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Reused medical needles lead to most HCV infections in India

Recently published data from India revealed that reused needles and syringes at dental and therapeutic facilities were the most common modes of hepatitis C infection. Researchers further observed a higher prevalence of hepatitis C among patients who were men, middle aged, low to middle socioeconomic status, and those who resided in rural areas. 

“As there exists a regional variation in the prevalence of HCV and health care practices, studying the clinical profile of HCV in different parts of the world assumes significance for the development of strategies to prevent and treat HCV infection,” the researchers wrote. “This information can have a great impact on making and/or reshaping policies on screening and curing the current infections as well as preventing new ones.”

The cohort comprised 8,035 patients seen at a facility in Punjab, India. Median age at presentation was 43 years (18-85 years) and 52.2% were aged 41 to 60 years. Most patients resided in rural areas (69.8%), belonged to middle (46.2%) and lower socioeconomic status (34.1%), and the ratio of men to women was 2.15.

Of the 6,561 patients with identifiable risk factors for HCV, the most common modes of infection included history of dental treatment (51.9%) and therapeutic injections (44.9%) with used needles or syringes, followed by surgical procedures (13.03%) and blood transfusion (2.5%).

At initial diagnosis, most patients had chronic HCV (55.8%) and many had cirrhosis (44.2%). Among the patients with cirrhosis, 12.9% had decompensation and 5.4% had hepatocellular carcinoma. Factors associated with cirrhosis and HCC at presentation included male sex, age older than 40 years and rural residence (P < .05). Most patients who presented with cirrhosis had a family history of HCV and received a diagnosis during family screening.

HCV genotype 1 and genotype 3 were the most common and were more often present among patients with a history of surgical intervention, tattooing and injection drug use (P < .05).

While only 2,435 of the 6,291 patients eligible for antiviral therapy agreed to undergo treatment, often due to the high cost of therapy and complications associated with pegylated interferon and ribavirin, the proportion of patients opting for treatment increased after the introduction of direct-acting antivirals (77.7%).

“The two most commonly identified probable risk factors for HCV infection in our study were exposure to therapeutic injections with reused needles and syringes and a past history of dental treatment,” the researchers concluded. “This emphasizes the need of national policies ensuring supervision and monitoring of all aspects of injection use in health care settings, especially mandatory use of disposable syringes and needles. Formulation and implementation of policies for proper disinfection and sterilization of equipment in dental and other surgical procedures and screening of patients before procedures can help in prevention of spread of HCV.” – by Talitha Bennett

Disclosure: The researchers report no relevant financial disclosures.