely by population and shows a distinctive hierarchy, particularly in concentrated epidemics. Testing strategies can be much more efficient through population prioritization by risk of exposure. General population testing is not programmatically efficient in concentrated epidemics.

Hepatitis B and Hepatitis C among Human Immunodeficiency Virus Infected Patients at a District Hospital in Mwanza, Tanzania

Human immunodeficiency virus (HIV), hepatitis B virus (HBV) and Hepatitis C virus (HCV) infections have been a major public health problem. HIV patients with HBV and HCV infection are at high risk of liver diseases which is associated with increased mortality. This study aims at determining the prevalence of hepatitis B surface antigen (HBsAg), HCV antibodies and HBV antibodies (anti-HBsAg) among HIV seropositive adults attending care and treatment clinic at Sengerema district hospital in Mwanza, Tanzania. A cross-sectional hospital based study was conducted between February and March 2017 among 243 HIV adult patients at Sengerema designated district hospital, Mwanza, Tanzania. Socio-demographic and other relevant information were collected using pre-tested questionnaires. Detection of HBsAg and HCV antibodies was done by commercial rapid immunochromatographic test while the detection of anti-HBsAg was done using enzyme linked immunosorbent assay. Data were analyzed by using STATA version 13. The median age of the study participants was 43, interquartile range (IQR): 37 - 51 years. The majority 172 (70.8) of study participants were female and the majority (88%) of participants had CD4 count of greater than 200 counts/μl. The prevalence of HBsAg, HCV antibodies and anti-HBsAg were 26/243 (10.7%, 95% confidence interval [CI]: 7 - 14), 20/243 (8.2%, 95% CI: 4.7 - 11.6) and (100/243) 41.2%, 95% CI: 35 - 47, respectively. Co-infection with HCV (OR: 4.45, 95% CI: 1.51 - 13.21, P = 0.007) was independenlty found to predict HbsAg positivity. History of blood transfusion (OR: 2.34, 95% CI: 1.08 - 5.06, P = 0.028) was significantly associated with anti-HBsAg among HIV infected individuals while, the rate of anti-HBsAg was found to decrease by 2.02 IU/L in a year increase in age. About one tenth of HIV infected individuals are co-infected with HCV and HBV with more than one third being positive for anti-HBsAg. There is a paramount need to emphasize the need for regular screening and proper management of these patients to reduce associated complications in resource limited countries where these infections are common.

Estimating Prevalence of Hepatitis C Virus Infection in the United States, 2013-2016.

Hepatitis C virus (HCV) infection is the most commonly reported bloodborne infection in the United States, causing substantial morbidity and mortality and costing billions of dollars annually. To update the estimated HCV prevalence among all adults aged ≥18 years in the United States, we analyzed 2013-2016 data from the National Health and Nutrition Examination Survey (NHANES) to estimate the prevalence of HCV in the noninstitutionalized civilian population and used a combination of literature reviews and population size estimation approaches to estimate the HCV prevalence and population sizes for four additional populations: incarcerated people, unsheltered homeless people, active-duty military personnel, and nursing home residents. We estimated that during 2013-2016 1.7% (95% confidence interval [CI], 1.4-2.0%) of all adults in the United States, approximately 4.1 (3.4-4.9) million persons, were HCV antibody-positive (indicating past or current infection) and that 1.0% (95% CI, 0.8-1.1%) of all adults, approximately 2.4 (2.0-2.8) million persons, were HCV RNA-positive (indicating current infection). This includes 3.7 million noninstitutionalized civilian adults in the United States with HCV antibodies and 2.1 million with HCV RNA and an estimated 0.38 million HCV antibody-positive persons and 0.25 million HCV RNA-positive persons not part of the 2013-2016 NHANES sampling frame. Conclusion: Over 2 million people in the United States had current HCV infection during 2013-2016; compared to past estimates based on similar methodology, HCV antibody prevalence may have increased, while RNA prevalence may have decreased, likely reflecting the combination of the opioid crisis, curative treatment for HCV infection, and mortality among the HCV-infected population; efforts on multiple fronts are needed to combat the evolving HCV epidemic, including increasing capacity for and access to HCV testing, linkage to care, and cure.

Declining prevalence of hepatitis C virus among university students in one of the main governorates in Egypt.

Background and aimsEgypt is considered to have the highest rate of hepatitis C virus (HCV) prevalence worldwide. However, HCV prevalence is currently declining due to the improvement of health education programs, improved environmental sanitation, and the introduction of novel treatment regimens. The aim of this work was to determine the HCV seroprevalence among Menoufia University students.MethodsThe current study included 48,972 students from Menoufia University, Egypt. Blood sample was obtained from every patient for HCV seromarker testing. In anti-HCV-positive subjects, quantitative PCR for HCV RNA was done.ResultsOverall, HCV antibody prevalence rate was 1%. This prevalence was higher in females (304/27,421; 1.1%) than in males (194/21,371; 0.9%). HCV-RNA PCR was positive in 355/48,972 (0.7%); the percentage of HCV PCR positive among the anti-HCV-positive was 71.3% (355/498 patients), with a higher prevalence among females than in males but without statistical significance. In addition, rural areas showed more prevalent HCV seroprevalence than urban areas.ConclusionThese prevalence rates for HCV infection are lower than that previously reported in the same age group denoting a new evidence for the reduction of prevalence and a hope for successful eradication of HCV in the forthcoming years.

Epidemiology of hepatitis B, C and D in Malawi: systematic review

BackgroundViral hepatitis is an important public health issue in sub-Saharan Africa. Due to rising mortality from cirrhosis and hepatocellular carcinoma and limited implementation of screening and treatment programmes, it has been characterised as a neglected tropical disease. Synthesis of the existing evidence on the epidemiology of viral hepatitis B, C and D in Malawi is required to inform policy and identify research gaps.MethodsWe searched Pubmed, EMBASE and Scopus for studies reporting the epidemiology of viral hepatitis B, C and D in Malawi from 1990 to 2018. Articles reporting prevalence estimates were included provided they described details of participant selection, inclusion criteria and laboratory methods (detection of HBsAg, anti-HCV or anti-HDV antibody, HCV antigen or HCV RNA or HDV RNA). We assessed study quality using a prevalence assessment tool. Where appropriate, a pooled prevalence was calculated using a DerSimonian Laird random effects model.ResultsSearches identified 199 studies, 95 full text articles were reviewed and 19 articles were included. Hepatitis B surface antigen (HBsAg) seroprevalence was assessed in 14 general population cohorts. The pooled prevalence among adults was 8.1% (95% CI 6.1, 10.3). In 3 studies where HBsAg was stratified by HIV status, no effect of HIV on HBsAg prevalence was observed (OR 1.2 (95% CI: 0.8, 1.6, p = 0.80)). In a single study of HIV/HBV infected individuals, anti-hepatitis D antibody (anti-HDV) prevalence was low (1.5%). HCV antibody prevalence (anti-HCV) ranged from 0.7 to 18.0% among 12 cohorts in general populations. Among three studies which used PCR to confirm current infection, the pooled rate of HCV RNA confirmation among anti-HCV positive individuals was only 7.3% (95% CI: 0.0, 24.3).ConclusionsHepatitis B is highly prevalent in Malawi. There is a paucity of epidemiological data from rural areas where 85% of the population reside, and the Northern region. Priority research needs include large-scale representative community studies of HBV, HDV and HCV seroprevalence, assessment of children following introduction of the HBV vaccine in 2002, prevalence estimates of viral hepatitis among individuals with cirrhosis and HCC and data on HCV prevalence using PCR confirmation, to support a viral hepatitis strategy for Malawi.

Cost Effectiveness of Universal Screening for Hepatitis C Virus Infection in the Era of Direct-Acting, Pangenotypic Treatment Regimens

Most persons infected with hepatitis C virus (HCV) in the United States were born from 1945 through 1965; testing is recommended for this cohort. However, HCV incidence is increasing among younger persons in many parts of the country and treatment is recommended for all adults with HCV infection. We aimed to estimate the cost effectiveness of universal 1-time screening for HCV infection in all adults living in the United States and to determine the prevalence of HCV antibody above which HCV testing is cost effective. We developed a Markov state transition model to estimate the effects of universal 1-time screening of adults 18 years or older in the United States, compared with the current guideline-based strategy of screening adults born from 1945 through 1965. We compared potential outcomes of 1-time universal screening of adults or birth cohort screening followed by antiviral treatment of those with HCV infection vs no screening. We measured effectiveness with quality-adjusted life-years (QALY), and costs with 2017 US dollars. Based on our model, universal 1-time screening of US residents with a general population prevalence of HCV antibody greater than 0.07% cost less than $50,000/QALY compared with a strategy of no screening. Compared with 1-time birth cohort screening, universal 1-time screening and treatment cost $11,378/QALY gained. Universal screening was cost effective compared with birth cohort screening when the prevalence of HCV antibody positivity was greater than 0.07% among adults not in the cohort born from 1945 through1965. Using a Markov state transition model, we found a strategy of universal 1-time screening for chronic HCV infection to be cost effective compared with either no screening or birth cohort-based screening alone.

Global, regional, and country‐level estimates of hepatitis C infection among people who have recently injected drugs

People who have recently injected drugs are a priority population in efforts to achieve hepatitis C virus (HCV) elimination. This study estimated the prevalence and number of people with recent injecting drug use living with HCV, and the proportion of people with recent injecting drug use among all people living with HCV infection at global, regional and country-levels. Data from a global systematic review of injecting drug use and HCV antibody prevalence among people with recent (previous year) injecting drug use were used to estimate the prevalence and number of people with recent injecting drug use living with HCV. These data were combined with a systematic review of global HCV prevalence to estimate the proportion of people with recent injecting drug use among all people living with HCV. There are an estimated 6.1 million [95% uncertainty interval (UI)=3.4-9.2] people with recent injecting drug use aged 15-64years living with HCV globally (39.2% viraemic prevalence; UI=31.6-47.0), with the greatest numbers in East and Southeast Asia (1.5 million, UI=1.0-2.1), eastern Europe (1.5 million, UI=0.7-2.4) and North America (1.0 million, UI=0.4-1.7). People with recent injecting drug use comprise an estimated 8.5% (UI=4.6-13.1) of all HCV infections globally, with the greatest proportions in North America (30.5%, UI=11.7-56.7), Latin America (22.0%, UI=15.3-30.4) and eastern Europe (17.9%, UI=8.2-30.9). Although, globally, 39.2% of people with recent injecting drug use are living with hepatitis C virus (HCV) and 8.5% of all HCV infections occur globally among people with recent injecting drug use, there is wide variation among countries and regions.

High Seroprevalence of Hepatitis C Virus Among Australian Psychiatric Inpatients: A Multicentre Study of Seroprevalence, Risk Factors and Treatment Experience

Background and aims: Treatment of hepatitis C virus (HCV) in patients with mental illness was previously hampered by the adverse neuropsychiatric effects of interferon therapy. The new era of directly acting antiviral (DAA) therapy has renewed interest in HCV treatment in this population due to its improved safety profile. The aims of this study were therefore to assess HCV prevalence and risk factors in psychiatric inpatients and to explore treatment models of care. Methods: This prospective study involved patients admitted to four inpatient psychiatric units, from December 2016 to December 2017. After consent HCV testing was performed, and information about HCV risk factors was obtained. Results: Two hundred and sixty patients (70% male), median age 44 years (IQR 24) participated in the study. The period prevalence of HCV antibody was 10·8% (95% CI 7-15). 80% of the study cohort had at least one risk factor for HCV. Independent predictors of HCV positive status were injection drug use (p<0·001, OR 44·05, 95% CI 7·9-245·5), exposure to custodial stay (p=0·011, OR 7·34, 95%CI 1·6-33·9), and age (p=0·011, OR 1·09, 95%CI 1·02-1·16). Of the 28 seropositive patients, 16 were HCV RNA positive. Eight of them were initiated on DAAs. Hepatitis nurses liaised with community mental health teams for treatment initiation. Six patients achieved sustained viral response, one achieved end of treatment response, and results are awaited in one. The remaining eight patients have proven difficult to engage with. Conclusion: HCV prevalence was high in this multicentric study cohort of psychiatric inpatients. Although treatment uptake was achieved only in 50% patients, it was successful in the majority. The findings highlight the urgent need to educate the mental health sector about the necessity to embed HCV screening practices and to build effective linkages for their patients to HCV treatment in the current DAA era. Funding: Unrestricted educational grant was received from Merck Sharp & Dohme (Australia) Pty Ltd (MSD), 2017 for this study. The funding agency had no role in the study design, execution or write- up. Conflict of interest: None Ethics approval: The project was approved by the Southern Adelaide Clinical Human Research Ethics committee (OFR #291.16 – HREC/16/SAC/232)

Integrated Hepatitis C Care for People Who Inject Drugs (Heplink): Protocol for a Feasibility Study in Primary Care.

BackgroundHepatitis C virus (HCV) infection is a major cause of chronic liver disease and death. Drug use remains the significant cause of new infections in the European Union, with estimates of HCV antibody prevalence among people who inject drugs ranging from 5% to 90% in 29 European countries. In Ireland and the European Union, primary care is a key area to focus efforts to enhance HCV diagnosis and treatment among people who inject drugs.ObjectiveThe Heplink study aims to improve HCV care outcomes among opiate substitution therapy (OST) patients in general practice by developing an integrated model of HCV care and evaluating its feasibility, acceptability, and likely efficacy.MethodsThe integrated model of care comprises education of community practitioners, outreach of an HCV-trained nurse into general practitioner (GP) practices, and enhanced access of patients to community-based evaluation of their HCV disease (including a novel approach to diagnosis, that is, Echosens FibroScan Mini 430). A total of 24 OST-prescribing GP practices were recruited from the professional networks and databases of members of the research consortium. Patients were eligible if they are aged ≥18 years, on OST, and attend the practice for any reason during the recruitment period. Baseline data on HCV care processes and outcomes were extracted from the clinical records of participating patients.ResultsThis study is ongoing and has the potential to make an important impact on patient care and provide high-quality evidence to help GPs make important decisions on HCV testing and onward referral.ConclusionsA substantial proportion of HCV-positive patients on OST in general practice are not engaged with specialist hospital services but qualify for direct-acting antiviral drugs treatment. The Heplink model has the potential to reduce HCV-related morbidity and mortality.Registered Report IdentifierRR1-10.2196/9043

Hepatitis C prevalence among the migrant population in Spain: A systematic review and meta-analysis

IntroductionSpain, which has one of the largest migrant populations in Europe, has committed to eliminating the hepatitis C virus (HCV). The aim of this study was to estimate the prevalence of HCV among migrant groups in Spain, a country of 46 million people, with an estimated HCV-antibody prevalence of 1.7%. MethodsStudies on HCV and migration in Spain were identified by systematically searching three databases from the first records to 30 November 2017, and consulting experts at the Ministry of Health and in the 17 Spanish autonomous communities. A meta-analysis was conducted to determine pooled HCV prevalence for the general migrant population. Prevalences were also calculated for high-risk migrant populations and populations who had undergone hospital screening, stratified by region of origin. ResultsOut of 243 studies identified, 26 met the eligibility criteria. The meta-analysis of the general migrant population found HCV antibody prevalence to be 1.6%. Migrants originating from European countries, including those at high or moderate risk for HCV, had the highest pooled prevalence (7.1%). In the general migrant population, prevalence was highest among sub-Saharan African migrants (3.1%) and lowest among Latin American migrants (0.2%). ConclusionBased on the limited available data, the prevalence among the general migrant population was found to be the same as the general Spanish population. Further research is needed to more accurately determine HCV prevalence for the overall migrant population and specific migrant subpopulations with a higher risk in the country as a whole and in each of Spain's 17 autonomous communities.

Estimates of state-level chronic hepatitis C virus infection, stratified by race and sex, United States, 2010

BackgroundHepatitis C virus (HCV) is the most common blood-borne viral infection in the United States. Previously, we used data from the National Health and Nutrition Examination Survey (NHANES) and mortality data from the National Vital Statistics System (NVSS) to estimate the prevalence of HCV antibodies (anti-HCV) and HCV RNA among all U.S. states. However, demographic differences in HCV burden at the state-level have not been systematically described. This analysis quantified the HCV burden stratified by sex and race (and associated disparities) for each U.S. state.MethodsBuilding on our previous method, we used three publicly available data sources to estimate HCV RNA prevalence among noninstitutionalized adults stratified by sex and race group. We used a small-area estimation approach that included direct standardization of NHANES demographic data with logistic regression modeling of HCV-related mortality data as an adjustment factor to estimate the state-level prevalence and total persons with chronic HCV infection for sex and race groups in all U.S. states.ResultsNationally, males had an estimated HCV RNA prevalence of 1.56% (95% CI: 1.37–1.84%) and females had a prevalence of 0.75% (95% CI: 0.63–0.96%). Stratified by race, national estimated prevalence of HCV RNA was highest among non-Hispanic black (2.43, 95% CI: 2.10–2.90%), followed by non-Hispanic white (1.05, 95% CI: 0.90–1.27%) and Hispanic/other (0.74, 95% CI: 0.59–1.04%). Males in most jurisdictions (41/51) have an HCV RNA prevalence that is between 1.5 and 2.5 times higher than their female counterparts.ConclusionsHCV infection disparities by sex are mostly consistent across the country. However, race differences in HCV infection differ by state and tailored prevention and treatment efforts specific to the local HCV epidemic are needed to reduce race disparities.

Maternal hepatitis C (HCV) infection and Anti-D immunoglobulin therapy: study testing antibodies, RNA and Genotype of HCV in Baghdad

Introduction: Hepatitis C virus (HCV) infection is a serious health problem. It is a major contributor to end-stage liver disease. Worldwide, 1–8% of all pregnant women were infected. Women with viral hepatitis may be at an increased risk of pregnancy complications. There are several obstetrics intervention acts as risk factors, which are specific to women pertaining the HCV infection; anti-D immunoglobulin (Ig) therapy may be one of them. Our objectives were to estimate the prevalence of HCV antibodies (anti-HCV), RNA, and genotype distribution among women with anti-D Ig therapy.Materials and methods: A cross sectional study was conducted. A sample of 154 Rhesus negative (Rh − ve) pregnant women regardless of the anti-D Ig therapy was collected. Anti-HCV were tested using third generation enzyme immunoassay (EIA-3) and immunoblot assay (Lia Tek-111), subsequently. In addition, 89 serum samples were subjected to molecular analysis using RT-PCR and DNA enzyme immunoassay (DEIA) method for the detection of HCV-RNA and genotypes.Results: Anti-HCV, and HCV-RNA seroprevalence were significantly higher (17.1, 35.5%) among women with anti-D Ig than their counter group (6.4, 13.16%), p = .038, .018, respectively. Significant direct positive dose response correlation (r = 0.78, p = .005) had been seen between number of anti-D Ig therapy and anti-HCV seropositive rate. Anti-D Ig therapy act as a risk factor (odds ratio (OR) = 3.01, 95%CI: 1.01–8.9) especially from the third dose onward. Women with anti-D Ig therapy were at higher risk (3.6 times more) of positive HCV-RNA (OR =3.6, 95%CI =1.19–10.837). Genotype HCV-1b showed higher prevalent (52.9%) among the recipients of anti-D Ig therapy while genotype HCV-3a (6.6%) was the lowest.Conclusions: Our study showed that Anti-D immunoglobulin therapy acts as a risk factor for acquiring HCV infection. Screening for HCV should be recommended for all recipients of anti-D Ig. Not only HCV antibodies but HCV-RNA detection being recommended for the diagnosis of HCV infection.A brief rational: Pregnant women with HCV infection are at risk of adverse obstetric outcome. Anti-D Ig therapy may be a risk factor for HCV infection. Hence, we conducted a cross sectional study with the objectives to estimate the prevalence of HCV antibodies (anti-HCV), RNA, and genotype distribution among women with anti-D Ig therapy. We found that anti-HCV and HCV-RNA seroprevalence were significantly higher in women with anti-D Ig. In addition, women with anti-D Ig therapy were 3.6 times more at risk of positive HCV-RNA with genotype HCV-1b showed higher prevalence. Therefore, anti-D Ig therapy is a risk factor for acquiring HCV infection and we recommend screening for HCV for all recipients of anti-D Ig. In addition, the diagnosis of HCV infection, should be made with HCV antibodies and HCV-RNA detection.

The Prevalence of Hepatitis C Virus Antibody in HIV-Negative Persons in Kenya, 2007.

The prevalence of hepatitis C virus (HCV) infection in the Kenyan population has not been previously determined. We estimated the Kenyan HCV prevalence in HIV-negative persons aged 15-64 years. This is a retrospective cross-sectional study using data from the 2007 Kenya AIDS Indicator Survey-a nationally representative sample of 15,853 persons aged 15-64 years who completed a health interview and provided a blood specimen. Of the 1,091 randomly selected participants, 50 tested positive for HCV antibody using the automated chemiluminescence immunoassay, corresponding to a weighted HCV antibody positivity rate of 4.4% (95% confidence interval: 3.3-5.9%) or 848,000 (range: 634,000-1,100,000) persons. Hepatitis C virus RNA, a marker for current infection, was not detected in any of the tested antibody-positive specimens. The high HCV antibody prevalence together with no current infection suggests that some HCV antibody serologic testing in Kenya may result in false positives whereas others may be because of spontaneous viral clearance.

The epidemiology of hepatitis C virus in Pakistan: systematic review and meta-analyses.

To characterize hepatitis C virus (HCV) epidemiology in Pakistan and estimate the pooled mean HCV antibody prevalence in different risk populations, we systematically reviewed all available records of HCV incidence and/or prevalence from 1989 to 2016, as informed by the Cochrane Collaboration Handbook. This systematic review was reported following the PRISMA guidelines. Populations were classified into six categories based on the risk of exposure to HCV infection. Meta-analyses were performed using DerSimonian and Laird random-effects models with inverse variance weighting. The search identified one HCV incidence study and 341 prevalence measures/strata. Meta-analyses estimated the pooled mean HCV prevalence at 6.2% among the general population, 34.5% among high-risk clinical populations, 12.8% among populations at intermediate risk, 16.9% among special clinical populations, 55.9% among populations with liver-related conditions and 53.6% among people who inject drugs. Most reported risk factors in analytical epidemiologic studies related to healthcare procedures. Pakistan is enduring an HCV epidemic of historical proportions—one in every 20 Pakistanis is infected. HCV plays a major role in liver disease burden in this country, and HCV prevalence is high in all-risk populations. Most transmission appears to be driven by healthcare procedures. HCV treatment and prevention must become a national priority.

Hepatitis C virus seroprevalence among haemodialysis patients, sickle cell patients and blood donors at a tertiary hospital in Yaounde, Cameroon

Background: Hepatitis C virus (HCV) infection is a serious health care problem in haemodialysis patients, sickle cell patients and blood donation in Africa. However, there is a paucity of information about this in Cameroon. This study presents the prevalence of antibodies to HCV among haemodialysis patients, sickle cell patients and blood donors at the Yaounde University Teaching Hospital, Cameroon.Methods: A total of 113 participants were included in the study. Sociodemographic data were collected using a questionnaire. The prevalence of HCV antibodies was determined by a rapid diagnostic test (DiaSpot HCV One Step Hepatitis C Virus Test Strip) and data were analysed using Statistical Package for Social Science. Results: Of the 113 patients, 18 tested positive, giving an overall prevalence of 15.9%. 15.6% (12/77) males had HCV antibodies, while 16.7% (6/36) females tested positive with HCV antibodies. HCV positive rates of 26.3% (10/38), 8.6% (3/35) and 12.5% (5/40) for haemodialysis patients, sickle cell patients and blood donors, respectively, were recorded. However, no statistical significant differences were observed in these three groups (p = 0.089).Conclusion: The present study reveals that the rate of HCV antibodies among the study population is high and Cameroon could be a highly endemic society for HCV infection.

Hepatitis C virus prevalence and associated risk factors among Indigenous Australians who inject drugs

Objective:To examine factors associated with hepatitis C virus (HCV) infection among a national sample of Indigenous and non‐Indigenous people who inject drugs (PWID) in Australia. Methods:Respondents were recruited from Australia’s Needle Syringe Program Survey; an annual bio‐behavioural surveillance project that monitors HCV antibody prevalence among PWID. Data from 2006–2015 were de‐duplicated to retain only one record where individuals participated in >1 survey round. Univariate and multivariable logistic regression examined demographic characteristics and injection‐related behaviours associated with exposure to HCV. Results:Among 17,413 respondents, 2,215 (13%) were Indigenous Australians. Compared to their non‐Indigenous counterparts, Indigenous respondents were significantly more likely to be exposed to HCV infection (53% vs. 60% respectively, p<0.001). Among Indigenous respondents, HCV antibody positivity was independently associated with a history of imprisonment (Adjusted Odd Ratio [AOR] 2.13, 95%CI 1.73–2.64), opioid injection (AOR 1.53, 95%CI 11.43–2.16), recruitment in a metropolitan location (AOR 1.27, 95%CI 1.02–1.59), engagement in opioid substitution therapy (AOR 2.83, 95%CI 2.23–3.59) and length of time since first injection (p<0.001). Conclusion:Indigenous PWID are more likely to be exposed to HCV infection than their non‐Indigenous counterparts. Implications for public health:Increased access to culturally sensitive harm reduction programs is required to prevent primary HCV infection and reinfection among Indigenous PWID. Given recent advances in HCV treatment, promotion of treatment uptake among Indigenous PWID may reduce future HCV‐related morbidity and mortality.

The epidemiology of hepatitis C virus in Iran: Systematic review and meta-analyses

The aim of this study was to characterize hepatitis C virus (HCV) epidemiology in Iran and estimate the pooled mean HCV antibody prevalence in different risk populations. We systematically reviewed and synthesized reports of HCV incidence and/or prevalence, as informed by the Cochrane Collaboration Handbook, and reported our findings following the PRISMA guidelines. DerSimonian-Laird random effects meta-analyses were implemented to estimate HCV prevalence in various risk populations. We identified five HCV incidence and 472 HCV prevalence measures. Our meta-analyses estimated HCV prevalence at 0.3% among the general population, 6.2% among intermediate risk populations, 32.1% among high risk populations, and 4.6% among special clinical populations. Our meta-analyses for subpopulations estimated HCV prevalence at 52.2% among people who inject drugs (PWID), 20.0% among populations at high risk of healthcare-related exposures, and 7.5% among populations with liver-related conditions. Genotype 1 was the most frequent circulating strain at 58.2%, followed by genotype 3 at 39.0%. HCV prevalence in the general population was lower than that found in other Middle East and North Africa countries and globally. However, HCV prevalence was high in PWID and populations at high risk of healthcare-related exposures. Ongoing transmission appears to be driven by drug injection and specific healthcare procedures.

Value of toll-like receptor 3 (TLR3) in chronic kidney disease patients with hepatitis C virus infection

Background Hepatitis C virus (HCV) infection is a severe public health problem with a worldwide predominance of 3%. An estimated 5–20% of infected patients develop cirrhosis annually, and 1–4% of them develop hepatocellular carcinoma. In Egypt, the prevalence of HCV antibody and HCV RNA are 10.0 and 7.0%, respectively, in the 15–59 years age group. In children of 1–14 years old, the prevalence of HCV antibody and HCV RNA are 0.4 and 0.2%, respectively. HCV infection is a cause of chronic kidney disease (CKD) and results in a significant problem in hemodialysis (HD) patients. Toll-like receptors (TLRs) might have an essential role in the pathogenesis of renal diseases. They include TLR1, TLR2, TLR3, TLR4, TLR5, TLR6, TLR7, TLR8, TLR9, TLR10, TLR11, TLR12, and TLR13, though the latter two are not found in humans. Recently, it is shown that the mouse and human kidney tubular epithelial cells appear to express TLR3 constitutively and upregulate its expression upon challenge with its legend. For this reason, it appears conceivable that this receptor might play an essential role in this organ in health and disease. Aim The present study was carried out to determine the value of TLR3 in CKD patients with HCV infection. Also, we aimed to study the levels of TLR3 for Child–Pugh different classes to determine its impact on the prognosis of liver disease in those patients. Patients and methods All participants were selected from the National Institute of Urology and Nephrology. Their ages ranged between 40 and 62 years. Our study included 130 individuals of which 105 patients were selected from a dialysis unit with the end-stage renal disease on regular HD three times/week for at least 1 year and 25 healthy participants as a control group. They were divided into three groups. The control group (GI) consisted of 25 clinically healthy participants matched for age and sex; GII constituted 45 HCV negative patients; and GIII had 60 HCV positive patients. GIII was subclassified into GIIIA, GIIIB, and GIIIC, each of which consisted of 20 patients according to the Child–Pugh scoring. All patients and control samples were subjected to the following tests: Antibody screening for HCV using the ELISA technique and quantitative HCV RNA by PCR. Detection of TLR3 was done using the ELISA technique. Other parameters such as Complete Blood Picture (CBC), Prothrombin Time (PT) (INR), urea, creatinine, Alanine Aminotransferase (ALT), Aspartate Aminotransferase (AST), total bilirubin, alkaline phosphatase, albumin, cholesterol, and triglycerides levels were also estimated. Results The percentage of HCV-positive cases among a studied group of patients on HD was 57.2%, and the percentage of negative cases was 42.8%. There was no significant difference between GI, GII, and GIII as regards age and duration of dialysis. There was a highly significant difference between GIII as regards TLR3, INR, urea, total bilirubin, albumin, and triglycerides compared with GI and GII. There was a highly significant positive correlation of TRL3 with creatinine and PCR RNA and a significant negative correlation with albumin and cholesterol. We also found that there was a highly significant difference between GIIIC as regards INR, total bilirubin, and albumin compared with GIIIA and GIIIB. TLR3 showed no significant difference between GIIIA, GIIIB, and GIIIC. Conclusion TLR3 may have a role in the pathogenesis of HCV infection-related CKD and can be used as a new marker for the development of HCV related end-stage renal disease.