Persistently high hepatitis C rates in haemodialysis patients in Brazil [a systematic review and meta-analysis]

We conducted a systematic review and meta-analysis of studies assessing HCV infection rates in haemodialysis patients in Brazil (Prospero CRD #42021275068). We included studies on patients under haemodialysis, comprising both convenience samples and exhaustive information from selected services. Patients underwent HCV serological testing with or without confirmation by HCV RNA PCR. Exclusion criteria were the following: absence of primary empirical information and studies without information on their respective settings, study year, accurate infection rates, or full specification of diagnostic tests. Studies with samples ≤ 30 and serial assessments with repeated information were also excluded. Reference databases included PubMed, LILACS, Scopus, and Web of Science for the period 1989–2019. A systematic review was carried out, followed by two independent meta-analyses: (i) studies with data on HCV prevalence and (ii) studies with a confirmatory PCR (i.e., active infection), respectively. A comprehensive set of different methods and procedures were used: forest plots and respective statistics, polynomial regression, meta-regression, subgroup influence, quality assessment, and trim-and-fill analysis. 29 studies and 11,290 individuals were assessed. The average time patients were in haemodialysis varied from 23.5 to 56.3 months. Prevalence of HCV infection was highly heterogeneous, with a pronounced decrease from 1992 to 2001, followed by a plateau and a slight decrease in recent years. The summary measure for HCV prevalence was 34% (95% CI 26–43%) for studies implemented before 2001. For studies implemented after 2001, the corresponding summary measure was 11% (95% CI 8–15%). Estimates for prevalence of active HCV infection were also highly heterogeneous. There was a marked decline from 1996 to 2001, followed by a plateau and a slight increase after 2010. The summary measure for active HCV infection was 19% (95% CI 15–25%) in studies carried out before 2001. For studies implemented after 2001, the corresponding summary measure was 9% (95% CI 6–13%). Heterogeneity was pervasive, but different analyses helped to identify its underlying sources. Besides the year each study was conducted, the findings differed markedly between geographic regions and were heavily influenced by the size of the studies and publication biases. Our systematic review and meta-analysis documented a substantial decline in HCV prevalence among Brazilian haemodialysis patients from 1992 to 2015. CKD should be targeted with specific interventions to prevent HCV infection, and if prevention fails, prompt diagnosis and treatment. Although the goal of HCV elimination by 2030 in Brazil remains elusive, it is necessary to adopt measures to achieve micro-elimination and to launch initiatives towards targeted interventions to curb the spread of HCV in people with CKD, among other high-risk groups. This is of particular concern in the context of a protracted COVID-19 pandemic and a major economic and political crisis.

Global Burden and Changing Trend of Hepatitis C Virus Infection in HIV-Positive and HIV-Negative MSM: A Systematic Review and Meta-Analysis

Background: The disease burden of hepatitis C virus (HCV) infection in HIV-positive and HIV-negative men who have sex with men (MSM) is changing. We aim to provide an updated comprehensive estimate of HCV prevalence and incidence among the HIV-positive and HIV-negative MSM population at the country, regional, and global levels and their changing trends over time.Methods: PubMed, Embase, PsycINFO, CINAHL, and conference databases were searched and eligible records on the prevalence and incidence of HCV antibodies were selected and pooled via a random-effects model. Meta-regression was performed to demonstrate the association between the pooled rates and study year.Results: A total of 230 articles reporting 245 records from 51 countries with 445,883 participants and 704,249 follow-up person-years were included. The pooled prevalence of HCV in MSM was 5.9% (95% CI: 5.1–6.8), with substantial differences between countries and regions. Low- and lower-middle-income countries (12.3 and 7.0%) manifested a larger disease burden than high- and upper-middle-income countries (5.8 and 3.8%). HCV prevalence in HIV-positive MSM was substantially higher than in HIV-negative MSM (8.1 vs. 2.8%, p < 0.001). The pooled incidence of HCV was 8.6 (95% CI: 7.2–10.0) per 1,000 person-years, with an increasing trend over time, according to meta-regression (p < 0.05).Conclusion: Global HCV prevalence in MSM varies by region and HIV status. Behavior counseling and regular HCV monitoring are needed in HIV-positive subgroups and high-risk regions. Given the upward trend of HCV incidence and sexual risk behaviors, there is also a continued need to reinforce risk-reduction intervention.Systematic Review Registration: PROSPERO, identifier CRD42020211028; https://www.crd.york.ac.uk/prospero/.

Risk of HCV infection associated with hospital-based invasive procedures: a systematic review and meta-analysis

Background: Healthcare settings, where invasive procedures are frequently performed, may play an important role in the transmission dynamics of blood-borne pathogens when compliance with infection control precautions remains suboptimal. This study aims at better understanding and quantifying the role of hospital-based invasive procedures on hepatitis C virus (HCV) transmission. Methods: We conducted a systematic review and meta-analysis to identify recent studies reporting association measures of HCV infection risk that are linked to iatrogenic procedures performed in hospital settings. Based on expert opinion, invasive procedures were categorized into 10 groups for which pooled measures were calculated. Finally, the relationship between pooled measures and the country-level HCV prevalence or the Healthcare Access and Quality (HAQ) index was assessed in meta-regressions. Findings: A total of 71 studies were included in the analysis. The most evaluated procedures were blood transfusion and surgery (60 and 37 studies, respectively). The pooled odds ratio (OR) of HCV infection varied widely, ranging from 1.46 (95%CI: 1.14-1.88) for dental procedures to 5.86 (1.26-27.24) for haemodialysis. The OR for blood transfusion was higher for transfusions performed before 1998 (3.77, 2.42-5.88) than for those without a specified date (2.26, 1.81-2.81). Finally, the country-level overall risk for all procedures was significantly associated with HCV prevalence, but not with the HAQ index. In procedure-specific analyses, the HCV infection risk was significantly negatively associated with the HAQ for endoscopy and positively associated with HCV prevalence for endoscopy and surgery. Interpretation: Various invasive procedures were documented to be significantly associated with HCV infection. Our results provide a ranking of procedures in terms of HCV risk that may be used for prioritization of infection control measures, especially in high HCV prevalence settings. Funding: INSERM-ANRS (France Recherche Nord and Sud Sida-HIV Hepatites)

Management of Hepatitis C in Dialysis Dependent Patients.

Prevalence of Hepatitis C (HCV) is quite high in Pakistan and in particular among maintenance hemodialysis (MHD) patients. HCV is associated with increasing morbidity and mortality among MHD patients. The current availability of direct acting antiviral therapy has changed the canvas for HCV prevalence in many countries. Aim of our study was to evaluate the status of HCV prevalence and its management at our center. Methods: This descriptive study was conducted at Nawaz Sharif Kidney Hospital Swat, Pakistan to evaluate the seroprevalence of HCV among MHD patients. Data regarding HCV status, PCR positivity and number of patietns on active treatment were evaluated. Results: A total of 109 patients were undergoing MHD in this study. The prevalence of patient who had HCV was 40 (36.6%). All patietns had PCR done and out of them PCR was positive in 28 Patients. All except 4 of the 28 patients had been started on HCV treatment with direct antiviral therapy for HCV. Conclusion: almost all of HCV PCR positive patients were being treated with DAA in our dialysis unit.

Dynamics of hepatitis C epidemic among people living with HIV in Estonia based on Estonian HIV cohort study

Background Estonia has a typical Eastern European HIV epidemic where the most frequent co-infection is chronic hepatitis C (HCV). We aimed to describe the changes in HCV prevalence, the distribution of HCV genotypes (GT), and HCV treatment in Estonian people living with HIV over 15 years. Methods We used data of subjects included to the Estonian HIV Cohort Study (E-HIV) before 31st of December 2015. We compared two time periods—first, 1st of January 2000 to 31st of December 2008 when the HIV epidemic was mostly spreading among people who inject drugs (PWID) and second, 1st of January 2009 to 31st of December 2015 when HIV started to emerge to the general population. Results Of 4422 HIV positives 3708 (84%) had information about their HCV serostatus; 2706 (61%) were HCV seropositive, of latter 1625 (60%) were HCV RNA positive, 239 (9%) had their HCV GT determined, and 141 (5%) received treatment for HCV. The dominating subtypes were 1b (42%) and 3a (37%) followed by 1a (16%), and the few cases of 2 (1.5%). HCV prevalence was 1.5 times (95% CI 1.4–1.6) higher in subjects diagnosed with HIV in first as compared to those diagnosed in second period (84% vs 56%, respectively). There were more men and the median age at HIV diagnosis was lower in HIV/HCV co-infected than in HIV mono-infected patients (70% vs 47% and 24 years vs. 30 years, respectively; both p < 0.001). Conclusion There is a decrease in HCV prevalence but it remains high among HIV positive PWID, suggesting that there is need for improvement of harm reduction programs among PWID.

Seroprevalence of Hepatitis C among Pregnant Women Attending Antenatal Care in Specialist Hospital Yola, Adamawa State Nigeria

Aims: To determine the prevalence of Hepatitis C among pregnant women attending antenatal care in Specialist Hospital Yola. Study Design: The prevalence of Hepatitis C was ascertained among pregnant women attending antenatal care in specialist hospital Yola, Adamawa State. Anti HcV antibody in the serum of the pregnant women was detected using a sandwich rapid diagnostic chromatographic test strip. Questioner was used to obtain the demographic data of the pregnant women. Place and Duration of Study: The study was carried out at the Specialist Hospital Yola where the samples were collected. Samples were processed and the analysis carried out at Microbiology Laboratory of Modibbo Adama University Yola. The study was conducted in March to June of 2021. Methodology: 251 consenting pregnant women of varying age and family background were enrolled in the study, where 15 were randomly selected using a systematic random sampling technique on each antenatal visit. Results: The prevalence of HcV in this study was 5.18% and the highest prevalence was found among age group 21-25years with 1.59% and the lowest among the age group 36 and above with 0.39%. Base on type of family, HcV was found to be higher in those from monogamous families (3.59%). Hcv Prevalence was also found to be high among those women who fall in the group ‘’others’’ which comprises of school dropped out and non-educated (1.59%). Participants with tribal marks, those no history of blood transfusion and intravenous drug abuse (IVDA) also showed high prevalence of the virus with percentage prevalence of 3.19%, 3.98% and 3.98% respectively. The study revealed that HCV infection is not significantly associated with age and family type (P value > .05) but significantly associated with educational status, possession of tribal mark/tattoo, history of blood transfusion, and drug abuse (P value < .05). Conclusion: HCV prevalence is low among pregnant women attending Specialist Hospital in Yola, Adamawa state Nigeria for antenatal care. Also, the percentage prevalence observed worldwide is within the range of 1.0-8.0%. However, there are other local governments areas with a dense population that may produce a major difference with the result obtained in this study.

Prevalence of HBV and HCV among Pregnant Women Attending Kumasi South Hospital (KSH), Ghana

Background and Aim: Both HBV and HCV infections have for decades remained serious public health concerns infecting thousands of people and claiming the lives of millions. The detrimental effects of these viral agents on the gravid women, the infants and the general population are well known and cannot be underestimated. Adequate and quality information on the disease prevalence remain one of the surest ways to tackling the infection head-on. This study therefore assessed the seroprevalence of HBV and HCV among pregnant women who received antenatal care services from the Kumasi South Hospital of the Kumasi Metropolis in the Ashanti Region of Ghana. Materials and Methods: A semi-structured questionnaire designed to capture participant’s demographic and gestational data including age, occupation, marital status, educational status and gestational period was administered by the researcher to 200 pregnant women to collect the data for this study. About 2-3mls of whole blood was drawn into an ethylenediamine tetraacetic acid (EDTA) and tested for HBsAg using Alere Determine HBsAg® test strip (sensitivity=95-100% and specificity=96-100%; Abbott Japan Co., Ltd.) and HCV antibodies using Serodia® HCV (sensitivity=100% and specificity=91.5%; Serodia, Fujirebio Inc., Tokyo, Japan) following standard procedures. Due to the lack of more advanced testing facilities such as PCR, each positive test result was repeated in order to reduce the possibility of false positive results. Data was analyzed using Microsoft Excel 2016 and IBM SPSS vs 25. Chi-square and Fisher’s exact test statistic were used to determine statistical associations between explanatory and outcome variables. Logistics regression was employed to determine potential demographic and gestational risk factors of HBV and HCV infection among the pregnant women. P-value of less than 0.05 was considered statistically significant. Results: Seroprevalence of HBV and HCV infection was 20.0% and 2.5% respectively. HBV infection increased with advancement in age from the least 7.1% among pregnant women aged < 20 years to the highest 22.0% among pregnant women aged 30-39 years until a sharp decline among those forty years and above. HCV prevalence generally declined with increase in age with the highest prevalence (14.3%) recorded among the <20 years old group. Unemployed (22.2%), married (20.3%), basic level educated (20.9%) and multiparous (21.3%) pregnant women recorded the highest HBV prevalence rates whereas unemployed (11.1%), unmarried (5.8%), basic level educated (3.4%) and multiparous (3.2%) pregnant women recorded the highest HCV prevalence rates. None of the demographic or gestational risk parameters was significantly associated with HBV infection in this study (p>0.05) however, age was significantly associated with HCV infection yet posed not significantly high likelihood to HCV infection among the pregnant women. Conclusion: The HBV prevalence as recorded is highly endemic and therefore requires urgent round table discussions to be properly addressed. Despite the low HCV prevalence, the futuristic detrimental effects it may pose to the general wellbeing of the citizenry cannot be in doubt owing to the high prevalence dominating among the younger pregnant women. Measures such as intensified public education coupled with mass screening and vaccination and treatment of HBV seronegative and positive individuals respectively is therefore advised to mitigate further spread of the disease.

Global Utilization Trends of Direct Acting Antivirals (DAAs) during the COVID-19 Pandemic: A Time Series Analysis

The 2019 novel coronavirus (COVID-19) pandemic has placed a significant strain on hepatitis programs and interventions (screening, diagnosis, and treatment) at a critical moment in the context of hepatitis C virus (HCV) elimination. We sought to quantify changes in Direct Acting Antiviral (DAA) utilization among different countries during the pandemic. We conducted a cross-sectional time series analysis between 1 September 2018 and 31 August 2020, using the IQVIA MIDAS database, which contains DAA purchase data for 54 countries. We examined the percent change in DAA units dispensed (e.g., pills and capsules) from March to August 2019 to the same period of time in 2020 across the 54 countries. Interrupted time-series analysis was used to examine the impact of COVID-19 on monthly rates of DAA utilization across each of the major developed economies (G7 nations). Overall, 46 of 54 (85%) jurisdictions experienced a decline in DAA utilization during the pandemic, with an average of −43% (range: −1% in Finland to −93% in Brazil). All high HCV prevalence (HCV prevalence > 2%) countries in the database experienced a decline in utilization, average −49% (range: −17% in Kazakhstan to −90% in Egypt). Across the G7 nations, we also observed a decreased trend in DAA utilization during the early months of the pandemic, with significant declines (p < 0.01) for Canada, Germany, the United Kingdom, and the United States of America. The global response to COVID-19 led to a large decrease in DAA utilization globally. Deliberate efforts to counteract the impact of COVID-19 on treatment delivery are needed to support the goal of HCV elimination.

Estimating regional prevalence of chronic hepatitis C with a capture-recapture analysis

Background The hepatitis C virus (HCV) infection is a candidate disease for micro-elimination. Accurate baseline HCV prevalence estimation is essential to monitor progress to micro-elimination but can be methodologically challenging in low-endemic regions like the Netherlands due to lack of disaggregated data by age or risk-groups on the number of chronic HCV patients (i.e. HCV RNA positive). This study estimates the number of patients that has had a chronic HCV infection (ever-chronic) in the Utrecht region of the Netherlands. Methods In the Utrecht province in the Netherlands, positive HCV tests from the period 2001–2015 from one diagnostic center and four hospital laboratories were collected. A two-source capture-recapture method was used to analyze the overlap between the two registries (with 92% HCV RNA and 8% HCV immunoblot confirmed infections) to obtain the number of ever-chronic HCV infections in the Utrecht region. The Utrecht region was defined as an area with a 25 km radius from the Utrecht city center. The current viremic HCV prevalence was calculated by taking into account the proportion of cured and deceased HCV patients from a local HCV retrieval (REACH) project. Results The estimated number of ever-chronic HCV patients was 1245 (95% CI 1164–1326) and would indicate a prevalence of 0.10 (95% CI 0.09–0.10) in the Utrecht region. This is 30% (95% CI 21–38%) more than the number of known HCV patients in the records. The ever-chronic HCV prevalence was highest in the 1960–1969 age cohort (0.16; 95% CI 0.14–0.18). Since 50% of the HCV patients were cured or deceased in the REACH-project, the number of current viremic HCV patients was estimated at 623 individuals in the Utrecht region (prevalence 0.05%). Conclusion The results of this study suggest a low ever-chronic and current HCV prevalence in the Utrecht area in the Netherlands, but other studies need to confirm this.

Developing and Piloting a Standardized European Protocol for Hepatitis C Prevalence Surveys in the General Population (2016–2019)

Background: A robust estimate of the number of people with chronic hepatitis C virus (HCV) infection is essential for an appropriate public health response and for monitoring progress toward the WHO goal of eliminating viral hepatitis. Existing HCV prevalence studies in the European Union (EU)/European Economic Area (EEA) countries are heterogeneous and often of poor quality due to non-probability based sampling methods, small sample sizes and lack of standardization, leading to poor national representativeness. This project aimed to develop and pilot standardized protocols for undertaking nationally representative HCV prevalence surveys in the general adult population.Methods: From 2016 to 2019 a team from the Robert Koch-Institute contracted by the European Centre for Disease Prevention and Control synthesized evidence on existing HCV prevalence surveys and survey methodology and drafted a protocol. The methodological elements of the protocol were piloted and evaluated in Bulgaria, Finland and Italy, and lessons learnt from the pilots were integrated in the final protocol. An international multidisciplinary expert group was consulted regularly.Results: The protocol includes three alternative study approaches: a stand-alone survey; a “nested” survey within an existing health survey; and a retrospective testing survey approach. A decision algorithm advising which approach to use was developed. The protocol was piloted and finalized covering minimum and gold standards for all steps to be implemented from sampling, data protection and ethical issues, recruitment, specimen collection and laboratory testing options, staff training, data management and analysis and budget considerations. Through piloting, the survey approaches were effectively implemented to produce HCV prevalence estimates and the pilots highlighted the strengths and limitations of each approach and key lessons learnt were used to improve the protocol.Conclusions: An evidence-based protocol for undertaking HCV prevalence serosurveys in the general population reflecting the different needs, resources and epidemiological situations has been developed, effectively implemented and refined through piloting. This technical guidance supports EU/EEA countries in their efforts to estimate their national hepatitis C burden as part of monitoring progress toward the elimination targets.