Hepatitis C virus infection and alanine transaminase levels in the generalpopulation: a survey in a southern Italian town

Background/Aim: The aim of the study was to estimate the prevalence, risk f actors and genotype distribution of hepatitis C virus (HCV) in the general population older than 5 years of age in a southern Italian town. The positi ve predictive value of alanine transaminase (ALT) screening in identifying HCV positive subjects was also assessed. Methods: Cluster random sampling from the census of the general population was used. ELISA and RIBA tests assessed the presence of anti-HCV; nested re verse transcription polymerase chain reaction (RT-PCR) was used to identify HCV-RNA; genotyping was performed by INNO-LIPA III. The association linkin g anti-HCV seropositivity with potential risk factors was assessed by multi ple logistic regression analysis. Results: Among the 488 subjects enrolled, 79 (16.2%) were anti-HCV positive . The prevalence increased from 1.2% in subjects 6-29 years of age to 42.1% in those greater than or equal to 60 years. Forty percent of these positiv e subjects also had abnormal ALT level and 54.4% were HCV RNA positive by P CR, The positive predictive value of the ALT test in identifying anti-HCV p ositive subjects was 65%; however, it was 46.7% in subjects younger than 60 years of age and 90.5% in those 60 or older. Genotype Ib was detected in 7 4% of subjects, type 2c in 23.3%, and type 1a in 2.3%. The only two variabl es significantly associated with HCV seropositivity in multivariate analysi s were age older than 45 years (O.R. 8.5; CI 95% = 3.0-24.1) and past use o f glass syringes (O.R. 3.4; CI 95% = 1.5-7.6). Conclusions: These findings confirm that HCV infection is endemic in southe rn Italy, particularly among the elderly. Percutaneous exposure, such as in jections with nondisposable, multiple-use, glass syringes used in the past for medical purposes may have played a major role in the spread of HCV infe ction. ALT screening is not useful in detecting HCV positive subjects in th e general population, particularly among subjects who could benefit from an tiviral therapy.