Serodetection of Hepatitis C Virus Infection among HIV Patients in Mingalardon Specialist Hospital
Tin Sandar Win, San Yu Maw, Yi Yi Kyaw & Win Win Maw
Myanmar Health Sciences Research Journal, Vol. 32, No. 1, 2020Abstract
with hepatitis C virus in HIV-infected individuals results in increased hepatic
complications. In the era of antiretroviral therapy, liver-related death among
HIV patients is the most prevalent non-AIDS related cause. HIV and HCV share
common pathways of mode of transmission. The aim of this study was to detect
hepatitis C in HIV patients and to
find out the coinfection rate in HIV patients from Mingalardon Specialist
Hospital. The study was done at Molecular
Technology Applications Division at Department of Medical Research from January
2016 to December 2016. A total of 150 participants including 83 males and 67
females were studied. Blood samples were tested for anti-HCV by enzyme-linked immunosorbent assay
(ELISA) method. Anti-HCV was positive in 15 (9 males, 6 females) and the prevalence
rate was found to be 10%. Anti-HCV positivity was found (33.3%, 5/15 each) in 19-29
years and 30-39 years followed by (26.7%, 4/15) in 40-49 years age
group. Among HCV- coinfected
patients, 80% (n=12) were reported as low level education; 20% (n=3) as high
level education and more common in urban (53.3%, 8/15) than rural area (46.7%,
7/15). Coinfection with HCV was in statistically significant association (p<0.05)
with IVDU history (57.1%, 8/14). Out of 52 patients with history of skin piercing, anti-HCV was detected in 17.3%
(n=9). Among HCV-coinfected patients, mean CD4 count was
493.87 cells/mm3. No HCV coinfection was encountered in patients with CD4 count <200 cells/mm3. The present study demonstrated that HCV coinfection was more common in male, residents from urban area, married people, low education and history of body piercing practice. The findings of this study would be indicative of a portion of hepatitis C coinfection among HIV patients in Myanmar.
Viral hepatitis C infection occurs commonly among HIV-infected individuals, with appro-ximately 25% of HIV-infected persons world-wide estimated to have concurrent chronic HCV infection. Complications related to HIV/HCV coinfection are becoming an increasing important issue. As improvements in HIV treatment have reduced the number of deaths due to opportunistic illness, liver disease has become a leading cause of hospitalization and death in people with HIV/AIDS.1
MATERIALS AND METHODS
MATERIALS AND METHODS
This study was a cross-sectional, laboratory- based descriptive study in which blood samples from HIV-infected patients were collected from outpatient department of Mingalardon Specialist Hospital. The study period was from January 2016 to December 2016. Laboratory examination was done at Molecular Technology Applications Division at Department of Medical Research. A total of 150 HIV-positive patients were included in this study. Blood samples in aliquot tubes were centrifuged for 10 minutes at 2000 rpm for serum separation. After centrifugation, the serum was transferred into another sterile aliquot tube with transfer disposable pipettes and then kept in a -20°C deep freezer before testing. According to the manufacturer’s instructions, anti-HCV ELISA was done by using HCV ELISA 3.0 test kit, Standard Diagnostics Inc., Republic of Korea. Data collected from the proforma was entered and analyzed by using computerized statistical software SPSS (Statistical Package for Social Science Version 16).
This study was carried out after taking approval from Ethical Research Committee of University of Medicine 2.DISCUSSION
The overall prevalence of HCV/HIV co-infection ranges from 1.2% to 98.5% in South and Southeast Asia. 6 In this study, of 150 tested HIV-positive patients, 55.3% (83/150) were male and 44.7% (67/150) were female patients. In Myanmar, the highest prevalence rate of HIV infection was found to be in the population aged 15- 49 years group. 7 Increased incidence of HIV infection among young adults may be due to increased sexual activity of that age group. HIV seropositivity was higher in male patients than female patients and this might be due to sexual promiscuous and life style of sexually active people, primarily men.
The present study found that the prevalence of HCV co-infection in HIV-infected patients was 10% (15/150). The prevalence of HCV infection in HIV-infected patients in this study was rather higher than that had been reported, 5% of HCV coinfection in 11,032 HIV-infected patients in Mandalay during 2012.8 This prevalence difference may be due to difference in test principle and diversity in study group. The previous study done by Sai Ko Ko Zaw, et al.8 used rapid test strips to detect anti-HCV antibodies whereas 3rd generation ELISA in this study.
In 2007, 100 cases of HIV-positive patients from Yangon General Hospital and New Yangon General Hospital, Myanmar were tested for anti-HCV antibody and it was found that 19% of HIV patients were positive for anti-HCV by RPHA method (SERODIA).3 One study done in Asia- Pacific Region found that HCV coinfection was approximately 10%.9 In the present study, the result was similar to that of the study done in Kenya (Nairobi) in which 10.3% HCV coinfection in total tested 300 HIV-infected individuals.10
This study found 10.8% (9/83) HCV co-infection in HIV-positive men and 9% (6/67) in HIV-positive women. The gender distri-bution of the present study was coincided with other studies. Many papers stated that majority of HCV coinfection in HIV- positive men were higher than the HIV- positive women. In the study done by et al.4, male and female prevalence was 9.5% and 1.2%, respectively, in Vietnam. The gender distribution of HCV coinfection in this study may be due to the fact that men are more likely to have multiple sex partners and practice of unprotected sex due to the polygamous nature of their relationship and IVDU in Myanmar.
In this study, HCV coinfection was relatively common in married (12.1%) than single (8.3%). Among the HCV-coinfected HIV patients, 80% had low level of education. Of 15 HCV-coinfected patients, 53.3% live in urban and the others (46.7%) live in rural area. In another study done in Nigeria by Mabayoje11, of 280 HIV-positive patients, the positivity rate of HCV-coinfection was higher in married (66.1%) than single (27.9%) and majority of HCV-coinfected patients had low level of education (62.5%).
High HCV coinfection in urban area may be due to increased population, level of standard of living (eg. from urban slum area), individual sexual behavior and also young age (working age group) population who come from different district areas. Although it has been accepted that sexual transmission of HCV is low, the number of married HIV patients was relatively high in HCV seropositivity than single in this study. The results from socio-demographics factor from this study may differ from those of other studies due to diversity of study population and geographic areas.
In the present study, the rate of HCV coinfection in HIV patients was higher among heterosexual (93.3%) than homo-sexual HIV patients (6.6%). Regarding the sexual behavior of HCV-coinfected HIV patients, 23.2% had homosexual behavior in the study done by Anderson, et al.12 in the HIV Atlanta cohort study.
Moreover, a study done in Malaysia by
Tan, et al.13 in 2004 reported that 4.4% of homosexual men had HCV coinfection. Most of the papers reported that HCV coinfection rate was higher in homosexual men. Sexual preference that was not associated with HCV co-infection in the present study may be due to a very small population of homosexual participants and general population of HIV- infected patients in Myanmar.
According to the results from this study, only 12.5% (n=2) was observed anti-HCV antibody positive among 16 patients of having blood transfusion history. Transfusion of blood products had been a leading cause of transmission of HCV; however, due to improved screening, transmission through transfusions has decreased in most developed countries.14
In this study, of 14 HIV patients with IVDU history, 64.3% (n=9) were anti-HCV positive. The rate of HCV coinfection in HIV patients was significantly associated with IVDU history (p<0.05). Many papers described that there was strong association with IVDU and HCV coinfection. In the present study, among the patients who had history of skin piercing (n=52), HCV coinfection was detected in 17.3% (n=13). Another study done in Mekelle Hospital, Ethiopia found that the prevalence of HCV coinfection was 8.6% in HIV patients who had skin piercing procedures.15 Thet Nwe Oo3 study from Myanmar reported that anti-HCV was detected in 20.5% of the HIV patients who had skin piercing history.
Skin piercing history in relation to HCV was different in various studies. It may depend on the status of tattooer or the person who make skin piercing to other people. The risk was higher if the skin piercing was done by non-professional than professional. This may probably associate with improperly sterilized needles and non-sterile non-disposable equipment. Therefore, presence and frequency of risk factors may be responsible for variation of anti-HCV positivity in different parts of Myanmar.
In this study, the mean CD4 count (488.7 cells/mm3) was found in HIV-HCV- coinfected study participants. There was no HCV coinfection encountered in patients with less than 200 cells/mm3 CD4 count. Among HIV pregnant mothers in Ghana in 2013, HCV coinfection prevalence was 4.1% and no HCV coinfection was detected under CD4 count 350 cells/mm3.16 The CD4 count result from the present study was compatible with these findings. Wondimeneh, et al.17 also found that HIV/HCV coinfection did not result in a significant reduction in the CD4 in HIV- infected persons in Ethiopia.
Immunosuppression from HIV infection may impair antibody formation, and false-negative HCV antibody tests have been reported in individuals co-infected with HIV. HCV RNA testing should be performed in anti-HCV negative, HIV-infected patients, especially those with CD4 cell count less than 200 cells/mm.3, 18
Coinfection with human immunodeficiency virus (HIV) and hepatitis C virus is common since both infections share similar route of transmission. Given the attention to HIV, it is more likely that HCV will be neglected and such neglect can result in irreversible cirrhosis and hepatocarcinoma. It is clear that HCV screening should be conducted as soon as an HIV-positive test is confirmed. This permits coinfection to be treated appropriately, quality care provided, and further disease progress prevented. Proper management of HIV-HCV coinfection is critical and can be highly effective in disease control. Prevention and control strategies should be implemented comprehensively to ensure their maximal effectiveness.
There were some limitations in this study. It was cross-sectional study and cannot establish relationship between the time of exposure and subsequent infection. Moreover, HCV coin-fection status was based on anti-HCV antibodies rather than HCV RNA detection. The patients are in immunocompromised condition so that the rate of indeterminate or false negative antibodies results may be high. Nonetheless, this study can be implied approximate data of serodetection of HCV in HIV patients in Myanmar.Go to : Goto
We would like to express our
sincere gratitude to Dr. Kyaw Zin Thant, Director- General and Dr. Hlaing Myat
Thu, Deputy Director-General, Department of Medical Research for allowing us to
do research at the Department of Medical Research. We are also indebted to Dr.
Win Thura, Associate Professor, Department of Preventive and Social Medicine,
University of Medicine 2 who helped in diverse ways during the data analysis. We would like to thank
Dr. Ko Ko Aung, Medical superintendent from Mingalardon Specialist Hospital, for his permission to collect specimens from the patients at the hospital. We also wish to extend a deep gratitude to Daw Ohnmar Lwin, Research Scientist of Molecular Application Research Division for her technical support and all the staffs from Molecular Application Research Division for helping us during this study. Last but not the least, we would also like to mention our heartfelt thanks to all patients who gave their consent willingly to participate in this study.
CONFLICT OF INTEREST
CONFLICT OF INTEREST
The authors declare that they have no competing interests.Go to : Goto
1. Franciscus A. An overview of HIV/HCV coinfection: A series of fact sheets written by experts in the field of liver disease. Version 3 [Internet]. 2015. [updated 2015 June 25; cited 2016 May 21]. Available from:
3. Thet Nwe Oo. Study of hepatitis B and hepatitis C viruses co-infection in HIV-positive patients in Yangon General Hospital and New Yangon General Hospital. [MMedSc thesis]. University of Medicine (1): Yangon; 2007.
4. Huy VB, Vernavong K & Kính NV. HBV and HCV coinfection among HIV/AIDS patients in the National Hospital
of Tropical, Vietnam. AIDS Research and Treatment 2014; 2014: 581021 Available from: https://doi.org/10.1155/ 2014/581021
5. Rao VB, Johari N & du Cros P. Hepatitis C seroprevalence and HIV coinfection in sub-Saharan Africa: A systematic review and meta-analysis. Lancet Journal 2015; 15(7): 819-824. Available from: doi: 10.1016/ S1473-3099 (15) 00006-7
6. Ye S, Pang L & Wang X. Epidemiological implications of HIV- Hepatitis C coinfection in South and Southeast Asia. Current HIV/AIDS Report 2014; 11(5): 128-133. Available from: doi 10.1007/s11904-014-0206-z
7. National AIDS Program. Myanmar-Global AIDS Response
Progress Report, 2015. Naypyitaw, National AIDS Program,
2015; p. 6.
8. Sai Ko Ko Zaw, Sai Thein Than Tun, Aye Thida, Thet Ko Aung, Win Maung, Myint Shwe, et al. Prevalence of hepatitis B and C virus among patients infected with HIV: A cross-sectional analysis of a large HIV care programme in Myanmar. Tropical Doctor 2013; 43(3): 113-115.
9. Zhou YH, Liu FL & Yao ZH. Comparison of HIV, HBV, HCV and coinfection prevalence between Chinese and Burmese intravenous drug users of the China-Myanmar border region. PLoS ONE 2011; 6(1): e16349.10. Muriuki BM, Gicheru MM, Wachira D, et al. Prevalence of hepatitis B and C coinfections among HIV-1 infected
individuals in Nairobi, Kenya. BMC Research Notes 2013; 6(2): 363-368.
11. Mabayoje VO, Muhibi MA & Akindele RA. Hepatitis C virus coinfection among people living with HIV/AIDS in a Nigerian teaching hospital. HIV and AIDS Review 2013; 12 (4):102-105.
12. Anderson KB, Guest JL & Rimland D. Hepatitis C virus coinfection Increases mortality in HIV-infected patients in the highly active antiretroviral therapy era: Data from the HIV Atlanta VA cohort study. Clinical Infectious Diseases 2004; 39(11): 1507-1513.
13. Tan SS, Leong CL & Lee CK. Treating hepatitis C in HIV/HCV coinfected patients in Malaysia - the outcomes and challenges. Medical Journal of Malaysia 2015; 70(5): 281-289.
14. Wolfgang WT, Kant JA & Weck KE. Hepatitis C virus quantification: optimization of strategies for detecting low-level viremia. Journal of Clinical Microbiology 2000; 38(2): 888-891.
15. Hadush H, Gebre-Sellassie S & Mihret A. Hepatitis C virus and Human Immuno-deficiency virus coinfection among atten-dants of Voluntary Counseling and Testing Centre and HIV follow-up clinics in Mekelle Hospital. The Pan African Medical Journal 2013; 14: 107.
16. Ntiamoah P. The prevalence of hepatitis B and /or hepatitis C virus (HBV and /or HCV) coinfection among HIV infected pregnant women. [MPhil thesis]. University of Science and Technology: Kwama Nkrumah; 2015.
17. Wondimeneh Y, Alem M & Asfaw F.
HBV and HCV seroprevalence and their correlation with CD4 cells and liver
enzymes among HIV positive individuals at University of Gondar Teaching Hospital, Northwest Ethiopia. Virology Journal 2013; 10: 171-186.
18. Chamie G, Bonacini M & Bangsberg DR. Factors associated with seronegative chronic hepatitis C virus infection in HIV infection. Clinical Infectious Diseases 2007; 44(4): 577-583.