Epidemiology of hepatitis C viral infection

Dear Sir,

The Review paper published by Chigurupati et al. ^[1] has discussed the incidence of hepatitis C viral infection among hemodialysis patients. The study results reveal an infection rate of 23% among the patients undergoing hemodialysis. Hepatitis C virus (HCV) infection is a blood-borne viral infection belonging to the RNA group of viruses that are spherical, enveloped, measure around 50 nm, possess a positive (+) sense single-stranded RNA as their nucleic acid, and belong to the Flaviviridae family and the genus Hepacivirus. HCV is primarily transmitted through parenteral route (exposure to blood and blood products), blood transfusion, intravenous drug use (IDU), and vertical route (from mother to child). Although less efficient, other modes of HCV transmission include occupational exposure, unsafe sexual contact, tattooing, and body piercing as in acupuncture. Household exposure resulting in percutaneous or mucous membrane exposure to infected blood (sharing razors/shrapnels and toothbrush) can also transmit HCV. ^[2] Global prevalence of HCV varies geographically, and the prevalence rates among the high-risk group differ from that of the general population. Most of the studies in India have stated that there was more than 20% prevalence among the patients undergoing hemodialysis, as in the case of the current study. Although India has a very low prevalence of both hepatitis B virus (HBV) (3.7%) and HCV (<2%) as compared to other developing countries, the cause of concern is the lack of reliable data on the epidemiology of HCV infection. ^[3],[4] A recent study that was conducted by me and my colleagues on the patients attending a tertiary care hospital (Prathima Institute of Medical Sciences Hospital) has revealed a low prevalence rate of HCV (0.04%) as compared to HBV (1.8%) and human immunodeficiency virus (HIV) (1.5%). ^[5]

The availability of a vaccine and inclusion of the vaccine in immunization programs in India and many other countries may lower the incidence of HBV in the future, but the cause of concern is the nonavailability of a vaccine against HCV. Although HCV prevalence rates are lower in the general population, the infection rates are significantly high in the risk groups. Considering the fact that HCV appears in different genotypes, studies in the future must be encouraged to find the prevalent genotype and the specific genotype found in particular groups of population. As there is no available vaccine recommended against HCV, prevention of HCV transmission remains a mainstay in reducing newer infections. As HCV infection initiates both hepatic and extrahepatic inflammation and since antiviral therapy against HCV may lead to toxic side effects, studies must be encouraged on pretherapeutic assessment and continuous and regular monitoring of the patients on treatment. Identification of comorbidities (coinfection with HBV, HIV, alcoholism, and extreme age) can help in reducing the morbidity and mortality associated with HCV infection. Epidemiological studies on the prevalence of HCV infection and distribution of genotypes in various geographical regions, and planning and implementation of specific guidelines in the diagnosis of acute and chronic HCV infection is the need of the hour.

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1755-6783.162401