Skip to main content

Advertisement

SpringerLink
Log in

Burden of Hepatitis C Virus Infection Among Older Adults in Long-Term Care Settings: a Systematic Review of the Literature and Meta-Analysis

  • Healthcare Associated Infections (G Bearman and D Morgan, Section Editors)
  • Published:
Current Infectious Disease Reports Aims and scope Submit manuscript

Abstract

Hepatitis C virus (HCV) infection is a significant cause of morbidity and mortality worldwide. The magnitude of the HCV burden has previously been the subject of debate, as representative data tend to exclude high-risk populations, including institutionalized persons. The purpose of this systematic review and meta-analysis was to estimate the prevalence of HCV infection among older adults in long-term care (LTC) and assess factors associated with the prevalence of HCV in this setting. The Preferred Reporting Items for Systematic Review and Meta-Analyses checklist was used as the methodological guide. Two reviewers independently assessed the study quality using a validated modified quality assessment tool. Six articles met inclusion criteria; the majority were cross-sectional studies (83.3 %) designed to estimate HCV infection prevalence rates and identify associated risk factors. HCV prevalence ranged from 1.4 to 11.8 %. A pooled HCV infection prevalence of 3.3 % (95 % confidence interval: 1.5–7.2 %) was estimated based on 1920 LTC residents with substantial heterogeneity noted (Q = 51.1, p < 0.001; I 2 = 90.2). Three of six studies reported statistically significant factors associated with an increased risk for HCV infection, including older age, female gender, history of blood transfusions, short duration of LTC residence, and hepatitis B virus positivity. This study reports a higher prevalence of HCV infection among older adults in LTC settings compared to community-dwelling older adults; however, accurate estimation of prevalence is limited by heterogeneity between and within studies, variation in sampling and recruitment methodologies, and absence of the HCV-RNA test to confirm active infection.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Lavanchy D. The global burden of hepatitis C. Liver Int. 2009;29 Suppl 1:74–81. The high prevalence of global HCV infection highlights the urgency to identify and reduce the burden of complications and co-morbidities associated with infection.

    Article  PubMed  Google Scholar 

  2. Lavanchy D. Evolving epidemiology of hepatitis C virus. Clin Microbiol Infect. 2011;17(2):107–15.

    Article  CAS  PubMed  Google Scholar 

  3. Holtzman D. Hepatitis C [On-line]. http://wwwnc.cdc.gov/travel/yellowbook/2014/chapter-3-infectious-diseases-related-to-travel/hepatitis-c. Accessed 25 Nov 2014.

  4. Mohd Hanafiah K, Groeger J, Flaxman AD, et al. Global epidemiology of hepatitis C virus infection: new estimates of age-specific antibody to HCV seroprevalence. Hepatology. 2013;57(4):1333–42. The development of primary prevention methods are vital to reduce chronic diseases associated with infection and improve survival, especially among older adults.

    Article  PubMed  Google Scholar 

  5. El-Serag HB, Mason AC. Rising incidence of hepatocellular carcinoma in the United States. N Engl J Med. 1999;340(10):745–50.

    Article  CAS  PubMed  Google Scholar 

  6. Smith BD, Morgan RL, Beckett GA, et al. Recommendations for the identification of chronic hepatitis C virus infection among persons born during 1945–1965. MMWR Recomm Rep. 2012;61(RR-4):1–32. In the United States, new hepatitis C virus infection therapies have been shown to be effective in reducing disease progression and offering a virologic cure. Therefore, it is important to identify at risk cohorts (adults 65 years and older) to offer targeted testing, education, and care to increase quality of life.

    PubMed  Google Scholar 

  7. Omland LH, Jepsen P, Krarup H, et al. Increased mortality among persons infected with hepatitis C virus. Clin Gastroenterol Hepatol. 2011;9(1):71–8.

    Article  PubMed  Google Scholar 

  8. El-Serag HB, Mason AC. Risk factors for the rising rates of primary liver cancer in the United States. Arch Intern Med. 2000;160(21):3227–30.

    Article  CAS  PubMed  Google Scholar 

  9. Davis GL, Alter MJ, El-Serag H, et al. Aging of hepatitis C virus (HCV)-infected persons in the United States: a multiple cohort model of HCV prevalence and disease progression. Gastroenterology. 2010;138(2):513–21. 521 e511-516.

    Article  PubMed  Google Scholar 

  10. Marcus EL, Tur-Kaspa R. Viral hepatitis in older adults. J Am Geriatr Soc. 1997;45(6):755–63.

    Article  CAS  PubMed  Google Scholar 

  11. Mindikoglu AL, Miller RR. Hepatitis C in the elderly: epidemiology, natural history, and treatment. Clin Gastroenterol Hepatol. 2009;7(2):128–34.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Centers for Disease Control and Prevention. Know more hepatitis [On-line]. Available at: http://www.cdc.gov/knowmorehepatitis/. Accessed 17 Nov 2014.

  13. Mathei C, Niclaes L, Suetens C, et al. Infections in residents of nursing homes. Infect Dis Clin N Am. 2007;21(3):761–72.

    Article  Google Scholar 

  14. Chien NT, Dundoo G, Horani MH, et al. Seroprevalence of viral hepatitis in an older nursing home population. J Am Geriatr Soc. 1999;47(9):1110–3.

    Article  CAS  PubMed  Google Scholar 

  15. Marcus EL, Dahoudi N, Tur-Kaspa R. Hepatitis C virus infection among elderly patients in a geriatric hospital. Arch Gerontol Geriatr. 1994;19(3):213–21.

    Article  CAS  PubMed  Google Scholar 

  16. Perz JF, Grytdal S, Beck S, et al. Case-control study of hepatitis B and hepatitis C in older adults: do healthcare exposures contribute to burden of new infections? Hepatology. 2013;57(3):917–24.

    Article  PubMed  Google Scholar 

  17. Floreani A. Hepatitis C: should antiviral therapy be offered to elderly patients? Nat Rev Gastroenterol Hepatol. 2009;6(9):503–4.

    Article  CAS  PubMed  Google Scholar 

  18. Oze T, Hiramatsu N, Yakushijin T, et al. Indications and limitations for aged patients with chronic hepatitis C in pegylated interferon alfa-2b plus ribavirin combination therapy. J Hepatol. 2011;54(4):604–11.

    Article  CAS  PubMed  Google Scholar 

  19. Antonucci G, Longo MA, Angeletti C, et al. The effect of age on response to therapy with peginterferon alpha plus ribavirin in a cohort of patients with chronic HCV hepatitis including subjects older than 65 yr. Am J Gastroenterol. 2007;102(7):1383–91.

    Article  CAS  PubMed  Google Scholar 

  20. Fischer GE, Schaefer MK, Labus BJ, et al. Hepatitis C virus infections from unsafe injection practices at an endoscopy clinic in Las Vegas, Nevada, 2007–2008. Clin Infect Dis. 2010;51(3):267–73.

  21. Schaefer MK, Jhung M, Dahl M, et al. Infection control assessment of ambulatory surgical centers. JAMA. 2010;303(22):2273–9.

    Article  CAS  PubMed  Google Scholar 

  22. Gutelius B, Perz JF, Parker MM, et al. Multiple clusters of hepatitis virus infections associated with anesthesia for outpatient endoscopy procedures. Gastroenterology. 2010;139(1):163–70.

    Article  PubMed  Google Scholar 

  23. Perz JF, Thompson ND, Schaefer MK, et al. US outbreak investigations highlight the need for safe injection practices and basic infection control. Clin Liver Dis. 2010;14(1):137–51.

    Article  PubMed  Google Scholar 

  24. Vandenbroucke JP, von Elm E, Altman DG, et al. Strengthening the reporting of observational studies in epidemiology (STROBE): explanation and elaboration. Ann Intern Med. 2007;147(8):W163–94.

    Article  PubMed  Google Scholar 

  25. von Elm E, Altman DG, Egger M, et al. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370(9596):1453–7.

    Article  Google Scholar 

  26. Yaphe S, Bozinoff N, Kyle R, et al. Incidence of acute hepatitis C virus infection among men who have sex with men with and without HIV infection: a systematic review. Sex Transm Infect. 2012;88(7):558–64.

    Article  PubMed  Google Scholar 

  27. Thompson SG, Higgins JP. How should meta-regression analyses be undertaken and interpreted? Stat Med. 2002;21(11):1559–73.

    Article  PubMed  Google Scholar 

  28. Rothstein HR, Borenstein M. Publication bias in meta-analysis: prevention, assessment, and adjustments. West Sussex: John Wiley & Sons, Ltd.; 2005.

    Book  Google Scholar 

  29. Baldo V, Floreani A, Menegon T, et al. Prevalence of antibodies against hepatitis C virus in the elderly: a seroepidemiological study in a nursing home and in an open population. The Collaborative Group. Gerontology. 2000;46(4):194–8.

    Article  CAS  PubMed  Google Scholar 

  30. Floreani A, Bertin T, Soffiati G, et al. Anti-hepatitis C virus in the elderly: a seroepidemiological study in a home for the aged. Gerontology. 1992;38(4):214–6.

    Article  CAS  PubMed  Google Scholar 

  31. Maral I, Dogruman-Al F, Bakar C, et al. Hepatitis B virus and hepatitis C virus seroprevalence in the elderly living in nursing homes. J Investig Med. 2009;57(6):717–9.

    PubMed  Google Scholar 

  32. Simor AE, Gordon M, Bishai FR. Prevalence of hepatitis B surface antigen, hepatitis C antibody, and HIV-1 antibody among residents of a long-term-care facility. J Am Geriatr Soc. 1992;40(3):218–20.

    Article  CAS  PubMed  Google Scholar 

  33. Mansour-Ghanaei F, Fallah MS, Jafarshad R, et al. Seroprevalence of hepatitis B and C among residents of Guilan nursing home. Hepat Mon. 2007;7(3):139–41.

  34. Liang TJ, Ghany MG. Current and future therapies for hepatitis C virus infection. N Engl J Med. 2013;368(20):1907–17.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Ghany MG, Strader DB, Thomas DL, et al. Diagnosis, management, and treatment of hepatitis C: an update. Hepatology. 2009;49(4):1335–74.

    Article  CAS  PubMed  Google Scholar 

  36. Strader DB, Wright T, Thomas DL, et al. Diagnosis, management, and treatment of hepatitis C. Hepatology. 2004;39(4):1147–71.

    Article  PubMed  Google Scholar 

  37. Nicolle LE. Preventing infections in non-hospital settings: long-term care. Emerg Infect Dis. 2001;7(2):205–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. New York State Department of Health, Metropolitan Area Regional Office, Bureau of Communicable Disease Control, 145 Huguenot Street, Suite 603, New Rochelle, NY, 10801, USA

    Kimberly J. Alvarez

  2. Columbia School of Nursing, Columbia University, 617 West 168th Street, New York, NY, 10032, USA

    Arlene Smaldone & Elaine L. Larson

  3. Center for Interdisciplinary Research to Prevent Infection, Columbia School of Nursing, Columbia University, 617 West 168th Street, New York, New York, 10032, USA

    Elaine L. Larson

Authors
  1. Kimberly J. Alvarez
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Arlene Smaldone
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Elaine L. Larson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kimberly J. Alvarez.

Ethics declarations

Conflict of Interest

Kimberly J. Alvarez, Arlene Smaldone, and Elaine L. Larson declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by the author.

Additional information

This article is part of the Topical Collection on Healthcare Associated Infections

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Alvarez, K.J., Smaldone, A. & Larson, E.L. Burden of Hepatitis C Virus Infection Among Older Adults in Long-Term Care Settings: a Systematic Review of the Literature and Meta-Analysis. Curr Infect Dis Rep 18, 13 (2016). https://doi.org/10.1007/s11908-016-0518-9

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11908-016-0518-9

Keywords

Search

Navigation