Clifford Gary M, Waterboer Tim, Dondog Bolormaa, Qiao You Lin, Kordzaia Dimitri, Hammouda Doudja, Keita Namory, Khodakarami Nahid, Raza Syed Ahsan, Sherpa Ang Tshering, Zatonski Witold, Pawlita Michael, Plummer Martyn, Franceschi Silvia
International Agency for Research on Cancer, 150 cours Albert Thomas, 69372 Lyon Cedex 08, France.
Infection, Inflammation and Cancer Program, German Cancer Research Center (DKFZ), Heidelberg, Germany.
Infect Agent Cancer. 2017 Feb 2;12:9. doi: 10.1186/s13027-017-0121-1. eCollection 2017.
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).
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.
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.
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.
具有极高治愈率的新型口服疗法有可能彻底改变全球丙型肝炎病毒（HCV）的治疗方式，但许多低收入和中等收入国家（LMIC）缺乏基于人群的HCV感染数据。
2004年至2009年期间，从中国、蒙古、波兰、几内亚、尼泊尔、巴基斯坦、阿尔及利亚、格鲁吉亚和伊朗9个国家按年龄分层的女性人群样本中收集干血斑。使用基于微珠的技术通过多重血清学检测法检测HCV抗体。
HCV粗流行率从蒙古的17.4%到伊朗的0.0%不等。在按年龄和国家调整的汇总模型中，各国与危险因素的关联在统计学上无显著差异，HCV阳性的唯一显著决定因素是年龄（≥45岁与<35岁的患病率比=2.84，95%CI 2.18-3.71）和产次（经产与未产=1.73，95%CI 1.02-2.93）。在HCV感染人数最多的三个国家（蒙古、巴基斯坦、中国）中，每个国家的HCV阳性率均随年龄显著增加，但与产次无关。与性伴侣或HPV感染均无关联。≥45岁女性的HCV流行率与近期女性HCV相关肝癌发病率的估计值相关性良好，但巴基斯坦略有例外，该国的HCV流行率（5.2%）高于预期。
全球女性中的HCV流行率差异极大。与分娩相关的医疗干预/住院可能是HCV传播途径，但性交不是。将干血斑采集与高通量HCV检测相结合，有助于在数据匮乏的低收入和中等收入国家开展血清流行病学研究。
