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Hepatitis C in HIV-infected patients with and without AIDS: prevalence and relationship to patient survival
T L Wright1, H Hollander, X Pu
1Department of Medicine, University of California, San Francisco 94121.
Insights
Hepatitis C virus (HCV) infection is more common in HIV-positive men who have sex with men, suggesting sexual transmission. HCV coinfection does not impact survival in these patients.
Area of Science:
- Virology
- Infectious Diseases
- Epidemiology
Background:
- Limited data exists on Hepatitis C virus (HCV) prevalence in Human Immunodeficiency Virus (HIV) patients and its effect on survival.
- Investigating risk factors beyond traditional routes like intravenous drug use is crucial.
Purpose of the Study:
- To determine the prevalence of HCV infection in HIV-positive individuals, particularly non-intravenous drug users.
- To explore potential transmission routes, such as homosexual contact.
- To assess the impact of HCV coinfection on the survival of HIV-infected patients.
Main Methods:
- Retrospective study of 512 predominantly non-intravenous drug-using, homosexual men, including 224 with AIDS.
- HCV antibody testing using enzyme immunoassay, confirmed by strip immunoblot assay and HCV RNA detection via polymerase chain reaction.
- Testing of enzyme immunoassay-negative samples for HCV RNA to identify occult infections.
Main Results:
- HCV infection prevalence was 11.7% in individuals without a history of intravenous drug use or transfusion.
- 87% of enzyme immunoassay-positive samples confirmed positive by further testing.
- HCV RNA was detected in 53% of antibody-positive samples, but rarely in antibody-negative samples (approx. 1%).
- HCV coinfection did not significantly affect survival in HIV-infected patients, regardless of AIDS status.
Conclusions:
- HCV infection is significantly more prevalent in HIV-positive, non-intravenous drug-using men than in blood donors, suggesting homosexual transmission.
- Serologically occult HCV viremia is uncommon; approximately half of seropositive individuals have detectable HCV RNA.
- HCV coinfection does not appear to negatively influence survival outcomes in HIV-infected individuals.
Background:
Limited information is available about the prevalence of hepatitis C virus in patients with human immunodeficiency virus in relation to specific risk factors or about the influence of hepatitis C virus coinfection on survival. This retrospective study addressed these questions.
Methods:
The study population consisted of 512 predominantly non-intravenous drug-using male homosexuals, 224 of whom had AIDS. Samples positive for hepatitis C virus antibody by second-generation enzyme immunoassay were further tested by means of strip immunoblot assay, and for hepatitis C virus RNA by means of polymerase chain reaction amplification. A randomly selected set of enzyme immunoassay-negative samples was also tested for hepatitis C virus RNA and, if hepatitis C virus RNA positive, by a second-generation recombinant immunoblot assay.
Results:
The prevalence of hepatitis C virus infection unaccounted for by intravenous drug use or transfusion was 11.7% by enzyme immunoassay, and 87% of sera positive by enzyme immunoassay were also positive by second-generation recombinant immunoblot assay or hepatitis C virus RNA analysis. Hepatitis C virus RNA was detectable in 53% of enzyme immunoassay-positive samples but in only about 1% of enzyme immunoassay-negative samples. Hepatitis C virus coinfection did not influence survival of HIV-infected patients with or without manifestations of AIDS.
Conclusions:
Hepatitis C virus infection in nontransfused, non-intravenous drug-using patients with HIV infection is several times more prevalent than in volunteer blood donors, suggesting homosexual transmission of hepatitis C virus. About half of patients seropositive for hepatitis C virus antibody have detectable hepatitis C virus RNA, and serologically occult hepatitis C virus viremia is rare. Hepatitis C virus coinfection does not appear to adversely influence survival.
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