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Vol. 13. Issue 6.
Pages 746-752 (November - December 2014)
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Vol. 13. Issue 6.
Pages 746-752 (November - December 2014)
Open Access
Hepatitis C virus infection in patients and family members attending two primary care clinics in Puebla, Mexico
Visits
734
Aurelio López-Colombo*, Daniel Meléndez-Mena, Virginia Sedeño-Monge, José R. Camacho-Hernández§, Eduardo Vázquez-Cruz, Eduardo R. Morales-Hernández, Francisca Sosa-Jurado**, Luis Márquez-Domínguez**, Gerardo Santos-López**,
Corresponding author
gerardo.santos.lopez@gmail.com

Correspondence and reprint request:
* Coordinación Delegacional de Investigación en Salud, Instituto Mexicano del Seguro Social, Puebla, México
Servicio de Gastroenterología, Hospital de Especialidades, Unidad Médica de Alta Especialidad, Centro Médico Nacional General de División Manuel Ávila Camacho, Instituto Mexicano del Seguro Social, Puebla, México
Facultad de Medicina, Universidad Popular Autónoma del Estado de Puebla, Puebla, México
§ Dirección, Unidad de Medicina Familiar Núm. 55, Instituto Mexicano del Seguro Social, Puebla, México
Coordinación Clínica de Educación e Investigación, Unidad de Medicina Familiar Núm. 6, Instituto Mexicano del Seguro Social, Puebla, México
División de Epidemiología, Hospital de Especialidades, Unidad Médica de Alta Especialidad, Centro Médico Nacional General de División Manuel Ávila Camacho, Instituto Mexicano del Seguro Social, Puebla, México
** Laboratorio de Biología Molecular y Virología, Centro de Investigación Biomédica de Oriente, Instituto Mexicano del Seguro Social, Metepec, Puebla, México
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Tables (6)
Table 1. Demographic data of the studied subjects from Clinics #6 and #55 in Puebla, Mexico.
Table 2. Prevalence of Anti-HCV and HCV RNA in the studied subjects from Clinics #6 and #55 in Puebla, Mexico, grouped by age.
Table 3. Risk factors in the studied subjects from Clinics #6 and #55 in Puebla, Mexico.
Table 4. Risk factors in HCV-RNA positive subjects from Clinics #6 and #55 in Puebla, Mexico.
Table 5. Risk factors in subjects from Clinics #6 and #55 in Puebla, Mexico grouped by age.
Table 6. Genotype and subtype of HCV in 30 of HCV-RNA-positive subjects from Clinics #6 and #55 in Puebla, Mexico.
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Abstract

Background. Approximately 180 million persons (∼2.8%) globally are estimated to be infected by hepatitis C virus (HCV). HCV prevalence in Mexico has been estimated to be between 1.2 and 1.4%. The aim of present work was to determine the prevalence of HCV infection in patients and family members attending two primary care clinics in Puebla, Mexico.

Material and methods. Patients and their accompanying family members in two clinics were invited to participate in this study between May and September 2010.

Results. A total of 10,214 persons were included in the study; 120 (1.17%) persons were anti-HCV reactive. Of the reactive subjects, detection of viral RNA was determined in 114 subjects and 36 were positive (31%). The more frequent risk factors were having a family history of cirrhosis (33.1%) and having a blood transfusion prior to 1995 (29%). After a multiple logistic regression analysis only transfusion prior to 1995 resulted significant to HCV transmission (p = 0.004). The overall detected HCV genotypes were as follows: 1a (29%), 1b (48.5%), 2/2b (12.8%), and 3a (6.5%).

Conclusion. The HCV prevalence in this population is in agreement with previous studies in other regions of Mexico.

Keywords:
HCV prevalence
Anti-HCV antibodies
HCV genotypes
Full Text
Introduction

Hepatitis C virus (HCV) infection is an important public health concern. Worldwide, 180 million persons (prevalence ~2.8%) are estimated to be infected.1 The primary diseases associated with HCV are chronic hepatitis, cirrhosis, and hepatocellular carcinoma.2

The actual prevalence of HCV is difficult to assess because serological tests do not discriminate among acute, chronic, or resolved infection, and the analyzed groups in most countries are not representative of the general population, such as blood donors, drug users, or individuals with high-risk sexual practices.35 In Latin America, HCV infection represents a serious health problem, calculating the overall HCV seroprevalence to be ~1.5%.6 It is estimated that the incidence of hepatitis C in Mexico ranges from 17,500 to 35,000 new cases of infected individuals each year.7

In Mexico, the prevalence of HCV is 1.2-1.4% in the open population and 30-35% in patients with active hepatitis.810 In Mexico, cirrhosis has shown an increasing tendency, rising from 12,058 cases in 2005 to 12,996 cases in 2006. In addition, cirrhosis is the second cause of death in the 15- to 64-year-old age group, being three times higher in males than in females. Puebla is the Mexican state with the highest mortality due to hepatic cirrhosis.11,12 Therefore, it is imperative to obtain epidemiological data on the asymptomatic population, which may contribute to determine, in part, the possible causes of the high incidence of hepatic diseases in this region. In this work we analyzed the prevalence of HCV and the main risk factors in patients and accompanying family members attending two primary care clinics.

Material and MethodsParticipants

Patients and family members or accompanying persons attending Clinics #6 and #55 located in the city of Puebla were invited to participate in the study between May and September 2010. There were no formal exclusion criteria but any one individual could be included only once. Subjects received a patient information sheet (Letter of Informed Consent) and a study-specific questionnaire. We obtained complete and reliable individual patient information (age, sex, health insurance and risk factors). This information was used to describe any relationship with HCV infection.

Testing

The initial screening of Anti-HCV reactivity of volunteers was carried out using Advanced Quality Rapid anti-HCV Test (Accutrack, Mexico, D.F., Mexico), which consists of a cartridge in which are present antigenic recombinant peptides corresponding to core, NS3, NS4 and NS5A proteins, highly reactive to anti-HCV. The test is based on immunochromatografy and is completed in 15 min. A drop of total blood (10 µL) was obtained of a puncture in the distal portion of the fifth finger of the any hand, which was applied on the well of the cartridge, immediately were added two drops of diluents; the test consider a reactive sample if a purple band is formed. Blood samples from peripheral vein were taken to reactive subjects and then were submitted to detection of viral RNA by using COBAS AmpliPrep/COBAS TaqMan HCV Test (Roche Diagnostics, Meylan, France). Genotypes were determined by Versant HCV Genotype 2.0 Assay (LiPA, Siemens Healthcare Diagnostics, Tarrytown, NY, U.S.A.).

Statistical analysis

For continuous variables, averages, frequencies and percentages were calculated. Associations between anti-HCV and HCV-RNA positivity were assessed using χ2 and Fisher’s Exact Tests. Associations between HCV RNA and risk factors were assessed by univariate (χ2 and Fisher’s Exact tests) and multivariate analysis (logistic regression). Logistic regression was performed when the potential risk factors had values of p ≤ 0.1 by univariate analysis. Statistical significance was defined as p ≤ 0.05. All statistical analyses were performed with IBM SPSS Statistics version 21.0 (SPSS Inc, Chicago, IL).

ResultsSeroprevalence of HCV

There were 5,237 samples obtained from Clinic #6 and 4,977 samples from Clinic #55, resulting in 10,214 persons. There were 7,454 (73%) females and 2,760 (27%) males with the most frequent age range in both clinics between 31 and 50 years (Table 1). Sixty persons from each clinic were positive to anti-HCV antibodies, maintaining the female population as more frequent: 47/60 (78%) and 46/60 (76.7%). These data show that female/male ratio in reactive individuals is similar to that of the studied population. Seroprevalence was 1.14% in Clinic #6 and 1.20% in Clinic #55; overall prevalence was 1.17% (120/10, 2014).

Table 1.

Demographic data of the studied subjects from Clinics #6 and #55 in Puebla, Mexico.

  Clinic #6Clinic #55Total
    (%)  (%) 
Sex             
Female  3,746  (71.5)  3,708  (74.5)  7,454  (73) 
Male  1,491  (28.5)  1,269  (25.5)  2,760  (27) 
Total  5,237  (100)  4,977  (100)  10,214  (100) 
Age (years)             
< 30  1,136  (21.5)  1,143  (22.8)  2,279  (22.3) 
31-50  2,388  (45.3)  2,460  (49)  4,848  (47.5) 
> 51  1,713  (32.5)  1,374  (27.4)  3,087  (30.2) 
Total  5,237  (100)  4,977  (100)  10,214  (100) 

Anti-HCV positivity was different according with the age group (Table 2), and ranged from 0.88% in < 30 years subjects to 1.61% in > 50 years subjects (p = 0.02).

Table 2.

Prevalence of Anti-HCV and HCV RNA in the studied subjects from Clinics #6 and #55 in Puebla, Mexico, grouped by age.

  Clinic #6  Clinic #55  Total  Prevalence (IC 95%)  p* 
Anti-HCV           
< 30 years  9/1,136  11/1,143  20/2,279  0.88 (0.50-1.26)  0.02 
31-50 years  27/2,388  24/2,460  50/4,848  1.03 (0.75-1.31)   
> 50 years  24/1,713  26/1,374  50/3,087  1.61 (1.17-2.05)   
Total  60/5,237  60/4,977  120/10,214  1.17 (0.97-1.37)   
HCV RNA           
< 30 years  3/8  1/08  4/16  25.0 (3.8-46.2)  0.300 
31-50 years  9/27  4/21  13/48  27.1 (14.5-39.7)   
> 50 years  9/24  10/26  19/50  38.0 (24.5-51.4)   
Total  21/59  15/55  36/114  31.6 (18.6-44.6)   
*

p value for Fisher’s exact test.

HCV-RNA detection

RT-PCR was performed in 59/60 HCV-reactive persons in Clinic #6 and 21 (35.6%) resulted to be HCV RNA positive. In subjects from Clinic #55, RT-PCR was performed in 55/60 of HCV-reactive subjects, of which 15 (27.3%) were HCV RNA positive. In both clinics a total of 114 RT-PCR tests were carried out for same number of subjects and 36 (31.6%) were positive. In the case of HCV-RNA positivity, no significant difference was observed in the age groups, however a trend to increase in the > 50 years group was noticed: 38 vs. 25% and 27.1% of groups of < 30 years and 31-50 years, respectively (Table 2).

Risk factors

The main risk factors in subjects were a family history of cirrhosis (33.1%) and blood transfusions prior to 1995 (29%), followed by use of tattoos and piercings, high-risk sexual behavior, or healthcarerelated occupation. Most of subjects presented only 1 risk factor (58.7%), while those which presented ≥ 3 risk factors were 3.6% only (Table 3).

Table 3.

Risk factors in the studied subjects from Clinics #6 and #55 in Puebla, Mexico.

  Clinic #6Clinic #55Total
  (%)  (%)  (%) 
Risk factor*             
Family history of cirrhosis  2,965  (45.2)  1,181  (19.8)  4,146  (33.1) 
Blood transfusions prior to 1995  1,608  (24.5)  2,018  (33.9)  3,626  (29) 
Tattoos or piercings  1,110  (16.9)  1,303  (21.9)  2,413  (19.3) 
Unsafe sexual practices  461  (7)  1,043  (17.5)  1,504  (12) 
Healthcare workers  396  (6.1)  351  (5.9)  747  (6) 
Intravenous drug use  21  (0.3)  58  (1)  79  (0.6) 
Total  6,561  (100)  5,954  (100)  12,515  (100) 
Number of risk factors presented             
718  (13.7)  520  (10.5)  1,238  (12.1) 
2,773  (53)  3,226  (64.8)  5,999  (58.7) 
1,542  (29.4)  1,067  (21.4)  2,609  (25.6) 
≥ 3  204  (3.9)  164  (3.3)  368  (3.6) 
Total  5,237  (100)  4,977  (100)  10,214  (100) 
*

Only subjects with one or more risk factors were considered and n represents the number of mentions obtained for every risk factor.

By univariate analysis we determined that having ≥ 3 risk factors (62.5 vs. 27.7%; p = 0.046), blood transfusion prior 1995 (42.0 vs. 13.7%; p = 0.002) or to be health worker (60 vs. 27.2%; p = 0.025) are significantly associated with HCV RNA positivity (Table 4). After a multiple logistic regression analysis only transfusion prior to 1995 may significantly contribute to HCV transmission (p = 0.004). The importance of this risk factor (odds ratio) was 3.81 and is presented with other potential risk factors in the table 4.

Table 4.

Risk factors in HCV-RNA positive subjects from Clinics #6 and #55 in Puebla, Mexico.

      Univariate analysisMultivariate analysis
Factor An  Anti-HCV(+)  HCV-RNA (+) n (%%)  Odds ratio (95% CI)  Odds ratio (95% CI) 
Gender             
Male  27  8 (29.6)  0.86  0.77  —  — 
Female  93  28 (30.1)  (0.32-2.29)     
Age (years)             
> 31  100  32 (32.0)  1.97  0.42  —  — 
≤ 30  20  4 (20.0)  (0.56-5.80)     
Two risk factors             
Yes  48  16 (33.3)  1.39  0.26  —  — 
No  72  20 (27.7)  (0.67 - 3.09)     
Three risk factors             
Yes  5 (62.5)  4.55  0.04  2.34  0.283 
No  112  31 (27.7)  (1.02-20.0)  (0.49-11.2)   
Transfusion prior to 1995             
Yes  69  29 (42.0)  4.2  0.00  3.81  0.004 
No  51  7 (13.7)  (1.69-10.8)  (1.45-9.99)   
Intravenous drug use             
Yes  0 (0.0)  0.71  0.51  —  — 
No  119  36 (30.2)  (0.63-0.80)     
Tattoos and piercings             
Yes  20  7 (35.0)  1.38  0.59  —  — 
No  100  29 (29.0)  (0.50-3.8)     
Family history of cirrhosis             
Yes  54  14 (25.9)  0.75  0.54  —  — 
No  66  22 (33.3)  (0.33-1.66)     
Unsafe sexual practices             
Yes  21  3 (14.2)  0.35  0.11  —  — 
No  99  33 (33.3)  (0.10-1.27)     
Health care worker             
Yes  10  6 (60)  4.19  0.02  3.66  0.283 
No  110  30 (27.2)  (1.10-15.9)  (0.87-15.4)   

Univariate analysis: Fisher’s exact test. Multivariate analysis: logistic regression.

In the univariate analysis (Table 5), the independent variable of family history of cirrhosis was associated with age groups of > 31-50 and > 50 years (47.0 and 50.3% respectively vs. 39.4% of < 30 years group; p = 0.010), while blood transfusion prior 1995 was associated with > 31-50 years and > 50 years groups (41.8 and 56.7% respectively vs. 16.9% of < 30 years group, p = 0.000). In contrast, tattoos and piercings were associated with the age group of < 30 years (56.2 vs. 21.5% and 11.7% of groups of 31-50 years and > 50 years, respectively; p = 0.000), unsafe sexual practices was also associated with the group age of < 30 years (21.1 vs. 10.9% of group > 50 years; p = 0.010). The < 30 years group was also associated with intravenous drug use (1.7 vs. 0.7% and 0.4% of groups age > 31-50 years and > 50 years respectively; p = 0.010).

Table 5.

Risk factors in subjects from Clinics #6 and #55 in Puebla, Mexico grouped by age.

Risk factorsAge group (years)
< 30  31 - 50  > 50 
Family history of cirrhosis  843 (39.4)  1976 (47.0)  1328 (50.3)  0.010 
Blood transfusion prior to 1995  362 (16.9)  1758 (41.8)  1491 (56.7)  0.000 
Tattoos or piercings  1198 (56.2)  906 (21.5)  306 (11.7)  0.000 
Unsafe sexual practices  451 (21.1)  764 (18.1)  289 (10.9)  0.010 
Healthcare workers  170 (7.9)  372 (8.8)  205 (7.8)  0.100 
Intravenous drug use  38 (1.78)  30 (0.7)  11 (0.4)  0.010 

Univariate analysis was performed and p ≤ 0.05 was considered significant.

HCV genotype

HCV genotypes and subtypes were determined in 31/36 HCV-RNA positive subjects (Table 6). The most frequent genotype in both clinics was 1b (45 and 54.5%, respectively) followed by 1a (30 and 27.3%, respectively). Genotypes 2, 2b and 3a were found in a minor proportion, and genotypes 4, 5 and 6 were not found. Overall frequencies (total of two clinics) were as follows: 25 (80.6%) subjects had HCV genotype 1, of which 15 (48.4%) had subtype 1b and 9 (29%) had subtype 1a; two subjects had subtype 2b (6.5%) and another two (6.5%) had genotype 2 and undetermined subtype, whereas two (6.5%) subjects had subtype 3a.

Table 6.

Genotype and subtype of HCV in 30 of HCV-RNA-positive subjects from Clinics #6 and #55 in Puebla, Mexico.

  Clinic #6Clinic #55Total
Genotype  Cases (%)Cases (%)Cases (%)
1a  (30.0)  (27.3)  (29.0) 
1b  (45.0)  (54.5)  15  (48.4) 
(5.0)  (-)  (3.2) 
2b  (5.0)  (9.1)  (6.5) 
(10.0)  (-)  (6.5) 
3a  (5.0)  (9.1)  (6.5) 
Total  20  (100.0)  11  (100.0)  31  (100.0) 

Genotypes were determined by Versant HCV Genotype 2.0 Assay.

Viral load

The viral load was analyzed in every genotyped HCV positive subject. These subjects were then prescribed medical treatment. The lowest viral load detected among all subjects was 4.24 log and the highest was 6.8 log, corresponding with genotypes 1a and 3a, respectively (data not shown). Statistical analysis searching for a relation between viral load and genotype was not performed due to the low number of cases.

Discussion

In the present study we identified HCV seroprevalence, genotype and the main risk factors in patients and family members attending two clinics of the Instituto Mexicano del Seguro Social (IMSS) in the city of Puebla, Mexico. Seroprevalence was 1.14% in Clinic #6 and 1.20% in Clinic #55. In Mexico, a prevalence of HCV infection has been reported to be between 0 and 2%, fluctuating between blood donors and the open population.9,10,13,14 In other populations may be higher, such as non-injection drug users (4.1%),15 hemodialysis patients (6.7%)16 or injection drug users (96%).17

With respect to HCV genotypes, the present study is similar to other previously published studies.9,1824 The most frequent subtypes in Mexico are 1a and 1b, which has clinical relevance because genotype 1 has been reported as highly resistant to standard peginterferon/ribavirin therapy. Detection of persons infected with this genotype represents a preventive method to refer the patients to the corresponding clinic and begin their treatment during the acute phase.

We found that the principal risk factors were having family members with cirrhosis (33.1%) and having blood transfusion prior 1995 (29%). However, only blood transfusions prior 1995 significantly contribute to HCV transmission (p = 0.004). This result indicates that the principal risk factor in Mexico is still transfusions prior to 1995 because the official Mexican NOM-003-SSA2-1993, which determines detection of HCV antibodies in blood banks, was published on July 18, 1994.7 Risk factors are dependent on the lifestyle of the individual. In developed countries, the principal risk factor is drug use, whereas in developing countries blood transfusions are still an important risk factor14,25 however, some studies finding no statistical association between HCV infection and blood transfusion.26

An additional aspect derived from this study is the possibility of sampling diverse asymptomatic subjects in order to detect HCV-infected persons who then can be referred for timely medical treatment.

Conclusion

In the present study we determined a seroprevalence of 1.17%, whereas 31% of these reactive subjects were positive to viral RNA. The main risk factor detected was blood transfusion prior to 1995. The detected HCV genotypes were 1a (29%), 1b (48.5%), 2/2b (12.8%), and 3a (6.5%). The prevalence in this population is in agreement with previous studies in other Mexican regions.

Abbreviations

  • HCV: hepatitis C virus

  • RT-PCR: reverse transcription polymerase chain reaction.

Declaration of Interest

The authors declare that they have no competing interests.

This work was supported by the Instituto Mexicano del Seguro Social, FIS/IMSS/PROT/G11/830.

References
[1.]
Mohd Hanafiah K., Groeger J., Flaxman A.D., Wiersma S.T..
Global epidemiology of hepatitis C virus infection: new estimates of age-specific antibody to HCV seroprevalence.
Hepatolosv, 57 (2013), pp. 1333-1342
[2.]
Chen S.L., Morgan T.R..
The natural history of hepatitis C virus (HCV) infection.
Int J Med Sci, 3 (2006), pp. 47-52
[3.]
Lavanchy D..
Evolving epidemiology of hepatitis C virus.
Clinical Microbiology and Infection, 17 (2011), pp. 107-115
[4.]
Chevaliez S., Pawlotsky J.M..
Hepatitis C virus serologic and virologic tests and clinical diagnosis of HCV-related liver disease.
Int J Med Sci, 3 (2006), pp. 35-40
[5.]
Sosa-Jurado F., Santos-Lopez G., Guzman-Flores B., Ruiz-Conde J.I., Melendez-Mena D., Vargas-Maldonado M.T., Martinez-Laguna Y., et al.
Hepatitis C virus infection in blood donors from the state of Puebla, Mexico.
[6.]
Alvarado-Mora M.V., Pinho J.R..
Epidemiological update of hepatitis B, C and delta in Latin America.
Antivir Ther, 18 (2013), pp. 429-433
[7.]
Fundación Mexicana para la Salud Hepática.
La hepatitis C como un problema de salud pública en México.
Sal Pub Mex, 53 (2011), pp. S61-S67
[8.]
Valdespino J.L., Conde-González C.J., Olaiz-Fernández G., Palma O., Kershenobich D., Sepúlveda J..
Seroprevalencia de la hepatitis C en adultos de México: & iquest; un problema de salud pública emergente.
Sal Pub Mex, 49 (2007), pp. s395-s403
[9.]
Santos-Lopez G., Sosa-Jurado F., Vallejo-Ruiz V., Melendez-Mena D., Reyes-Leyva J..
Prevalence of hepatitis C virus in the Mexican population: a systematic review.
J Infection, 56 (2008), pp. 281-290
[10.]
Chiquete E., Panduro A..
Low prevalence of anti-hepatitis C virus antibodies in Mexico: A systematic review.
Intervirology, 50 (2007), pp. 1-8
[11.]
Anonimous. Morbilidad y mortalidad por cirrosis hepática. In: Salud: México 2006. México, D.F.: Secretaría Salud; 2007.
[12.]
Anonimous. Programa Nacional de Salud 2007-2012. México, D.F., México: Secretaría de Salud; 2007.
[13.]
Burguete-García A.I., Conde-González C.J., Jimenez-Mendez R., Juarez-Diaz Y., Meda-Monzon E., Torres-Poveda K., Madrid-Marina V..
Hepatitis C seroprevalence and correlation between viral load and viral genotype among primary care clients in Mexico.
Sal Pub Mex, 53 (2011), pp. S7-S12
[14.]
Romero-Figueroa S., Ceballos-Salgado E., Santillan-Arreygue L., Miranda-Garcia M., Rubio-Lezama M., Garduno-Garcia J.J..
Risk factors associated with hepatitis C virus infection in an urban population of the State of Mexico.
Archives of Virology, 157 (2012), pp. 329-332
[15.]
Campollo O., Roman S., Panduro A., Hernandez G., Diaz-Barriga L., Balanzario M.C., Cunningham J.K..
Non-injection drug use and hepatitis C among drug treatment clients in west central Mexico.
Drug Alcohol Depend, 123 (2012), pp. 269-272
[16.]
Mendez-Sanchez N., Motola-Kuba D., Chavez-Tapia N.C., Bahena J., Correa-Rotter R., Uribe M..
Prevalence of hepatitis C virus infection among hemodialysis patients at a tertiary-care hospital in Mexico City, Mexico.
J Clin Microbiol, 42 (2004), pp. 4321-4322
[17.]
White E.F., Garfein R.S., Brouwer K.C., Lozada R., Ramos R., Firestone-Cruz M., Perez S.G., et al.
Prevalence of hepatitis C virus and HIV infection among injection drug users in two Mexican cities bordering the U.S.
Sal Pub Mex, 49 (2007), pp. 165-172
[18.]
Dehesa-Violante M., Bosques-Padilla F., Kershenobich-Stalnikowitz D..
Prevalence of hepatitis C virus genotypes in Mexican patients.
Rev Gastroenterol Mex, 72 (2007), pp. 344-348
[19.]
Garcia-Montalvo B.M., Macossay-Castillo M..
Preliminary data for genotype distribution and epidemiological aspects of hepatitis C virus infection in blood donors from Yucatan, Mexico.
Transfusion Medicine, 17 (2007), pp. 488-490
[20.]
Rivas-Estilla A.M., Cordero-Perez P., Trujillo-Murillo Kdel C., Ramos-Jimenez J., Chen-Lopez C., Garza-Rodriguez Mde L., Ramirez-Gutierrez A., et al.
Genotyping of hepatitis C virus (HCV) in infected patients from Northeast Mexico.
Ann Hepatol, 7 (2008), pp. 144-147
[21.]
Idrovo A.J., Fernandez J.A..
Which is the real genotype distribution of hepatitis C virus infection in Mexico?.
Ann Hepatol, 7 (2008), pp. 389
[22.]
Garcia-Montalvo B.M., Galguera-Colorado P.L..
Distribution of hepatitis C virus genotypes, risk factors and liver disease in patients from Yucatan, Mexico.
Ann Hepatol, 7 (2008), pp. 345-349
[23.]
Mendez-Sanchez N., Gutierrez-Grobe Y., Kobashi-Margain R.A..
Epidemiology of HCV infection in Latin America.
Ann Hepatol, 9 (2010), pp. 27-29
[24.]
Jimenez-Mendez R., Uribe-Salas F., Lopez-Guillen P., Cisneros-Garza L., Castaneda-Hernandez G..
Distribution of HCV genotypes and HCV RNA viral load in different regions of Mexico.
Ann Hepatol, 9 (2010), pp. 33-39
[25.]
Dehesa-Violante M., Nunez-Nateras R..
Epidemiology of hepatitis virus B and C.
Arch Med Res, 38 (2007), pp. 606-611
[26.]
Oliveira-Filho A.B., Pimenta Ado S., Rojas Mde F., Chagas M.C., Crespo D.M., Crescente J.A., Lemos J.A..
Likely transmission of hepatitis C virus through sharing of cutting and perforating instruments in blood donors in the State of Para, Northern Brazil.
Cad Saude Publica, 26 (2010), pp. 837-844
Copyright © 2014. Fundación Clínica Médica Sur, A.C.
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