High Rate of Hepatitis B and C Coinfections Among People Living with HIV-1 in Bulgaria: 2010–2014

Abstract

In a representative nationwide study, we have determined the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) coinfections among HIV-positive patients diagnosed during the period 2010-2014 in Bulgaria. Despite a relatively low rate of new HIV diagnoses, the rates of hepatitis B and C coinfections among these patients fell within the upper range reported in Europe. HBsAg and HCV antibodies (Ab) were found in 10.4% and 25.6% of the tested individuals, respectively. Importantly, high rates of active hepatitis infections were confirmed by detection of HBV DNA in 51.1% and HCV RNA in 78.1% of the tested individuals. Hepatitis coinfections affected mostly high risk groups and persons with multiple risk behavior, including people who inject drugs, men who have sex with men, prisoners, and Roma people.

HCV transmission in high-risk communities in Bulgaria

“…The cohort described in this study is comprised of individuals who have high-risk behavior and are HIV-positive [2]. All studied cases (n = 125) are HIV/HCV coinfected.…”

“…Serum samples were available from 53.8% (n = 503) of all newly diagnosed HIV cases (n = 934) identified during 2010–2014 in Bulgaria [2]. All patients provided written informed consent to participate in this study and answered a questionnaire about sex, age, origin of birth, risk behaviors, partners (spouse or cohabitation), occupation, and if they have ever traveled to a foreign country, used injection drug, received blood transfusion or been imprisoned.…”

“…The specimens were tested for HCV antibody (anti-HCV) by commercial enzyme immunoassay kits (NanbaseC-96 3.0, General Biological Corporation, Hsin-Chu, Taiwan and Murex anti-HCV, version 4.0 Abbott/Murex, Murex Biotech South Africa Proprietary, Kyalami, Republic of South Africa). Anti-HCV positive samples (n = 203) were tested for HCV RNA using Amplicor Hepatitis C virus Test, version 2.0 (Roche Molecular Systems, Branchburg, New Jersey, USA) [2]. HCV RNA positive specimens (n = 171) were genotyped in this study (n = 125) and were used for further analysis.…”

“…The rates of newly diagnosed infections with Human Immunodeficiency Virus (HIV) in Bulgaria are low; however, among individuals with HIV, the prevalence of coinfection with hepatitis B virus (HBV) and hepatitis C virus (HCV) and HIV coinfections fall within the upper range reported in Europe—10.4% and 25.6%, respectively [1, 2]. High rates of active hepatitis infections were confirmed by detection of HBV DNA in 51.1% and HCV RNA in 78.1% of the tested HIV-positive individuals [2]. Hepatitis virus coinfections with HIV affected mostly high-risk behavior groups, including people who inject drugs (PWID), men who have sex with men (MSM), people with history of incarceration, and Roma people [3].…”

The evaluation of antiretroviral treatment in HIV and hepatitis B virus (HBV) co-infected persons in Beijing, China, 2010-2018: a retrospective cohort study

“…Worldwide, approximately 37 million people are infected with HIV and about 5-20% are co-infected with HBV [6,7]. By the end of Sep. 2018, a total of 849,602 HIV patients were alive in China [8], 67.3% of whom had received antiretroviral therapy (ART) treatment [9], and the prevalence of HIV and HBV co-infection was 8.7-14% [4,10]. HIV and HBV shared transmission routes, including intravenous drug abuse, blood transfusion or blood products, sexual and mother-to-child transmission, whereas the immunodeficiency also caused by HIV enhances the likelihood of HBV persistence [1,2,7].…”