Regional, Age, and Sex Patterns of Hepatitis C Virus Infection in Russia: Insights from a 42,000-Participant Serosurvey.

Identifying population groups at greatest risk of hepatitis C virus (HCV) infection is essential for targeting screening and treatment. We analyzed the seroprevalence of antibodies to HCV (anti-HCV) and HCV RNA in serum samples from 37,291 conditionally healthy volunteers collected between 2018 and 2022, and from 4764 individuals sampled in 2008, totaling 42,055 participants. In 2018-2022, anti-HCV prevalence varied by region, ranging from 1.1 to 1.4% in Belgorod, Moscow, and St. Petersburg to 1.8-2.1% in Dagestan, Tatarstan, Novosibirsk, Tyva, and southern Yakutia, and reaching 3.4-5.2% in Khabarovsk and the Arctic zone of Yakutia. In 2008, prevalence in Moscow, Rostov, Sverdlovsk, Tyva, and Yakutia ranged from 1.7% to 3.3%. A significant decline over time was observed: from a mean of 2.6 ± 0.5% in 2008 to 1.9 ± 0.1% in 2018-2022 (p < 0.01). In recent years, men were more frequently anti-HCV-positive than women (2.5 ± 0.2% vs. 1.5 ± 0.2%, p < 0.01), whereas no sex differences were noted in 2008. The age of a sharp prevalence increase shifted from the 20-29 cohort in 2008 to the 30-39 cohort in 2018-2022. Based on the demographic structure, we estimate ~3.23 million anti-HCV carriers in Russia. HCV RNA was detectable in only one-third of seropositive individuals, identifying them as candidates for antiviral therapy. Thus, in contemporary Russia, men aged over 30 years have the highest risk of HCV infection and should be prioritized for targeted screening.