Published online Aug 28, 2015. doi: 10.3748/wjg.v21.i32.9476
Peer-review started: April 23, 2015
First decision: May 18, 2015
Revised: June 3, 2015
Accepted: July 18, 2015
Article in press: July 18, 2015
Published online: August 28, 2015
We analyzed prevalence, risk factors and hepatitis C virus (HCV) genotype distribution in different population groups in Croatia in the context of HCV epidemiology in Europe, with the aim to gather all existing information on HCV infection in Croatia which will be used to advise upon preventive measures. It is estimated that 35000-45000 of the Croatian population is chronically infected with HCV. Like in other European countries, there have been changes in the HCV epidemiology in Croatia over the past few decades. In some risk groups (polytransfused and hemodialysis patients), a significant decrease in the HCV prevalence was observed after the introduction of routine HCV screening of blood/blood products in 1992. Injecting drug users (IDUs) still represent a group with the highest risk for HCV infection with prevalence ranging from 29% to 65%. Compared to the prevalence in the Croatian general population (0.9%), higher prevalence rates were found in prison populations (8.3%-44%), human immunodeficiency virus-infected patients (15%), persons with high-risk sexual behavior (4.6%) and alcohol abusers (2.4%). Low/very low prevalence was reported in children and adolescents (0.3%) as well as in blood donors (0%-0.009%). In addition, distribution of HCV genotypes has changed due to different routes of transmission. In the general population, genotypes 1 and 3 are most widely distributed (60.4%-79.8% and 12.9%-47.9%, respectively). The similar genotype distribution is found in groups with high-risk sexual behavior. Genotype 3 is predominant in Croatian IDUs (60.5%-83.9%) while in the prison population genotypes 3 and 1 are equally distributed (52.4% and 47.6%). Data on HCV prevalence and risk factors for transmission are useful for implementation of preventive measures and HCV screening.
Core tip: As in other European countries, epidemiology of hepatitis C has changed in Croatia in last few decades. In addition, changes in the hepatitis C virus (HCV) genotype distribution were observed due to changes in prevailing routes of transmission. Although a decline in HCV prevalence was observed in some risk groups (polytransfused and hemodialysis patients), HCV prevalence is still high in injecting drug users (IDUs) (29%-65%), reaching 100% in older injectors and those reporting sharing injection equipment. In addition, a high HCV prevalence (8.3%-44%) was found in Croatian prisoners reflecting high proportion of IDUs within this population group. Since IDUs represent a group with the highest risk for HCV, strategies to reduce risk among IDUs should be considered.