Prevalence and risk factors of Hepatitis C virus infection in Brazil, 2005 through 2009: a cross-sectional study

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Abstract

Background

Hepatitis C chronic liver disease is a major cause of liver transplant in developed countries. This article reports the first nationwide population-based survey conducted to estimate the seroprevalence of HCV antibodies and associated risk factors in the urban population of Brazil.

Methods

The cross sectional study was conducted in all Brazilian macro-regions from 2005 to 2009, as a stratified multistage cluster sample of 19,503 inhabitants aged between 10 and 69 years, representing individuals living in all 26 State capitals and the Federal District. Hepatitis C antibodies were detected by a third-generation enzyme immunoassay. Seropositive individuals were retested by Polymerase Chain Reaction and genotyped. Adjusted prevalence was estimated by macro-regions. Potential risk factors associated with HCV infection were assessed by calculating the crude and adjusted odds ratios, 95% confidence intervals (95% CI) and p values. Population attributable risk was estimated for multiple factors using a case–control approach.

Results

The overall weighted prevalence of hepatitis C antibodies was 1.38% (95% CI: 1.12%–1.64%). Prevalence of infection increased in older groups but was similar for both sexes. The multivariate model showed the following to be predictors of HCV infection: age, injected drug use (OR = 6.65), sniffed drug use (OR = 2.59), hospitalization (OR = 1.90), groups socially deprived by the lack of sewage disposal (OR = 2.53), and injection with glass syringe (OR = 1.52, with a borderline p value). The genotypes 1 (subtypes 1a, 1b), 2b and 3a were identified. The estimated population attributable risk for the ensemble of risk factors was 40%. Approximately 1.3 million individuals would be expected to be anti-HCV-positive in the country.

Conclusions

The large estimated absolute numbers of infected individuals reveals the burden of the disease in the near future, giving rise to costs for the health care system and society at large. The known risk factors explain less than 50% of the infected cases, limiting the prevention strategies. Our findings regarding risk behaviors associated with HCV infection showed that there is still room for improving strategies for reducing transmission among drug users and nosocomial infection, as well as a need for specific prevention and control strategies targeting individuals living in poverty.

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Most cited references 25

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The prevalence of hepatitis C virus infection in the United States, 1999 through 2002.

Gregory Armstrong, Annemarie Wasley, Edgar Simard … (2006)

Defining the primary characteristics of persons infected with hepatitis C virus (HCV) enables physicians to more easily identify persons who are most likely to benefit from testing for the disease. To describe the HCV-infected population in the United States. Nationally representative household survey. U.S. civilian, noninstitutionalized population. 15,079 participants in the National Health and Nutrition Examination Survey between 1999 and 2002. All participants provided medical histories, and those who were 20 to 59 years of age provided histories of drug use and sexual practices. Participants were tested for antibodies to HCV (anti-HCV) and HCV RNA, and their serum alanine aminotransferase (ALT) levels were measured. The prevalence of anti-HCV in the United States was 1.6% (95% CI, 1.3% to 1.9%), equating to an estimated 4.1 million (CI, 3.4 million to 4.9 million) anti-HCV-positive persons nationwide; 1.3% or 3.2 million (CI, 2.7 million to 3.9 million) persons had chronic HCV infection. Peak prevalence of anti-HCV (4.3%) was observed among persons 40 to 49 years of age. A total of 48.4% of anti-HCV-positive persons between 20 and 59 years of age reported a history of injection drug use, the strongest risk factor for HCV infection. Of all persons reporting such a history, 83.3% had not used injection drugs for at least 1 year before the survey. Other significant risk factors included 20 or more lifetime sex partners and blood transfusion before 1992. Abnormal serum ALT levels were found in 58.7% of HCV RNA-positive persons. Three characteristics (abnormal serum ALT level, any history of injection drug use, and history of blood transfusion before 1992) identified 85.1% of HCV RNA-positive participants between 20 and 59 years of age. Incarcerated and homeless persons were not included in the survey. Many Americans are infected with HCV. Most were born between 1945 and 1964 and can be identified with current screening criteria. History of injection drug use is the strongest risk factor for infection.

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The prevalence of hepatitis C virus infection in the United States, 1988 through 1994.

Miriam J Alter, Deanna Kruszon-Moran, Omana Nainan … (1999)

Because many persons with chronic hepatitis C virus (HCV) infection are asymptomatic, population-based serologic studies are needed to estimate the prevalence of the infection and to develop and evaluate prevention efforts. We performed tests for antibody to HCV (anti-HCV) on serum samples from 21,241 persons six years old or older who participated in the third National Health and Nutrition Examination Survey, conducted during 1988 through 1994. We determined the prevalence of HCV RNA by means of nucleic acid amplification and the genotype by means of sequencing. The overall prevalence of anti-HCV was 1.8 percent, corresponding to an estimated 3.9 million persons nationwide (95 percent confidence interval, 3.1 million to 4.8 million) with HCV infection. Sixty-five percent of the persons with HCV infection were 30 to 49 years old. Seventy-four percent were positive for HCV RNA, indicating that an estimated 2.7 million persons in the United States (95 percent confidence interval, 2.4 million to 3.0 million) were chronically infected, of whom 73.7 percent were infected with genotype 1 (56.7 percent with genotype 1a, and 17.0 percent with genotype 1b). Among subjects 17 to 59 years of age, the strongest factors independently associated with HCV infection were illegal drug use and high-risk sexual behavior. Other factors independently associated with infection included poverty, having had 12 or fewer years of education, and having been divorced or separated. Neither sex nor racial-ethnic group was independently associated with HCV infection. In the United States, about 2.7 million persons are chronically infected with HCV. People who use illegal drugs or engage in high-risk sexual behavior account for most persons with HCV infection.

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Epidemiology of hepatitis C virus infection.

Miriam J Alter (2007)

Globally, hepatitis C virus (HCV) has infected an estimated 130 million people, most of whom are chronically infected. HCV-infected people serve as a reservoir for transmission to others and are at risk for developing chronic liver disease, cirrhosis, and primary hepatocellular carcinoma (HCC). It has been estimated that HCV accounts for 27% of cirrhosis and 25% of HCC worldwide. HCV infection has likely been endemic in many populations for centuries. However, the wave of increased HCV-related morbidity and mortality that we are now facing is the result of an unprecedented increase in the spread of HCV during the 20th century. Two 20th century events appear to be responsible for this increase; the widespread availability of injectable therapies and the illicit use of injectable drugs.

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Author and article information

Contributors

Leila MMB Pereira

Celina MT Martelli

Regina C Moreira

Edgar Merchan-Hamman

Airton T Stein

Regina Maria A Cardoso

Gerusa M Figueiredo

Ulisses R Montarroyos

Cynthia Braga

Marília D Turchi

Gabriela Coral

Deborah Crespo

Maria Luiza C Lima

Luis Claudio A Alencar

Marcelo Costa

Alex A dos Santos

Ricardo AA Ximenes

Journal

Journal ID (nlm-ta): BMC Infect Dis

Journal ID (iso-abbrev): BMC Infect. Dis

Title: BMC Infectious Diseases

Publisher: BioMed Central

ISSN (Electronic): 1471-2334

Publication date Collection: 2013

Publication date (Electronic): 1 February 2013

Volume: 13

Page: 60

Affiliations

[1 ]Universidade de Pernambuco, Faculdade de Ciências Médicas de Pernambuco, Hospital Universitário Oswaldo Cruz, Rua Arnóbio Marques, 310, Santo Amaro, CEP: 50100-130, Recife, PE, Brazil

[2 ]Instituto do Fígado de Pernambuco, Rua Aluísio Azevedo, 209, Santo Amaro, 50.100-130, Recife, PE, Brazil

[3 ]Universidade Federal de Goiás, Instituto de Patologia Tropical e Saúde Publica, Departamento de Saúde Coletiva, Rua Delenda Rezende de Mello, s/n, sala 405, Setor Universitário, CEP: 74605050, Goiânia, GO, Brazil

[4 ]Universidade Federal de Pernambuco, Departamento de Medicina Tropical, Av. Prof. Moraes Rego, s/n, Cidade Universitária, CEP: 50670-420, Recife, PE, Brazil

[5 ]Instituto Adolfo Lutz, Av. Dr. Arnaldo, nº 355, Cerqueira Cézar, CEP: 01246-902, Capital, SP, Brazil

[6 ]Universidade de Brasília, Faculdade de Ciências da Saúde, Departamento de Saúde Coletiva. DSC - Faculdade de Saúde, Campus Universitário Darcy Ribeiro – Asa Norte, CEP: 70910-900, Brasília, DF, Brazil

[7 ]Fundação Universidade Federal de Ciências da Saúde de Porto Alegre, Rua Sarmento Leite, 245, Bom Fim, CEP: 90050-170, Porto Alegre, RS, Brazil

[8 ]Departamento de Epidemiologia, Universidade de São Paulo, Faculdade de Saúde Pública, Avenida Dr. Arnaldo 715, Cerqueira Cesar, 01246-904, São Paulo, SP, Brazil

[9 ]Fundação Oswaldo Cruz, Centro de Pesquisas Aggeu Magalhães, Av Moraes Rego, s/n, Cidade Universitária, CEP: 50000-230, Recife, PE, Brazil

[10 ]Secretaria de Saúde Pública do Estado do Pará, Av. Conselheiro Furtado, 1597, CEP 66040-100, Belém, PA, Brazil

[11 ]Universidade Federal de Pernambuco, Departamento de Medicina Preventiva e Social, Av. Prof. Moraes Rego, s/n, Cidade Universitária, CEP: 50670-420, Recife, PE, Brazil

[12 ]Hospital de Base do DF, Area Especial, Asa Sul, CEP:70.335-900, Brasília, DF, Brazil

[13 ]Instituto Bioestatístico –IBCT, Rua Bernal do Couto, 1311, Umarizal, CEP: 67150-050, Belem, PA, Brazil

Article

Publisher ID: 1471-2334-13-60

DOI: 10.1186/1471-2334-13-60

PMC ID: 3574834

PubMed ID: 23374914

SO-VID: 16088aa0-1ed5-4eba-b687-fd3a38ea3641

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 6 August 2012

Date accepted : 11 January 2013

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Prevalence and risk factors of Hepatitis C virus infection in Brazil, 2005 through 2009: a cross-sectional study

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Abstract

Background

Methods

Results

Conclusions

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Point-Of-Care Testing for Hepatitis

Most cited references 25

The prevalence of hepatitis C virus infection in the United States, 1999 through 2002.

The prevalence of hepatitis C virus infection in the United States, 1988 through 1994.

Epidemiology of hepatitis C virus infection.

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