High Frequency of Active HCV infection among Sero-positive Cases in West Africa and Evidence for Multiple Transmission Pathways.

Layden JE1, Phillips RO2, Owusu-Ofori S3, Sarfo FS2, Kliethermes S1, Mora N4, Owusu D3, Nelson K5, Opare-Sem O2, Dugas L4, Luke A4, Shoham D4, Forbi JC6, Khudyakov YE6, Cooper RS4.

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Abstract

BACKGROUND:

Sub-Saharan Africa (SSA) has among the highest global Hepatitis C Virus (HCV) prevalence estimates. However, reports suggesting high rates of serologic false positives and low levels of viremia have led to uncertainty regarding the burden of active infection in this region. Additionally, little is known about the predominant transmission risk factors in SSA.

METHODS:

We prospectively recalled 363 past blood donors (180 who were rapid screen assay (RSA) positive and 183 that were RSA negative at time of donation) to identify the level of active infection and risk factors for infection at a teaching hospital in Kumasi, Ghana. Participants had repeat blood testing and were administered a questionnaire on risk factors.

RESULTS:

The frequency of HCV active infection ranged from 74.4% to 88% depending on the criteria used to define serologically positive cases. Individuals with active disease had biochemical evidence of liver inflammation and median viral loads of 5.7 log copies/ml. Individuals from the northern and upper regions of Ghana had greater risks of infection compared to participants from other areas. Additional risk factors included traditional circumcision, home birth, tribal scarring and HBV co-infection.

CONCLUSIONS:

Viremic infection was common among serologically confirmed cases. Attention to testing algorithms is needed to define the true HCV burden in SSA. These data also suggest that several transmission modes are likely contributing to the current HCV epidemic in Ghana, and the distribution of these practices may result in substantial regional variation in prevalence.