Prevalence and risk factors of Hepatitis C virus infection in Brazil, 2005 through 2009: a cross-sectional study

Abstract Background 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. Methods 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. Results 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. Conclusions 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.

We thank to National Hepatitis Study Group whose names are listed below, by their collaboration and support in the organization and development of the study at local level: Zulma Medeiros (Centro de Pesquisas Aggeu Magalhães-FIOCRUZ), Demócrito Miranda Filho (Universidade de Pernambuco), Maria Mabel Melo (LACEN-PE), Conceiçao Sá (Hemocentro—HEMOPI-PI), Carlos Henrique Nery Costa (Universidade Federal do Piaui), Arnaldo de Jesus Dominici (Universidade Federal do Maranhao), Maria das Graças Aragão (Universidade Federal do Maranhao), Elizabeth de Souza Lima (LACEN-MA), Jose Milton de Castro Lima (Universidade Federal do Ceara), Jose Wellington Oliveira Lima (FUNASA-CE), Maria do Carmo Vidal Gadelha Lima (LACEN-CE), Gilmar Amorim de Sousa (Universidade Federal do Rio Grande do Norte), Marcia Araujo Barreto (Universidade Federal do Rio Grande do Norte), Manoel Jaime Xavier Filho (Universidade Federal da Paraiba), Joria Viana Guerreiro (Universidade Federal da Paraiba), Dayse Mercia Cavalcanti de Oliveira (FUNASA-AL), Maria Rosileide Bezerra Alves (Secretaria Estadual de Saude de Alagoas), Ivoneide Moreira de Oliveira Barros (LACEN-PB), Tereza Virginia Silva B.Nascimento (Universidade Federal de Sergipe), Lucia Maria Sayde de Azevedo Tavares (FUNASA-SE), Raymundo Parana Ferreira Filho (Universidade Federal da Bahia), Jose Tavares-Neto (Universidade Federal da Bahia), Maria Alice Sant’Anna Zarife (LACEN-BA), Rodrigo Sebba Aires (Secretaria Estadual de Saúde de Goias), Fluvia Pereira A. da Silva (Secretaria Municipal de Saúde de Goiania), Beatriz Maranhao Bariani (LACEN-GO), Jose Ivan Aguiar (Universidade Federal do Mato Grosso do Sul), Eugenio Barros (Secretaria Municipal de Saúde-Campo Grande), Gilza Bastos dos Santos (LACEN-MS), Francisco Souto (Universidade Federal do Mato Grosso), Cor Jesus Fernando Fontes (Universidade Federal do Mato Grosso), Virg?nia Correia de Azevedo (LACEN-MT), Roberto de Melo Dusi (Secretaria Estadual de Saude - DF), L?dia Maria Pinto Luna (LACEN-DF), Jose Carlos da Fonseca (Universidade Federal do Amazonas), Leila Melo Brasil (Fundacao Medicina Tropical do Amazonas), Katia Biscuola de Campos (Programa Nacional de Prevencao e Controle das Hepatites Virais/SVS/ Ministerio da Saude), Cirley Maria de Oliveira Lobato (Serviço de Assistência Especializada - Secretaria Estadual de Saúde- AC), Mônica de Breu Moraes (Secretaria Estadual de Saúde-Acre, Programa Estadual de Hepatites), Janaina Mazaro (LACEN, Rio Branco, Acre), Maria de Nazaré Miranda de Cavalcante (Secretaria de Estado da Saúde de Amapá); Clóvis Omar Sá Miranda (Secretaria de Saúde do Estado do Amapá, Macapá, Amapa, Brazil), Márcia Socorro Cavalcante Porcy (LACEN-Amapa, Brazil), Ana Ruth Silva de Araújo (Universidade Federal do Amazonas), Marlúcia da Silva Garrido (Fundação de Vigilância em Saúde do Amazonas-Departamento de Vigilância Epidemiológica), Márcia Noronha Barbosa (Fundação de Vigilância em Saúde-AM), Raimundo Aldo Tavares (Secretaria Estadual de Saúde Pública - PA), Maria de Fátima Chaves Oliveira (Secretaria Estadual de Saúde-PA), José Américo Lozich de Aquino (LACEN-PA), Juan Miguel Villalobos-Salcedo (Universidade Federal de Rondônia), Fábio Luiz Storer (Faculdade São Lucas, Porto Velho- RO), Luiz Renerys de Lima Pinheiro (Secretaria de Saúde de Estado da Saúde de Roraima), Jacqueline de Aguiar Barros (Secretaria de Estado da Saúde de Roraima), Juliana Cristina Ferreira Lima (LACEN-RR), Nádja Duarte Oliveira Souza (Universidade Federal do Tocantins), Arlete Lopes da Cunha Otoni (Secretaria de Estado da Saúde do Tocantins); Gisele Christina O. Silva (LACEN-TO), Paraná Dominique Muzillo (Universidade Federal do Paraná), Lucimar Bozza (Secretaria Municipal de Saúde de Curitiba); Yatiyo Matsui Moriya (LACEN-Paraná), Esther Buzaglo Dantas-Correa (Universidade Federal de Santa Catarina), Ana Cristina Vidor (Prefeitura Municipal de Florianópolis), Ana Duarte Cardoso (LACEN-SC), Alexandro Alves (Universidade Federal de Ciências da Saúde de Porto Alegre), Maria Eugênia Pinto (Universidade Federal de Ciências da Saúde de Porto Alegre), Zenaida Marion Alves Nunes Lyra Vidal (Instituto de Pesquisa Biologica IPB Lacen RS), Angelica Espinosa Barbosa Miranda (Universidade Federal do Espírito Santo), Moacir Soprani (Secretaria Estadual de Saúde do Espírito Santo), Patrícia Rolim Prates (LACEN-ES), Cristiane Alves Villela-Nogueira (Universidade Federal do Rio de Janeiro), Mariza Miranda Theme-Filha (ENSP-FIOCRUZ), Carlos Augusto da Silva Fernandes (LACEN – RJ), Angela Maria Miranda Spina (Instituto Adolfo Lutz), Flair José Carrilho (Universidade de São Paulo), Antônio Alci Barone (Universidade de São Paulo), Rosângela Teixeira (Universidade Federal de Minas Gerais–UFMG); Keli Bahia Felicíssimo Zocratto (Centro Universitário Newton Paiva), Sônia Conceição Diniz (Secretaria de Estado da Saúde de Minas Gerais).

We also thank to the Brazilian Ministry for Health and Pan American Health Organization by the financial support, to the University of Pernambuco Foundation by the administrative support and to the National Institute of Science and Technology for Health Technology Assessment (CNPq) by providing scholarships to R.A.A.X.(n. 308311/2009-4), C.M.T.M. (n. 306489/2010-4) and M.D.T.(n. 306928/2010-8).