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Hepatitis C virus infection in chronic liver disease in Natal
Insights
Hepatitis C virus (HCV) significantly contributes to chronic liver disease in South Africa, with most infections not linked to blood transfusions. Blood donor screening alone won't prevent most HCV cases.
Area of Science:
- Hepatology
- Infectious Diseases
- Epidemiology
Background:
- Hepatitis C virus (HCV) and hepatitis B virus (HBV) are significant causes of chronic liver disease globally.
- South Africa is an HBV-endemic area, necessitating an understanding of co-infections and other viral etiologies.
- The prevalence of anti-HCV in patients with cirrhosis, hepatocellular carcinoma (HCC), and chronic active hepatitis (CAH) in this region was previously understudied.
Purpose of the Study:
- To determine the seroprevalence of antibodies to hepatitis C virus (anti-HCV) in patients diagnosed with cirrhosis, HCC, and CAH.
- To investigate the role of HCV as an etiological agent in chronic liver disease within an HBV-endemic area of South Africa.
- To assess the proportion of HCV infections associated with blood transfusions.
Main Methods:
- A cross-sectional seroprevalence study was conducted.
- Patients with suspected cirrhosis, HCC, and CAH were recruited from a referral hospital.
- Diagnoses were confirmed using histological, serological, or imaging methods. Anti-HCV and hepatitis B surface antigen (HBsAg) were tested using enzyme immunoassays and supplemental neutralization assays.
Main Results:
- Anti-HCV seroprevalence was 23% for cirrhosis (18/77), 24% for HCC (8/33), and 33% for CAH (2/6).
- Hepatitis B surface antigen (HBsAg) was detected in 21% of cirrhotic, 46% of HCC, and 17% of CAH patients.
- Only 18% of anti-HCV positive cases were linked to prior blood transfusions, indicating non-transfusion-related transmission in the majority (82%).
Conclusions:
- HCV is a significant etiological factor in the pathogenesis of chronic liver disease among the studied South African population.
- Screening of blood donors for anti-HCV would not prevent the majority of chronic liver disease cases caused by HCV in this setting.
- HCV and HBV appear to have distinct modes of transmission in southern Africa.
Abstract:
The aim of this cross-sectional seroprevalence study was to determine the prevalence of antibodies to hepatitis C virus (HCV) (anti-HCV) in patients with cirrhosis, hepatocellular carcinoma (HCC) and chronic active hepatitis (CAH) attending a referral hospital in a hepatitis B virus (HBV)-endemic area in South Africa. One hundred and ten patients with suspected cirrhosis, 44 with suspected HCC and 6 with chronic hepatitis were initially included. The diagnoses were confirmed in 77 patients with cirrhosis (histologically or macroscopically at peritoneoscopy), 33 patients with HCC (histologically or elevated alpha-fetoprotein levels plus focal lesion on hepatic imaging) and 6 patients with CAH (histologically) without antinuclear antibodies. All patients were tested for anti-HCV with the Abbott second-generation enzyme immunoassay combined with a supplemental neutralisation assay, and hepatitis B surface antigen (HBsAg). Anti-HCV seroprevalence for cirrhosis, HCC and CAH were 18/77 (23%), 8/33 (24%) and 2/6 (33%) respectively. HBsAg was detected in serum in 16 (21%), 15 (46%) and 1 (17%) patient respectively. Only 1 patient (with cirrhosis) was positive for both anti-HCV and HBsAg. Of those who were anti-HCV-positive, 4/18 (22.2%) cirrhotics, none with HCC and 1/2 (50%) with CAH, had previously received blood transfusions, resulting in a cumulative frequency of 5/28 (18%). Our results indicate that HCV is an important aetiological agent in the pathogenesis of chronic liver disease in our patients. In the majority of patients (82%), the infection was not transfusion-related. Thus, screening of blood donors for anti-HCV would not prevent the majority of cases of chronic liver disease secondary to HCV. It appears as if HCV and HBV have different modes of transmission in southern Africa.