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PLoS One. 2017 Nov 14;12(11):e0187893. doi: 10.1371/journal.pone.0187893. eCollection 2017.

Evolution of acute hepatitis C virus infection in a large European city: Trends and new patterns.

Author information

Epidemiology Service, Public Health Agency of Barcelona, Barcelona, Spain.
Spanish Field Epidemiology Training Programme (FETP/PEAC), National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain.
CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
Liver Unit, Hospital Clínic, Barcelona. IDIBAPS, Barcelona, Spain.
CIBER of Hepatic and Digestive Diseases (CIBERehd), Madrid, Spain.
Internal Medicine-Infectious Diseases, Hospital del Mar, Barcelona, Spain.
Hospital Clinic- August Pi i Sunyer Biomedical Research Institute, University of Barcelona, Barcelona, Spain.
Infectious Diseases, Hospital Vall de Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, CIBERehd, Barcelona, Spain.
Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
Sexually Transmitted Infections Unit, Hospital Vall de Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
Liver Unit, Internal Medicine, Laboratory of Malalties Hepàtiques, Vall d'Hebron Institut de Recerca-Hospital Universitari Vall d´Hebron, (VHIR-HUVH), Universitat Autònoma de Barcelona, Barcelona, Spain.


The aims of this study were to describe the evolution of acute hepatitis C virus (HCV) infections since 2004 and to determine its associated factors. Acute HCV infections diagnosed in Barcelona from 2004 to 2015 were included. Incidence ratios (IR) were then estimated for sex and age groups. Cases were grouped between 2004-2005, 2006-2011 and 2012-2015, and their incidence rate ratios (IRR) were calculated. In addition, risk factors for acute HCV infection were identified using multinomial logistic regression for complete, available and multiple imputed data. 204 new HCV cases were identified. Two peaks of higher IR of acute HCV infection in 2005 and 2013 were observed. Men and those aged 35-54 had higher IR. IRR for men was 2.9 times greater than in women (95% confidence intervals (CI): 1.8 ‒ 4.7). Factors related to the period 2012-2015 (versus 2006-2011) were: a) sexual risk factor for transmission versus nosocomial (relative-risk ratio (RRR): 13.0; 95% CI: 2.3 ‒ 72.1), b) higher educated versus lower (RRR: 5.4; 95% CI: 1.6 ‒ 18.7), and c) HIV co-infected versus not HIV-infected (RRR: 53.1; 95% CI: 5.7 ‒ 492.6). This is one of the few studies showing IR and RRRs of acute HCV infections and the first focused on a large city in Spain. Sexual risk for transmission between men, higher educational level and HIV co-infection are important factors for understanding current HCV epidemic. There has been a partial shift in the pattern of the risk factor for transmission from nosocomial to sexual.

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