Epidemiology of Hepatitis C Virus Infection Among 1,959 Patients in Shiraz, Southern Iran, Between 1991 and 2016

Background: Hepatitis C virus (HCV) infection is an important public health hazard, with approximately 71 million chronically HCV-infected individuals around the world. Objectives: This study was designed to provide epidemiologic information on HCV, evaluate the possible route of transmission and its associated risk factors, and characterize the prevalence and distribution of HCV genotypes among HCV-infected patients in Fars Province, Southern Iran. Methods: This cross-sectional descriptive-analytical study was performed with the medical records of patients with HCV infection who had referred to the Gastroenterohepatology Research Center, Shiraz, Iran. The extracted data had been gathered from 1991 to 2016. The data included the time of diagnosis, demographic information, information on the course of the disease (including symptoms at disease onset), history of exposure to possible routes of transmission, risk factors, HCV genotype (if available), and family history of HCV infection. The relationship between two categorical variables was determined using the chi-square or Fisher's exact tests. The relationship between categorical and quantitative variables was tested by one-way ANOVA. The Kendall-tau test was used to show the changing trends of risk factors regarding age and year groups. Univariate analysis was done and odds ratios were calculated to determine the relationship between genotypes and possible routes of HCV transmission. Results: From the total of 1,959 patients, 1,748 (88.20%) were males. An analysis of the trend of possible risk factors showed that the prevalence of cupping, intravenous drug use (IVDU), non-intravenous drug use (non-IVDU), penetrating trauma, tattooing, and high-risk sexual behaviors significantly increased over the study period. A significant reduction was observed in the rate of major thalassemia. The most prevalent HCV genotype was genotype 1(49.3%), followed by genotype 3 (39.6%). Multivariate analysis of the possible routes of transmission revealed that cupping was associated with the increased risk of HCV genotype 1 infection. Conclusions: This study reports non-IVDU as the most common associated risk factor and genotype 1 as the most prevalent genotype in patients infected with HCV. Knowing risk factors can lead to making better policies and implement more effective interventions to prevent the spread of HCV infection.