SRINAGAR: A hospital-based study from North Kashmir has found hepatitis C infection in 18.30 per cent of 1,087 patients tested, with intravenous drug use emerging as the strongest associated risk factor. Hepatitis B was detected in 3.42 per cent of 1,081 patients.
The study also found that young adults aged 20-40 accounted for nearly a third of hepatitis C-positive cases and identified 13 patients with hepatitis B and C co-infection, prompting the researchers to call for expanded, region-specific screening and early diagnosis.
The findings are reported in a study, Seroprevalence and associated risk factors of Hepatitis B and C in a cross-sectional study from North Kashmir, authored by Shakil U. Rehman, Neesa Majeed, Tanveer Ahmad Mir, Nazima Nazir, Showkat Ahmad Lone and Junaid Ahmad. Rehman is from the Department of Pharmacology, Government Medical College Baramulla; Majeed, Nazir, Lone and Ahmad are from the Virus Research and Diagnostic Laboratory, Department of Microbiology, Government Medical College Baramulla; and Mir is from the Centre of Research for Development, University of Kashmir, Srinagar.
The paper was published in Discover Medicine in July 2026 by Springer Nature.
Study Scope
The cross-sectional study was conducted at the Department of Microbiology, Government Medical College Baramulla, between September 2023 and November 2024. Although most participants were from Baramulla district, patients from adjoining Kupwara and Bandipora districts were also included.
The researchers tested blood samples using enzyme-linked immunosorbent assay (ELISA), screening for hepatitis B surface antigen (HBsAg) and antibodies against hepatitis C virus (HCV). They subsequently used statistical tests and multivariable logistic regression to examine associations between infection and potential risk factors.
The researchers described it as the first hospital-based study of HBV and HCV seroprevalence in North Kashmir using ELISA, providing what they termed “novel and regional specific epidemiological insights.”
Of the 1,081 patients tested for hepatitis B, 37 were positive, producing a seroprevalence of 3.42 per cent. Among the 1,087 tested for hepatitis C, 199 were positive, producing a seroprevalence of 18.30 per cent.
The researchers compared these figures with national seroprevalence figures cited in the study of 0.95 per cent for HBV and 0.32 per cent for HCV.
HCV Risk
Intravenous drug use stood out most strongly in the hepatitis C analysis.
Among the HCV-positive patients, 134 of 206 intravenous drug users tested positive, representing 65.04 per cent of that group. In the multivariable analysis, intravenous drug users had an adjusted odds ratio of 18.4, with a 95 per cent confidence interval of 9 to 39.49.
The researchers wrote that intravenous drug users were “about 18.41 times more likely to have HCV infection compared to non-IV drug users.”
The study also found statistically significant associations between HCV infection and being an outpatient, fever, sex, planned surgery and being in the 20-40 age group.
The adjusted odds ratio for the 20-40 age group was 4.3 compared with the 0-20 reference group. There were 162 HCV-positive patients in the 20-40 age category, accounting for 32.46 per cent of all HCV-positive cases.
The researchers linked the high proportion among young adults and intravenous drug users primarily to clustering among substance users and the sharing of needles and related paraphernalia.
They also noted that social and behavioural factors such as peer groups, socioeconomic status, marginalisation, impulsivity, pleasure-seeking and curiosity could contribute to intravenous drug use among younger people, although these were presented as possible contributing factors rather than variables directly established by the study.
Co-Infection
The study identified 13 patients who were infected with both hepatitis B and hepatitis C.
Co-infection was highest in the 18-35 age group, at 2.32 per cent, followed by 0.52 per cent among those above 35. The 0-18 age group recorded the lowest rate.
The researchers highlighted the concentration of hepatitis C among younger people and those using intravenous drugs as a particular concern.
The study also found hepatitis C among patients being screened before planned surgery or other invasive procedures. While only 2.7 per cent of HCV-positive patients belonged to this category, the researchers regarded these cases as important because some patients had no clinical signs or symptoms of viral hepatitis and were detected incidentally during pre-procedure screening.
HBV Findings
Hepatitis B showed a different pattern from hepatitis C.
Of the 1,081 patients tested, 37 were HBsAg-positive. The prevalence was 2.31 per cent among men and 1.11 per cent among women, but the difference was not statistically significant.
Likewise, the researchers found no statistically significant association between HBV infection and intravenous drug use, jaundice, renal dialysis, age, fever or patient type.
Two categories did show statistically significant associations: patients scheduled for surgery or other invasive procedures, and the category labelled “others”, which included complaints such as acute diarrhoeal disease, chills, rashes and severe acute respiratory infection.
The researchers cautioned that these complaints themselves had not been directly implicated in hepatitis B infection. Instead, they suggested that the findings could indicate the presence of otherwise undetected or subclinical HBV infections that were being discovered incidentally during screening.
Hospital Caveat
The researchers stressed that the figures should not be interpreted as a population-wide estimate for North Kashmir.
The study was carried out at a single tertiary-care hospital, and patients were tested because they were clinically suspected of having viral hepatitis, were considered at risk, or required testing before a procedure. Participants were also selected through convenience sampling.
The authors therefore stated that the findings “cannot be extrapolated to the prevalence in the community” without community-based screening.
They also acknowledged that the hospital setting could partly explain the unusually high HCV figure because suspected and high-risk patients were more likely to be tested, while a substantial proportion of HCV-positive patients belonged to the intravenous drug-use group.
Screening Call
Despite the limitation, the researchers said the findings warrant expanded screening beyond the hospital environment.
For hepatitis B, they called for widespread screening outside hospital settings to establish the prevalence, trends and risk factors in the wider community.
For hepatitis C, they recommended greater public awareness and prevention efforts, along with targeted screening of high-risk groups.
The paper particularly identifies intravenous drug users and dialysis patients as groups requiring early and timely diagnosis. It also recommends routine screening of patients undergoing invasive procedures, including minimally invasive procedures involving mucosal exposure.
The researchers concluded that periodic community and targeted screening is needed to assess the extent of HBV and HCV infection, including among people who may be carrying the viruses without symptoms.
The paper notes that the difference between the two infections may partly reflect the availability of an effective hepatitis B vaccine as part of India’s standard immunisation schedule, while no effective vaccine is currently available for hepatitis C.
The researchers ultimately describe the findings as evidence of a significant regional burden and call for “urgent, region specific screening and early diagnosis” to prevent further transmission.
