High frequency of active HCV infection among seropositives in West Africa and evidence for multiple transmission pathways
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Date
2015
Journal Title
Journal ISSN
Volume Title
Publisher
Journal of Hepatology
Abstract
Background and Aims: Sub-Saharan Africa (SSA) has among the
highest global Hepatitis C Virus (HCV) sero-prevalence estimates.
However, reports suggesting high rates of serologic false positives
and low levels of detectable viremia has led to uncertainty
regarding the burden of active HCV infection in this region.
Additionally, little is known about the predominant transmission
risk factors and mechanisms in this region. The aims of this study
were to determine the frequency of active infection among persons
who screened positive for HCV infection and identify risk factors
for HCV infection.
Methods: Between May 2013 and January 2014 we recalled 363
blood donors [180 rapid screen assay (RSA) (Accu-Tell HCV) positive
and 183 RSA negative at time of donation] to identify the level of
active infection and risk factors at Komfo Anokye Teaching Hospital
in Kumasi, Ghana. Participants had blood drawn for serologic and
virologic testing (HBVsAg Abbott Architect CIA, HIV 4th generation
Ab/Ag test, the HCV Advia Centaur HCV CIA, and Abbott RealTime
PCR assay for HCVRNA quantitative levels). HCV genotypes were
determined by the generated NS5b sequences (SuperScript® VILO™
cDNA Synthesis Kit). A questionnaire on demographics and risk
factors was administered.
Results: The frequency of active infection varied based on serologic
testing results, but was overall high. In subjects with a positive
CIA Serologic Antibody Assay [Signal to Cut-off ratio (S/C) >1],
the rate of active viremia was 74.4%, and increased to 88% among
the individuals with a CIA S/C ≥11. Individuals were predominantly
infected with genotype 2, and the median viral load among actively
infected individuals was 5.75 log cp/ml. Blood donors from the
northern and upper regions of Ghana had substantially higher risks
of infection compared to those from the middle belt. Individual level
Odds ratio statistical significant risk factors included: traditional
circumcision (3.8), home birth (2.0), tribal scarring (2.2) and HBV
co-infection (2.7). See Table 1.
Conclusions: Among serologically confirmed cases, active infection
rates were high. Appropriate testing algorithms should be widely
implemented to define the true HCV burden in SSA. These
data also suggest that several transmission modes, particularly those associated with cultural skin-piercing practices, are likely
contributing to the current HCV epidemic in Ghana, and the
distribution of these practices may result in regional variation in
prevalence.
Description
An article published by Journal of Hepatology
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Citation
Journal of Hepatology 2015 vol. 62 | S263–S864