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Prevalence and risk factors of Hepatitis C virus infection in Brazil, 2005 through 2009: a cross-sectional study

Leila MMB Pereira12, Celina MT Martelli34, Regina C Moreira5, Edgar Merchan-Hamman6, Airton T Stein7, Regina Maria A Cardoso8, Gerusa M Figueiredo8, Ulisses R Montarroyos14, Cynthia Braga9, Marília D Turchi3, Gabriela Coral7, Deborah Crespo10, Maria Luiza C Lima119, Luis Claudio A Alencar1, Marcelo Costa12, Alex A dos Santos13 and Ricardo AA Ximenes14*

Author affiliations

1 Universidade de Pernambuco, Faculdade de Ciências Médicas de Pernambuco, Hospital Universitário Oswaldo Cruz, Rua Arnóbio Marques, 310, Santo Amaro, CEP: 50100-130, Recife, PE, Brazil

2 Instituto do Fígado de Pernambuco, Rua Aluísio Azevedo, 209, Santo Amaro, 50.100-130, Recife, PE, Brazil

3 Universidade Federal de Goiás, Instituto de Patologia Tropical e Saúde Publica, Departamento de Saúde Coletiva, Rua Delenda Rezende de Mello, s/n, sala 405, Setor Universitário, CEP: 74605050, Goiânia, GO, Brazil

4 Universidade Federal de Pernambuco, Departamento de Medicina Tropical, Av. Prof. Moraes Rego, s/n, Cidade Universitária, CEP: 50670-420, Recife, PE, Brazil

5 Instituto Adolfo Lutz, Av. Dr. Arnaldo, nº 355, Cerqueira Cézar, CEP: 01246-902, Capital, SP, Brazil

6 Universidade de Brasília, Faculdade de Ciências da Saúde, Departamento de Saúde Coletiva. DSC - Faculdade de Saúde, Campus Universitário Darcy Ribeiro – Asa Norte, CEP: 70910-900, Brasília, DF, Brazil

7 Fundação Universidade Federal de Ciências da Saúde de Porto Alegre, Rua Sarmento Leite, 245, Bom Fim, CEP: 90050-170, Porto Alegre, RS, Brazil

8 Departamento de Epidemiologia, Universidade de São Paulo, Faculdade de Saúde Pública, Avenida Dr. Arnaldo 715, Cerqueira Cesar, 01246-904, São Paulo, SP, Brazil

9 Fundação Oswaldo Cruz, Centro de Pesquisas Aggeu Magalhães, Av Moraes Rego, s/n, Cidade Universitária, CEP: 50000-230, Recife, PE, Brazil

10 Secretaria de Saúde Pública do Estado do Pará, Av. Conselheiro Furtado, 1597, CEP 66040-100, Belém, PA, Brazil

11 Universidade Federal de Pernambuco, Departamento de Medicina Preventiva e Social, Av. Prof. Moraes Rego, s/n, Cidade Universitária, CEP: 50670-420, Recife, PE, Brazil

12 Hospital de Base do DF, Area Especial, Asa Sul, CEP:70.335-900, Brasília, DF, Brazil

13 Instituto Bioestatístico –IBCT, Rua Bernal do Couto, 1311, Umarizal, CEP: 67150-050, Belem, PA, Brazil

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Citation and License

BMC Infectious Diseases 2013, 13:60  doi:10.1186/1471-2334-13-60

Published: 1 February 2013



Hepatitis C chronic liver disease is a major cause of liver transplant in developed countries. This article reports the first nationwide population-based survey conducted to estimate the seroprevalence of HCV antibodies and associated risk factors in the urban population of Brazil.


The cross sectional study was conducted in all Brazilian macro-regions from 2005 to 2009, as a stratified multistage cluster sample of 19,503 inhabitants aged between 10 and 69 years, representing individuals living in all 26 State capitals and the Federal District. Hepatitis C antibodies were detected by a third-generation enzyme immunoassay. Seropositive individuals were retested by Polymerase Chain Reaction and genotyped. Adjusted prevalence was estimated by macro-regions. Potential risk factors associated with HCV infection were assessed by calculating the crude and adjusted odds ratios, 95% confidence intervals (95% CI) and p values. Population attributable risk was estimated for multiple factors using a case–control approach.


The overall weighted prevalence of hepatitis C antibodies was 1.38% (95% CI: 1.12%–1.64%). Prevalence of infection increased in older groups but was similar for both sexes. The multivariate model showed the following to be predictors of HCV infection: age, injected drug use (OR = 6.65), sniffed drug use (OR = 2.59), hospitalization (OR = 1.90), groups socially deprived by the lack of sewage disposal (OR = 2.53), and injection with glass syringe (OR = 1.52, with a borderline p value). The genotypes 1 (subtypes 1a, 1b), 2b and 3a were identified. The estimated population attributable risk for the ensemble of risk factors was 40%. Approximately 1.3 million individuals would be expected to be anti-HCV-positive in the country.


The large estimated absolute numbers of infected individuals reveals the burden of the disease in the near future, giving rise to costs for the health care system and society at large. The known risk factors explain less than 50% of the infected cases, limiting the prevention strategies. Our findings regarding risk behaviors associated with HCV infection showed that there is still room for improving strategies for reducing transmission among drug users and nosocomial infection, as well as a need for specific prevention and control strategies targeting individuals living in poverty.

Hepatitis C virus; Prevalence; Genotype; Cross sectional study; Risk factors