Findings from Integrated Behavioral and Biologic Survey among Males Who Inject Drugs (MWID) — Vietnam, 2009–2010: Evidence of the Need for an Integrated Response to HIV, Hepatitis B Virus, and Hepatitis C Virus

Abstract

IntroductionGiven the overlapping modes of transmission of HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV), understanding the burden and relationship of these infections is critical for an effective response. Representative data on these infections among males who inject drugs (MWID), the key high-risk population for HIV in Vietnam, are currently lacking.MethodsData and stored specimens from Vietnam’s 2009-2010 Integrated Biologic and Behavioral Survey, a cross-sectional study among high-risk populations, were used for this analysis. Plasma samples were tested for HIV, HBV, and HCV using commercial assays. A questionnaire was administered to provide demographic, behavior, and service-uptake information. Provincial-level analyses were conducted to profile MWID enrollees and to provide estimates on the prevalence of HIV, HBV, and HCV infection.ResultsAmong 3010 MWID sampled across 10 provinces, the median (range) HIV prevalence was 28.1% (1.0%-55.5%). Median prevalence for current HBV infection (HBsAg+) was 14.1% (11.7%-28.0%), for previous exposure to HBV (total anti-HBc+) was 71.4% (49.9%-83.1%), and for current or past HCV infection (HCV Ag/Ab+) was 53.8% (10.9%-80.8%). In adjusted analysis, HBsAg+ (aOR: 2.09, 1.01-4.34) and HCV Ag/Ab+ (aOR: 19.58, 13.07-29.33) status were significantly associated with HIV infection; the association with total anti-HBc+ approached significance (aOR: 1.29, 0.99-1.68).ConclusionThe prevalence and association between HIV, HBV, and HCV are high among MWID in Vietnam. These findings indicate the need for integrated policies and practice that for the surveillance, prevention, screening, and treatment of both HIV and viral hepatitis among MWID in Vietnam.

High hepatitis C virus (HCV) prevalence among men who have sex with men (MSM) in Vietnam and associated risk factors: 2010 Vietnam Integrated Behavioural and Biologic Cross-Sectional Survey

“…A detailed description of the methodology has been described previously 9. Briefly, a representative sample of MSM was surveyed during September 2009–February 2010 for HIV infection along with associated risk behaviours (eg, condom use, needle-sharing) and exposure to HIV/AIDS prevention and care services.…”

“…Much of this burden is attributed to the estimated 8%–12% population prevalence of hepatitis B virus (HBV) and up to 26.7% of liver cancer attributed to HCV infection 7 8. Higher rates of HCV and HBV infection are reported among PWID and people living with HIV (PLHIV) 7 9. In one study, an estimated 39.6% (95% CI 34.8% to 44.3%) of those PLHIV receiving HIV treatment tested anti-HCV+ 10…”

“…Among a representative sample of male PWID sampled in the Vietnam 2009–2010 Integrated Biologic and Behavioural Survey (IBBS), the median prevalence of combination HCV antigen/antibody (HCV Ag/Ab) was 53.8%; both HCV Ag/Ab detection and current HBV infection were strongly associated with HIV coinfection 9. The latter findings are particularly important to HIV care and treatment programmes given the comorbidity associated with chronic HCV and HBV coinfections even in the era of highly effective HIV-suppressive antiretroviral therapy (ART) 11 12.…”

CD4 Recovery and Survival among Adults Co-infected with HIV and Hepatitis B or C Virus, Ho Chi Minh City, Vietnam

“…Hepatitis C virus (HCV) infection prevalence is lower, estimated at 0.5-4% [2,3,6]. However, higher HBV and HCV infection prevalences are reported among people living with HIV (PLHIV) and at risk for HIV in Vietnam, ascribed to overlapping behavioral risks for HIV, HBV and HCV exposures [3,7,8]. In a study among people who inject drugs (PWID) in northern Vietnam, prevalence of HIV was 42.4%; of hepatitis B core antibody (HBc Ab), 80.9%; and of antibody to HCV (anti-HCV), 74.1% [8].…”

“…In a study among people who inject drugs (PWID) in northern Vietnam, prevalence of HIV was 42.4%; of hepatitis B core antibody (HBc Ab), 80.9%; and of antibody to HCV (anti-HCV), 74.1% [8]. The 2009-2010 surveillance data among male PWID in 10 Vietnam provinces found HBsAg-positive prevalence of 12% to 28% across provinces and combined HCV antigen/antibody prevalence of 11% to 87%; HCV antigen/antibody prevalence was higher among HIV-positive (95.8%) compared with HIV-negative male PWID (52.2%) [7]. Previous studies have reported that HBV and HCV co-infections among PLHIV are associated with increased hepatic disease and overall morbidity and mortality [9][10][11][12].…”