Hepatitis C virus seroprevalence in the general female population of 9 countries in Europe, Asia and Africa.
BACKGROUND
New oral treatments with very high cure rates have the potential to revolutionize global management of hepatitis C virus (HCV), but population-based data on HCV infection are missing in many low and middle-income countries (LMIC).


METHODS
Between 2004 and 2009, dried blood spots were collected from age-stratified female population samples of 9 countries: China, Mongolia, Poland, Guinea, Nepal, Pakistan, Algeria, Georgia and Iran. HCV antibodies were detected by a multiplex serology assay using bead-based technology.


RESULTS
Crude HCV prevalence ranged from 17.4% in Mongolia to 0.0% in Iran. In a pooled model adjusted by age and country, in which associations with risk factors were not statistically heterogeneous across countries, the only significant determinants of HCV positivity were age (prevalence ratio for ≥45 versus <35 years = 2.84, 95%CI 2.18-3.71) and parity (parous versus nulliparous = 1.73, 95%CI 1.02-2.93). Statistically significant increases in HCV positivity by age, but not parity, were seen in each of the three countries with the highest number of HCV infections: Mongolia, Pakistan, China. There were no associations with sexual partners nor HPV infection. HCV prevalence in women aged ≥45 years correlated well with recent estimates of female HCV-related liver cancer incidence, with the slight exception of Pakistan, which showed a higher HCV prevalence (5.2%) than expected.


CONCLUSIONS
HCV prevalence varies enormously in women worldwide. Medical interventions/hospitalizations linked to childbirth may have represented a route of HCV transmission, but not sexual intercourse. Combining dried blood spot collection with high-throughput HCV assays can facilitate seroepidemiological studies in LMIC where data is otherwise scarce.
International Agency for Research on Cancer, 150 cours Albert Thomas, 69372 Lyon Cedex 08, France.
Gary M
GM
Clifford
Infection, Inflammation and Cancer Program, German Cancer Research Center (DKFZ), Heidelberg, Germany.
Tim
T
Waterboer
Infection, Inflammation and Cancer Program, German Cancer Research Center (DKFZ), Heidelberg, Germany.
Bolormaa
B
Dondog
Cancer Institute of the Chinese Academy of Medical Sciences, Beijing, China.
You Lin
YL
Qiao
Iv. Javakhishvili Tbilisi State University, Tbilisi, Georgia.
Dimitri
D
Kordzaia
Institut National de Sante Publique, Algiers, Algeria.
Doudja
D
Hammouda
Department of Obstetrics and Gynaecology, Centre Hospitalier Universitaire de Donka, Conakry, Guinea.
Namory
N
Keita
Infertility and Reproductive Health Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Nahid
N
Khodakarami
Department of Surgery, The Aga Khan University, Karachi, Pakistan.|Centre de Recherche du CHUM, Département de Médecine Sociale et Préventive Université de Montréal, Quebec, Canada.
Syed Ahsan
SA
Raza
Kist Medical College, Lalitpur, Nepal.
Ang Tshering
AT
Sherpa
The Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland.
Witold
W
Zatonski
Infection, Inflammation and Cancer Program, German Cancer Research Center (DKFZ), Heidelberg, Germany.
Michael
M
Pawlita
International Agency for Research on Cancer, 150 cours Albert Thomas, 69372 Lyon Cedex 08, France.
Martyn
M
Plummer
International Agency for Research on Cancer, 150 cours Albert Thomas, 69372 Lyon Cedex 08, France.
Silvia
S
Franceschi
Epidemiology; Hepatitis C virus; Liver cancer; Serology