Original Article| Volume 53, P79-84, July 2018

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Declining prevalence and increasing awareness of HCV infection in Italy: A population-based survey in five metropolitan areas

Published:February 20, 2018DOI:


      • In Italy the seroprevalence for anti-HCV among the general population is outdated.
      • We evaluated 4907 subjects in 5 metropolitan areas.
      • The birth-cohort prevalence peaked in elderly.
      • Nearly 80% of the anti-HCV subjects were aware of their status.
      • This epidemiological pattern does not warrant a policy of screening in Italy.



      Data on the prevalence of hepatitis C virus (HCV) infection in Italy are outdated and usually derived from studying residents in small towns.


      To assess prevalence of and risk factors for HCV infection among Italian residents in 5 metropolitan areas, subjects ≥20 years of age were randomly selected from the list of the general practitioners' registers in 2015. Anti-HCV was tested by a salivary test; HCV-RNA, HCV genotypes, and ALT were determined in positive individuals. Logistic regression analysis evaluated independent risk factors for HCV.


      Of the 4907 enrolled subjects, 112 (2.3%) tested anti-HCV positive. The prevalence of HCV increased with age, from 0.2% in subjects born after the year 1984, to 4.2% in those born before the year 1935 (P < 0.01). The birth-cohort prevalence peaked (7.0%) in elderly. Serum HCV-RNA was detected in 1.7% of the whole population. Nearly 80% of anti-HCV subjects were aware of their status. Age > 70 years, low education level, past use of glass syringes, blood transfusion, intravenous drug use, and cohabitation with an anti-HCV positive subject predicted the HCV positivity.


      In metropolitan areas in Italy, HCV is prevalent in elderly, reflecting a cohort effect determined by modalities of viral transmission no longer operative. The impact of the infection will further diminish in the years to come due to the natural depletion of the reservoir of the virus. This age pattern and the high proportion of subjects aware of their status do not warrant a policy of screening.


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        • Cornberg M.
        • Razawi H.A.
        • Alberti A.
        • et al.
        A systematic review of hepatitis C virus epidemiology in Europe, Canada, and Israel.
        Liv Intern. 2011; 31: 30-60
        • Sagnelli E.
        • Stroffolini T.
        • Mele A.
        • Almasio P.
        The importance of HCV on the burden of chronic liver disease in Italy: a multicentre study.
        J Med Virol. 2005; 75: 522-527
        • The Writing Committee on behalf of the Consensus Panel
        Expert Consensus Conference: the screening for hepatitis C virus infection in adults in Italy, May 5–6, 2005.
        Dig Liver Dis. 2006; 38: 445-451
        • Mariano A.
        • Scalia Tomba G.
        • Tosti M.E.
        • et al.
        Estimating the incidence, prevalence and clinical burden of hepatitis C over time in Italy.
        Scand J Infect Dis. 2009; 41: 689-699
        • Guadagnino V.
        • Stroffolini T.
        • Rapicetta M.
        • et al.
        Prevalence, risk factors, and genotype distribution of hepatitis C virus infection in the general population: a community-based survey in southern Italy.
        Hepatology. 1997; 26: 1006-1011
        • Guadagnino V.
        • Stroffolini T.
        • Caroleo B.
        • et al.
        Hepatitis C virus infection in an endemic southern area of Italy 14 years later: evidence for a vanishing disease.
        Dig Liver Dis. 2013; 45: 403-407
        • Osella A.R.
        • Misciagna G.
        • Leone A.
        • et al.
        Epidemiology of hepatitis C virus infection in an area of southern Italy.
        J Hepatol. 1997; 27: 30-35
        • Cozzolongo R.
        • Osella A.R.
        • Elba S.
        • et al.
        Epidemiology of HCV infection in the general population: a survey in a southern Italian town.
        Am J Gastroenterol. 2009; 104: 2740-2746
        • Bellentani S.
        • Pozzato G.
        • Saccoccio G.
        • et al.
        Clinical course and risk factors of hepatitis C virus related liver disease in the general population: report from the Dionysos study.
        Gut. 1999; 44: 874-880
        • Maio G.
        • d'Argenio P.
        • Stroffolini T.
        • et al.
        Hepatitis C virus infection and alanine transaminase levels in the general population: a survey in a southern Italian town.
        J Hepatol. 2000; 33: 116-120
        • Pendino G.M.
        • Mariano A.
        • Surace P.
        • et al.
        Prevalence and aetiology of altered liver tests: a population based survey in a Mediterranean town.
        Hepatology. 2005; 41: 1151-1159
        • Ansaldi F.
        • Bruzzone B.
        • Salmaso S.
        • et al.
        Different seroprevalence and molecular epidemiology patterns of hepatitis C virus infection in Italy.
        J Med Virol. 2005; 76: 327-332
        • Fabris P.
        • Baldo V.
        • Baldovin T.
        • et al.
        Changing epidemiology of HCV and HBV infections in northern Italy.
        J Clin Gastroenterol. 2008; 42: 527-532
        • Mazzeo C.
        • Azzaroli F.
        • Giovanelli S.
        • et al.
        Ten year incidence of HCV infection in northern Italy and frequency of spontaneous viral clearance.
        Gut. 2003; 52: 1030-1034
        • Morisco F.
        • Loperto I.
        • Stroffolini T.
        • et al.
        Prevalence and risk factors of HCV infection in a metropolitan area in southern Italy: tail of a cohort infected in past decades.
        J Med Virol. 2017 Feb; 89 (Epub 2016 Jul 27): 291-297
        • Stroffolini T.
        • Mariano A.
        • Iantosca G.
        Reported risk factors are useless in the detection of HCV-positive subjects in the general population.
        Dig Liver Dis. 2004; : 36.547-50
        • Esteban J.I.
        • Sauleda S.
        • Quer J.
        The changing epidemiology of hepatitis C virus infection in Europe.
        J Hepatol. 2008; 48: 148-162
        • Larrat S.
        • Bourdon C.
        • Baccardi M.
        • et al.
        Performance of an antigen-antibody combined assay for hepatitis C virus testing without venipuncture.
        J Clin Virol. 2012; 55: 220-225
        • ISTAT – National Statistics Institute of Italy
        Population census, interpolated and extrapolated population tables.
        (Available at: (Last accessed on March 19, 2016)
        • Kondili L.A.
        • Chionne P.
        • Costantino A.
        • et al.
        Infection rate and spontaneous seroreversion of anti-hepatitis C during the natural course of hepatitis C virus infection in the general population.
        Gut. 2002; 50: 693-696
        • Reitox Italian Focal Point
        National report to the European monitoring centre for drugs and drug addiction.
        (Available at)
        • Caporaso N.
        • Ascione A.
        • Sroffolini T.
        Spread of hepatitis C infection within families. Investigations of an Italian multicenter group.
        J Viral Hepat. 1988; 1: 67-72
        • Stroffolini T.
        • Lorenzoni U.
        • Menniti-Ippolito F.
        • Infantolino D.
        • Chiaramonte M.
        Hepatitis C virus infection in spouses: sexual transmission or common exposure to the same risk factors?.
        Am J Gastroenterol. 2001; 96: 3138-3141
        • US Preventive Services Task Force
        Screening for hepatitis C virus infection in adults: recommendation statement.
        Ann Intern Med. 2004; 140: 462-464
        • Seef L.B.
        • Buskell-Bales Z.
        • Wright E.C.
        • et al.
        Long-term mortality after transfusion-associated non-A, non-B hepatitis.
        New Engl J Med. 1992; 327: 1906-1911
        • Fusco M.
        • Girardi E.
        • Piselli P.
        • et al.
        Epidemiology of viral hepatitis infections in an area of southern Italy with high incidence rates of liver cancer.
        Eur J Cancer. 2008; 44: 847-853
        • Mariano A.
        • Caserta C.
        • Pendino G.M.
        • et al.
        Antiviral treatment for hepatitis C virus infection: effectiveness at general population level in a highly endemic area.
        Dig Liver Dis. 2009; 41: 509-515
        • Di Stefano R.
        • Stroffolini T.
        • Ferraro D.
        • et al.
        Endemic hepatitis C virus infection in a Sicilian town: further evidence for iatrogenic transmission.
        J Med Virol. 2002; 67: 339-344