Hepatitis C virus in Vietnam: high prevalence of infection in dialysis and multi-transfused patients involving diverse and novel virus variants.
Hepatitis C virus (HCV) is a genetically diverse pathogen infecting approximately 2-3% of the world's population. Herein, we describe results of a large, multicentre serological and molecular epidemiological study cataloguing the prevalence and genetic diversity of HCV in five regions of Vietnam; Ha Noi, Hai Phong, Da Nang, Khanh Hoa and Can Tho. Individuals (n=8654) with varying risk factors for infection were analysed for the presence of HCV Ab/Ag and, in a subset of positive specimens, for HCV RNA levels (n=475) and genotype (n=282). In lower risk individuals, including voluntary blood donors, military recruits and pregnant women, the prevalence of infection was 0.5% (n=26/5250). Prevalence rates were significantly higher (p<0.001) in intravenous drug users (IDUs; 55.6%, n=556/1000), dialysis patients (26.6%, n=153/575) commercial sex workers (CSWs; 8.7%, n=87/1000), and recipients of multiple blood transfusions (6.0%, n=32/529). The prevalence of HCV in dialysis patients varied but remained high in all regions (11-43%) and was associated with the receipt of blood transfusions [OR: 2.08 (1.85-2.34), p=0.001], time from first transfusion [OR: 1.07 (1.01-1.13), p=0.023], duration of dialysis [OR: 1.31 (1.19-1.43), p<0.001] and male gender [OR: 1.60 (1.06-2.41), p=0.026]. Phylogenetic analysis revealed high genetic diversity, particularly amongst dialysis and multi-transfused patients, identifying subtypes 1a (33%), 1b (27%), 2a (0.4%), 3a (0.7%), 3b (1.1%), 6a (18.8%), 6e (6.0%), 6h (4.6%), 6l (6.4%) and 2 clusters of novel genotype 6 variants (2.1%). HCV genotype 1 predominated in Vietnam (60%, n=169/282) but the proportion of infections attributable to genotype 1 varied between regions and risk groups and, in the Southern part of Vietnam, genotype 6 viruses dominated in dialysis and multi-transfused patients (73.9%). This study confirms a high prevalence of HCV infection in Vietnamese IDUs and, notably, reveals high levels of HCV infection associated with dialysis and blood transfusion.
Ireland Vietnam Blood-Borne Virus Initiative (IVVI), Dublin, Ireland and Ha Noi Vietnam.
Linda
L
Dunford
Michael J
MJ
Carr
Jonathan
J
Dean
Allison
A
Waters
Linh Thuy
LT
Nguyen
Thu Hong
TH
Ta Thi
Lan Anh Bui
LA
Thi
Huy Duong
HD
Do
Thu Thuy Duong
TT
Thi
Ha Thu
HT
Nguyen
Trinh Thi
TT
Diem Do
Quynh Phuong
QP
Luu
Jeff
J
Connell
Suzie
S
Coughlan
Hien Tran
HT
Nguyen
William W
WW
Hall
Lan Anh
LA
Nguyen Thi
D001803:Blood Transfusion; D005260:Female; D016174:Hepacivirus / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D006526:Hepatitis C / Q000453:epidemiology* / Q000821:virology; D006801:Humans; D008297:Male; D008889:Military Personnel; D010802:Phylogeny; D011247:Pregnancy; D015995:Prevalence; D060888:Real-Time Polymerase Chain Reaction; D006435:Renal Dialysis; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012307:Risk Factors; D014744:Vietnam / Q000453:epidemiology