AND THE COLLABORATIVE STUDY GROUP 4 drug abuse (21 cases, 14 men all Γ΅ 40-years-old), previous The aims of this study were the following: 1) to estitransfusion (22 cases, 18 women), and not having paid mate the prevalence of hepatitis C virus (HCV) antibody employment. Although routes of transmission other (anti-HCV) in a population-based survey of French resithan IV drug abuse and transfusion may not be formally dents not selected for risk factors; 2) to investigate the excluded they were not found to be statistically signifiassociation between anti-HCV seropositivity, viremia, cant. Hepatitis C appears to be a major public health the infecting HCV genotype, and the alanine transamiconcern in France. A more active screening policy may nase (ALT) level; and 3) to identify risk factors for HCV be required because only 17 of 72 cases (24%) were aware infection by a nested case control study within this surof their HCV seropositivity before enrollment in the vey sample. The anti-HCV seroprevalence survey was study. (HEPATOLOGY 1997;25:1490-1496.) performed in 6,283 volunteers (20-to 59-years-old) randomly selected from 45,377 consecutive individuals undergoing routine medical checkup in social security
Primo-infection with hepatitis C virus (HCV) is usually medical centers covering 4 of the 22 ''re Β΄gions'' of France. asymptomatic. Only 10% of patients become jaundiced, and Seventy-two volunteers were anti-HCV positive, a crude the clinical course is usually mild. 1 The most serious conseprevalence of 1.15%. Fifty percent of these positive volquences of HCV result from chronic infection. However, the unteers also had an abnormal ALT level and 81% were development of an HCV carrier state without major liver HCV-RNA positive by polymerase chain reaction (PCR). anomalies as assessed by liver function tests is not uncom-The prevalence weighted for age, sex, and place of resimon and some patients with histological evidence of chronic dence was 1.05% (95% CI: 0.75-1.34). The weighted prevaactive hepatitis or cirrhosis present minimal clinical evidence lence was lower among men ΓΊ 40-years-old (0.5%; 95% of liver disease. 2,3 HCV infection is most commonly identified CI: 0.1-1.0) and was close to 1% in all other age and sex following diagnosis of chronic liver disease of 10 to 30 years groups. Prevalence was inversely correlated with socioduration. 4 Surveys of overt clinical infections thus give a poor professional status with the highest rate being found estimate of the overall prevalence of HCV infection in the among those with no paid employment (2.2%; 95% CI: general population. Only seroprevalence studies using large 1.3-3.0). The HCV prevalence (1.7%; 95% CI: 1.0-2.3) was numbers of subjects not selected for risk factors can yield highest in southeastern France. Seventy-eight percent accurate information on the health burden associated with of positive intervenous (IV) drug abusers were infected HCV in the general population. Although long-term mortality with HCV genotypes 1a or 3, whereas 80% of the transfuassociated with chronic hepatitis C remains to be detersion-associated cases were infected by HCV genotypes mined, 5 prevalence data from representative surveys would 1b or 2a. Only three variables were significantly associhelp plan clinical and prevention activities. ated with HCV seropositivity in multivariate analysis: IV
Most available information about HCV antibody (anti-HCV) seroprevalence in the French population are from studies of high risk groups, 6-8 blood donors (anti-HCV prevalence from 0.6% to 0.8% in 1991, 9,10 and 0.3% in 1994 11 ), and preg-Abbreviations: HCV, hepatitis C virus; anti-HCV, HCV antibody; ELISA, enzyme-linked nant women (prevalence from 1% to 2%). 12 immunosorbent assay; SIA, strip immunoblot assay; PCR, polymerase chain reaction; ALT, alanine transaminase; IV, intravenous; CI, confidence interval; OR, odds ratio.
We report results of a population-based survey of the prev-From the