High frequency of active HCV infection among seropositives in West Africa and evidence for multiple transmission pathways

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.
An article published by Journal of Hepatology
Journal of Hepatology 2015 vol. 62 | S263–S864