Incidence and risk factors for HCV infection at the cohort site

While previous studies have focused on risk factors for HCV infection in urban settings, we analysed data from the intake of the village cohort study to explore HCV risk factors in a rural area: 475/4,022 (11.8%) study subjects aged 5-65 years had anti-HCV antibodies. Intravenous injections accounted for 21.7% of all infections seen among adults, followed by intravenous infusions (16.2%), and past intravenous treatment for schistosomiasis (12.4%). Other known risk factors (surgery, blood transfusions, complicated deliveries, endoscopies…) accounted for a limited amount of infections (Arafa et al., J Hepatol, 2005).


Among children (< 20 years old), although 47 of them were infected, only few infections could be explained (complicated deliveries in young married girls). Children had been exposed to injections, blood transfusion, or surgery in the past 20 years, but with no apparent increased risk for HCV infection. Child infections tended to cluster at the household level (Plancoulaine et al., Gut, 2008), and segregation analysis provided evidence for a dominant major gene predisposing to HCV infection. The predisposing allele frequency was 0.013, indicating that 2.6% of the subjects were predisposed to HCV infection (Laouénan et al., Hum Genet, 2009). Linkage analysis is now ongoing to locate this major gene within the whole genome.


HCV incidence was estimated during the follow-up of the 3,580 subjects who tested negative at baseline. 25 participants (11 females) seroconverted in 10,578 person years of follow-up (PY) [incidence rate of 2.4/1,000 person-years; 95% CI=1.6–3.5]. The median (IQR) age at seroconversion was 26 (19-35) years among males and 20 (13-24) years among females. The only significant risk factor identified for these cases was receiving medical injections. Two of the 17 viremic seroconvertors were infected with the same strain as at least one of their family members, giving a 12% estimate for intra-familial transmission of HCV (Mostafa et al., Liver Int, 2010).


Main conclusion of this study: in this rural cohort study, intravenous injections and infusions contributed to the majority of infections among adults. In children, infections were rare and tended to cluster in families, possibly in relation with a dominant major gene whose allele would be present in 2.6% of individuals. HCV incidence was estimated at 2.4 per 1,000 person-years.


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