High HCV infection rate in sub-Saharan Africa, with prevalence especially high in people with HIV

Prevalence of hepatitis C virus (HCV) infection is high in sub-Saharan Africa, according to a report in The Lancet Infectious Diseases. UK investigators conducted a meta-analysis of 213 studies involving approximately 1.2 million people in 33 countries. Overall HCV prevalence was 3%, but this differed between regions and risk groups. Approximately 6% of people with HIV had HCV co-infection.

“We recorded a high seroprevalence of HCV across populations in sub-Saharan Africa, including in HIV-positive adults,” comment the authors. “We identified regional variation.”

Globally up to 150 million individuals are infected with HCV. The infection therefore represents an important global health challenge, especially for poorer countries. Data on the epidemiology of HCV in sub-Saharan Africa is badly out of date. A review published in 2002 found a prevalence of 3% but with significant regional variations. Few studies have looked at rates of HIV/HCV co-infection, but there is some evidence that HIV is associated with a higher risk of infection with HCV.

Investigators wanted to update understanding of the HCV epidemic in the region. They therefore conducted a systematic review and meta-analysis of studies published between 2002 and 2014 that reported on HCV prevalence in sub-Saharan Africa and rates of HIV/HCV co-infection.

Studies were divided according to whether the population was considered low risk for HCV (antenatal clinic attendees; blood donors; patients recruited in the general population), or high risk (patients with liver disease; patients who’d received blood products or had surgery; people who inject drugs). People living with HIV were considered separately.

A total of 287 cohorts were included in the analysis and the overall HCV prevalence rate was approximately 3%. However, this varied between region, ranging from 7% in central Africa to 4% in west Africa and 1% in southeast Africa.

Overall prevalence among low-risk groups was 2.65%. But, once again, there were some regional variations with infection rates highest in central Africa and lowest in southeast Africa.

Just over 3% of antenatal clinic attendees were HCV-positive, an infection rate similar to that seen in the overall low-risk population. The investigators therefore suggest that antenatal patients would be a good population in which to monitor HCV trends in the overall population.

Approximately 12% of high-risk individuals were infected with HCV. Prevalence ranged between 46% in a cohort of people who inject drugs in Kenya to 10% among people with liver disease.

Approximately 6% of people with HIV had HCV co-infection, with rates varying from nearly 7% in west Africa to 4.5% in southeast Africa.

“There is a clear unmet need for prevention and treatment, access to which needs to be improved for both monoinfected and co-infected individuals,” conclude the authors.