Risk of Hepatitis C Virus Infection Associated With Hospital-based Invasive Procedures

Paul Henriot; Mathieu Castry; Liem Binh Luong Nguyen; Yusuke Shimakawa; Kévin Jean; Laura Temime


Aliment Pharmacol Ther. 2022;56(4):558-569. 

In This Article

Abstract and Introduction


Background: Healthcare settings, where invasive procedures are frequently performed, may play an important role in the transmission dynamics of blood-borne pathogens when compliance with infection control precautions is suboptimal.

Aims: To understand and quantify the role of hospital-based invasive procedures on hepatitis C virus (HCV) transmission.

Methods: We conducted a systematic review and meta-analysis to identify recent studies reporting association measures of HCV infection risk that are linked to iatrogenic procedures. Based on expert opinion, invasive procedures were categorised into 10 groups for which pooled measures were calculated. Finally, the relationship between pooled measures and the country-level HCV prevalence or the Healthcare Access and Quality (HAQ) index was assessed by meta-regression.

Results: We included 71 studies in the analysis. The most frequently evaluated procedures were blood transfusion (66 measures) and surgery (43 measures). The pooled odds ratio (OR) of HCV infection varied widely, ranging from 1.46 (95% confidence interval: 1.14–1.88) for dental procedures to 3.22 (1.7–6.11) for transplantation. The OR for blood transfusion was higher for transfusions performed before 1998 (3.77, 2.42–5.88) than for those without a specified/recent date (2.20, 1.77–2.75). In procedure-specific analyses, the HCV infection risk was significantly negatively associated with the HAQ for endoscopy and positively associated with HCV prevalence for endoscopy and surgery.

Conclusions: Various invasive procedures were significantly associated with HCV infection. Our results provide a ranking of procedures in terms of HCV risk that may be used for prioritisation of infection control interventions, especially in high HCV prevalence settings.


Hepatitis C virus (HCV) is mainly a blood-borne virus associated with an estimated global sero-prevalence of 2.5%.[1] However, wide between-country discrepancies are observed, with Egypt and Pakistan having high anti-HCV prevalence in the general population.[1] Chronic HCV infection, which is most of the time asymptomatic, may lead to serious complications like cirrhosis or hepatocellular carcinoma (HCC), with about 20% developing HCC.[2] Highly effective and well-tolerated direct-acting antiviral treatments (DAAs) are now available, but these treatments remain costly. An estimated 79% of people chronically infected with HCV worldwide still did not know their status in 2019,[3] limiting the population impact of DAAs. In addition, the residual risk of HCC is suspected to remain relatively high among patients who cured chronic HCV infection.[4] Moreover, HCV treatment should not be the only way of fighting new infections, as accumulating evidence suggests that even after the DAA therapy-induced sustained virological response reinfection can occur, especially in people who inject drugs.[5] Therefore, prevention interventions to limit the risk of HCV contamination remain key in the global response against HCV.[6]

Although injection drug use has been established to be the most important risk factor for acquiring a new HCV infection globally,[7] healthcare settings may play an important role in HCV transmission dynamics, due to the high frequency of invasive procedures and over-representation of HCV-infected individuals among hospitalised patients. Medical procedures have been linked to multiple HCV outbreaks worldwide, for instance in Egypt,[8] India[9] or the United States.[10] In healthcare settings where compliance with infection control interventions is suboptimal, patients may still become infected following blood transfusion or haemodialysis.[11,12] Previous hospitalisation has been identified as a major risk factor for HCV infection in many countries.[13] In the countries where HCV prevalence is high, infection control interventions may not be systematically implemented, and data are scarce regarding HCV infection risks.

In this context, a better control of hospital-acquired infections would significantly help in the fight against HCV epidemics. This requires a clear understanding of the role played by different high-risk procedures within healthcare settings. We conducted a systematic review and meta-analysis to synthesise the strength of association between different hospital-based invasive procedures and HCV infection risk, in order to rank these procedures according to the risk of iatrogenic HCV transmission.