Risk Factors For Hepatitis C Virus Infection Research Articles

Molecular and contextual markers of hepatitis C virus and drug abuse.

The spread of hepatitis C virus (HCV) infection involves a complex interplay of social risks, and molecular factors of both virus and host. Injection drug abuse is the most powerful risk factor for HCV infection, followed by sexual transmission and additional non-injection drug abuse factors such as co-infection with other viruses and barriers to treatment. It is clearly important to understand the wider context in which the factors related to HCV infection occur. This understanding is required for a comprehensive approach leading to the successful prevention, diagnosis, and treatment of HCV. An additional consideration is that current treatments and advanced molecular methods are generally unavailable to socially disadvantaged patients. Thus, the recognition of behavioral/social, viral, and host factors as components of an integrated approach to HCV is important to help this vulnerable group. Equally important, this approach is key to the development of personalized patient treatment - a significant goal in global healthcare. In this review, we discuss recent findings concerning the impact of drug abuse, epidemiology, social behavior, virology, immunopathology, and genetics on HCV infection and the course of disease.

Phylogeography, Risk Factors and Genetic History of Hepatitis C Virus in Gabon, Central Africa

BackgroundThe epidemiological and molecular characteristics of hepatitis C virus (HCV) infection in the general population have been poorly investigated in Africa. The aim of this study was to determine the prevalence, genotype distribution and epidemic history of HCV in the Gabonese general population.Methods/Principal FindingsA total of 4042 sera collected from adults in 220 villages in all nine administrative areas of the country were screened for antibodies to HCV. HCV NS5B region sequencing was performed for molecular characterization and population genetic analyses. Of 4042 tested sera, 455 (11.2%) were positive. The seroprevalence of HCV varied significantly by administrative area, with the highest rate in Ogooué-Lolo province (20.4%) and the lowest in Ogooué-Maritine province (3.7%). History of parenteral injections, past hospital admission and age over 55 years were independent risk factors for HCV infection (p<0.0001). Phylogenetic analyses showed that 91.9% of the strains were genotype 4 (HCV-4), 5.7% genotype 1 and 2.2% genotype 2. HCV-4 strains were highly heterogeneous, with more than eight subtypes; subtype 4e predominated (57.3%). Coalescence analyses indicated that subtype 4e was the oldest, with an estimated most recent common ancestor of 1702 [95% CI, 1418–1884]. The epidemic profile indicated that it spread exponentially during the first part of the 20th century, probably by iatrogenic transmission.Conclusions/SignificanceThese results confirm the endemicity of HCV subtype 4e in Gabon and show that its spread is due to a cohort effect, with previous, possibly iatrogenic events. More extensive epidemiological studies are needed to better characterize the route of transmission and the dissemination of HCV in Gabon.

Risk factors for Hepatitis C virus (HCV) transmission and efficiency of antiviral therapy in chronically infected patients

Background: This study monitored the prevalence and genotype distribution of HCV in patients suspected for infection as well as risk factors for infection and transmission of HCV in northeast Croatia. Methods: From January 2009 to December 2011, 405 plasma specimens of patients suspected for HCV infection were tested by the COBAS TaqMan HCV test v2.0 (Roche Diagnostics) ; 77 HCV- positive samples were genotyped using the Linear Array HCV Genotyping test (Roche) ; 33 HCV- positive patients with unfavorable liver tests were further treated with anti-viral therapy and monitored at weeks 28 and 53. Risk factors for HCV infection and transmission were analyzed from patient-filled questionnaires (age, sex, risk behavior etc.) and their clinical data (age at initial HCV infection, degree of liver inflammation and fibrosis). Results: Out of 405 tested patients, 198 (48.8%) were HCV-positive and the highest prevalence of infection was found in men and women between 30 and 40 years of age. HCV genotype distribution in northeast Croatia was similar to other European regions: G1 was the most common (66.6%), followed by G3 (22.1%), G4 (10.4%), and G2 (1.3%) ; genotypes G5 and G6 were not detected. Viral therapy evaluated at week 53 demonstrated that 58 % of patients were virus- free, 12 % had lower viral load while 12 % showed no change in viral load. Moreover, HCV G1-infected patients showed a delayed response to antiviral therapy when compared to G3 and G4-infected patients: 31 % G1-, 40 % G3- and 50 % G4-infected patients were virus-free at week 28 ; 58 % G1-, 60 % G3- and 50 % G4-infected patients were virus- free at week 53. Significant risk factors for HCV infection and transmission in northeast Croatia include history of blood transfusion, surgery before the year 1993, and body piercing in 31-40 year-old men (p<0.05). Conclusion: Our results strengthen the importance of early testing for HCV infection in men showing the symptoms of chronic hepatitis (muscle pain, appetite loss, history of jaundice) since they are statistically more often intravenous drug, piercing, and tattoo users then women in our region.

Management of Patients Coinfected With HCV and HIV: A Close Look at the Role for Direct-Acting Antivirals

With the development of effective therapies against human immunodeficiency virus (HIV), hepatitis C virus (HCV) infection has become a major cause of morbidity and mortality among patients with both infections (coinfection). In addition to the high prevalence of chronic HCV, particularly among HIV-infected injection drug users, the rate of incident HIV infections is increasing among HIV-infected men who have sex with men, leading to recommendations for education and screening for HCV in this population. Liver disease is the second leading and, in some cases, a preventable cause of death among coinfected patients. Those at risk for liver disease progression are usually treated with a combination of interferon (IFN) and ribavirin (RBV), which is not highly effective; it has low rates of sustained virologic response (SVR), especially for coinfected patients with HCV genotype 1 and those of African descent. Direct-acting antivirals might overcome factors such as immunodeficiency that can reduce the efficacy of IFN. However, for now it remains challenging to treat coinfected patients due to interactions among drugs, additive drug toxicities, and the continued need for combination therapies that include pegylated IFN. Recently developed HCV protease inhibitors such as telaprevir and boceprevir, given in combination with pegylated IFN and RBV, could increase the rate of SVR with manageable toxicity and drug interactions. We review the latest developments and obstacles to treating coinfected patients.

Epidemiology of Viral Hepatitis and Hepatocellular Carcinoma

Most cases of hepatocellular carcinoma (HCC) are associated with cirrhosis related to chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infection. Changes in the time trends of HCC and most variations in its age-, sex-, and race-specific rates among different regions are likely to be related to differences in hepatitis viruses that are most prevalent in a population, the timing of their spread, and the ages of the individuals the viruses infect. Environmental, host genetic, and viral factors can affect the risk of HCC in individuals with HBV or HCV infection. This review summarizes the risk factors for HCC among HBV- or HCV-infected individuals, based on findings from epidemiologic studies and meta-analyses, as well as determinants of patient outcome and the HCC disease burden, globally and in the United States.

High false‐negative rate of anti‐HCV among Egyptian patients on regular hemodialysis

Routine serological testing for hepatitis C virus (HCV) infection among hemodialysis (HD) patients is currently recommended. A dilemma existed on the value of serology because some investigators reported a high rate of false-negative serologic testing. In this study, we aimed to detect the false-negative rate of anti-HCV among Egyptian HD patients. Seventy-eight HD patients, negative for anti-HCV, anti-HIV, and hepatitis B surface antigen, were tested for HCV RNA by reverse transcriptase polymerase chain reaction (RT-PCR). In the next step, the viral load was quantified by real-time PCR in RT-PCR-positive patients. Risk factors for HCV infection, as well as clinical and biochemical indicators of liver disease, were compared between false-negative and true-negative anti-HCV HD patients. The frequency of false-negative anti-HCV was 17.9%. Frequency of blood transfusion, duration of HD, dialysis at multiple centers, and diabetes mellitus were not identified as risk factors for HCV infection. The frequency of false-negative results had a linear relation to the prevalence of HCV infection in the HD units. Timely identification of HCV within dialysis units is needed in order to lower the risk of HCV spread within the HD units. The high false-negative rate of anti-HCV among HD patients in our study justifies testing of a large scale of patients for precious assessment of effectiveness of nucleic acid amplification technology testing in screening HD patient.

Hepatitis C virus infection in hemodialysis patients in Maracaibo, Venezuela

Over a two year period, the incidence of hepatitis C virus (HCV) infection was evaluated in 29 hemodialysis patients, aged between 15 and 75 years (mean ± SD: 45 ± 39.5 years), from the University Hospital Hemodyalisis Unit, Maracaibo, Zulia State, Venezuela. Anti-HCV antibodies were determined using a fourth generation ELISA (Innotest HCV Ab IV) kit and positive blood samples were tested using a recombinant assay kit (Inno-LIA HCV Ab III), both kits from Innogenetics N.V., Belgium. The findings indicate a lack of HCV seroconversion in the hemodialysis patients over the study period, confirmed by the recombinant assay. Risk factors for HCV infection were 0.3270 (95% confidence interval: 0.01323-8.080) in patients undergoing hemodialysis. The findings suggest a lack of significant sources for HCV infection due to the preventive measures to avoid its transmission in the hemodialysis unit.

Behavioral and Healthcare-Associated Risk Factors for Chronic Hepatitis C Virus Infection in Korea

The risk factors related to hepatitis C virus (HCV) infection showed geographic and temporal differences. We investigated HCV-related risk factors in Korea where intravenous drug use (IVDU) is uncommon. The HCV-related risk factors were investigated in a prospective, multicenter chronic HCV cohort (n = 711) using a standardized questionnaire in four university hospitals. The results were compared with those of 206 patients with chronic liver diseases not related to either of HCV or hepatitis B virus infection (comparison group). The IVDU was found in 3.9% and remote blood transfusion (≥ 20 yr ago) in 18.3% in HCV cohort group, while that in comparison group was in none and 5.3%, respectively. In a multivariate logistic analysis, transfusion in the remote past (odds ratio [OR], 2.99), needle stick injury (OR, 4.72), surgery (OR, 1.89), dental procedures (OR, 2.96), tattooing (OR, 2.07), and multiple sexual partners (2-3 persons; OR, 2.14, ≥ 4 persons; OR, 3.19), were independent risk factors for HCV infection. In conclusion, the major risk factors for HCV infection in Korea are mostly related to conventional or alterative healthcare procedures such as blood transfusion in the remote past, needle stick injury, surgery, dental procedure, and tattooing although multiple sex partners or IVDU plays a minor role.

Hepatitis C virus-host interactions: Etiopathogenesis and therapeutic strategies

Hepatitis C virus (HCV) is a significant health problem facing the world. This virus infects more than 170 million people worldwide and is considered the major cause of both acute and chronic hepatitis. Persons become infected mainly through parenteral exposure to infected material by blood transfusions or injections with nonsterile needles. Although the sexual behavior is considered as a high risk factor for HCV infection, the transmission of HCV infection through sexual means, is less frequently. Currently, the available treatment for patients with chronic HCV infection is interferon based therapies alone or in combination with ribavirin and protease inhibitors. Although a sustained virological response of patients to the applied therapy, a great portion of patients did not show any response. HCV infection is mostly associated with progressive liver diseases including fibrosis, cirrhosis and hepatocellular carcinoma. Although the focus of many patients and clinicians is sometimes limited to that problem, the natural history of HCV infection (HCV) is also associated with the development of several extrahepatic manifestations including dermatologic, rheumatologic, neurologic, and nephrologic complications, diabetes, arterial hypertension, autoantibodies and cryglobulins. Despite the notion that HCV-mediated extrahepatic manifestations are credible, the mechanism of their modulation is not fully described in detail. Therefore, the understanding of the molecular mechanisms of HCV-induced alteration of intracellular signal transduction pathways, during the course of HCV infection, may offer novel therapeutic targets for HCV-associated both hepatic and extrahepatic manifestations. This review will elaborate the etiopathogenesis of HCV-host interactions and summarize the current knowledge of HCV-associated diseases and their possible therapeutic strategies.

The Investigation of HIV and HCV Infection and Risk Factors among Opiate Drug Users in Beijing, China

Objective: To explore the prevalence of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) and the risk factors among opiate drug users in Beijing. Methods: The opiate drug users enrolled in methadone maintenance treatment clinics of Beijing from 30 November 2004 to 31 March 2008 were investigated. The blood samples were collected and tested for HIV and HCV infection and questionnaires were used for all subjects admitted. Results: Among 1211 eligible subjects, 12 HIV and 713 HCV-positive subjects were observed; the HIV and HCV prevalences were .99% and 58.88%, respectively. Young age, unemployment, injection drug use, and more frequent and longer drug use were the independent risk factors for HCV infection using the multiple logistic regression analysis. The younger drug users are more likely to be infected than the older ones, and the adjusted odds ratios (OR) of 18–30 and 30–40 versus 40–54 years were 1.81 (95% confidence interval (95% CI): 1.13–1.92) and 1.51 (95% CI: 1.08–2.10). The drug users who were unemployed (OR = 1.70, 95% CI: 1.23–2.37), with injection drug use (OR = 10.99, 95% CI: 7.26–16.65), with more frequent drug use (OR = 2.42, 95% CI: 1.31–2.46), and with longer heroin abuse history (OR = 8.06, 95% CI: 1.19–57.54) were more likely to be infected with HCV. Conclusions: The HCV infection was popular among opiate drug users in Beijing. The findings indicated the need for educating the users taking into account their low literacy levels and the necessity for job training and decreasing the injection drug use and the frequency of drug use administrated as the prevention and intervention methods for controlling the HIV/HCV infection in this population.

Transmission of Hepatitis C virus among spouses in Cameroon and the Central African Republic

Heterosexual transmission of hepatitis C virus (HCV) is uncommon, with few studies undertaken in Central Africa. To determine the frequency of inter-spouse HCV transmission, cross-sectional studies of elderly individuals in Ebolowa, Cameroon and Nola, Central African Republic, in which, respectively, 24 and 83 long-term couples had been identified, were examined further. Blood samples were tested for antibody to HCV. Anti-HCV positive samples were genotyped by phylogenetic analysis of a fragment of the NS5B gene. In Nola, 4 out of 9 (44.4%) wives of anti-HCV positive husbands and 1 out of 74 (1.4%) wives of anti-HCV negative husbands were anti-HCV positive (P < 0.001); in Ebolowa, the corresponding proportions were 10 out of 15 (66.7%) and 3 out of 9 (33.3%) (P = 0.21). After adjustment for age and site-specific risk factors of HCV infection, HCV seropositivity of the wives remained associated with their husbands' HCV serostatus, significantly so in Nola (P = 0.003) and marginally in Ebolowa (P = 0.06). In 7 out of 14 concordant seropositive couples, the genotype could be determined in both spouses. Four couples were infected with different genotypes, while three were infected with the same genotype. Thus, serological concordance between the spouses was related to a combination of infections acquired independently and inter-spouse transmission. It could not be determined whether inter-spouse transmission occurred sexually, through blood-blood contact, or otherwise. Inter-spouse transmission may have contributed to the high prevalence among elderly populations of Central Africa since some patients infected during healthcare subsequently transmitted the virus to their spouse.

Lack of association of hepatitis C virus (HCV) antibodies and juvenile onset systemic lupus erythematosus (jSLE)

Aim To determine the prevalence and possible association of HCV infection and jSLE. Methods: We evaluated 40 jSLE patients (according to ACR criteria); mean age = 19 ± 4.4 years and mean disease duration = 6 ± 3.2 years; 34 females, 6 males. Twenty healthy children and 20 rheumatic fever patients matched for age and sex were included as controls. All subjects were interviewed in order to search for risk factors for HCV infection including use of endovenous drugs, blood products transfusions, promiscuous sexual activity, previous hospitalizations and/or invasive diagnostic or therapeutic procedures. Serum samples were tested for ANAs by standard techniques and for anti-HCV antibodies using a high sensitive third generation microparticle enzyme immunoassay (AxSYM HCV version 3.0, Abbott Lab.).

Hepatitis C and Hepatitis B Virus Infection: Epidemiology and Risk Factors in a Large Cohort of Pregnant Women in Lorestan, West of Iran

: Background: There are little data on the prevalence of serological markers of hepatitis B and hepatitis C viruses in pregnant women in Iran.Objectives: This study was designed to determine the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection among pregnant women in Lorestan, west of Iran.Patients and Methods: Serum samples of 827 pregnant women who lived in rural (36.8%) and urban areas (63.2%) of Lorestan were collected during 2007-2008. Data were obtained through questionnaires. Samples were first screened for anti-HCV and anti-HBc by ELISA. Those who were positive for anti-HBc were tested for HBsAg.Results: Anti-HBc was found in 28 of 827 pregnant women (overall prevalence, 3.4%; 14 of 523 in urban areas, 2.7%; 14 of 304 in rural areas, 4.6%). Of the 28 positive samples, 6 (0.7%) were positive for HBs-Ag. Only 2 samples (0.2%) were anti-HCV-positive.Conclusions: These results underscore the need for prenatal screening for HBV infection in pregnant women and treatment of newborns from HBsAg-positive mothers. More studies are needed to identify risk factors of HCV infection and highlight the importance of HCV screening and treatment programs. Implication for health policy/practice/research/medical education:The authors mentioned that low prevalence of HBV and HCV in this region establish a national program for regular screening of all pregnant women. Most pregnant women are asymptomatic and clinically disease free and they might not be aware that they are infected and can transmit their infection to newborns. Therefore, prenatal screening for HBV infection in pregnant women and treatment of newborns from HBsAg-positive mothers and also identify risk factors of HCV infection is nessecerry. Please cite this paper as:Mohebbi SR, Sanati A, Cheraghipour K, Rostami Nejad M, Mohaghegh Shalmani H, Zali MR. Hepatitis C and Hepatitis B Virus Infection: Epidemiology and Risk Factors in a Large Cohort of Pregnant Women in Lorestan, West of Iran. Hepat Mon. 2011; 11(9):736-9. DOI: 10.5812/kowsar. 1735143X.749 ©2011 Kowsar M.P.Co. All rights reserved.

Hepatitis C and Hepatitis B Virus Infection: Epidemiology and Risk Factors in a Large Cohort of Pregnant Women in Lorestan, West of Iran

There are little data on the prevalence of serological markers of hepatitis B and hepatitis C viruses in pregnant women in Iran. This study was designed to determine the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection among pregnant women in Lorestan, west of Iran. Serum samples of 827 pregnant women who lived in rural (36.8%) and urban areas (63.2%) of Lorestan were collected during 2007-2008. Data were obtained through questionnaires. Samples were first screened for anti-HCV and anti-HBc by ELISA. Those who were positive for anti-HBc were tested for HBsAg. Anti-HBc was found in 28 of 827 pregnant women (overall prevalence, 3.4%; 14 of 523 in urban areas, 2.7%; 14 of 304 in rural areas, 4.6%). Of the 28 positive samples, 6(0.7%) were positive for HBs-Ag. Only 2 samples (0.2%) were anti-HCV-positive. These results underscore the need for prenatal screening for HBV infection in pregnant women and treatment of newborns from HBsAg-positive mothers.More studies are needed to identify risk factors of HCV infection and highlight the importance of HCV screening and treatment programs.

O1-S10.04 Lifestyle as marker of Hepatitis C infection in HIV infected MSM in Amsterdam, The Netherlands

BackgroundSince 2000, hepatitis C virus (HCV) infection, associated with high risk sexual behaviour, has emerged as an STI among HIV infected MSM. We aimed to identify individual and network-related factors...

Prevalence and risk factors of Hepatitis C among individuals presenting to HIV testing centers, Hawassa city, Southern Ethiopia

BackgroundHepatitis C virus (HCV), either alone or in combination with Human Immunodeficiency virus (HIV), constitutes a major public health concern. This study was conducted to describe the prevalence and risk factors for HCV infection in people with and without HIV infection.MethodsBlood samples and data on socio-demographic and risk factors for HCV infection were collected from consecutive 400 HIV- positive and 400 HIV- negative individuals attending HIV testing centers in Hawassa city, from October to December, 2008. All sera were tested for antibody to HCV infection (anti-HCV) using enzyme linked immunosorbent assay (ELISA). Sera positive for anti-HCV were further tested for viral ribonucleic acid (RNA) levels using real-time polymerase chain reaction.ResultsThe rate of anti-HCV positivity was 10.5% in the HIV- infected individuals compared with 6% in the HIV negative group (p = 0.002). HCV-RNA was detected in 9.1% of anti-HCV positive samples and rates were comparable between HIV- infected and HIV- non-infected individuals. There was no significant difference in odds of HCV infection in participants with and without HCV risk factors in either HIV sero-group.ConclusionHIV infected individuals had significantly higher rate of anti-HCV although most of them showed no evidence of viraemia. Hence, while priority should be given for HIV infected patients, testing those with anti-HCV for HCV-RNA remains important.

Prevalence and Risk Factors of Asymptomatic Hepatitis C Virus Infection in Bangladesh

Objectives There are paucity of information about prevalence and risk factor of hepatitis C virus (HCV) in Bangladesh. Methods Blood was collected from 1018 randomly selected subjects from a semi-urban area of Bangladesh. Anti-HCVs were checked in the blood twice using a third-generation commercial kit. The data of the questionnaires were analyzed to find possible risk factors. Results Nine of the 1018 subjects (88%) were tested positive for anti-HCV. The HCV-positive subjects were >28 years old. Major risk factors for HCV infection were treatment by unqualified and traditional practitioners, history of mass-vaccination against smallpox, hair cutting and shaving by barbers, and body piercing. However, known risk factors such as blood transfusion, surgery, invasive therapy, and intravenous drug use were not detected in any HCV-infected subjects. Conclusion Control of HCV infection in Bangladesh may be difficult because the risk factors are related to normal tradition and culture of Bangladeshi people.

Prevalence and trend of hepatitis C virus infection among blood donors in Chinese mainland: a systematic review and meta-analysis.

BackgroundBlood transfusion is one of the most common transmission pathways of hepatitis C virus (HCV). This paper aims to provide a comprehensive and reliable tabulation of available data on the epidemiological characteristics and risk factors for HCV infection among blood donors in Chinese mainland, so as to help make prevention strategies and guide further research.MethodsA systematic review was constructed based on the computerized literature database. Infection rates and 95% confidence intervals (95% CI) were calculated using the approximate normal distribution model. Odds ratios and 95% CI were calculated by fixed or random effects models. Data manipulation and statistical analyses were performed using STATA 10.0 and ArcGIS 9.3 was used for map construction.ResultsTwo hundred and sixty-five studies met our inclusion criteria. The pooled prevalence of HCV infection among blood donors in Chinese mainland was 8.68% (95% CI: 8.01%-9.39%), and the epidemic was severer in North and Central China, especially in Henan and Hebei. While a significant lower rate was found in Yunnan. Notably, before 1998 the pooled prevalence of HCV infection was 12.87% (95%CI: 11.25%-14.56%) among blood donors, but decreased to 1.71% (95%CI: 1.43%-1.99%) after 1998. No significant difference was found in HCV infection rates between male and female blood donors, or among different blood type donors. The prevalence of HCV infection was found to increase with age. During 1994-1995, the prevalence rate reached the highest with a percentage of 15.78% (95%CI: 12.21%-19.75%), and showed a decreasing trend in the following years. A significant difference was found among groups with different blood donation types, Plasma donors had a relatively higher prevalence than whole blood donors of HCV infection (33.95% vs 7.9%).ConclusionsThe prevalence of HCV infection has rapidly decreased since 1998 and kept a low level in recent years, but some provinces showed relatively higher prevalence than the general population. It is urgent to make efficient measures to prevent HCV secondary transmission and control chronic progress, and the key to reduce the HCV incidence among blood donors is to encourage true voluntary blood donors, strictly implement blood donation law, and avoid cross-infection.

Hepatitis C in hemodialysis: the contribution of injection drug use

Hepatitis 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. This 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). Of 325 patients, 68 had positive HCV RNA results. The comparison between patients with positive and negative PCR results revealed significant 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)]. Injection drug use was an independent risk factor for HCV infection among chronic renal disease patients on HD.

Alternative risk factors of HCV infection in a rural community in China

A case-control study was conducted in Linxian, Henan Province in China to explore potential risk factors for hepatitis C virus (HCV) infection unassociated with injection drug use. One hundred and ninety-two persons (41.7% male, 95.8% aged >60 years) were recruited from an earlier cohort. Of these, 48 were HCV positive and 144 HCV negative. Residence in a plain region and 3-10 injections in a health setting per year were significantly associated with HCV in both univariate and multivariate analysis (P<0.01). In rural China, the geographic distribution of HCV infection was heterogeneous and associated with injections in a health setting, a pattern which differed from the epidemics in injection drug users in urban cities.