Universidade de Pernambuco, Faculdade de Ciências Médicas de Pernambuco, Hospital Universitário Oswaldo Cruz, Rua Arnóbio Marques, 310, Santo Amaro, CEP: 50100-130, Recife, PE, Brazil.
BMC Infect Dis. 2013 Feb 1;13:60. doi: 10.1186/1471-2334-13-60.
Hepatitis C chronic liver disease is a major cause of liver transplant in developed countries. This article reports the first nationwide population-based survey conducted to estimate the seroprevalence of HCV antibodies and associated risk factors in the urban population of Brazil.
The cross sectional study was conducted in all Brazilian macro-regions from 2005 to 2009, as a stratified multistage cluster sample of 19,503 inhabitants aged between 10 and 69 years, representing individuals living in all 26 State capitals and the Federal District. Hepatitis C antibodies were detected by a third-generation enzyme immunoassay. Seropositive individuals were retested by Polymerase Chain Reaction and genotyped. Adjusted prevalence was estimated by macro-regions. Potential risk factors associated with HCV infection were assessed by calculating the crude and adjusted odds ratios, 95% confidence intervals (95% CI) and p values. Population attributable risk was estimated for multiple factors using a case-control approach.
The overall weighted prevalence of hepatitis C antibodies was 1.38% (95% CI: 1.12%-1.64%). Prevalence of infection increased in older groups but was similar for both sexes. The multivariate model showed the following to be predictors of HCV infection: age, injected drug use (OR = 6.65), sniffed drug use (OR = 2.59), hospitalization (OR = 1.90), groups socially deprived by the lack of sewage disposal (OR = 2.53), and injection with glass syringe (OR = 1.52, with a borderline p value). The genotypes 1 (subtypes 1a, 1b), 2b and 3a were identified. The estimated population attributable risk for the ensemble of risk factors was 40%. Approximately 1.3 million individuals would be expected to be anti-HCV-positive in the country.
The large estimated absolute numbers of infected individuals reveals the burden of the disease in the near future, giving rise to costs for the health care system and society at large. The known risk factors explain less than 50% of the infected cases, limiting the prevention strategies. Our findings regarding risk behaviors associated with HCV infection showed that there is still room for improving strategies for reducing transmission among drug users and nosocomial infection, as well as a need for specific prevention and control strategies targeting individuals living in poverty.
丙型肝炎慢性肝病是发达国家肝移植的主要原因。本文报道了首次在全国范围内进行的基于人群的调查,旨在估计巴西城市人口中丙型肝炎病毒抗体的血清流行率和相关危险因素。
这项横断面研究于 2005 年至 2009 年在巴西所有宏观区域进行,采用分层多阶段聚类样本,包括 19503 名年龄在 10 至 69 岁之间的居民,代表生活在所有 26 个州首府和联邦区的个体。采用第三代酶免疫分析法检测丙型肝炎病毒抗体。对血清阳性者进行聚合酶链反应和基因分型复测。按宏观区域估计调整后的流行率。通过计算粗比值比、95%置信区间(95%CI)和 p 值,评估与 HCV 感染相关的潜在危险因素。使用病例对照方法,对多种因素的人群归因危险度进行估计。
丙型肝炎病毒抗体的总体加权流行率为 1.38%(95%CI:1.12%-1.64%)。感染率随年龄增长而增加,但在性别之间无差异。多变量模型显示,以下因素为 HCV 感染的预测因素:年龄、注射吸毒(比值比[OR]=6.65)、嗅吸毒品(OR=2.59)、住院(OR=1.90)、缺乏污水处理导致社会贫困的群体(OR=2.53)、以及使用玻璃注射器注射(OR=1.52,p 值接近边缘)。鉴定出基因型 1(亚型 1a、1b)、2b 和 3a。风险因素总和的估计人群归因危险度为 40%。预计该国将有 130 万人丙型肝炎病毒抗体呈阳性。
感染人数的大量绝对估计数揭示了未来疾病的负担,给医疗保健系统和整个社会带来了成本。已知的危险因素解释了不到 50%的感染病例,限制了预防策略的实施。我们对与 HCV 感染相关的风险行为的研究结果表明,仍有空间改善减少吸毒者和医院感染传播的策略,以及针对贫困人口的特定预防和控制策略。