Factors associated with hepatitis C prevalence differ by the stage of liver fibrosis: A cross-sectional study in the general population in Poland, 2012-2016

Abstract

Background & aims: There is a considerable burden of hepatitis C in Europe related to the lack of prompt diagnosis. We aimed to estimate the prevalence and related risk factors of HCV infections by the stages of liver fibrosis, using non-invasive methods, to understand testing needs in Poland.

Methods: A cross-sectional study was conducted in 2012-2016 adopting a stratified random sampling of primary health care units followed by systematic sampling of patients within each unit. Study participants filled a questionnaire and donated blood for laboratory HCV testing. Additionally, the results of liver function tests and platelet count were collected to calculate APRI and FIB-4 scores. Cases were classified according to the level of fibrosis: 'significant fibrosis' (APRI≥0.7 or FIB4≥1.45) and 'no significant fibrosis' (APRI<0.7 and FIB4<1.45).

Results: Of 21 875 study participants, 102 were HCV-RNA positive. Prevalence of HCV infections and significant fibrosis was estimated at 0.47% (95% CI 0.38% - 0.57%) and 0.12% (0.08% - 0.17%), respectively. Cases with significant fibrosis accounted for 51.6% (33.4%-69.9%) in men and 34.4% (17.3%-51.4%) in women. There was no correlation between the HCV prevalence and age. Blood transfusion prior to 1992 strongly predicted significant fibrosis as did the history of injecting drug use (IDU) and ever having an HCV-infected sexual partner in men and caesarean sections in women. Factors associated with HCV infection without significant fibrosis were tattooing in men and younger age in women. We acknowledge limited possibility to study the associations between IDU and ever having HCV-infected sexual partner, given small sample sizes for these exposures.

Conclusions: As no clear birth cohort affected by HCV could be identified, risk factor-based screening in the general population should be considered, taking into account the association between the increased risk of liver fibrosis and the history of transfusion prior to 1992 and caesarean sections.

Fig 1. Comparison of APRI and FIB4 scores in HCV-RNA positive individuals.

The vertical and horizontal lines indicate the cut-off points for significant fibrosis for APRI and FIB4 scores, respectively. Two cut-off points are presented: APRI≥0.7 and FIB4≥1.45 (high sensitivity and low specificity) and APRI≥1.5 and FIB4≥3.25 (low sensitivity and high specificity).

Fig 2. Prevalence of HCV-RNA and prevalence of significant fibrosis defined by APRI≥0.7 and FIB4≥1.45 by sex and age group.