Expanding the epidemiological understanding of hepatitis C in South Africa: Perspectives from a patient cohort in a rural town

Abstract

Globally, ~71 million people are viraemic for hepatitis C virus (HCV) infection, with 10.2 million (14%) residing in sub-Saharan Africa. [1] The prevalence of HCV in South Africa (SA) is <1%, with modelled data suggesting ~600 000 infected. [2] Despite typical HCV transmission risks being present in SA, such as people who inject drugs (PWID), pre-1992 blood or blood products (before universal HCV screening was introduced into blood services), parenteral injuries in healthcare workers and traditional practices such as scarification, HCV epidemiology is incompletely characterised. Historically, blood transfusion service HCV incidence, as a marker of the general population in SA, is low at 0.03 -0.1%. [3,4] Unsurprisingly, recent data from key populations in SA demonstrate a high prevalence of HCV and HIV-HCV co-infection. [5] HCV prevalence studies in men who have sex with men (MSM) have demonstrated rates of 6%, with genotype (GT) 1a and 3a the predominant genotypes identified. [6] Interestingly, to date no GT5a, an HCV genotype unique to SA, has been identified in any of the key population studies in SA. Local key population data align with global epidemiology as the current major drivers of ongoing HCV infection. [7] Key population patients tend to be younger, the median age being 29 years in SA, whereas the other HCV prevalence peak comprised people invariably >50 years of age. [5,6,8] In recent data from Cape Town looking at a general HCV patient cohort accessing treatment, 26% of patients had no identifiable risk factor, possibly pointing towards other parenteral exposure, e.g. through traditional or unsafe medical practices, as a likely means of transmission. [9] Rwandan data also identified that, in This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

Hepatitis C Virus Genotype 5 Variability in Treatment-Naïve Patients in South Africa

“…Sustained virologic response (SVR) rates of 71-77% and 64% after treatment of genotype 5 infections with pegylated interferon + ribavirin have been reported in South Africa and France, respectively [51][52][53]. DAA treatment of HCV in South Africa has been reported in a pilot study of 21 individuals [20]. The overall SVR was 95%; however, only 8 individuals with genotype 5 were evaluated.…”

“…Multiple studies have reported that HCV genotype is a determinant of treatment response and disease pathogenesis [11][12][13][14]. HCV genotype 5 was originally identified in South Africa [15,16], where it represents 35-60% of all HCV genotypes [16][17][18][19][20]. However, pockets of genotype 5 infections have been reported in France, Spain, Syria, Greece, Botswana, Ethiopia, India, and Belgium [21][22][23][24][25][26][27][28][29][30][31][32].…”