1. Asymptomatic hepatitis C prevalence in anti-HCV positive subjects (population based study) Valentina Liakina, Arida Buivydiene, Saule Brasiskiene, Jonas Valantinas Centre of Hepatology, Gastroenterology and Dietetics Clinic of Gastroenterology, Nephrourology and Surgery Faculty of Medicine, Vilnius University

2. 11th Annual Conference of the Baltic Network Against Life-threatening Viral Infections 24-27 April 2014 - Vilnius, Lithuania 2 To estimate the prevalence of anti-HCV in various regions of Lithuania To assess the amount of HCV carriers Aims

3. 11th Annual Conference of the Baltic Network Against Life-threatening Viral Infections 24-27 April 2014 - Vilnius, Lithuania 33 Survey was performed in 2010-2013. 3737 volunteers (age from 18 till 76 years) from healthy population who wanted to know their ant-HCV status in Vilnius, Kaunas, Klaipeda, Panevezys, Siauliai, Ignalina, Utena and Zarasai regions of Lithuania were admitted for anonymous anti-HCV testing. The study protocol was approved by Lithuanian Ethics Committee. All participants answered anonymous questionnaire with HCV risk factors. Financial support – ROCHE-Lietuva Methods

4. 11th Annual Conference of the Baltic Network Against Life-threatening Viral Infections 24-27 April 2014 - Vilnius, Lithuania 44 Methods Anti-HCV antibodies were detected by: 2010-2011: rapid lateral flow immunochromatography test from peripheral capillary blood (Core HCV-WB; Core Diagnostics, Birmingham B2 5HG, UK). 2012-2013: rapid qualitative immunoassay from saliva samples (OraQuick® HCV Rapid Antibody Tests OraSure Technologies, Inc, Bethlehem PA 18015 USA). Anti-HCV positive cases were confirmed by 2-step chemiluminescent microparticle immunoassay on venous blood (Architect System anti-HCV; Abbott, 65205 Wiesbaden, Germany). HCV RNA qualitative detection was performed with COBAS AMPLICOR Hepatitis C Virus (HCV) Test, version 2.0 (Roche Diagnostics, Mannheim, Germany). HCV genotypes detection was performed with VERSANT HCV Genotyping assay (LiPA) (Siemens)

5. 11th Annual Conference of the Baltic Network Against Life-threatening Viral Infections 24-27 April 2014 - Vilnius, Lithuania 55 Overall 3737, anti-HCV (crude rate) – 85/2,27% RegionRegional population, n Study cohort, n/% Anti-HCV positive cases, n Anti-HCV positivity, % Vilnius6321871747/0.28482.75 Kaunas393307154/0.0453.25 Klaipeda210155486/0.23112.26 Siauliai149218515/0.35101.94 Panevezys135210151/0.1121.32 Ignalina17568246/1.441.63 Utena41751262/0.6320.76 Zarasai17693176/0.9931.7 Overall15970893737/0.23852.27

6. 11th Annual Conference of the Baltic Network Against Life-threatening Viral Infections 24-27 April 2014 - Vilnius, Lithuania 6 Anti-HCV prevalence in the European countries Hahne et al. BMC Infect Dis. 2013 Apr 18;13:181.

7. 11th Annual Conference of the Baltic Network Against Life-threatening Viral Infections 24-27 April 2014 - Vilnius, Lithuania 7 Hahne SJM et all, BMC Infectious Diseases 2013;13:181

8. 11th Annual Conference of the Baltic Network Against Life-threatening Viral Infections 24-27 April 2014 - Vilnius, Lithuania 8 Hope VD et all, Epidemiol Infec 2014;142:270-286

9. 11th Annual Conference of the Baltic Network Against Life-threatening Viral Infections 24-27 April 2014 - Vilnius, Lithuania 99 N=85 Tested for anti-HCV from venous blood N=51 Refuse further testing or were inaccessible N=34 Anti-HCV positive N=44/86.3% Anti-HCV negative N=7/13.7% HCV RNA negative N=15/34.1% HCV RNA positive N=29/65.9%

10. 11th Annual Conference of the Baltic Network Against Life-threatening Viral Infections 24-27 April 2014 - Vilnius, Lithuania 10 HCV carriers 1.96% anti-HCV positive 58800 subjects and 65,9% of them are HCV carriers 1,29% of population are HCV carriers (38700 subjects)

11. 11th Annual Conference of the Baltic Network Against Life-threatening Viral Infections 24-27 April 2014 - Vilnius, Lithuania 11 HCV genotypes in asymptomatic carriers Genotype 1 – 13/45% Genotype 2 – 6/20% Genotype 3 – 10/35% Liakina V et al. Med Sci Monit, 2009; 15(4): PH17-23 Genotype 1 – 65% Genotype 2 – 8.7% Genotipas 3 – 26.3% HCV genotypes in chronic hepatitis cohort

12. 11th Annual Conference of the Baltic Network Against Life-threatening Viral Infections 24-27 April 2014 - Vilnius, Lithuania 12 HCV transmission routes ORp Injection drug use – 43 <0,0001 HCV infection in family member – 11 0,0002 Blood transfussions – 6 0,0002 Delivery – 5 0,0224 Tattoo – 4 0,0013 Open trauma – 4 0,0009 Tooth removal/prosthetics – 3 0,0048 Multiple and long-lasting hospitalizations – 3 0,0064

13. 11th Annual Conference of the Baltic Network Against Life-threatening Viral Infections 24-27 April 2014 - Vilnius, Lithuania 13 Esteban JI et al. J of Hepatology 2008;48:148-162 HCV transmission routes

14. 11th Annual Conference of the Baltic Network Against Life-threatening Viral Infections 24-27 April 2014 - Vilnius, Lithuania 14 Blood donations Hemodialysis Surgery Dentistry Abortions Risky sexual behavior Piercing Not confirmed as HCV transmission routes

15. 11th Annual Conference of the Baltic Network Against Life-threatening Viral Infections 24-27 April 2014 - Vilnius, Lithuania 15 Conclusions 1.96% of Lithuanian population is anti-HCV positive (as confirmed by venous blood testing) ~ 58800 subjects 65,9% anti-HCV positive subjects are HCV RNA positive – HCV carriers ~ 38700 subjects The main HCV reservoir is intravenous drug users

16. 11th Annual Conference of the Baltic Network Against Life-threatening Viral Infections 24-27 April 2014 - Vilnius, Lithuania 16

17. 11th Annual Conference of the Baltic Network Against Life-threatening Viral Infections 24-27 April 2014 - Vilnius, Lithuania 17 Esteban JI et al. J of Hepatology 2008;48:148-162 Changes in HCV transmission routes and HCV genotypes distribution