The epidemiological picture of hepatitis C virus (HCV) infection in the general population is largely unknown, even in developed countries. The aim of this study was to estimate the prevalence and genotype distribution of HCV amongst a large sample of the Italian general population. A total of 3,577 serum samples were collected and screened for anti-HCV antibodies. ELISA and RIBA tests were used to assess the presence of anti-HCV. NS5b region sequencing was performed for molecular characterization. Of 3,577 tested sera, 95 (2.7%) were anti-HCV positive and a genome was detected and sequenced in 50 sera. The age-adjusted prevalence was 4.4%. Seroprevalence increased with age, following a North-South gradient, and increased steeply between the 15 and 30 and 31-45 age groups. Subtype 1b showed the highest prevalence in all geographical areas and age groups, followed by subtypes 2c (detected mainly in the elderly population in Southern Italy), 4a/d, and 3a (detected exclusively in adults) and 1a. These findings confirm that Central and Southern Italy are hyperendemic areas. The high prevalence observed in adults over age 30 is mainly attributable to an increase in 1b-prevalence but also to subtypes 2c- and 3/4-infections. Age-specific prevalence data and molecular characterization of the virus suggest that two transmission patterns co-exist in Italy: one characterized by subtype 1b and 2c infections, mainly in adults older than 60 years, and the other by subtype 3 and 4 infections, mainly in the 31-60 year age group, and consistent with intravenous drug use and immigration.
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