Study Estimates Global HCV Prevalence Among Women of Childbearing Age

Having reliable estimates can help governments and relevant agencies develop better test-and-treat strategies to reduce vertical transmission and total disease burden.

A new study has reported on the global prevalence of hepatitis c virus (HCV) among women of childbearing age, but who are not necessarily pregnant.

“Most estimates of HCV prevalence for women of childbearing age (15–49 years) are from studies of pregnant women, particularly those engaged in prenatal care, and probably do not represent the true prevalence in all women within this age group,” wrote the study investigators.

Therefore, the team, led by Ellen Dugan, MPH, Center for Disease Analysis Foundation, CO, conducted a modeling and literature review to determine HCV burden at the global and national levels.

Considering the increasing trends of liver-related morbidity and mortality, HCV burden poses a global health concern. As such, the investigators noted that identifying regional hotspots of disease would be necessary to strategize for screening and treatment plans.

Study Highlights

The team’s analysis was based on country-specific demographics and HCV epidemiology data.

To complement this information, they searched PubMed, Embase, and grey literature for studies published between Jan 1, 2000-June 30, 2018, which reported on antibody or viraemic prevalence in women of childbearing age.

“Studies from the literature review and studies in models were compared by use of a data quality scoring system and models were updated, as appropriate, when a better study was identified,” the investigators wrote.

These models were then used to calculate the 2019 prevalence of HCV in their target population. If countries did not have a model, the team then extrapolated by Global Burden of Disease (GBD) region.

Thus, Dugan and team estimated that 14,860,000 (95% CI, 9,667, 000–18,282,000) of age-relevant women had HCV globally in 2019. This corresponded to a viraemic prevalence of 0.78% (95% CI, 0.62-0.86).

They further noted that prevalence increased with age—thus increasing from 0.25% (95% CI, 0.20-0.27) in women aged 15-19 years to 1.21% (95% CI, 0.97-1.34) in those aged 45-49 years.

As for specific countries, China and Pakistan had the greatest numbers of infections, accounting for 16% and 15%, respectively, of the world’s total infections.

However, viraemic prevalence was notably highest in Mongolia (5.14%; 95% CI, 3.46-6.28) and Burundi (4.91%; 95% CI, 3.80-18.75).

Among the countries with ≥500 cases, Chile had the lowest viraemic prevalence (0.07%; 95% CI, 0.04-0.12.

Viraemic prevalence in the United States was 0.49% (95% CI, 0.37-0.64), with an estimated number of 368,000 cases.

And finally, among the GBD regions, eastern Europe had the highest viraemic prevalence (3.39%; 95% CI, 1.88-3.54); among the World Health Organization (WHO) regions, the Eastern Mediterranean region had the highest viraemic prevalence (1.75%; 95% CI 1.26– 1.90).

Universal HCV Screening

Dugan and her team noted the rarity in recommendations for routine HCV testing among this subpopulation of women. Perinatal HCV screening is likewise rare.

Out of the 26 countries in European Union, 3 routinely perform perinatal HCV screening.

Furthermore, the American Association for the Study of Liver Diseases and the US Centers for Disease Control and Prevention (CDC) started recommending perinatal screening in early 2020.

“However, because risk-based screening remains in place for the general population of women of childbearing age and treatment is not recommended during pregnancy, vertical transmission will not be reduced under these new guidelines,” the investigators wrote. 

Risk-based screening thus runs the risk of leading to underdiagnosis as compared with universal screening.

“Women of childbearing age should be considered a key population to target for HCV prevention because of the potential for vertical transmission and increased use of injection drugs over time among some members of this demographic,” they stressed.

The study, “Global prevalence of hepatitis C virus in women of childbearing age in 2019: a modelling study,” was published online in The Lancet: Gastroenterology & Hepatology.