HCV,HBV, and HIV seroprevalence,coinfections, and related behaviors among male injection drug users in Arak,Iran

This study explored the prevalence and related risk behaviors for hepatitis C (HCV), hepatitis B (HBV), and human immunodeficiency virus (HIV) among a sample of male injection drug users (IDUs) in Arak, Iran. One hundred male IDUs attending methadone maintenance clinics between April and September 2012 were enrolled and evaluated for HCV, HBV, and HIV infection. The majority of study participants (56%) had evidence of HCV exposure, 6% had evidence of HBV, and 19% were HIV-infected. Coinfections were frequent; 15% had evidence of HIV and HCV, 6% had evidence of HBV and HCV, and 5% had serologic markers for all three infections. Most (84%) were susceptible to HBV infection. A history of any syringe sharing (54%) and syringe sharing in prison (25%) were common. In bivariate analyses, a history of any syringe sharing and syringe sharing in prison were both associated with all three viral infections. The high prevalence of HCV, HBV, HIV, and coinfections among IDU in Arak is concerning and indicates rapid disease spread outside of Iran's main urban centers. Prevention efforts should expand vaccination for IDUs who are nonimmune to HBV and continue to target syringe sharing with efforts such as needle exchange programs, including inside prisons.     

Hepatitis C virus coinfection in a cohort of HIV-infected individuals from Santos, Brazil: seroprevalence and associated factors

Although HIV/hepatitis C virus (HCV) coinfection has been recognized worldwide in individuals exposed to blood-borne and sexually transmitted diseases (STD), limited data are available on the epidemiology of this coinfection in Brazil. A cross-sectional study was carried out to estimate the prevalence of HCV seropositivity in a cohort of people living with HIV/AIDS in Santos, Brazil, and to investigate potential risk factors for HCV infection. Anti-HCV antibodies were sought by using two immunoenzymatic assays. Overall HCV seroprevalence was 36.2% (95% confidence interval [CI] 31.9-40.4%). However, it was significantly higher (84.8%, 95% CI 78.2-91.3%) among intravenous drug users (IDU) as compared to non-IDU (20.9%, 95% CI 16.8-25.1%) (p < 0.001). Multiple logistic regression analysis revealed that HCV seropositivity among IDU was independently associated with needle sharing (adjusted odds ratio [adjOR] = 4.28, p = 0.07) and with serologic evidence of exposure to other bloodborne agents: HBV (adjOR = 4.39, p = 0.01) and HTLV-I/II (adjOR = 6.43, p = 0.02). In contrast, no association with lifetime number of sexual partners, history of STD, or of sex with commercial sex workers (CSW) could be demonstrated. Among non-IDU, HCV seropositivity was independently associated with sexual partnership with IDU (adjOR = 2.15, p = 0.08) and with HBV seropositivity (adjOR = 1.71, p = 0.05), but not with engaging in oral or anal receptive intercourse or having sex with CSW. Results indicate that exposure to blood and sexual partnership with IDU constitute the main risk factors for HCV acquisition among HIV-positive patients in Santos, Brazil. Prevention of HCV spread in this population should thus include harm reduction measures and information on safer sex practices for both IDU and their sexual partners.     

The prevalence of hepatitis B and C in HIV-positive Greek patients: relationship to survival of deceased AIDS patients

OBJECTIVES: To determine the prevalence of hepatitis viruses B (HBV) and C (HCV) co-infections in HIV-infected patients and the overall impact of these co-infections on deceased AIDS patients survival. METHODS: One hundred and eighty-one patients (159 males, 22 females) infected with HIV, attending an academic AIDS unit in Athens, Greece, constituted the study population. The study population consisted of 124 homo/bisexual men, 34 heterosexuals, 12 intravenous drug users (IDU) and 11 blood transfusion recipients. Virological markers tested for HBV infection included HBsAg, anti-HBs and total anti-HBc by enzyme-linked immunoassays. Detection of HCV antibodies was carried out by third generation enzyme-linked immunoassay, and repeatedly positive samples were further tested by a supplemental enzyme-linked immunoassay; only sera reactive by both methods were considered to be HCV-positive. RESULTS: The prevalence of HBV markers was 67.4%: 71.8% in homo/bisexuals, 35.3% in heterosexuals, 91.7% in IDUs and 90.9% in blood transfusion recipients (P = 0.00004). The prevalence of HCV antibodies was 13.8%: 8.1% in homo/bisexuals, 8.8% in heterosexuals, 58.3% in IDU and 45.5% in blood transfusion recipients (P<0.000001). The prevalence of HCV antibodies was not significantly higher in homo/bisexuals than in heterosexuals (P= 0.8). Coinfection with HBV or HCV, or both, did not influence the survival of deceased AIDS patients (n = 73). CONCLUSIONS: HBV infection was equally prevalent among homo/bisexuals and IDU with HIV infection, whereas HCV infection was more prevalent in IDU than in homo/bisexuals with HIV infection. The prevalence of HCV infection was equal among heterosexuals and homo/bisexuals, indicating that if sexual transmission of HCV occurs, homo/bisexuals are not at greater risk than heterosexuals. Finally, the survival of deceased AIDS patients was not affected by the presence of HBV and HCV co-infections.     

Survey of risk behaviour and HIV prevalence in an English prison.

An anonymous, voluntary, linked cohort study was undertaken to determine the prevalence of HIV infection and identify risk factors for the spread of infection in an English prison. Three hundred and seventy-eight (68%) of the inmates participated. The HIV point prevalence was 0.26%. Injecting drug use (IDU) was the most significant HIV risk factor within 20% admitting IDU at any time, of whom 58% injected whilst in prison. Of those injecting in prison 73% shared needles. Two inmates admitted having sex with a male partner in prison. This study demonstrates that the potential exists in this setting for an outbreak of blood-borne virus infection; hepatitis B virus (HBV), hepatitis C virus (HCV) and HIV infection. Injecting drug use and needle sharing represent the greatest risk.     

Hepatitis C virus among non‐injecting cocaine users (NICUs) in South America: can injectors be a bridge?

Aim To investigate the factors associated with hepatitis C virus (HCV) infection among non‐injecting cocaine users (NICUs) and to compare practices associated with HCV and HIV infection. Design An intercountry cross‐sectional study. Setting Buenos Aires and Montevideo metropolitan areas. Participants A total of 871 NICUs. Measurements NICUs were interviewed and their blood was drawn and used for HCV, HIV, HBV surface antigen (HbsAg), HB‐anticore and Venereal Disease Research Laboratory (VRDL) antibody assays. Bivariate and multivariate logistic regression analyses included comparisons of HCV and HIV mono‐infected participants with HCV–HIV seronegatives. Findings Prevalence rates were 8.8 [95% confidence interval (CI): 6.9–10.8) for HCV and 7.9 (95% CI: 6.1–9.7) for HIV. HCV‐infected NICUs were twice as likely as HCV–HIV seronegatives to have shared straws for cocaine snorting or sniffing, even when adjusted for other variables. HCV prevalence rates ranged from 3.6% among NICUs who denied sharing straws and having had an injection drug user (IDU) or an HIV‐positive sexual partner to 12.6% among participants who reported ever having shared straws or having had either an IDU‐ or HIV‐positive sexual partner (χ²_trend = 6.56, P = 0.01). Conclusions Non‐injecting cocaine users from South America are vulnerable to multiple infections and HCV infection appears to occur through the sharing of straws. HCV infection is associated with intimate relationships with IDUs or HIV‐seropositive partners, supporting the hypothesis that HCV risk may be due primarily to risk‐taking behaviour associated with drugs in this population.     

Prevalence and determinants of hepatitis delta virus infection among HIV/hepatitis B-coinfected adults in care in the United States

Hepatitis delta virus (HDV) infection increases the risk of liver complications compared to hepatitis B virus (HBV) alone, particularly among persons with human immunodeficiency virus (HIV). However, no studies have evaluated the prevalence or determinants of HDV infection among people with HIV/HBV in the US. We performed a cross-sectional study among adults with HIV/HBV coinfection receiving care at eight sites within the Center for AIDS Research Network of Integrated Clinical Systems (CNICS) between 1996 and 2019. Among patients with available serum/plasma specimens, we selected the first specimen on or after their initial HBV qualifying test. All samples were tested for HDV IgG antibody and HDV RNA. Multivariable log-binomial generalized linear models were used to estimate prevalence ratios (PRs) with 95% CIs of HDV IgG antibody-positivity associated with determinants of interest (age, injection drug use [IDU], high-risk sexual behaviour). Among 597 adults with HIV/HBV coinfection in CNICS and available serum/plasma samples (median age, 43 years; 89.9% male; 52.8% Black; 42.4% White), 24/597 (4.0%; 95% CI, 2.4%–5.6%) were HDV IgG antibody-positive, and 10/596 (1.7%; 95% CI, 0.6%–2.7%) had detectable HDV RNA. In multivariable analysis, IDU was associated with exposure to HDV infection (adjusted PR = 2.50; 95% CI, 1.09–5.74). In conclusion, among a sample of adults with HIV/HBV coinfection in care in the US, 4.0% were HDV IgG antibody-positive, among whom 41.7% had detectable HDV RNA. History of IDU was associated with exposure to HDV infection. These findings emphasize the importance of HDV testing among persons with HIV/HBV coinfection, especially those with a history of IDU.     

Meta-analysis of hepatitis C seroconversion in relation to shared syringes and drug preparation equipment

Aims We conducted a systematic review of studies reporting seroincidence of hepatitis C infection (HCV) in relation to shared syringes and drug preparation equipment among injection drug users (IDUs). We identified published and unpublished studies that met inclusion criteria. Design We estimated the relative contributions of shared syringes and drug preparation equipment to HCV transmission using random‐effects meta‐analysis, and analyzed potential sources of heterogeneity of effects among studies. Findings Syringe sharing was associated with HCV seroconversion [pooled risk ratio (PRR) = 1.94, 95% confidence interval (CI) 1.53, 2.46], as was sharing drug preparation containers (PRR = 2.42, 95% CI 1.89, 3.10), filters (PRR = 2.61, 95% CI 1.91, 3.56), rinse water (PRR = 1.98, 95% CI 1.54, 2.56), combinations of this equipment (PRR = 2.24, 95% CI 1.28, 3.93) and ‘backloading’, a syringe‐mediated form of sharing prepared drugs (PRR = 1.86, 95% CI 1.41, 2.44). Meta‐regression results showed that the association between syringe sharing and seroconversion was modified by HCV seroprevalence in the IDU populations. Conclusions The risk of hepatitis C infection through shared syringes is dependent upon hepatitis C infection seroprevalence in the population. The risk of hepatitis C infection through shared drug preparation equipment is similar to that of shared syringes. Because the infection status of sharing partners is often unknown, it is important for injection drug users to consistently avoid sharing unsterile equipment used to prepare, divide or inject drugs and avoid backloading with an unsterile syringe.     

Ongoing incident hepatitis C virus infection among people with a history of injecting drug use in an Australian prison setting, 2005‐2014: The HITS‐p study

Hepatitis C virus (HCV) transmission is high in prisons. This study investigated trends in HCV incidence and associated factors among a cohort of prisoners with a history of injecting drug use in New South Wales, Australia. Data were available from the Hepatitis C Incidence and Transmission Study—prisons (HITS‐p) from 2005 to 2014. Temporal trends in HCV incidence were evaluated. Factors associated with time to HCV seroconversion among people with ongoing injecting was assessed using Cox proportional hazards. Among 320 antibody‐negative participants with a history of injecting drug use (mean age 26; 72% male), 62% (n=197) reported injecting drug use during follow‐up. Overall, 93 infections were observed. HCV incidence was 11.4/100 person‐years in the overall population and 6.3/100 person‐years among the continually imprisoned population. A stable trend in HCV incidence was observed. Among the overall population with ongoing injecting during follow‐up, ≥weekly injecting drug use frequency was independently associated with time to HCV seroconversion. Among continuously imprisoned injectors with ongoing injecting during follow‐up, needle/syringe sharing was independently associated with time to HCV seroconversion. This study demonstrates that prison is a high‐risk environment for acquisition of HCV infection. Needle and syringe sharing was associated with HCV infection among continually imprisoned participants, irrespective of frequency of injecting or the type of drug injected. These findings highlight the need for the evaluation of improved HCV prevention strategies in prison, including needle/syringe programmes and HCV treatment.     

Prevalence of sexually transmitted infections and associated risk factors among populations of drug abusers.

A cross-sectional survey was conducted of sexually transmitted diseases (STDs) and risky behaviors among 407 drug abusers in treatment facilities in 1998. Infections with human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), herpes simplex virus type 2 (HSV-2), and syphilis were detected by testing serum antibody levels; chlamydia and gonorrhea were detected by testing nucleic acid levels in urine. Logistic regression analysis was performed to measure associations. Prevalences of antibodies were as follows: to HSV-2, 44.4%; to HCV, 35.1%; to HBV, 29.5%; to HIV, 2.7%. The prevalence of syphilis was 3.4%; of chlamydia, 3.7%; and of gonorrhea, 1.7%. Of the 407 subjects, approximately 62% had markers for 1 of the STDs. HIV infection was associated with African American race, use of smokable freebase (crack) cocaine, and STD history. HBV infection was associated with age >30 years, injecting drugs, needle sharing, a history of treatment for drug abuse, and African American race. HCV infection was associated with an age >30 years, injecting drugs, and needle sharing, and HSV-2 infection with an age >30 years, female sex, and African American race. Syphilis was associated with a history of STDs. High prevalences of STDs among drug abusers indicate the need for integration of STD screening and treatment into drug treatment programs.     

Seroprevalence study of hepatitis C and Hepatitis B virus among hospitalized intravenous drug users in Ahvaz, Iran (2002-2006)

Background and Aims

Viral hepatitis is a serious complication among intravenous drug users (IDUs). The objectives of this study were to determine the seroprevalence of hepatitis B and C viruses (HBV and HCV), and associated risk factors among IDUs at a teaching hospital in Ahvaz, southwest Iran.

Methods

Medical records of 333 IDUs hospitalized from 2002 to 2006 at Razi Hospital, which is affiliated to Ahvaz Jundishapur University of Medical Sciences, were reviewed. Cases meeting the criteria for a diagnosis of viral hepatitis infection were included in this study. Patients’ characteristics, clinical and laboratory findings were extracted. Data of cases with hepatitis virus infection (HVI), called the HVI group and without HVI, called the NHVI group, were compared, using the chi-square test for qualitative variables and the t-test for quantitative variables. Differences with a P < 0.05 were considered significant.

Results

Out of a total of 333 IDUs, 115 (34.5%), mostly male, with a mean age of 24.8±6.2 had HVI. More than 65% had a history of imprisonment. The mean duration of IDU was 4.5±1.6 years for the HVI group and 1.8±0.4 years for the NHVI group (P < 0.05). 85% of the HVI group and 45% of the NHVI group shared injection equipment (P < 0.05). 103 patients (30.9%) had HCV and 12 (3.6%) had HBV infection. There was a significant difference in age, duration of drug abuse, time spent in prison, sharing injection equipment, history of surgery, blood transfusion, packs of cigarettes per year and human immunodeficiency virus (HIV) co-infection between the two groups (P < 0.05).

Conclusions

HVI in IDU population is a prevalent complication, and is associated with heavy smoking (high number of packs of cigarettes per year), sharing injection equipment, long duration of drug usage, long duration of prison stay, HIV co-infection, history of surgery, blood and blood products transfusion. Older age, longer duration of IDU and imprisonment put the cases at higher risk of acquiring HCV in comparison to HBV.     

Hepatitis C virus risk behaviors within the partnerships of young injecting drug users

Aims Young injection drug users (IDU) are at high risk for hepatitis C virus (HCV). We sought to determine whether perceiving one's injecting partner to be HCV positive was associated with decreased odds of engaging in receptive needle/syringe sharing (RNS) or ancillary equipment sharing (AES) with that partner. Design Cross sectional study. Setting 2003 to 2007 in San Francisco. Participants 212 young (under age 30) IDU who were HCV antibody negative reported on 492 injecting partnerships. Measurements Self‐reported RNS and AES within injecting partnerships. Findings RNS and AES (in the absence of RNS) occurred in 23% and 64% of injecting partnerships in the prior month. The odds of engaging in RNS were significantly lower for relationships in which the participant reported that his/her partner was HCV positive (odds ratio [OR] 0.49; 95% confidence interval [CI] 0.25–0.95). This association was attenuated when adjusted for reusing one's own needle/syringe (adjusted OR 0.57; 95% CI 0.28–1.15). The odds of engaging in AES were lower for participants who did not know the HCV status of their partner, only among non‐sexual partnerships (OR 0.47; 95% CI 0.29–0.76). Conclusions Because perceiving one's partner to be HCV positive was associated with decreased RNS, increased HCV testing and partner disclosure may be warranted. AES was common and was decreased only among non‐sexual partnerships in which the HCV status of the partner was not known. This suggests that interventions to reduce AES in young IDU must be widespread.     

Epidemiological and clinical burden of chronic hepatitis B virus/hepatitis C virus infection. A multicenter Italian study

BACKGROUND/AIMS: This study assess prevalence, risk factors, and clinical and virological features of dual hepatitis B virus (HBV)/hepatitis C virus (HCV) infection. METHODS: We evaluated 837 hepatitis B surface antigen positive patients, prospectively enrolled in 14 Italian units. RESULTS: Anti-HCV was present in 59 cases (7%); age specific prevalences were 4.5% (0-30 years), 4.4% (>30-50) and 14% (>50). Independent predictors of dual infection were age >42 years, history of I.V. drug use (IDU), blood transfusion and residence in the South of the country. The strength of the association with IDU was high, but this exposure accounted for five coinfection cases only. Cirrhosis was present in 107 of the 709 patients with HBV alone (15.1%), in 30 of 69 with hepatitis D virus coinfection (43%) and in 17 of 59 with HCV coinfection (28.8%); a light alcohol use was marginally associated with cirrhosis. Of 36 B/C coinfected patients, 16 (44.4%) had only HBV-DNA in serum, (median age=47.5 years) five (13.9%) had both HBV-DNA and HCV-RNA (age=53), nine (25%) had HCV-RNA alone (age=59) and six (16.7%) tested negative for both. CONCLUSIONS: This study depicts the epidemiological and clinical burden of dual HBV/HCV infection in Italy.     

Hepatitis B virus infection and immunization status in a new generation of injection drug users in San Francisco

Hepatitis B virus (HBV) infection is common among injection drug users (IDU). Younger IDU, however, may be less susceptible to infection due to the implementation of public health interventions, such as universal immunization programs and syringe exchange programs. To investigate the current epidemiology of HBV infection and control among a new generation of drug users in the United States, we conducted interviews and examined HBV serologic markers in a cross-section of street-recruited IDU under age 30 in San Francisco, CA. Of the 831 persons studied, 21% showed serologic evidence of current or past infection; 22% had isolated antibodies to hepatitis B surface antigen consistent with vaccine-mediated immunity; and 56% had no HBV markers. In multivariate analyses, HBV infection was associated with drug use behaviour in heterosexual males; sexual behaviour in males who have sex with males; and both drug use and sexual behaviour in females. Vaccine-mediated immunity was independently associated with female sex and younger age. In conclusion, HBV transmission persists among young IDU in San Francisco. Few young injectors show evidence of successful immunization and the majority remains susceptible to disease. Until the broad effects of universal vaccination are seen, targeted and innovative approaches to immunizing young IDU in the US are needed to prevent a substantial number of new HBV infections.     

HBV/HCV co‐infection is associated with a high level of HCV spontaneous clearance among drug users and blood donors in China

Understanding the biology of spontaneous clearance of hepatitis C virus (HCV) infection could lead to improved strategies to prevent the sequelae associated with chronic HCV infection. Chronic infections with hepatitis virus are very common in China, but the factors associated with spontaneous clearance of HCV have not been adequately studied. We evaluated the spontaneous clearance of HCV among 1918 drug users and 1526 HCV‐seropositive blood donors in Guangzhou, China. Among participants who were co‐infected with hepatitis B virus (HBV), 41.38% of drug users and 39.47% of blood donors had cleared their HCV infection without antiviral therapy compared to 9.41% of drug users and 16.73% of blood donors who were mono‐infected with a single virus (P<.01). The proportion of subjects who had cleared their HCV infection was significantly greater in the co‐infected subjects whose serum HBV DNA was greater than 2000IU/mL than those with lower levels. A multiple logistic regression analysis found female gender, IL28B rs8099917 TT genotype, HBV co‐infection and blood donors (vs drug users) associated with increased spontaneous clearance of HCV infection. Although acute HCV infections are common in China, the incidence of chronic HCV may be reduced among the high prevalence of chronic HBV and IL28B genotypes associated with spontaneous clearance of HCV in Chinese populations.     

Needle exchange use, sexual risk behaviour, and the prevalence of HIV, hepatitis B virus, and hepatitis C virus infections among Bulgarian injection drug users

At a time when the rates of HIV, hepatitis C virus (HCV), and hepatitis B virus (HBV) infections have risen among injection drug users (IDUs) in other countries in the region, little is known about the prevalence of these infections among Bulgarian injectors and about their sexual risk behaviours. IDUs (n = 773) in a community-based needle exchange programme (NEP) and two major drug treatment facilities in Sofia completed a structured interview and were tested for HIV, HBV, and HCV antibodies. While HCV prevalence in the sample was 73.9%, HBV and HIV prevalence was low -6% and 0.5%, respectively. Having more than 10 sexual partners, having sex with someone with hepatitis C or another IDU, and never using a condom with another IDU were common among those who were recruited through NEP. As 40% of the IDUs reported using NEP, it appears that needle exchange provides an opportunity to reach high-risk populations and prevent sexual transmission of blood-borne pathogens.     

Chronic hepatitis B and other correlates of spontaneous clearance of hepatitis C virus among HIV-infected people with hemophilia

OBJECTIVE: To identify correlates of spontaneous hepatitis C virus (HCV) clearance among people with human immunodeficiency virus (HIV) co-infection. DESIGN: Baseline (2001-2004) analysis of a cohort study of people with hemophilia. METHODS: Detailed questionnaire data were used to identify dates of primary HCV and HIV infections and to categorize sex; race; alcohol use; interferon treatment; hepatitis B virus (HBV) status; and HIV/AIDS history, treatment and current status. Spontaneous HCV clearance was defined as nondetection of HCV RNA by polymerase chain reaction assay in paired annual plasma, excluding those treated with interferon. Chi-squared, Fisher exact test, and logistic regression were used to identify correlates of clearance. RESULTS: Among 478 HIV-infected participants, 61 (12.8%) had cleared HCV. Among the 31 participants with chronic HBV (as well as HIV), 16 (51.6%) had cleared HCV. With chronic HBV, HCV clearance was increased 11.2-fold (95% confidence interval, 5.1-24.8), after adjusting for sex, race, and hemophilia severity. Excluding the participants with chronic HBV, the prevalence of HCV clearance was 10.1%; and it was significantly reduced among males (9.7%, P = 0.05), blacks (1.6%, P = 0.01), and participants with severe hemophilia (8.2%, P = 0.02). HCV clearance was not associated with HIV RNA detection in plasma, CD4 cell count, anti-HIV therapy, AIDS history, ages at or years of HIV or HCV infection, or alcohol consumption. CONCLUSIONS: HCV clearance is unambiguously and markedly increased with chronic HBV infection among HIV co-infected people.     

SEN virus co-infection among HCV-RNA-positive mothers, risk of transmission to the offspring and outcome of child infection during a 1-year follow-up

SEN is a newly discovered blood-transmissible virus. Among its variants, SENV-D and -H are most often associated with non-A, -E hepatitis. Very little is known about the risk of vertical transmission of the virus. By using polymerase chain reaction with specific primers for SENV-D and -H, we investigated the prevalence of SENV-H and -D infection, the transmission rate of SENV infection and clinical features of SENV-infected children in 89 hepatitis C virus (HCV)-positive human immunodeficiency virus type 1-negative mothers. SENV infection was found in 36 (40%) mothers, and SENV-D was more frequent than SENV-H infection (34/36, 94%vs 5/36, 14%, P < 0.01). No difference in SENV infection rates was found between injection drug user (IDU) mothers (17/51, 33%) and mothers with no risk for bloodborne infection (19/38, 50%, P = ns). SENV-H infection was found only in IDU mothers and mothers with HCV genotype1b. Both SENV-D and -H can be transmitted to the offspring with an overall rate of 47%. Vertical transmission of HCV does not facilitate SENV infection of the offspring. Among 17 SENV-infected children, none was co-infected with HCV. Maternal HCV genotype or viral load does not interfere with mother-to-infant transmission of SENV. Persistence of SENV infection was demonstrated in 100% of infected children after 1-year follow-up, but none had clinical evidence of liver disease.     

Hepatitis C virus infection is associated with the development of hepatocellular carcinoma.

A possible causative role for the recently discovered hepatitis C virus (HCV) in the development of hepatocellular carcinoma (HCC) was investigated by assay of sera from HCC patients in Japan for antibodies to a recombinant HCV antigen and to hepatitis B virus (HBV) antigens. Among the 253 HCC patients examined, 156 (61.7%) had no serum markers of either a previous or a current HBV infection (group I), 46 (18.2%) were negative for HBV surface antigen but positive for anti-HBV surface and/or anti-HBV core antibody, indicating the occurrence of a previous, transient HBV infection (group II), and 51 (20.2%) were chronically infected HBV carriers as evidenced by positivity for HBV surface antigen (group III). The prevalence of HCV antibody in group I (68.6%) and II (58.7%) patients was significantly higher than for group III (3.9%) or in 148 additional patients with other (non-HCC) cancers (10.1%) (P less than 0.01). Thus, there appears to be a strong association between HCV infection and the development of HCC, particularly in patients for which HBV infection cannot be implicated as a causative factor. The data also suggest an additional mode of transmission for HCV other than blood transfusion, since a history of blood transfusion was shown in only about 30% of the HCV antibody-positive HCC patients in groups I and II. A high prevalence of HCV antibody was also shown among patients with HCC whose disease was originally thought to be due to very high ethanol consumption.     

Prevalence of HIV and other sexually transmitted infections among female commercial sex workers in Argentina

Sexually transmitted infections (STIs) have shown to enhance the transmission of human immunodeficiency virus (HIV) and to be more common among female commercial sex workers (FSWs). A cross-sectional study was conducted among 625 FSWs in six cities of Argentina in 2000-2002. The seroprevalence of HIV, hepatitis B virus (HBV), hepatitis C virus (HCV), human T-cell lymphotropic virus type I/II, and syphilis was 3.2%, 14.4%, 4.3%, 1.6%, and 45.7%, respectively. Syphilis was associated with older age (>/= 30 years, adjusted odds ratio [AOR] = 2.6 to 4.9), >/= 10 years in sex work (AOR = 2.2), use of illegal drugs (AOR = 2.1), and a prior history of an STI (AOR = 3.0). HBV and syphilis was the most common co-infection in 44 (7.5%) subjects. FSWs in Argentina are exposed to HIV and other STIs due to high-risk sexual and illegal drug use behavior. Renewed efforts are necessary to intervene effectively in this high-risk population.