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ORIGINAL ARTICLE Table of Contents   
Year : 2009  |  Volume : 52  |  Issue : 1  |  Page : 17-19
Seroprevalence of hepatitis viruses in patients infected with the human immunodeficiency virus


Department of Microbiology, Maulana Azad Medical College, New Delhi 110 019, India

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   Abstract 

Objective: The co-infection of Hepatitis B and C viruses with HIV accelerates disease progression and also has an effect on the management of patients infected with HIV. The prevalence of HIV co-infection with hepatitis viruses varies widely. This study is planned to evaluate the prevalence of HIV co-infection with Hepatitis B and C viruses in North India. Materials and Methods: A total of 1178 patients enrolled in the ART center were retrospectively analyzed for the presence of HBV and HCV on the basis of the presence of HBsAg and anti-HCV markers. Results: In patients infected with HIV, the prevalence of co-infection with HBV was 9.9% (117/1178), the prevalence of co-infection with HCV was 6.3% (74/1178) and the prevalence co-infection with both HBV and HCV was ~1% (12/1178). Discussion: The prevalence rate of HBV and HCV are increasing in patients infected with HIV. Having acquired the knowledge about the importance of such a co-infection, it is essential that all the patients infected with HIV be screened for HBV and HCV co-infection.

Keywords: HIV, HBV, HCV, seroprevalence, co-infection

How to cite this article:
Jain M, Chakravarti A, Verma V, Bhalla P. Seroprevalence of hepatitis viruses in patients infected with the human immunodeficiency virus. Indian J Pathol Microbiol 2009;52:17-9

How to cite this URL:
Jain M, Chakravarti A, Verma V, Bhalla P. Seroprevalence of hepatitis viruses in patients infected with the human immunodeficiency virus. Indian J Pathol Microbiol [serial online] 2009 [cited 2019 Dec 11];52:17-9. Available from: http://www.ijpmonline.org/text.asp?2009/52/1/17/44955



   Introduction Top


People at high risk for Human Immunodeficiency Virus (HIV) infection are also likely to be at increased risk for other pathogens like the Hepatitis B Virus (HBV) and the Hepatitis C Virus (HCV), which share the route of transmission with HIV. There is a high degree of epidemiological similarity between these viruses in terms of routes of transmission, associated risk factors and the presence of these viruses in various body fluids. [1],[2],[3] With increased availability of antibiotics and anti-fungal drugs, HBV and HCV infection are becoming a cause for significant concern for individuals infected with HIV. Ever since the institution of high affinity anti-retroviral therapy (HAART) in individuals infected with HIV, liver disease has emerged as a major cause of morbidity and mortality in such individuals. [4],[5],[6]

The co-infection of HCV with HIV is associated with a loss of immunological control of HCV and more rapid progression of HCV disease. [4],[6] In a multi-center AIDS cohort study (MACS) in 2002, it was observed that liver-related mortality rates per 1000 person-years of observation were 1.7 in HIV-seropositive patients, 0.8 in HBsAg positive patients and 14.25 in the co-infected patients (significantly higher as compared with monoinfected patients). [4]

Furthermore, co-infection with hepatitis viruses may complicate the delivery of anti retroviral therapy (ART) by increasing the risk of drug-related hepatotoxicity and may interfere with the selection of specific agents. Expert guidelines developed in the United States and Europe recommend screening of all individuals infected with HIV for infection with HCV and HBV to help in appropriate management of such patients. In developing countries like India, no such uniform guidelines are available.

Globally, the studies conducted on the prevalence of hepatitis viruses in patients infected with HIV have shown the rate of HIV and HBV/HCV co-infection to be around 12 to 15%. [7],[8],[9] Few studies conducted in India have shown the prevalence of co-infection of HBV with HIV to vary in different geographical areas from as low as 9% to as much as 30% and of HCV with HIV to vary from 2 to 8%. [10],[11],[12],[13] The present retrospective study, with a larger sample size, was an endeavor to detect the current prevalence of HBV and/or HCV co-infection in patients infected with HIV in Delhi and the adjoining areas.


   Materials and Methods Top


The present study was conducted in the virology laboratory in the Department of Microbiology. This laboratory receives samples from a 3000-bed tertiary care hospital and caters to patients from Delhi and the adjacent states in Northern India. The samples are received from the ART center for detection of HBV and HCV markers. For HBV, the marker used in our laboratory for routine screening is HBV surface antigen (HBsAg). The test is performed using commercially available enzyme linked immunosorbent assay (ELISA) (BIORAD). Anti-HCV is done using 3 rd /4 th generation ELISA (Dia Sorin). The test is performed as per the manufacturer's instructions. The validity of the test is assessed as per the given criterion and the result is calculated. Serum samples that giving borderline results are retested and those repeatedly giving borderline values are considered negative.

HBV and HCV markers were retrospectively and longitudinally assessed from January 2006 to December 2007. The demographic profile of the patients was noted.


   Results Top


We received 1178 HIV-positive samples from the ART clinic during the 2 year study period. The mean age of the study group was 28.4 years old. The percentage of male patients was 73% (860/1178) as compared with 27% (318/1178) for female patients. Thus, the male:female ratio of the study group was 2.7:1.

The prevalence of HBV as assessed on the basis of the presence of HBsAg in patients infected with HIV was 9.9% (117/1178), the prevalence of HCV with HIV was 6.3% (74/1178) and the prevalence of HIV with both HBV and HCV was ~ 1% (12/1178). The distribution of HBV and HCV co-infection in patients infected with HIV is as shown in [Table 1].


   Discussion Top


India has a high burden of HIV, ranking 2 nd in the global list. [14] Also, among the individuals infected with HIV, it is estimated that 2-4 million people have chronic HBV co-infection, while 4-5 million are co-infected with HCV. [15] It is already reported that co-infection of HBV and or HCV with HIV complicates the clinical course, management and therapy for HIV infection. The geographical variance of co-infection rates of HBV and HCV may be due to different risk factors and type of exposure. [11],[12],[13]

Our observations showed that the mean age of the study group is less as compared with previous studies from India. [10],[11] Thus, the younger population in the economically productive age group is being increasingly affected by HIV, leading to a loss to the economy. This could be because of the increased exposure of this population to the risk factors like promiscuity, parenteral drug abuse, etc. The increase in the prevalence of HIV infection in the younger population could also be attributed to a lack of awareness in spite of intensive programs carried out on the national and international levels.

The study group comprised predominantly of a male population (73%), which is significantly higher than the female population (27%; P < 0.01). This is in accordance with previous studies showing that male subjects are at a significantly higher risk of acquiring HIV infection. [11],[12]

In the present study, the rate of co-infection with HBV and HCV either alone or in combination was ~ 17%, a significantly higher rate than reported in the general population. [10],[16] In the present study, both the HIV/HBV and HIV/HCV co-infections were higher in the sexually active age group as compared with another study from India [11] where HCV/HIV co-infection was higher in the > 50 years old age group. In India, we could not find a study where co-infection with both HCV and HBV was reported in patients with HIV as seen in the present study, hence, it is likely that the prevalence rate of HBV and HCV is increasing in patients infected with HIV and both these viruses can be seen in the same patient.

The implication of HBV and/or HCV co-infection in patients with HIV is of serious concern in developing countries like India. Knowledge about HBV/HCV co-infection in individuals infected with HIV has become important since the institution of HAART has prolonged their life and they need to be managed for their co-infection with HBV and/or HCV. The present study underlines the necessity of a uniform guideline in which all the patients infected with HIV should be screened for HBV and HCV to help the management of co infection.

 
   References Top

1.Sulkowski MS. Viral hepatitis and HIV coinfection. J Hepatol 2008;48:353-67.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.Rustgi VK, Hoofnagle JH, Gerin JL, Gelmann EP, Reichert CM, Cooper JN, et al . Hepatitis B virus infection in the acquired immunodeficiency syndrome. Ann Intern Med 1984;101:795-7.  Back to cited text no. 2  [PUBMED]  
3.Brendon Mc Caroon, Thyagarajan SP. Human Immunodeficiency virus and hepatotropic viruses: Interaction and treatment. Indian J Med Microbiol 1998;16:4-11.  Back to cited text no. 3    
4.Chung RT. Hepatitis C and B viruses: the new opportunists in HIV infection. Top HIV Med 2006;14:78-83.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]
5.Bica I, McGovern B, Dhar R, Stone D, McGowan K, Scheib R, et al . Increasing mortality due to end stage liver disease in patients with human immunodeficiency virus infection. Clin Infect Dis 2001;32:492-7.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]
6.Thio CL, Scaberg EC, Skolasky R Jr, Phair J, Visscher B, Muρoz A, et al . HIV-1, hepatitis B virus and risk of liver related mortality in the Multicenter cohort study (MACS). Lancet 2002;360:1921-6.  Back to cited text no. 6    
7.Rouet F, Chaix ML, Inwoley A, Anaky MF, Fassinou P, Kpozehouen A, et al . Frequent occurrence of chronic hepatitis B virus infection among West African HIV type 1 infected children. Clin Infect Dis 2008;46:361-6.  Back to cited text no. 7  [PUBMED]  [FULLTEXT]
8.Telatela SP, Matec MI, Munubhi EK. Seroprevalence of hepatitis B and C viral co infection with Human Immunodeficiency Virus attending the pediatric HIV care and treatment center at Muhimbili National Hospital in Dar-es-Salaam, Tanzania. BMC Public Health 2007;7:338.   Back to cited text no. 8    
9.Egah DZ, Banwat EB, Audu ES, Iya D, Mandong BM, Anele AA, et al . Hepatitis B surface antigen, hepatitis C and HIV antibodies in a low -risk donor group, Nigeria. East Mediterr Health J 2007;13:961-6.  Back to cited text no. 9  [PUBMED]  
10.Tankhiwale SS, Khadase RK, Jalgoanker SV. Seroprevalence of anti HCV and hepatitis B surface antigen in HIV infected patients. Indian J Med Microbiol 2003;21:268-70.  Back to cited text no. 10  [PUBMED]  Medknow Journal
11.Saravanan S, Velu V, Kumarasamy N, Nandakumar S, Murugavel KG, Balakrishnan P, et al . Coinfection of hepatitis B and hepatitis C virus in HIV infected patients in South India. World J Gastroenterol 2007;13:5015-20.  Back to cited text no. 11  [PUBMED]  [FULLTEXT]
12.Kumarasamy N, Solomon S, Flanigan TP, Hemalatha R, Thyagarajan SP, Mayer KH. Natural history of human immunodeficiency virus disease in southern India. Clin Infect Dis 2003;36:79-85.   Back to cited text no. 12  [PUBMED]  [FULLTEXT]
13.Padmapriyadarsini C, Chandrabose J, Victor L, Hanna LE, Arunkumar N, Swaminathan S. Hepatitis B or hepatitis C co-infection in individuals infected with human immunodeficiency virus and effect of anti-tuberculosis drugs on liver function. J Postgrad Med 2006;52:92-6.   Back to cited text no. 13  [PUBMED]  Medknow Journal
14.National AIDS Control Organization (NACO). HIV/AIDS epidemiological Surveillance and Estimation report for the year 2005. Available from: http://www.nacoonline.org/. [last accessed on 2007 Jun 10].  Back to cited text no. 14    
15.Alter MJ. Epidemiology of viral hepatitis and HIV co-infection. J Hepatol 2006;44:S6-9.  Back to cited text no. 15  [PUBMED]  [FULLTEXT]
16.Chandra M, Khaja MN, Farees N, Poduri CD, Hussain MM, Aejaz Habeeb M, et al . Prevalence, risk factors and genotype distribution of HCV and HBV infection in the tribal population: A community based study in south India. Trop Gastroenterol 2003;24:193-5  Back to cited text no. 16  [PUBMED]  

Top
Correspondence Address:
Anita Chakravarti
79, Southpark Apartment, Kalkaji, New Delhi 110 019
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.44955

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    Tables

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