title: High frequency of active HCV infection among seropositive cases in west Africa and evidence for multiple transmission pathways.
abstract: BACKGROUND
  Sub-Saharan Africa (SSA) has one of the highest global hepatitis C virus (HCV) prevalence estimates. However, reports that suggest 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 who 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 with participants from other areas. Additional risk factors included traditional circumcision, home birth, tribal scarring, and hepatitis B virus coinfection.
  
  
  CONCLUSIONS
  Viremic infection was common among serologically confirmed cases. Attention to testing algorithms is needed in order 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 that the distribution of these practices may result in substantial regional variation in prevalence.
authors.affiliation: Department of Public Health Sciences Department of Medicine, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Layden
authors.affiliation: Komfo Anokye Teaching Hospital Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
authors.forename: Richard O
authors.initials: RO
authors.lastname: Phillips
authors.affiliation: Komfo Anokye Teaching Hospital.
authors.forename: Shirley
authors.initials: S
authors.lastname: Owusu-Ofori
authors.affiliation: Komfo Anokye Teaching Hospital Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
authors.forename: Fred Stephen
authors.initials: FS
authors.lastname: Sarfo
authors.affiliation: Department of Public Health Sciences Department of Medicine, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Kliethermes
authors.affiliation: Department of Public Health Sciences.
authors.forename: Nallely
authors.initials: N
authors.lastname: Mora
authors.affiliation: Komfo Anokye Teaching Hospital.
authors.forename: Dorcas
authors.initials: D
authors.lastname: Owusu
authors.affiliation: Departments of Epidemiology and International Health, Johns Hopkins School of Public Health, Baltimore, Maryland.
authors.forename: Kenrad
authors.initials: K
authors.lastname: Nelson
authors.affiliation: Komfo Anokye Teaching Hospital Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
authors.forename: Ohene
authors.initials: O
authors.lastname: Opare-Sem
authors.affiliation: Department of Public Health Sciences.
authors.forename: Lara
authors.initials: L
authors.lastname: Dugas
authors.affiliation: Department of Public Health Sciences.
authors.forename: Amy
authors.initials: A
authors.lastname: Luke
authors.affiliation: Department of Public Health Sciences.
authors.forename: David
authors.initials: D
authors.lastname: Shoham
authors.affiliation: Molecular Epidemiology and Bioinformatics Laboratory, Division of Viral Hepatitis, Centers for Disease Control, Atlanta, Georgia.
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Forbi
authors.affiliation: Molecular Epidemiology and Bioinformatics Laboratory, Division of Viral Hepatitis, Centers for Disease Control, Atlanta, Georgia.
authors.forename: Yury E
authors.initials: YE
authors.lastname: Khudyakov
authors.affiliation: Department of Public Health Sciences.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Cooper
mesh_terms: D000328:Adult; D001782:Blood Donors; D018562:Disease Transmission, Infectious; D005260:Female; D005869:Ghana / Q000453:epidemiology; D006526:Hepatitis C / Q000453:epidemiology* / Q000635:transmission*; D006801:Humans; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires
keywords: Africa; HCV; prevalence; transmission