Hepatitis C virus infection in chronic liver disease in Natal.
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.
Soni
P N
PN
Gastrointestinal Unit, University of Natal, Durban.
Tait
D R
DR
Gopaul
W
W
Sathar
M A
MA
Simjee
A E
AE
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000453:epidemiology*; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D016174:Hepacivirus / Q000276:immunology; D006509:Hepatitis B / Q000453:epidemiology / Q000276:immunology; D006514:Hepatitis B Surface Antigens / Q000032:analysis; D006526:Hepatitis C / Q000150:complications / Q000453:epidemiology* / Q000276:immunology; D018937:Hepatitis C Antibodies / Q000032:analysis; D006521:Hepatitis, Chronic / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000453:epidemiology*; D008113:Liver Neoplasms / Q000150:complications / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D016036:Seroepidemiologic Studies; D013019:South Africa / Q000453:epidemiology
D006514:Hepatitis B Surface Antigens; D018937:Hepatitis C Antibodies