Seroprevalence of human immunodeficiency virus, hepatitis B and C viruses and syphilis among blood donors in Koudougou (Burkina Faso) in 2009

Background

The high prevalence of numerous transfusion-transmitted infectious diseases such as human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV) and syphilis in sub-Saharan Africa affects the safety of blood for recipients. This study was undertaken with the aim of determining the seroprevalence of HIV, HCV, HBV, syphilis and socio-demographic risk factors associated with blood donation in a new regional blood transfusion centre in Burkina Faso.

Material and methods

Sera samples were screened for hepatitis B surface antigen (HBsAg), antibodies to HCV, HIV types 1 and 2 and to Treponema pallidum using enzyme-linked immunosorbent assays and Rapid Plasma Reagin test (RPR) respectively. All the reactive samples for HIV, HBsAg, and HCV were confirmed using a second enzyme-linked immunosorbent assays. Antibodies to Treponema pallidum were confirmed with a Treponema pallidum haemagglutination test (TPHA).

Results

From the total of 4,520 blood donors in 2009, 1,348 (29.82%) were infected with at least one pathogen and 149 (3.30%) had serological evidence of multiple infections. The overall seroprevalence rate of HIV, HBV, HCV and syphilis was 2.21%, 14.96%, 8.69% and 3.96%, respectively. Among blood donors with multiples infections, the most common dual or triple combinations were HBsAg-HCV (1.39%), HBsAg-syphilis (0.66%) and HBsAg-HCV-syphilis (0.11%). The highest prevalences of HBsAg and HIV were found among blood donors from rural areas and in the age groups of 20–29 years and >40 years old, respectively.

Conclusion

HBV and HCV remain the greatest threats to blood safety in Burkina Faso. Strict selection and retention of voluntary, non-remunerated low-risk blood donors are recommended to improve blood safety in the regional blood transfusion centre of Koudougou.     

Prevalence of HIV and HCV infections in two populations of Malian women and serological assays performances

AIM:To estimate the prevalence of human immunodeficiency virus(HIV) and hepatitis C virus(HCV) infections in women in Mali and to evaluate the performance of serological assays.METHODS:Two prospective studies were conducted in 2009 and 2010 in Mali.They concerned first,1000 pregnant women attending six reference health centers in Bamako(Malian capital) between May 26 and June 16,2009;and secondly,231 women over 50 years who consulted general practitioners of two hospitals in Bamako between October 25 and December 24,2010.Blood samples were collected and kept frozen in good condition before analysis.All samples depicted as positive using HIV/HCV enzyme immuno-assay screening assays were submitted to confirmation analysis.Molecular markers of HCV were characterized.RESULTS:The seroprevalence of HIV and HCV in the population of pregnant women was 4.1% and 0.2% respectively.Among older women the seroprevalence was higher and similar for HIV and HCV(6.1% vs 6.5%).The anti-HIV prevalence was not different in young and older women(4.1% vs 6.1%).In contrast,the anti-HCV prevalence was higher in older compared to younger women(6.5% vs 0.2%,P < 0.01).Of 2 pregnant women who were HCV seropositive,only one was polymerase chain reaction(PCR) reactive and infected by genotype 2,with a viral load of 1600 IU/mL.Regarding older women who were HCV seropositive,13 out of 15 were PCR reactive,infected by genotype 1 or 2.Globally HCV genotype 2 was predominant.The positive predictive value(PPV) measured with VIKIA HIV test in young women was 100% therefore significantly higher than the 87.5% measured in older women(P < 0.05).Conversely,the PPV measured with Monolisa HCV assay in older women was 88.2% and higher than the 14.3% measured in younger women(P < 0.01).CONCLUSION:Whereas HIV prevalence was similar in both subpopulations HCV was more frequent among older women(P < 0.01).The PPV of screening assays varied with the age of the subjects.     

Prevalence and genotype characterization of human papillomaviruses among HIV-seropositive in Ouagadougou, Burkina Faso

Background

Approximately, 15–20 of 40 HPVs that infect the female genital tract confer a high-risk of invasive cancer, thus HPVs account for 95% of cervix cancers. The objectives of this study were to: (i) estimate the prevalence of HPV infection in women infected with HIV in Ouagadougou, (ii) identify potential carcinogenic HPV strains and (iii) determine whether existing HPV vaccines match the isolated strains.

Methods

From May 2009 to April 2010, 250 HIV-infected women were included in this study. Each woman was screened for the presence of HPV and for HPV genotype using PCR/hybridization technique.

Results

Of the 250 HIV-infected women, 59.6% were infected with at least one type of HPV. High-risk HPVs were identified with the following prevalence: HPV-18 (25.0%); HPV-50′S (25.5%); HPV-30′S (20.8%); HPV-16 (4.7%); HPV-45 (3.7%). Low-risk HPVs were represented by HPV-6 (5.7%) and HPV-11 (0.9%).

Conclusion

The issue of the study showed that the existing vaccines: Gardasil and Cervarix may be used in the country although they match only HPV-16, HPV-18, HPV-6 and HPV-11. Further investigations should be continued for the establishment of vaccine that matches all genotypes circulating in the country.     

Hepatitis B or hepatitis C coinfection in HIV-infected pregnant women in Europe

Objectives

The aim of the study was to investigate the prevalence of and risk factors for hepatitis C or B virus (HCV or HBV) coinfection among HIV‐infected pregnant women, and to investigate their immunological and virological characteristics and antiretroviral therapy use.

Methods

Information on HBV surface antigen (HBsAg) positivity and HCV antibody (anti‐HCV) was collected retrospectively from the antenatal records of HIV‐infected women enrolled in the European Collaborative Study and linked to prospectively collected data.

Results

Of 1050 women, 4.9% [95% confidence interval (CI) 3.6–6.3] were HBsAg positive and 12.3% (95% CI 10.4–14.4) had anti‐HCV antibody. Women with an injecting drug use(r) (IDU) history had the highest HCV‐seropositivity prevalence (28%; 95% CI 22.8–35.7). Risk factors for HCV seropositivity included IDU history [adjusted odds ratio (AOR) 2.92; 95% CI 1.86–4.58], age (for ≥35 years vs. <25 years, AOR 3.45; 95% CI 1.66–7.20) and HBsAg carriage (AOR 5.80; 95% CI 2.78–12.1). HBsAg positivity was associated with African origin (AOR 2.74; 95% CI 1.20–6.26) and HCV seropositivity (AOR 6.44; 95% CI 3.08–13.5). Highly active antiretroviral therapy (HAART) use was less likely in HIV/HCV‐seropositive than in HIV‐monoinfected women (AOR 0.34; 95% CI 0.20–0.58). HCV seropositivity was associated with a higher adjusted HIV RNA level (+0.28log₁₀ HIV‐1 RNA copies/mL vs. HIV‐monoinfected women; P=0.03). HIV/HCV‐seropositive women were twice as likely to have detectable HIV in the third trimester/delivery as HIV‐monoinfected women (AOR 1.95; P=0.049).

Conclusions

Although HCV serostatus impacted on HAART use, the association between HCV seropositivity and uncontrolled HIV viraemia in late pregnancy was independent of HAART.     

Seroprevalence and incidence of transfusion-transmitted infectious diseases among blood donors from regional blood transfusion centres in Burkina Faso, West Africa

Background and objective The high prevalence of numerous transfusion‐transmitted infectious diseases such as HIV, HBV, HCV and syphilis in sub‐Saharan Africa affects blood safety for transfusion recipients. The aim of this study was to evaluate the prevalence and incidence of transfusion‐transmissible infectious diseases among blood donors in Burkina Faso. Methods A retrospective study of blood donors’ records from January to December 2009 was conducted. Prevalence and incidence of viral infections were calculated among repeat and first‐time blood donors. Results Of the total of 31 405 first‐time volunteer blood donors in 2009, 24.0% were infected with at least one pathogen and 1.8% had serological evidence of multiple infections. The seroprevalence of HIV, HBV, HCV and syphilis in first‐time volunteer donors was 1.8%, 13.4%, 6.3% and 2.1%, respectively. In 3981 repeat donors, the incidence rate was 3270.2, 5874.1 and 6784.6 per 100 000 donations for anti‐HIV‐1, HBsAg and anti‐HCV, respectively. These numbers varied significantly according to populations where blood is collected and blood centres in Burkina Faso. Conclusion The relatively high prevalence of viral markers in first‐time volunteers and remarkably high incidence of infections in repeat donors raise concerns regarding the safety of these donors and suggest that implementation of NAT might significantly improve the situation.     

Risk factors for mother-to-child transmission of hepatitis C virus: Maternal high viral load and fetal exposure in the birth canal

Aim: Mother‐to‐child transmission (MTCT) is the major transmission pathway of hepatitis C virus (HCV) in children. However, its risk factors remain unsettled for introduction of putative intervention. Methods: Pregnant women screened for HCV and MTCT in children born to antibody‐positive mothers were prospectively studied in Tottori, Japan. Results: Among 41 856 screened women, 188 (0.45%) were HCV antibody‐positive, of whom 61% had detectable HCV RNA. While 10 of the 34 children (29%) born to high viral load (HVL: ≥6.0 × 10⁵ IU/mL) mothers were infected, none born to RNA‐detectable but non‐HVL mothers were infected (P < 0.001). MTCT among vaginally delivered children born to HVL mothers was analyzed. Children delivered after 4 h or more of labor were more frequently infected than were those born within 4 h of labor (P = 0.019). Premature rupture of fetal membranes was significantly more common in infected children than in uninfected children (P < 0.001). Durations of membrane rupture and labor were longer in infected children than in uninfected children (P = 0.008 and P = 0.040, respectively). Elective cesarean section that eliminates these risk factors, other than HVL, significantly reduced MTCT from nine of 22 (41%) to none of nine children (0%) (P = 0.032). Conclusion: Our data suggest that contamination of the fetus in the birth canal with infected maternal blood is a major risk factor for HCV MTCT, in addition to maternal HVL. To rationalize intervention by elective cesarean section, the natural history of infected children should be carefully evaluated.     

Hepatitis C virus antibody-positive patients with HIV infection have a high risk of insulin resistance: a cross-sectional study

Objective

The aim of the study was to characterize and compare insulin resistance (IR) in hepatitis C virus (HCV)‐antibody (Ab)‐positive and HCV‐Ab‐negative patients with HIV infection.

Methods

This was a single‐centre cross‐sectional study of 1041 HIV‐infected patients (373 HCV‐Ab‐positive; 167 with detectable plasma HCV RNA). Metabolic and anthropometric assessments were performed, including measurement of IR using the homeostasis model for assessment of insulin resistance (HOMA‐IR).

Results

The prevalence of IR (i.e. a HOMA‐IR score ≥3.8) was significantly higher in HCV‐Ab‐positive than in HCV‐Ab‐negative patients (47.7 vs. 32.7%; P<0.0001). On multivariable linear regression analysis, the following variables were associated with HOMA‐IR score, expressed as an estimate of the percentage variation (Est.): high‐density lipoprotein cholesterol (per 0.3 mmol/L increase: Est.–4.1; P=0.01), triglycerides (per 0.1 mmol/L increase: Est. 0.6; P<0.001), alcohol intake (Est. ?12.4; P=0.002), sedentary lifestyle (Est. 14.7; P<0.001), CD4 T‐cell count in the highest quartile, i.e. ≥690 cells/μL (Est. 20.7; P=0.002), body mass index in the highest quartiles, i.e. ≥22.54 kg/m² (Est. 30.5–44.7; P<0.001), waist‐to‐hip ratio in the highest quartile, i.e. >1 (Est. 30.2; P<0.001) and HCV‐Ab positivity (Est. 24.4; P<0.001).

Conclusions

Our data confirm that HCV‐Ab positivity is an independent risk factor for IR. Management aimed at correcting known risk factors for IR should be implemented.     

Impact of HIV on liver fibrosis in men with hepatitis C infection and haemophilia

Summary. Hepatitis C virus (HCV) is the major cause of liver disease in haemophilia. Few data exist on the proportion with liver fibrosis in this group after long‐term HCV and HIV co‐infection. We conducted a cross‐sectional multi‐centre study to determine the impact of HIV on the prevalence and risk factors for fibrosis in haemophilic men with chronic hepatitis C. Biopsies were independently scored by Ishak, Metavir and Knodell systems. Variables were tested for associations with fibrosis using logistic regression and receiver operating curves (ROC). Of 220 biopsied HCV(+) men, 23.6% had Metavir ≥F3 fibrosis, with higher mean Metavir fibrosis scores among HIV/HCV co‐infected than HCV mono‐infected, 1.6 vs. 1.3 (P = 0.044). Variables significantly associated with fibrosis included AST, ALT, APRI score (AST/ULN × 100/platelet × 10⁹/L), alpha‐fetoprotein (all P < 0.0001), platelets (P = 0.0003) and ferritin (P = 0.0008). In multiple logistic regression of serum markers, alpha‐fetoprotein, APRI and ALT were significantly associated with ≥F3 fibrosis [AUROC = 0.77 (95% CI 0.69, 0.86)]. Alpha‐fetoprotein, APRI and ferritin were significant in HIV(?) [AUROC = 0.82 (95% CI 0.72, 0.92)], and alpha‐fetoprotein and platelets in HIV(+) [AUROC = 0.77 (95% CI 0.65, 0.88]. In a multivariable model of demographic and clinical variables, transformed (natural logarithm) of alpha‐fetoprotein (P = 0.0003), age (P = 0.006) and HCV treatment (P = 0.027) were significantly associated with fibrosis. Nearly one‐fourth of haemophilic men have Metavir ≥3 fibrosis. The odds for developing fibrosis are increased in those with elevated alpha‐fetoprotein, increasing age and past HCV treatment.     

Serological survey of HIV and syphilis in pregnant women in Madagascar

Objectives Peripartal transmission of human immunodeficiency virus (HIV) and Treponema pallidum, the causative agent of syphilis, leads to severe consequences for newborns. Preventive measures require awareness of the maternal infection. Although HIV and syphilis testing in Madagascar could be theoretically carried out within the framework of the national pregnancy follow‐up scheme, the required test kits are rarely available at peripheral health centres. In this study, we screened blood samples of pregnant Madagascan women for HIV and syphilis seroprevalence to estimate the demand for systemic screening in pregnancy. Methods Retrospective anonymous serological analysis for HIV and syphilis was performed in plasma samples from 1232 pregnant women that were taken between May and July 2010 in Ambositra, Ifanadiana, Manakara, Mananjary, Moramanga and Tsiroanomandidy (Madagascar) during pregnancy follow‐up. Screening was based on Treponema pallidum haemagglutination tests for syphilis and rapid tests for HIV, with confirmation of positive screening results on line assays. Results Out of 1232 pregnant women, none were seropositive for HIV and 37 (3%) were seropositive for Treponema pallidum. Conclusions Our findings are in line with previous studies that describe considerable syphilis prevalence in the rural Madagascan population. The results suggest a need for screening to prevent peripartal Treponema pallidum transmission, while HIV is still rare. If they are known, Treponema pallidum infections can be easily, safely and inexpensively treated even in pregnancy to reduce the risk of transmission.     

Prevalence of seromarkers of HBV and HCV among blood donors in eastern Saudi Arabia, 1998–2001

The prevalence of serological markers of HBV and HCV were determined for blood donors in eastern Saudi Arabia. Between 1998 and 2001, 13 443 donors (10 778 Saudi and 2665 non‐Saudi), were screened for HBsAg, anti‐HBc Ab, and anti‐HCV Ab using commercial kits. There was a steady decrease in the HBsAg (2.58 and 1.67%), anti‐HBc rates (15.32 and 9.15%), and anti‐HCV (1.04 and 0.59%) rates between 1998 and 2001, respectively. However, there was a marked difference between Saudi and non‐Saudi donors with regard to anti‐HBc (P < 0.001) and anti‐HCV (P < 0.01), but not HBsAg prevalence rates in the same time period.     

Daily cannabis and reduced risk of steatosis in human immunodeficiency virus and hepatitis C virus‐co‐infected patients (ANRS CO13‐HEPAVIH)

Liver steatosis is common in human immunodeficiency virus (HIV)‐hepatitis C virus (HCV)‐co‐infected patients. Some recent studies have found that cannabis use is negatively associated with insulin resistance in the general population and in HIV‐HCV‐co‐infected patients. Given the causal link between insulin resistance and steatosis, we hypothesized that cannabis use has a positive impact on steatosis. Therefore, we aimed to study whether cannabis use in this population was associated with a reduced risk of steatosis, measured by ultrasound examination. ANRS CO13‐HEPAVIH is a French nationwide multicentre cohort of HIV‐HCV‐co‐infected patients. Medical and socio‐behavioural data from clinical follow‐up visits and annual self‐administered questionnaires were prospectively collected. A cross‐sectional analysis was conducted using data from the first visit where both ultrasound examination data for steatosis (positive or negative diagnosis) and data on cannabis use were available. A logistic regression model was used to evaluate the association between cannabis use and steatosis. Among study sample patients (n = 838), 40.1% had steatosis. Fourteen per cent reported daily cannabis use, 11.7% regular use and 74.7% no use or occasional use (“never or sometimes”). Daily cannabis use was independently associated with a reduced prevalence of steatosis (adjusted odds ratio [95% CI] = 0.64 [0.42;0.99]; P = .046), after adjusting for body mass index, hazardous alcohol consumption and current or lifetime use of lamivudine/zidovudine. Daily cannabis use may be a protective factor against steatosis in HIV‐HCV‐co‐infected patients. These findings confirm the need for a clinical evaluation of cannabis‐based pharmacotherapies in this population. Eudract.ema.europa.eu number, DGS050367.     

Hepatitis C/HIV co‐infection is associated with higher mortality in hospitalized patients with Hepatitis C or HIV

Summary. Up to 10% of all patients with Hepatitis C virus (HCV) infection are co‐infected with human immunodeficiency virus (HIV); 25–30% of HIV patients are co‐infected with HCV. The aim of this study was to examine the association of HCV/HIV co‐infection with outcomes of hospitalized patients compared to those with HCV or HIV monoinfection. Using the 2006 Nationwide Inpatient Sample, patients with HCV or HIV monoinfection or HCV/HIV co‐infection were identified using ICD‐9‐CM codes. We compared liver‐related and infection‐related admission between the three groups of patients. Multivariate logistic regression was performed to identify independent predictors of in‐hospital mortality. A total of 474 843 discharges with HCV monoinfection, 206 758 with HIV monoinfection and 56 304 with HCV/HIV co‐infection were included. Liver‐related admissions were more common in co‐infected patients (15.4%) compared to those with HIV monoinfection (3.3%, P < 0.001). Primary infectious hospitalizations were more common in HIV monoinfection (33.9%) compared to co‐infected patients (26%, P < 0.001). HCV/HIV co‐infection was associated with higher mortality compared to HCV monoinfection (OR 1.41, 95% CI 1.20–1.65) but not when compared to monoinfected‐HIV patients. HCV‐associated cirrhosis or complications thereof conferred four times greater mortality risk in patients with HIV (OR 3.96, 95% CI 3.29–4.79). The rate of hospitalization for HCV/HIV co‐infected patients (23.5%) was significantly higher than those with HCV (14.8%) or HIV (19.9%) (P < 0.001). HCV/HIV co‐infection is associated with significantly higher rates of hospitalization and is a risk factor for in‐hospital mortality compared to patients with isolated HCV.     

Effect of pregnancy on immunological and virological outcomes of women on ART: a prospective cohort study in rural Uganda, 2004-2009

Objectives Before antiretroviral therapy (ART) introduction, pregnancy was associated with a sustained drop in CD4 cell count in HIV‐infected women. We examined the effects of pregnancy on immunological and virological ART outcomes. Methods Between January 2004 and March 2009, we studied HIV‐infected women receiving ART in a prospective open cohort study in rural Uganda. We used random effects regression models to compare the CD4 counts of women who became pregnant and those who did not, and among the pregnant women before and after pregnancy. CD4 count and proportions with detectable viral load (≥400 copies/ml) were compared between the two groups using the Mann–Whitney rank sum test and logistic regression respectively. Results Of 88 women aged 20–40 years receiving ART, 23 became pregnant. At ART initiation, there were no significant differences between those who became pregnant and those who did not in clinical, immunological and virological parameters. Among women who became pregnant, CD4 cell count increased before pregnancy (average 75.9 cells/mm³ per year), declined during pregnancy (average 106.0) but rose again in the first year after delivery (average 88.6). Among women who did not become pregnant, the average CD4 cell count rise per year for the first 3 years was 88.5. There was no significant difference in the proportions of women with detectable viral load at last clinic visit among those who became pregnant (8.7%) and those who did not (16.1%), P = 0.499. Conclusion Pregnancy had no lasting effect on the immunological and virological outcomes of HIV‐infected women on ART.     

Co-infection of human herpesvirus type 2 (HHV-2) and human immunodeficiency virus (HIV) among pregnant women in Rio de Janeiro,Brazil

Pregnant women who are infected with the Human Immunodeficiency Virus (HIV) are particularly vulnerable to severe and recurrent infections with Human Herpesvirus 2 (HHV-2). Neonatal transmission of HHV-2 has been associated with malformations and neurological sequelae in infants, which makes it very important to perform antenatal monitoring for genital herpes. In the study, 134 pregnant women infected with HIV were tested for HHV-2 IgM and IgG using an enzyme-linked immunosorbent assay (ELISA) and had HHV-2 DNA analyzed by Real Time Polymerase Chain Reaction (qPCR). Fisher’s exact test was applied to analyze the epidemiological dates (p??1. Our study found high HHV-2/HIV coinfection prevalence and HHV-2 viremia among patients with recurrent and primary genital infection, reinforcing the need of prevention and control of HHV-2 infection in order to avoid this virus transmission.     

Effect of hepatitis B virus on steatosis in hepatitis C virus co‐infected subjects: A multi‐centre study and systematic review

It remains unclear whether hepatitis B virus (HBV) infection may modify the severity of viral steatosis in patients coinfected with chronic hepatitis C virus (HCV). We examined the influence of coinfection with HBV on prevalence of steatosis in chronic hepatitis C in a multi‐centre cohort of HBV‐HCV subjects, and by performing a systematic review and meta‐analysis of the literature. We centrally and blindly assessed steatosis prevalence and severity in a cohort of HBV‐HCV coinfected subjects compared to HCV and HBV monoinfected controls and we performed a systematic review of studies addressing the prevalence of steatosis in HBV‐HCV subjects compared to HCV controls. In the clinical cohort, we included 85 HBV‐HCV, 69 HBV and 112 HCV subjects from 16 international centres. There was no significant difference in steatosis prevalence between the HBV‐HCV and the HCV groups (33% vs 45%, P = .11). In subgroup analysis, lean HBV‐HCV subjects with detectable HBV DNA had less steatosis than lean HCV subjects matched for HCV viremia (15% vs 45%, P = .02). Our literature search identified 5 additional studies included in a systematic review. Overall, prevalence of steatosis > 5% was similar in HBV‐HCV infection compared to HCV (pooled odds ratio [OR] 0.91, 95% CI 0.53‐1.6) although there was significant heterogeneity (I² 69%, P = .007). In conclusion, although the prevalence of steatosis is similar in HBV‐HCV compared to HCV subjects, our analysis suggests that there may be an inhibitory effect of HCV‐induced steatogenesis by HBV in certain subgroups of patients.     

GB virus C infection among young,HIV‐negative injection drug users with and without hepatitis C virus infection

Summary. Our study examined the association between GB virus C (GBV‐C) and (i) hepatitis C virus (HCV) infection status, (ii) biomedical indicators of liver disease (alanine and aspartate aminotransferases) and (iii) HCV RNA level among young injection drug users (IDUs) recruited using street outreach and respondent‐driven methods. Cross‐sectional and longitudinal analyses were completed. GBV‐C (active or resolved) infection was significantly (P < 0.05) more prevalent among HCV antibody‐positive (anti‐HCV+) (65.1%) than antibody‐negative (anti‐HCV?) (32.3%) (OR = 3.9, 95% CI: 2.3–6.9) IDUs. The prevalence of resolved GBV‐C infection was highest among those with chronic HCV infection (41.9%), followed by those with resolved HCV infection (34.4%) and significantly lower (P < 0.05) among anti‐HCV participants (16.9%). Although not statistically significant (P = 0.13), a similar pattern was observed for active GBV‐C infection. No association between GBV‐C infection status and biomedical indicators of liver disease or HCV RNA level over time was observed. In conclusion, GBV‐C infection prevalence was higher among anti‐HCV+ compared to anti‐HCV? young IDUs, similar to prior studies among older populations. In particular, chronically HCV‐infected young IDUs had an increased rate of GBV‐C clearance.     

Low plasma levels of dehydroepiandrosterone sulphate in HIV-positive patients coinfected with hepatitis C virus

Objectives

To evaluate plasma levels of dehydroepiandrosterone sulphate (DHEAS) in a cohort of HIV‐infected patients and to analyse factors associated with DHEAS levels.

Methods

We conducted a cross‐sectional survey in the Nîmes University Hospital cohort of HIV‐infected patients in south‐eastern France. All HIV‐infected patients with at least one outpatient visit between 1 January and 1 September 2002 were included in the study. Sociodemographic, clinical, therapeutic, immuno‐virological and plasma DHEAS level data were collected during this period. Hepatitis C virus (HCV) coinfection was defined as the presence of HCV antibody with positive RNA. To identify factors associated with plasma DHEAS levels, Spearman's rank correlation and univariate and multivariate linear regression analyses were used.

Results

The DHEAS plasma level was measured in 137 patients (104 men and 33 women), 37 (27.0%) of whom were HCV coinfected. The median age of the patients was 39.1 years [interquartile range (IQR): 34.9–48.7] for women and 41.8 years (36.5–47.7) for men. The median DHEAS level was 5.5 μmol/L (IQR: 2.3–8.8) for the whole sample of 137 patients, and was lower in women (2.4 μmol/L; 1.5–6.6) than in men (6.1 μmol/L; 2.5–9.0) (P<0.01), and lower in patients coinfected with HCV (2.1 μmol/L; 0.6–6.7) than in those not coinfected (6.6 μmol/L; 3.0–9.1) (P<0.01). Of all prognostic factors studied in the variance covariance analysis, three factors were associated with DHEAS: age, gender and HCV coinfection. Subgroup analysis revealed that the age‐adjusted mean of the DHEAS level was lower in HCV coinfected patients for both women (1.3±1.1 μmol/L) and men (4.0±0.7 μmol/L), compared with patients not HCV coinfected (women, 5.3±0.7 μmol/L; men, 7.2±0.4 μmol/L) (P<0.01).

Conclusions

This is the first report of the determination of DHEAS plasma levels in HIV/HCV coinfected patients. When age and sex were taken into account, the DHEAS plasma level was found to be significantly lower in HCV coinfected patients. To date, the pathophysiology of such findings is unknown.

     

Antibody screening tests variably overestimate the prevalence of hepatitis C virus infection among HIV‐infected adults in Ghana

HIV coinfection with HCV has been poorly studied in sub‐Saharan Africa, and the reliability of available seroprevalence estimates remains uncertain. The study aim was to determine HCV RNA prevalence in HIV‐infected subjects receiving care in Kumasi, Ghana, and relate the findings to HCV antibody detection. From a population of 1520 HIV‐infected adults, all HBsAg‐positive subjects (n = 236) and a random subset of HBsAg‐negative subject (n = 172) were screened for HCV RNA using pooled plasma; positive samples were genotyped by core and NS5B sequencing. HCV antibodies were detected by three commercial screening assays and confirmed by the line immunoassay. HCV RNA was detected in 4/408 subjects (1.0%, 95% confidence interval 0.0–1.9%), comprising 3/236 (1.3%; 0.0–2.8%) HBsAg‐positive and 1/172 (0.6%; 0.0–1.8%) HBsAg‐negative subjects. HCV RNA‐positive subjects showed reactivity in all three antibody screening assays. Among HCV RNA‐negative subjects, 5/67 (7.5%), 5/67 (7.5%) and 19/67 (28.4%) showed antibody reactivity by each screening assay, respectively, including two (3.0%) with reactivity by all three assays. Only one sample (1.5%) had confirmed antibody reactivity by line immunoassay indicating past HCV infection. HCV‐positive subjects (three males, two females) were aged 30–46 years, by questionnaire‐based interview reported surgical procedures and blood transfusion as risk factors for infection. HCV genotypes were 2 (subtypes 2j, 2l, 2k/unassigned) and 1 (subtype unassigned). Without further testing, HCV antibody screening assays variably overestimated HCV prevalence among HIV‐infected subjects in Ghana. These findings inform the interpretation of previous seroprevalence estimates based upon screening assays alone.     

Knowledge and attitudes about hepatitis C virus (HCV) infection and its treatment in HCV mono‐infected and HCV/HIV co‐infected adults

Hepatitis C virus (HCV) treatment is rapidly changing but little is known about patients' attitudes and knowledge about HCV. This study used a cross‐sectional survey to examine the relationship between HCV knowledge and attitudes towards HCV in patients with HCV mono‐infection and HIV/HCV co‐infection. Subsequently, an education intervention was developed with an abridged version of the cross‐sectional survey administered before and after the education session to assess changes in knowledge and attitudes. 292 people participated in the cross‐sectional survey, and 87 people participated in the education intervention. In the cross‐sectional survey, the mean knowledge score regarding HCV was low (<50% of the total possible score). Mono‐infected and co‐infected individuals shared similar knowledge deficits and attitudes towards HCV despite having distinct demographic differences. Attitudes endorsed by patients included the following: 57% feared the consequences of HCV on their life, 37% felt HCV was not fatal, 27% did not believe they needed HCV medication, 21% felt ashamed of having HCV and 16% felt HCV treatment was not important. Attitudes that reflected indifference and shame towards HCV were associated with lower knowledge scores (HCV knowledge score of 15.1 vs. 17.5, P < 0.01 for indifference and 15.3 vs. 17.2 for shame, P = 0.02). The education intervention improved knowledge scores but did not modify the assessed attitudes. Intervention studies are needed to effectively change attitudes towards HCV infection and treatment.