Risk Factors For HCV Infection Research Articles

Evidence of association between hepatitis C virus genotype 2b and nosocomial transmissions in hemodialysis centers from southern Brazil

BackgroundHepatitis C virus infection is a serious public health problem. Hemodialysis is considered one of the main risk factors of HCV infection, due to several invasive medical procedures and potential nosocomial transmission that patients with chronic renal failure (CRF) are continuously submitted. The aims of this study were to determine the prevalence of HCV and its genotypes in patients with CRF in hemodialysis units in southern Brazil.MethodsDemographic data and risk factors for HCV transmission were collected and analyzed. These data were obtained from patients undergoing hemodialysis treatment from January 2009 to August 2010, on two dialysis units of Rio Grande, southern Brazil. Genotyping was carried out by sequencing analysis of HCV NS5b, core-E1 junction and 5′UTR genomic regions.ResultsOne hundred fifty-nine patients under regular hemodialysis treatment were studied. HCV prevalence was 23.3%. HCV-infected patients had been on dialysis treatment for 91.9 months, a more prolonged period compared to HCV-negative patients (p = 0.001). While HCV genotypes 1b and 3a were identified as the most frequent strains, a surprisingly high proportion of genotype 2b was observed among patients in one of the dialysis centers compared to the general HCV-infected population of the same area. Hemodialysis treatment exposure time and healthcare working were associated with HCV infection.ConclusionsBesides the efforts to minimize nosocomial transmission of HCV, some events of transmission are still evidenced in dialysis units.

HCV infection among cocaine users in the state of Pará, Brazilian Amazon

In this study, the prevalence, genotype frequency, and risk factors for HCV infection in 384 cocaine users were determined. One hundred twenty-four (32.3%) cocaine users had anti-HCV antibodies and 120 (31.3%) had HCV-RNA. Genotyping results indicated the predominance of genotypes 1 (73.3%) and 3 (26.7%). Multivariate analysis showed an association of HCV infection with tattoos, shared use of paraphernalia, daily cocaine use, and a long history of cocaine use. The epidemiological aspects of HCV infection among cocaine users presented here should serve as an incentive for the establishment of a program of hepatitis C prevention and control by the local public-health authorities in the Amazon.

Prevalence and risk factors of hepatitis C and B virus infections in hemodialysis patients and their spouses: A multicenter study in Beijing, China

Hemodialysis patients are at risk for hepatitis C and B virus infections. This study investigated the prevalences and risk factors of HCV and HBV infection and the distribution of HCV genotypes among hemodialysis patients and their spouses. From August to November 2011, a cross-sectional study was conducted on 20 hemodialysis units in Beijing to investigate prevalences and risk factors for markers of HCV and HBV among 2,120 patients and 409 spouses. In hemodialysis patients, prevalences of anti-HCV, HCV RNA, and hepatitis B surface antigen (HBsAg) were 6.1%, 4.6%, and 7.0%, respectively. The prevalence of HCV antibodies among spouses was 0.5%, of HCV RNA was 0.2%, and of HBsAg was 4.2%. Risk factors for HCV infection were dialysis duration, blood transfusion, and attending more than one dialysis unit. HBV infection was independently associated with age, family member with hepatitis infection, gender, and surgery. The predominant HCV genotypes were 1b (89.0%) and 2a (7.7%), and genotypes 3a, 3b, and 6a were each 1.1%. A significant decrease in HCV and HBV prevalences in Chinese dialysis units showed that infection control measures were effective. However, because nosocomial transmissions persist, strict adherence to infection control measures should be emphasized to reduce the risk of transmission.

Seroprevalence of hepatitis C virus infection among surgical nurses, their patients and blood donation candidates in Poland

To assess the prevalence of anti-hepatitis C virus (HCV) in surgical nurses and midwives, to compare the rate with other female groups (their patients from the same hospitals and blood donation candidates) in a cross-sectional serosurvey, and to evaluate the alleged risk factors for acquiring an occupational infection. Between February 2008 and June 2009, participants from 16 hospitals selected at random in West Pomerania, Poland completed a written questionnaire detailing potential risk factors for HCV infection. Serum samples were assayed for anti-HCV using third-generation testing methods. Of 414 staff members, six were found to be anti-HCV positive [1.4%, 95% confidence interval (CI) 0.7-3.1%]. The seropositive status of staff was discovered during this one-off screening. A logistic regression model indicated that for anti-HCV seropositivity, only the length of employment was associated with increased odds of being infected [odds ratio (OR) 2.8; P < 0.006]. The prevalence of anti-HCV was 1.1% (12/1118, 95% CI 0.6-1.9%) in 1118 female patients, and 0% (0/801, 95% CI 0-1.1%) in 801 female blood donation candidates. A significant staff/patient difference in anti-HCV prevalence was observed among those aged >50 years (6.9% vs 1.0%; P < 0.007). For this age group, being a nurse was associated with higher odds (OR 8.8; P < 0.005) of being infected with HCV. Comparison of HCV prevalence rates pointed to a decreasing trend in the order: surgical nurses/midwives, patients and blood donation candidates; this may indicate occupational risk. The greatest risk factor for contracting HCV infection was length of employment, suggesting a possible effect of accumulated exposure to contaminated blood and other body fluids. There is a need for better recognition of HCV infection as a consequence of prolonged blood exposure among surgical and gynaecological staff.

Epidemiological aspects of HCV infection in HIV-infected individuals in Piauí State, Northeast Brazil

In this study, the prevalence, genotypic frequency, and risk factors for HCV infection in 768 patients infected with HIV were determined. Fifty-two (6.77%) HIV-positive individuals had anti-HCV antibodies and 26(3.39%) had HCV-RNA. Genotyping results indicated that all RT-PCR samples from patients infected with HCV belonged to genotype 1. Multivariate analysis revealed an association of HIV-HCV coinfection with drug use and having received blood transfusions before 1994. The relatively low prevalence of HCV infection in the HIV-positive population in that region may be a consequence of the small number of drug users in the sample, despite a strong association between HCV infection and drug use.

Routine exposure to blood within hostel environments might help to explain elevated levels of hepatitis C amongst homeless drug users: Insights from a qualitative study

BackgroundAlthough homelessness is a risk factor for HCV infection, there is a lack of research exploring the relationship between living in a hostel for homeless people and blood-borne viruses. The tendency to focus on risky injecting practices and HCV has also eclipsed the transmission risks potentially posed by spilt and dried blood. MethodsSemi-structured qualitative interviews were conducted with 40 homeless drug users (HDUs) (29 men and 11 women). The aim of the study was to explore the support needs of HDUs staying in emergency hostels or night shelters, but blood emerged as an unexpected recurring topic within participants’ accounts. Accordingly, all blood data were coded and analysed inductively. ResultsParticipants reported that spilt and dried blood were routine features of hostel life, particularly in larger night shelters. Given that the hepatitis C virus can survive outside the human body for several weeks and even months, this poses a worrying but largely overlooked transmission risk. According to the HDUs interviewed, hostel providers were often slow to remove blood and other bodily waste, leaving residents to clean it themselves or to avoid soiled areas. ConclusionsThe routine presence of blood within hostel environments might help to explain elevated levels of HCV amongst homeless drug users. However, there is a need for robust quantitative and qualitative research to systematically test and explore associations between HCV and hostel life. Recommendations are made for improving hostel cleanliness, apprising hostel staff and residents of HCV and other blood-borne virus transmission risks, and ensuring that blood and other bodily waste are deemed unacceptable features of any hostel setting.

Intravenous Drug Use and Hepatitis C Virus in Iran

Abstract This article does not have abstract.

Risk factors and seroprevalence of hepatitis C virus antibody among blood donors in Lagos

This study was undertaken (i) to determine the seroprevalence of antibodies to Hepatitis C virus (anti -HCV) among blood donors (ii) to document the incidence of known risk factors for HCV infection among blood donors. This is a cross sectional prospective study among apparently normal blood donors. Subjects were recruited from three different hospitals in Lagos metropolis. All recruited donors were evaluated for HCV infection- associated risk factors by questionnaire interviews. Sera samples from recruited donors were tested for anti-HCV using third generation Murex (Murex Biotech, South Africa) and fourth generation Dialab Enzyme Linked Immunosorbent Assay (ELISA) kits (Dialab. Austria). A total of three hundred and thirty four blood donors were screened, of which seven (2.1 %) were positive for anti-HCV. The blood donors comprised 15 (4.5 %) females and 319 (95.5 %) males. There was an association between anti-HCV positivity and history of multiple sex partners and previous sexually transmitted infections (X2-15.9; p < 0.05) Majority of blood donors were family replacement 317 (94.9 %) with anti-HCV prevalence of 2.2 % (7/317) while 5.1 % (17/334) were voluntary non remunerated with anti-HCV prevalence of 0% (p >0.05) CONCLUSION: Prevalence of anti-HCV among blood donors in Lagos (2.1%) is low as in most previous reports from Nigeria and some other parts of Africa.

Prevalence and risk factors of HCV infection in Poland

According to small studies carried out in preselected populations, the estimated prevalence of anti-hepatitis C virus (HCV) antibodies in Poland ranges from 0.6 to 2.1%. The aim of this study was to evaluate the prevalence of anti-HCV and HCV RNA among patients and healthcare workers. Anti-HCV antibodies were measured (Elecsys, Roche) in serum samples from 26,057 adults, consecutive patients or healthcare workers, from hospitals and out patient clinics not involved in the management of liver diseases. The majority of them (18,233) consented to fill out an anonymous questionnaire related to possible risk factors for HCV infection. Anti-HCV-positive samples were assessed for HCV RNA (Cobas Amplicor, Roche). A multivariate logistic regression model and the χ² test or the Fisher's exact test were applied. Anti-HCV antibodies were detected in 1.9% of individuals, and 31% of them demonstrated HCV RNA, which varied from 26% in hospitals to 66% in specialistic out-patient clinics. Prevalence of anti-HCV was significantly lower in healthcare workers (1.42%) than in patients (1.92%). Significant independent risk factors for anti-HCV positivity were as follows: male sex, more than three hospitalizations in a lifetime, blood transfusions before 1992, and intravenous drug use. The only significant risk factor for HCV RNA was intravenous drug use. An analysis carried out for multispecialistic hospitals demonstrated significantly lower prevalence of HCV RNA positivity in healthcare workers. Prevalence of anti-HCV in the Polish population studied was up to 1.9%, but active infection could be diagnosed in only 31% of them. Intravenous drug use, blood transfusions before 1992, multiple hospitalizations, and male sex increase the risk of HCV infection.

Primary risk factors of hepatitis C virus infection: a Meta-analysis

To provide evidence for decision-making on primary hepatitis C prevention through analyzing the main risk factors of hepatitis C virus infection. A comprehensive search was carried out in China Hospital Knowledge Database (CHKD), Wanfang Data, EBSCO, FMJS and Elsevier databases to identify all case-control and cohort studies published from 1994 to 2010 that evaluated the risk factors on the transmission of hepatitis C virus. Data manipulation and statistical analyses were performed using Stata 11.0 and RevMan 5.0 softwares. A total of 25 case-control studies were included in this Meta-analysis, which contained 4370 cases and 8606 controls. In univariate analysis, the pooled odds ratio (OR) and 95% confidence interval (CI) on the risk factors associated with HCV seropositivity were "blood transfusion" 4.23 (2.82 - 6.35), "having had surgical operations" 2.13 (1.70 - 2.67), "intravenous drug use" 52.28 (34.12 - 80.11), "having sex with intravenous drug users" 7.19 (3.13 - 16.51), "histories of having had STDs" 3.43 (2.70 - 4.34). In multivariate analysis, pooled OR and 95%CI of the risk factors associated with HCV seropositivity were:having had following "histories as blood transfusion" 6.03 (3.97 - 9.15), "surgeries" 2.10 (1.44 - 3.07), "intravenous drug use" 44.90 (31.13 - 64.76), "having sex with intravenous drug users"3.87 (2.07 - 7.24), "having STDs" 2.05 (1.19 - 3.52). Blood transfusion, intravenous drug use and having sex with intravenous drug users were the risk factors of HCV infection. Due to existing biases, the relationship between having had surgical operations and HCV infection was inconclusive. There appeared weak correlation between STDs and HCV infection, but the result was not so stability.

Prevalence of and risk factors for hepatitis C virus infection among blood donors in Chengdu, China

The objectives of the study were to estimate the prevalence of anti-hepatitis C virus (HCV) positivity among blood donors from Chengdu, China, and to determine risk factors associated with infection. In this study, data were collected from volunteer blood donors between July 2006 and June 2007. Anti-HCV test was performed in 119,518 donors. To identify risk factors associated with HCV infections a case-control study was conducted in 305 unique HCV-seropositive blood donors and 610 seronegative donors matched for age and sex. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using logistic regression. The population attributable risk (PAR) to risk factor was estimated according to the Bruzzi's formula. The prevalence of anti-HCV positivity was 0.53% (95% CI: 0.489-0.572%). The final multivariate model included the following independent HCV risk factors: razor sharing (OR=29.16; 95% CI: 12.89-66.00), blood transfusion (OR=20.84; 95% CI: 3.76-115.45), acupuncture (OR=8.01; 95% CI: 3.16-20.30), a history of hospitalization, injections >10 years earlier, a family history of hepatitis B, dental treatment, and ear piercing. The PAR of risk factors are 68.4%, 6.3%, 14.1%, 23.1%, 29.5%, 29.3%, 38.9%, and 27.8%, respectively, and the total PAR is 98.3%. Infection with HCV among blood donors in Chengdu is associated with iatrogenic risk factors and beauty treatment-related risk. Razor sharing is an important risk factor for HCV infection. These results indicate that infection control measures in healthcare settings may reduce the burden of HCV infection and there is a need for development of effective educational programs to improve HCV knowledge among beauty culture professionals, barber cosmetologists, and the general public to avoid risk behaviors.

Risk factors for hepatitis C virus transmission obscure in nigerian patients.

Aim. To determine the prevalence of anti-HCV and risk factors associated with HCV infection in Nigerians. Materials and Method. Patients attending a general outpatient clinic were administered a structured questionnaire on the risk factors for HCV infection. They were also tested for anti-HCV using a third generation enzyme-linked immunosorbent assay. Result. The seroprevalence of anti-HCV was 4.7%. Among the risk factors evaluated, none was found to be significantly associated with anti-HCV seropositivity. Conclusion. The risk factors associated with HCV infection in Nigerian patients are obscure. This warrants further studies on the epidemiology of this important cause of liver disease.

Acute hepatitis C in persons infected with the human immunodeficiency virus (HIV): The "Real-life Setting" proves the concept

ObjectivesOutbreaks of sexually transmitted acute HCV infection have been described recently in several cities in the western world. The epidemic affects mainly MSM who are coinfected with HIV and is supposably linked to certain sexual risk practices. Here, we compared our findings with current knowledge and recommendations.MethodsHIV-positive patients with the diagnosis of acute HCV infection were included in the retrospective analysis. The patients came from outpatient infectious disease centers in northern German cities. We looked at markers of HIV and HCV infection and compared patients who received treatment and those who did not. Treated patients were followed up to 72 weeks.ResultsThree hundred nineteen HIV-positive patients with the diagnosis of acute hepatitis C between 2001 and 2008 and were included in the analysis. All patients were male, 315 (99%) patients were of caucasian origin, 296 (93%) declared homosexual contacts as a risk factor for HCV infection, intravenous drug use was declared in 3 (1%) cases. Median age at HCV diagnosis was 40 years (range 20-69 years). Median HCV viral load was 1.2 × 106 IU/mL, 222 patients (70%) had HCV genotype 1, 59 (18%) genotype 4. The median time of HIV infection was 5.5 years (range 0 to 22.4 years). Median HIV viral load was 110 copies/mL (range 25 to 10 × 106 copies/mL). The median CD 4 count was 461 cells/mm3 (range 55- 1331 cells/mm3). Two hundred and fourty-six patients (77%) received anti-HCV treatment, and 175 (55%) had completed therapy by the time of the analysis. Median treatment duration was 33 weeks (IQR 24.1-49.9). 93 of the 175 treated patients (53%) reached a sustained virological response (SVR). In the multivariate analysis, ART at diagnosis, HCV RNA drop at week 12, hemoglobin levels and higher platelets were associated with SVR. Treatment duration was significantly higher in the SVR group (40.6 weeks vs 26.6 weeks, p < 0.0001). Seventy-three patients (23%) did not receive anti-HCV treatment. In 19 of the untreated patients (26%) the hepatitis C virus was cleared spontaneously.ConclusionsOur findings confirm that acute hepatitis C in HIV infected patients affects mainly MSM who acquire HCV sexually. Patients had a short duration of HIV infection and a stable immunological situation. In this real-life setting from urban regions in northern Germany, treatment rates appear to be high and effective.

Epidemiology and risk factors of HCV infection among hemodialysis patients in countries of the Eastern Mediterranean Regional Office of WHO (EMRO): a quantitative review of literature

Hepatitis C virus infection (HCV) is the major co-morbidity of patients on chronic hemodialysis. There are many scattered and heterogeneous data about this infection in hemodialysis patients living in countries of the Eastern Mediterranean Region Office of WHO (EMRO) and its distribution is unknown in this region. To provide a more comprehensive tabulation of available data on the epidemiological characteristics and risk factors for HCV infection in hemodialysis patients in Iran and other EMRO countries. A systematic review was carried out based on the computerized literature databases. In all, 95% confidence intervals of infection rates were calculated using the approximate normal distribution model. Pooled odds ratios and 95% CIs were calculated by random effects models. The heterogeneity was assessed by either Q or χ2 statistics and quantified by I 2. We identified 62 studies that fulfilled our inclusion criteria involving 17,846 hemodialysis subjects. A total of 5,704 (32%) patients had positive serology for HCV infection. The prevalence ranged from 6–72% across countries. Pooled HCV seroprevalence was 17% (95% CI 13–20), 63% (95% CI 61–64), 48% (95% CI 45–51), 72% (95% CI 68–76), 23% (95% CI 21–24) in Iran, Saudi Arabia, Egypt, Morocco and Tunisia respectively. Hemodialysis duration OR = 7.63 (95% CI 4.64–12.53), transfusion OR = 2.06 (95% CI 1.47–2.89) and previous transplantation failure OR = 2.66 (95% CI 1.46–4.86) were major risk factors of HCV infection. Age, sex and dialysis session/week were not associated with infection rate. Nearly 32% (95% CI 31–33) of hemodialysis patients in the EMRO countries are infected with HCV. Despite evolution of new strategies to confine HCV transmission among hemodialysis patients, nosocomial transmission is still the major route of HCV infection in these patients in this region.

Prevalence of hepatitis C, hepatitis B, and HIV infection among hemodialysis patients in Jenin District (Palestine)

Background and Aims: End-stage renal disease patients treated by hemodialysis (HD) are more susceptible for infection by viral hepatitis and human immunodeficiency virus (HIV) infections. Infection by these viruses is promoted by the characteristic immunological dysfunction that develops in renal failure and interferes with the patient's ability to eliminate these viruses. Prevalence of these viruses among hemodialysis patients in Jenin District (Palestine) was not studied until now, we aimed in this study to determine the prevalence of HCV, HBV and HIV among hemodialysis patients in Jenin District using serological methods, and to define the main risk factors for HCV infection. Materials and Methods: End-stage renal disease (ESRD) patients on maintenance hemodialysis from various demographic areas in Jenin District were included in the study. Data such as age, sex, drug abuse, history of transplantation were examined. Serological markers for HCV, HBV and HIV were determined using a microparticle enzyme immunoassay (MEIA). Pearson’ s correlation factor and independent samples t-test were used to analyze the significance of results. Results: The patients were 77 (42 males, 35 females, mean age 50.73 ± 16.78 years [age range: 14 – 80 years]), the mean duration of dialysis was 26.97 months with a standard deviation of 35.19 days. The prevalence of HCV was 24.68 % while the prevalence of HBsAg and HIV were 0% respectively. HCV seropositivity was associated with longer period of dialysis (P=0.000). There was no statistically significant correlation between age and HCV seropositivity (P=0.630), also there was no statistically significant relationship between sex and infection with HCV (P=0.849). Conclusion: The prevalence of HCV among hemodialysis patients in Jenin District is high compared to many Arab and other countries. None of the patients were a former drug abuser or had a history of tattooing. None of the patients was with a former transplant was HCV positive, so it seemed that the infection was mainly nosocomial during dialysis process. Duration of dialysis was an important risk factor (P=0.000). Dialysis staff, incomplete disinfection of dialysis machines (monitors), non-isolation of HCV positive patients on special dialysis units or special monitors may be important risk factors. So, careful attention of the preventive infection control measures is essential to limit the transmission of HCV in the dialysis unit in Jenin District.

Hepatitis C in hemodialysis: the contribution of injection drug use

BackgroundHepatitis C virus (HCV) infection is the most common cause of acute or chronic hepatitis in patients on hemodialysis (HD). The purpose of this study was to describe the prevalence of positive HCV RNA and investigate injection drug use as an emerging risk factor in patients with chronic renal disease on HD. MethodsThis was a multicenter cross-sectional study with 325 patients with chronic renal disease on HD in the period between August 1, 2005 to August 30, 2006, receiving care at four institutions in the city of Porto Alegre, Southern Brazil. Epidemiological data were collected by means of a structured questionnaire. The following laboratory tests were performed: alanine aminotransferase (ALT), anti-hepatitis C virus antibodies (anti-HCV), and qualitative polymerase chain reaction (PCR). ResultsOf 325 patients, 68 had positive HCV RNA results. The comparison between patients with positive and negative PCR results revealed signifi cant differences in duration of HD (mean = 71 versus 52.4 months; p = 0.02); previous blood transfusion (92% versus 72%; p < 0.01); injection drug use (13% versus 0.7%; p < 0.01); anti-HCV positivity at start of HD therapy (60% versus 4%; p < 0.01); and mean ALT value (39 versus 26.5; p < 0.01). Logistic regression analysis showed a positive HCV RNA independently associated to being on HD for more than five years [OR: 2.1 (95% CI 1.2 - 3.8)]; previous blood transfusion [OR: 3.7 (95% CI 1.4 - 9.5)]; and injection drug use [OR: 22.6 (95% CI 4.2 - 119.6)]. ConclusionInjection drug use was an independent risk factor for HCV infection among chronic renal disease patients on HD.

Likely transmission of hepatitis C virus through sharing of cutting and perforating instruments in blood donors in the State of Pará, Northern Brazil

We determined the risk factors for HCV infection in blood donors in the State of Pará, Northern Brazil. We examined 256 blood donors seen at the Blood Bank of Pará State between 2004 and 2006. They were divided into two groups, depending on whether they were infected with HCV or not; 116 donors were infected with HCV, while the other 140 were free of infection. The HCV-RNA was detected by real-time PCR. All of the participants filled out a questionnaire about possible risk factors. The data were evaluated using simple and multiple logistic regressions. The main risk factors for HCV were found to be use of needles and syringes sterilized at home (OR = 4.55), invasive dental treatment (OR = 3.08), shared use of razors at home (OR = 1.99), sharing of disposable razors in barbershops, beauty salons, etc. (OR = 2.34), and sharing manicure and pedicure material (OR = 3.45). Local and regional health authorities should educate the public about sharing perforating and cutting materials at home, in barber/beauty shops, and in dental clinics as risk factors for HCV infection.

Prevalence of chronic viral hepatitis in people of south Asian ethnicity living in England: the prevalence cannot necessarily be predicted from the prevalence in the country of origin

The prevalence of hepatitis B and hepatitis C in immigrant communities is unknown. Immigrants from south Asia are common in England and elsewhere, and the burden of viral hepatitis in these communities is unknown. We aimed to determine the prevalence of viral hepatitis in immigrants from south Asia living in England, and we therefore undertook a community-based testing project in such people at five sites in England. A total of 4998 people attending community centres were screened for viral hepatitis using oral fluid testing. The overall prevalence of anti-hepatitis C virus (HCV) in people of south Asian origin was 1.6% but varied by country of birth being 0.4%, 0.2%, 0.6% and 2.7% in people of this ethnic group born in the UK, India, Bangladesh and Pakistan, respectively. The prevalence of hepatitis B surface antigen was 1.2%-0.2%, 0.1%, 1.5% and 1.8% in people of this ethnic group born in the UK, India, Bangladesh and Pakistan, respectively. Analysis of risk factors for HCV infection shows that people from the Pakistani Punjab and those who have immigrated recently are at increased risk of infection. Our study suggests that migrants from Pakistan are at highest risk of viral hepatitis, with those from India at low risk. As prevalence varies both by country and region of origin and over time, the prevalence in migrant communities living in western countries cannot be easily predicted from studies in the country of origin.

Comments on: Dynamic relations for sparsely sampled Gaussian processes

To evaluate the prevalence of HBV, HCV, HDV and HEV infections in populations with different categories of risk and the seroprevalence of HBV and HCV infections in subjects asking for a medical examination. We conducted a cross-sectional, epidemiological study in 2,851 subjects from the SubCarpathian and South-Eastern Romania (including 17 counties, 34% of the country area and 42% of the population). The subjects were divided into four groups: controls (n=2,540, i.e. consecutive subjects asking for a medical examination), subjects with very low risk (students; n=44), with low risk (doctors and nurses; n=93) and with high risk for viral hepatitis (hemodialysis patients; n=174). All subjects were screened for HBsAg, antiHCV and ALT level. In populations at risk, antiHBs, HBeAg, antiHBe, antiHBc (IgG), HBV-DNA, HCV-RNA, antiHDV(IgG) and antiHEV(IgG) were also assessed. In controls, HBV seroprevalence was 5.59% and HCV seroprevalence 4.56%. The risk factors for HBV infection were: age, male gender and South-East region of Romania. The risk factors for HCV infection were: age, female gender, elevated ALT level and the South-East region of Romania. In the very low risk population HBV, HCV, HDV and HEV seroprevalence was: 2.27%, 0%, 0% and 12.5%, respectively. In low risk population the seroprevalence was 2.15%, 1.07%, 0% and 13.98%. In hemodialysis patients, HBV and HCV seroprevalence were 7.91%, respectively 39.26%. HCV-RNA was detectable in 20.69% cases. In the South and South-Eastern Romania the seroprevalence of viral hepatitis infections is intermediate, similar to other Romanian regions or the Balkans.

Risk Factors for HCV Infection in Pakistan

Purpose: To evaluate possible routes of transmission for HCV infection in Pakistan. Methods: A retrospective study was conducted based on file review of patients being treated for hepatitis C at The Liver Research Clinic at Holy Family Hospital Rawalpindi, Pakistan. Informed consent was obtained from all patients included in the study. Convenient sampling was utilized and a total of 750 patients were included in the study. Demographic data was recorded and patients were asked about several risk factors for hepatitis C by the post-graduate trainees at The Holy Family Hospital in Rawalpindi, Pakistan. Patients were asked in particular about history of unsafe injection practices, use of unclean razors and history of blood transfusion. Data was entered and descriptive analysis was performed using SPSS version 13. Results: A total of 750 patients were included in the study. The mean age of patients was 35.7 years (15-63). There were 368 (48.7%) male and 382 (50.5%) female patients. 655 (87.3%) patients were married. The following risk factors were identified after detailed interview from the patients: 80 (10.6%) patients had a history of unsafe injection practices either due to needle sharing or acquired from a medical facility, 48 (6.3%) admitted to the use of reuse of razors from barbers, 43 (5.7%) had a history of unhygienic dental treatment. 30 (4.0%) patients had been transfused with blood/ blood products for a surgical procedure in the hospital. A large majority of patients 452 (59.8%) had multiple risk factors for hepatitis C. 194 (25.7%) patients had a first-degree relative with hepatitis C. No risk factor could be identified in 97 (12.9%) patients. 81 (10.7%) patients were co-infected with hepatitis B. Conclusion: Unsafe injection practices are still the most common risk factor for transmission of hepatitis C followed by reuse/sharing of shaving razors. Majority of patients had multiple routes of transmission of HCV.