Hospital-visiting pregnant women signal an increased spread of hepatitis C infection in Khyber Pakhtunkhwa region of Pakistan

BACKGROUND: Seroprevalence of hepatitis C in Khyber Pakhtunkhwa province of Pakistan was determined by screening blood samples of expectant mothers seeking antenatal care in gynecological units of district hospitals. The rationale behind this cohort study was that the availability of free-of-cost antenatal care in district hospitals brings expectant mothers from a broader geographical range in each district and thus provides a large sample-size of healthy pregnant women of known medical history for Hepatitis C Virus (HCV) surveillance. The study was carried out along a south west to north east transact of five districts, Kohat-Peshawar-Nowshera-Charsadda-Mardan, with the central district Peshawar and outer districts Kohat and Mardan bordering northern mountainous ranges of the Khyber Pakhtunkhwa province. This distribution of districts along the transact allowed the study to gauge the impact of proximity to remote highland communities on the HCV burden of visiting pregnant women tested for HCV infection. METHODS: The cohort study randomly selected 150 pregnant women visiting each hospital for serological screening for Anti-HCV carried out by ELISA assay. The feasibility of ICT and RT-PCR assays for HCV prevalence was also examined in the present study. RESULTS: With a total of 750 blood specimen screened, the results of ELISA tests revealed a staggering 5.9% frequency of Anti-HCV in the five districts with the frequency of ELISA positive cases ranging from 3.3% in Nowshera, 4.7% in Charsadda, 6.0% in Peshawar, 6.7% in Kohat, and 8.7% in Mardan. The relatively higher frequencies of Anti-HCV cases among hospital visiting pregnant women in Peshawar, Kohat and Mardan were consistent with the proximity of these hospitals to the highland communities in the bordering mountain ranges. Compared to 44 Anti-HCV positive serologic specimens detected by ELISA, only 26 and 10 blood specimens were tested positive by ICT and PCR methods, respectively. Our study validates ELISA as a reliable diagnostic technique for both acute and chronic HCV infection. CONCLUSION: The HCV infection rate of 5.9% in Khyber Pakhtunkhwa province clearly exceeds the HCV prevalence rates reported for other regions in Pakistan, making this province a hotspot of HCV infection in the country.