The evolving incidence of hepatitis C virus infection in Italy.

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KOWSAR
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The Evolving Incidence of Hepatitis C Virus Infection in Italy
Rinaldo Pellicano 1*, Sharmila Fagoonee 2
1 Department of Gastroenterology and Hepatology, Molinette Hospital, Turin, Italy
2 Molecular Biotechnology Center, University of Turin, Turin, Italy
A R T I C L E I N F O
Article history:
Received: 24 Dec 2012
Revised: 01 Jan2012
Accepted: 12 Jan 2012
Keywords:
Hepatitis C
Liver Cirrhosis
Epidemiology
Article type:
Letter to Editor
Please cite this paper as:
Pellicano R, Fagoonee S. The Evolving Incidence of Hepatitis C
Virus Infection in Italy. Hepat Mon. 2012;12(2):124-5. DOI: 10.5812/
hepatmon.820
Copyright c 2012 Kowsar M. P. Co. All rights reserved.
Hepat Mon. 2012;12(2):124-125. DOI: 10.5812/hepatmon.820
* Corresponding author: Rinaldo Pellicano. Surgeries of Gastroenterology
and Hepatology, Hospital-Based Molinette SGAS Via Cavour 31-rd floor,
10123, Torino, Italy. Tel: +39-6333565 (ext: 011), Fax: +39-6333623; (ext: 011),
E-mail: rinaldo_pellican@hotmail.com
DOI: 10.5812/hepatmon.820
Copyright c2012 Kowsar M.P.Co. All rights reserved.
Dear Editor,
The epidemiology of chronic liver diseases (CLD) in Ita-
ly is changing. This is due to the decreasing rate of viral
hepatitis (1) and the increased number of steatosis and
nonalcoholic steatohepatitis cases, which are emerging
as a new epidemic with a wide spectrum of metabolic
disorders (2). This scenario reflects what has occurred
in Italy over the last few decades, as the vaccination
program against the Hepatitis B virus (HBV), mandatory
since the 1991, has helped to achieve complete immuni-
zation of newborns, adolescents and young adults (3). Si-
multaneously, the epidemiology of the Hepatitis C virus
(HCV) has evolved, due to factors such as increased blood
transfusion safety, improvements in healthcare condi-
tions, continuing expansion of intravenous drug use
(IDU) and immigration from endemic areas. The lack of
a prophylactic vaccine or universally active therapy has
made the prevention of this chronic infection extremely
important. Identification of infected persons and of the
risk factors associated with acquiring a HCV infection
may allow the development of strategies to reduce its in-
cidence and control the resulting epidemic (4).
The prevalence of the HCV in Europe is nearly 1%, but
this varies geographically along a north-south gradient,
ranging from approximately 0.5% in Northern countries
to 2% in Mediterranean areas (5). In Northern Italy, the
Dionysos study collected data regarding 6,917 inhabit-
ants of two towns (Campogalliano and Cormons). The
overall prevalence of positivity to the HCV antibody was
found to be 3.2%. When the prevalence was analysed ac-
cording to different age groups, it was relatively low ( <
1%) up to 40 years, but the rate rose sharply thereafter, to
reach a value of 10% in subjects older than 60 years (6).
This suggested a cohort effect. In a rural area of Central
Italy, Raffaele et al. carried out a prevalence study, which
included 344 subjects selected by random sampling
among 3,308 inhabitants older than 16 years. The in-
ferred HCV positivity prevalence rate was 22.4% with an
increased trend particularly evident as a result of ageing
(7). In a Southern Italian town, Cozzolongo et al. found a
seroprevalence for anti-HCV positivity of 2.6%; this preva-
lence increased from 1% in subjects aged < 30 years to 7.7%
in those > 70 years (8). The incidence of HCV infection is
very difficult to estimate accurately because many pa-
tients with acute HCV infection are asymptomatic, and
thus, do not present themselves for diagnosis (4). Data
from the US suggests that the annual incidence of HCV
infection fell from 230,000 new cases per year in the

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The Evolving Incidence of Hepatitis C
Pellicano R
Hepat Mon. 2012;12(2):124-125
late 1980s to approximately 35,000 new cases per year
in the 1990s (4). In Northern Italy, Mazzeo et al. carried
out a study on the ten year incidence of HCV infection in
a representative cohort of 1,646 adults from the general
population of two Apennine hill towns. The incidence
was 50.3 cases per 100,000 inhabitants/year while 16.9%
of anti-HCV positive subjects spontaneously cleared the
virus while 7 out of 11 also lost HCV-RNA from both serum
and leukocytes (9). Although Italian scientific literature
is rich with controversial epidemiological data obtained
in limited populations, the pattern of HCV infection in
the whole population overall is poorly defined. In a re-
cent issue of Hepatitis Monthly, La Torre et al. estimated
HCV infection trends in Italy during the years 1996-2006
(10). To evaluate the incidence rates, the authors inte-
grated specific ministerial data (Ministry of Health) with
population data from the National Institute of Statistics
(ISTAT), a public and independent research organization.
A strong reduction was observed in the analyzed years
(-12,45%), distributed equally among males (-12,23%) and
females (-12,8%). Considering all age groups, the inci-
dence rate decreased from 2.02 to 0.55 per 100,000. This
reduction was significant in all age groups (10). Reported
prevalence and incidence rates of HCV infection in the
community vary, not only depending on the specificity
and sensitivity of the method used, but also according
to the study design, geographical origin, and other char-
acteristics of the included populations (4). Many studies
have been carried out in blood donors or in other spe-
cific populations (for example intravenous drug users).
Scarce data is however available in the general popula-
tion. The strengths of the study by La Torre et al. lie in the
study design, which included the whole population over
a long period of follow-up, and in the use of the joinpoint
regression method. The latter is useful in determining
the occurrence of changes during distinct periods of
time in trend data. Thus, it identifies the calendar years
in which statistically significant changes in the trends
occur, and the annual percentage of change within the
identified period. On the other hand, the potential limi-
tations, as reported by the authors, are the poor quality
of reporting. In conclusion, studies such as that of La
Torre et al. (10), are crucial in increasing our knowledge
of worldwide HCV infection rates and to plan health pol-
icy strategies.
Authors’ Contribution
R.P: idea, literature reviewing and manuscript writing;
S.F literature reviewing and contribution to manuscript
writing
Financial Disclosure
None declared.
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