IMPACT OF RISK FACTORS IN THE SCRUTINY AND DIAGNOSIS OF HEPATITIS C

Introduction

Chronic hepatitis C is considered a public health problem. Risk factors for infection traditionally identified as blood transfusion, major surgeries, organ donation, hemodialysis, vertical transmission have undergone an epidemiological transition. Other risk factors have become the main causes of new infections, such as intravenous drug use, sexual intercourse, prison, and tattoos.

Objective

To describe the risk factors associated with the positivity of Hepatitis C by analyzing the epidemiological profile of populations at high risk for Hepatitis C.

Methods

A cross-sectional study was carried out in the Mexican population as part of an HCV 2-years screening program implemented from December 2017 to December 2019. People were invited to participate in the program mainly in public health institutions, or through special campaigns in state and federal social rehabilitation centers and prisons. Adults (> 18 years) with informed consent were included for the study. Participants received a multiple-choice questionnaire to identify sociodemographic variables and the existence of any risk factor for HCV. A rapid test for HCV was performed and those participants whose results were reactive were applied a PCR test to determine quantification of HCV RNA. For the statistical analysis, the population was classified according to risk, as a general population with at least one risk factor and a high-risk population. A logistic regression model adjusted for sociodemographic variables and risk factors for the general population was developed to analyze the factors that may be associated with HCV positivity.

Results

This national cross-sectional cohort included 297,397 eligible subjects with a rapid test performed. Of the total number of rapid tests carried out, 13,085 subjects were reactive (4.4%) and 9,426 subjects (3.2% of the total population) were confirmed as positive by PCR test. The prevalence of viremia in the general population was 2.5%, while in the population with HIV was 3.1% and in persons deprived of their liberty (CERESO) was 18.5%. (Table) The median age in the total population was 43 years. Jalisco (10.1%) and Colima (7.7%) were the states with the highest percentage of positive results, followed by Baja California (7.4%). The percentage of people with viremia increases with age, going from 1.1% in the group of 18-29 years to more than 4.7% in those older than 60 years. In this cohort, the most common risk factors were history of acupuncture/ tattooing/piercings (21%), intravenous drug use (15%), and high-risk sexual practices (12%). From the logistic regression by risk population, we found that having at least one risk factor increased the odds of being HCV positive by 62% (OR = 1.62, IC 95% 1.54-1.69), compared with the population without risk factors. When conducted the analysis by type of specific population, the results showed that incarcerated people were 55 times more likely to be positive for Hepatitis C and 14 times more likely to be positive to HCV, compared to the HIV positive population.

Conclusions

In this cross-sectional study with different high-risk populations for detecting hepatitis C, we identified 3.2% of viremic patients who were linearly related to older age and the existence of risk factors. Based on the results for this analysis, screening and diagnosis in high-risk populations, even those that are routinely marginalized, could be more effective.

The authors declare that there is no conflict of interest.