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CC BY-NC-ND 4.0 · Journal of Gastrointestinal Infections
DOI: 10.1055/s-0045-1811266
Brief Report

Secondary Analysis for Surveillance of Hepatitis C Virus Transmission from a Secondary-Level Hospital in Himachal Pradesh, India: A Brief Report

Authors

  • Vandana Sharma 

    1   RT-PCR Laboratory at Palkwah, Regional Hospital Una, Una, Himachal Pradesh, India

  • Mahima Mahima

    1   RT-PCR Laboratory at Palkwah, Regional Hospital Una, Una, Himachal Pradesh, India

  • Rahul Kaundal

    2   Regional Hospital Una, Una, Himachal Pradesh, India

  • Sanjay Mankotia

    2   Regional Hospital Una, Una, Himachal Pradesh, India

  • Dinesh Kumar

    3   Department of Community Medicine, Dr. Rajendra Prasad Government Medical College Kangra at Tanda, Himachal Pradesh, India

Funding Not applicable.
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Abstract

The National Viral Hepatitis Control Program (NVHCP) in India provides free diagnostic and therapeutic services. Analysis of secondary data under the program helps to understand about hepatitis and its associated risk factors. The present study was undertaken to analyze the secondary data (April 2023–December 2024) for hepatitis C virus (HCV) infection and associated factors at a secondary hospital in Himachal Pradesh, India. A total of 283 records were evaluated, where majority of the patients (69.6%) belonged to rural area. About half (52.0%) HCV-positive patients with mean hepatitis C viral load of 0.95 × 105 IU/mL were people who inject drugs (PWIDs). Additionally, PWIDs showed a high HCV positivity rate (63.1%). Odds of HCV infection was found to be significantly higher in males (odds ratio [OR]; 2.4; 95% CI: 1.2–4.7) and PWIDs (1.8; 95% CI: 1.1–3.0). Hepatitis C viral load among HCV-positive patients was not associated with gender, area (rural/urban), and PWID status. Occurrence of co-infection with human immunodeficiency virus (HIV) in HCV-positive PWIDs is also observed. Hence, there is a need to share information between NVHCP and National HIV/acquired immune deficiency syndrome Control Program for surveillance and formulation of public health interventions toward achieving elimination targets set by World Health Organization for 2030.


 

Keywords

hepatitis C virus - injection use - hepatitis C viral load

Introduction

Hepatitis C virus (HCV), is a bloodborne, enveloped, RNA icosahedral virus belonging to the family Flaviviridae and genus Hepacivirus. Infection with HCV can be debilitating leading to chronic hepatitis and life-threatening complications like cirrhosis, hepatocellular carcinoma, and liver failure, with considerable morbidity.[1] HCV infection is commonly transmitted through unsafe injection use, unscreened blood donors, surgery, in utero transmission from mother to child, unsafe sexual behavior, tattooing, and body piercing.[2] People who inject drugs (PWIDs) are particularly vulnerable to HCV infection and are reported to have high (>30%) positivity.[3] Worldwide, approximately 50 million people have chronic condition with annual 1 million new HCV infections.

In India, approximately 5.5 million people are currently living with chronic HCV infection. In addition, India sees approximately 1,40,000 new infections and 26,000 deaths annually due to HCV infection. India is one of the 10 countries accounting for 80% of all global HCV infection among PWIDs and one of the 6 countries sharing half of global HCV burden.[4] India has launched the National Viral Hepatitis Control Program (NVHCP), aiming to eliminate hepatitis due to HCV by 2030 by improving access to diagnosis and treatment. Under the program, a network of laboratory facilities is created to promote HCV diagnosis.[5]

Different studies have shown hepatitis C infection to be common among preliminary screenings for viral infections in Himachal Pradesh.[6] [7] Moreover, there is evidence of significantly increased percentage of HCV infection in PWIDs from Himachal Pradesh.[8] In the state of Himachal Pradesh, laboratories have been established in almost every district for HCV testing. Hence, the present study was carried out to assess epidemiology of HCV and its associated factors using laboratory-based information under NVHCP.


 

Methods

It was a retrospective record-based assessment performed from April 2023 to December 2024 at a district hospital in Una, Himachal Pradesh, India. Assessment was done for routinely collected variables under NVHCP, and data were analyzed using R studio (4.3.1). The chi-square test for categorical variables was used for their association with HCV positivity. Means were compared with Student's t-test and both were assessed at 5.0% significance level. Logistic regression was done and odds ratio (OR) was also calculated to assess strength of association between independent variables and dependent variable (HCV positivity). For viral load, linear regression was done to assess strength and direction of association with age and duration of drug use. OR for logistic and coefficient for linear regression with 95% confidence interval (95% CI) was reported.


 

Results

A total of 283 records were analyzed. Out of these, 241 (85.2%) were males and 42 (14.8%) were females, with a ratio of 5.4:1. The average and median age of the patients was 32.4 years and 28 years (range: 14–79 years), respectively. All the patients were screened for hepatitis C viral load, which was performed by Truenat HCV RNA assay (Molbio Diagnostics, Goa, India). Patients with detectable load were considered positive and those with undetectable level as negative. Accordingly, 167 patients (59%) were positive, while 116 patients (41%) were negative. The mean hepatitis C viral load was 0.95 × 105 IU/mL.

Majority of the patients (69.6%) belonged to rural area with a male preponderance (60.8%) and higher number of positive patients (41.3%). Patients belonging to urban area (30.4%) constituted 17.7% of the positive patients. [Table 1] enlists the association of HCV positivity with basic characteristics of patients.

Table 1

Association of HCV positivity with basic characteristics under National Viral Hepatitis Control Program (NVHCP) in one district of Himachal Pradesh

Characteristics

Negative

Positive

OR (95%CI)

Male

91 (37.8%)

150 (62.2%)

2.42 (1.2–4.7)

Female

25 (59.5%)

17 (40.5%)

Rural

80 (40.6%)

117 (59.4%)

1.0 (0.6–1.7)

Urban

36 (41.9%)

50 (58.1%)

ART

20 (41.7%)

28 (58.3%)

0.9 (0.5–1.8)

No ART

96 (40.9%)

139 (59.1%)

Pregnant

4 (36.4%)

7 (63.6%)

0.7 (0.1–3.2)

Nonpregnant

18 (41.9%)

13 (58.1%)

PWID

75 (36.9%)

128 (63.1%)

1.8 (1.1–3.0)

Non-PWID

41 (51.2%)

39 (48.8%)

Abbreviations: ART, antiretroviral therapy; CI, confidence interval; OR, odds ratio; PWIDs, people who inject drugs.


OR for HCV positivity was not found to be significantly associated with rural area, antenatal women, and patients on antiretroviral therapy (ART). However, HCV positivity was found to be significant for males and PWIDs. Approximately, one-fifth of the PWIDs belonged to urban area (n = 57), whereas, rural area had 2.5 times (n = 146) more PWIDs compared with urban area.

Among HCV-positive individuals, the mean viral load was statistically similar among drug users [PWID: 0.9 (1.4); non-PWID: 0.6 (1.1)], gender [males: 0.9 (1.5); females: 0.5 (0.6)], and area [rural: 0.8 (1.4); urban: 1.0 (1.4)]. There was no significant association between age of patients (0.01; 95% CI: 0.04–0.07) or duration of drug use (0.14; 95% CI: −0.38–0.68) and hepatitis C viral load.


 

Discussion

Current assessment showed HCV positivity among males and PWIDs. This association might be possibly driving the disease transmission. It is alarming to note that high frequency of HCV infection was detected in PWIDs under 40 years of age and accounted for 61% of HCV-positive individuals in our study. Intravenous drug use (IVDU) is a menace not only in India, but also all over the globe. IVDU poses a significant risk for HCV infection and results in uneven distribution of HCV prevalence worldwide.[9] Evidence also shows that globally 43.6% and in South-East Asia region around 21.2% new HCV infections occur among PWIDs and mostly these PWIDs are males.[10]

A significant number of male PWIDs belonged to rural area and in line with our assessment, a study also showed differential distribution of HCV infection among PWIDs in rural/urban areas (rural: 71.0%; urban: 46.8%).[11] It could be inferred that individuals from rural areas might lack awareness regarding hepatitis C infection transmission through IVDU and need awareness. In contrast to our result, a study from Himachal Pradesh found young college-going males from urban area to be the predominant intravenous drug users.[2] Nevertheless, the problem of IVDU needs to be addressed with a focus on tracking, testing, and treating PWIDs. Therefore, it is suggested that an early linkage of PWIDs with primary care providers will help in the diagnosis and management of HCV infection in vulnerable and high-risk groups of people.[12]

In the present study, hepatitis C viral load was nonsignificantly associated with duration of IVDU, supporting the existing literature.[13] However, results are unequivocal for this type of association. A few studies depicted a stable hepatitis C viral load over time in certain populations, meanwhile others have shown substantial variations.[14] Such ambiguities could be the result of sample size, variations in quantifying methods, and other confounding factors like follow-up duration and study design.

Not only to HCV, PWIDs are prone to human immunodeficiency virus (HIV) infection as well. HIV weakens the cellular immune responses in patients leading to faster advancement of chronic HCV. Consequently, treatment of HCV in HIV-coinfected patients ought to be a high priority.[4] In our study, some of the PWIDs were on ART for HIV/acquired immune deficiency syndrome (AIDS) treatment. Surveillance of HCV and HIV is important for formulating public health interventions in PWIDs. More qualitative research is required for estimation of HCV and HIV prevalence among PWIDs and for providing solutions and measures that can be practiced for tackling infections. Future investigations aiming to delineate the ongoing scenario for HCV and HIV infection acquisition and spread in hospital setting and in general population should be designed. None of the patients in our study had co-infection with HBV.

There are some limitations to the study. We have analyzed all the available records and baseline data of the patients presenting at our hospital. Patients were not followed up in the study. This will take time and in future we are planning another study with follow-up and treatment. Additionally, we could not get the reports on status of liver cirrhosis of the patients. Hence, data on cirrhosis versus non-cirrhosis could not be included in the current study.

This is a hospital-based study and might not mirror the real-world reality of HCV infection. However, as a first ever report from Una district of Himachal Pradesh on HCV, it provides the guidance and pilot work for future studies. To conclude, our results confirm that HCV screening at a secondary-level hospital is timely placed to monitor the progress of HCV spread under NVHCP. Still, there is a need to share information with National HIV/AIDS Control Program, as it provides care and support to PWID—as a key population—under targeted intervention project.[15] This will help in monitoring HCV and HIV incidences and progress toward achieving elimination targets set by World Health Organization for 2030.


 

 

Conflict of Interest

None declared.

Acknowledgment

None.

Ethical Approvals and Consent

This study is the outcome of retrospectively analyzed data maintained in our district hospital. Therefore, ethical approval and consent were not required.


Author Contributions

V.S. conceptualized the study, analyzed the data, and wrote the manuscript. M.M. helped in data collection and compilation. R.K. and S.M. critically revised the manuscript and provided administrative support. D.K. helped in data analysis, interpretation, and manuscript writing. All the authors read and approved the final version of manuscript.



Address for correspondence

Vandana Sharma, PhD
RT-PCR Laboratory at Palkwah, Regional Hospital Una
Una 174303, Himachal Pradesh
India   

Publikationsverlauf

Eingereicht: 13. Mai 2025

Angenommen: 28. Juli 2025

Artikel online veröffentlicht:
06. Oktober 2025

© 2025. Gastrointestinal Infection Society of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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