Changes in hepatitis C virus infection routes and genotypes

distribution in chronic hepatitis C cohort of Lithuania

Valentina Liakina, Danutė SpeičienėAlgimantas Irnius, Jonas Valantinas

Centre of Hepatology, Gastroenterology and DieteticsFaculty of Medicine, Vilnius University

Chronic hepatitis C cohort

From 1996 to 2006 about 2000 chronic hepatitis C patients were admitted for antiviral treatment at the Center of Hepatology, Gastroenterology and Dietetics of Vilnius University Hospital Santariškių Klinikos.

1158 patients (638 males and 520 females; age range, 16-80 years; mean age, 48.7±13.0 years) were enrolled into the study of HCV infection routes.

Anonymous questionnaire with the list of possible infection routes was proposed to the participants.

Data were published in Medical Science Monitor 2009

Genotypes distribution in chronic hepatitis C patients

0

50

100

150

200

250

300

total <30 31-40 41-50 51-60 61-70 >71

genotype 1

genotype 2

genotype 3

Patients

Age groups

1a

1a/b

1b

2

2a

2a/b

2a/c

3

3a

Subtypes distribution in chronic hepatitis C patients

Analysis of chronic hepatitis C patients with a single risk factor for HCV acquisition

Variables, n/%

Total,477/41.2

Gr. 174/47.4

Gr. 2 5/33.2

Gr. 397/40.2

Gr. 491/38.9

Gr. 588/44.7

Gr. 652/50.0

P value

Males:females 260:217 54:20 44:31 63:34 47:44 35:53 17:35 <.0001

Surgery 288/60.4 24/32.4 39/52.0 48/49.5 63/69.2 71/80.7 43/82.7 <.0001

Donations 54/11.3 2/2.7 12/16.0 27/27.8 10/11.0 2/2.3 1/1.9 <.0001

Transfusions 31/6.5 4/5.4 5/6.7 10/10.3 6/6.6 5/5.7 1/1.9 NS

Open trauma 15/3.1 3/4.1 5/6.7 2/2.1 2/2.2 2/2.3 1/1.9 NS

Tattoo 16/3.4 11/14.9 2/2.7 3/3.1 0 0 0 <.0001

Intravenous drug use 26/5.5 22/29.7 2/2.7 2/2.1 0 0 0 <.0001

Occupational exposure 11/2.3 4/5.4 2/2.7 1/1.0 2/2.2 1/1.1 1/1.9 NS

Long-lasting and multiple hospitalization 28/5.9 2/2.7 5/6.7 5/5.2 5/5.5 6/6.8 5/9.6 NS

Hemodialysis 6/1.2 0 1/1.3 0 4/4.4 1/1.1 0 .0733

Chronic hepatitis C in family member 4/0,8 2/2.7 2/2.7 0 0 0 0 NS

Multivariate analysis of HCV risk factors depending on the age of patients

Variables CHC cohort overall, n=1158

Patients with single risk factor, n=477

Patients with detected HCV genotypes, n=391

OR P value OR P value OR P value

Gender, males vs females 0.442 <.0001 0.432 .0047 0.441 <.0001

Genotype 1 vs 3 Not included in analysis Not included in analysis 2.098 .1376

Genotype 2 vs 3 Not included in analysis Not included in analysis 2.389 .1126

Surgery 1.571 .0236 Not confirmed* 1.508 .0383

Tattoo 0.348 .0242 0.110 .0342 Not confirmed*

Intravenous drug use 0.150 <.0001 0.134 .0004 0.167 <.0001

CHC in family 0.093 .0076 0.017 .0236 0.107 .0121

LMH 2.330 .0045 Not confirmed* 2.600 .0014

LMH, Long or multiple hospitalizations; CHC in family, Chronic hepatitis C in a family member.*An independent risk factor not confirmed by multivariate logistic regression analysis.

Multivariate analysis of hepatitis C virus risk factors depending on the gender

Variables CHC cohort overall, n=1158

Patients with single risk factor, n=477

Patients with detected HCV genotypes, n=391

OR P value OR P value OR P value

Age 1.039 <.0001 1.026 .0427 1.038 <.0001

Donations 0.285 <.0001 Not confirmed* 0.287 <.0001

Transfusions Not confirmed* 9.074 .0011 Not confirmed*

Surgery 2.314 .0013 12.059 .0011 2.353 .0009

LMH 0.383 .0144 Not confirmed* 0.386 .0151

Open traumas 0.338 .0010 Not confirmed* 0.339 .0010

Occupational exposure 4.329 .0059 Not confirmed* 4.359 .0056

LMH, Long or multiple hospitalizations.*An independent risk factor not confirmed by multivariate logistic regression analysis.

Risk factors for hepatitis C virus acquisition and genotypes

Conclusions

• In our population HCV genotype 1 (subtype 1b) prevails – more than 70%, genotype 3 – about 30% and few genotype 2.

• Genotype 1 mostly spreads nosocomialy, genotype 3 - through intravenous drug use.

• Nosocomial HCV transmission is well controlled and the main recent infection route is intravenous drug use.

• The shift in HCV transmission pathways predetermined the shift in HCV genotypes from 1 to 3.

• The safety of blood and blood products transfusions strongly depend on NAT sensitivity and still is a worldwide problem, especially in case of paid donations.

• Despite control of nosocomial HCV spread we can not expect a decrease of HCV infected persons due infection spread through less controlled IDU route.

• Interplay between HCV spread lowering and increasing factors will determine the status of infection in our and other European countries.