High Frequency of Active HCV Infection Among Seropositive Cases in West Africa and Evidence for Multiple Transmission Pathways Journal Article


Authors: Layden, J. E.; Phillips, R. O.; Owusu-Ofori, S.; Sarfo, F. S.; Kliethermes, S; Mora, N; Owusu, D.; Nelson, K.; Opare-Sem, O.; Dugas, L; Luke, A; Shoham, D; Forbi, J. C.; Khudyakov, Y. E.; Cooper, R. S.
Article 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.
Keywords: Africa; Prevalence; transmission; HCV
Journal Title: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
Volume: 60
Issue: 7
ISSN: 1537-6591; 1058-4838
Publisher: . Published by Oxford University Press on behalf of the Infectious Diseases Society of America  
Date Published: 2015
Start Page: 1033
End Page: 1041
Language: ENG
DOI/URL:
Notes: LR: 20150313; CI: (c) The Author 2014; JID: 9203213; OTO: NOTNLM; 2014/12/04 [aheadofprint]; ppublish