HIV and Hepatitis C Virus Testing Delays at Methadone Clinics in Guangdong Province, China

Xia, Ying; McLaughlin, Megan M.; Chen, Wen; Li, Ling; Tucker, Joseph D.

doi:10.1371/journal.pone.0066787

Cited by 7 publications

(4 citation statements)

References 31 publications

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“…We were also limited to describing the HCV antibody prevalence upon entry to MMT, which is not directly reflective of all MMT clients. We could only include MMT clients who had at least one anti-HCV test result within 6 months in the primary analysis; due to the high early attrition rate in MMT, many clients drop-out without receiving HCV antibody testing [ 44 , 45 ]. We excluded 13.5% of cases due to a lack of HCV antibody testing within 6 months of entry.…”

Section: Discussionmentioning

confidence: 99%

Baseline HCV Antibody Prevalence and Risk Factors among Drug Users in China’s National Methadone Maintenance Treatment Program

Wang¹,

Shi²,

Rou³

et al. 2016

PLoS ONE

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BackgroundHepatitis C virus (HCV) is the most common viral infection among injecting drug users worldwide. We aimed to assess HCV antibody prevalence and associated risk factors among clients in the Chinese national methadone maintenance treatment (MMT) program.MethodsData from 296,209 clients who enrolled in the national MMT program between March 2004 and December 2012 were analyzed to assess HCV antibody prevalence, associated risk factors, and geographical distribution.ResultsAnti-HCV screening was positive for 54.6% of clients upon MMT entry between 2004 and 2012. HCV antibody prevalence at entry declined from 66.8% in 2005 to 45.9% in 2012. The most significant predictors of HCV seropositivity were injecting drug use (adjusted odds ratio [AOR]: 8.34, 95% confidence interval [CI]: 8.17–8.52, p<0.0001) and a history of drug use ≥9 years (AOR: 2.01, 95% CI: 1.96–2.06, p<0.0001). Being female, of Uyghur or Zhuang ethnicity, and unmarried were identified as demographic risk factors (all p-values<0.0001). Of the 28 provincial-level divisions included in the study, we found that 5 divisions had HCV antibody prevalence above 70% and 20 divisions above 50%. The HCV screening rate within 6 months after MMT entry greatly increased from 30.4% in 2004 to 93.1% in 2012.ConclusionsThe current HCV antibody prevalence remains alarmingly high among MMT clients throughout most provincial-level divisions in China, particularly among injecting drug users and females. A comprehensive prevention strategy is needed to control the HCV epidemic among MMT clients in China.

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Section: Discussionmentioning

confidence: 99%

Baseline HCV Antibody Prevalence and Risk Factors among Drug Users in China’s National Methadone Maintenance Treatment Program

Wang¹,

Shi²,

Rou³

et al. 2016

PLoS ONE

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“…In China, small sample studies suggest that 8.25–56.9% of HIV-infected persons were simultaneously infected with HCV ( 10 – 14 ). Delayed testing for HIV and HCV is common among patients at methadone clinics in Guangdong, with numerous patients experiencing delays of ≥2 months ( 13 , 14 ). Early diagnosis and enrollment in care is particularly crucial in a highly populated country such as China; thus, expediting HIV and HCV testing is important ( 15 ).…”

Section: Introductionmentioning

confidence: 99%

Detection and analysis of hepatitis C virus in HIV-infected patients in the Guangxi province of China

Wei

et al. 2017

Experimental and Therapeutic Medicine

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The aim of the present study was to investigate the prevalence rate of hepatitis C virus (HCV) infection in human immunodeficiency virus (HIV)-positive individuals and to study the infection status of HCV RNA in HIV-infected individuals who did not have anti-HCV antibodies in the Guangxi province of China, in order to provide basis for screening and clinical treatment of hepatitis C in future. Data were collected from patients recruited via a questionnaire. Between August 2008 and January 2009, 300 HIV-infected individuals were randomly selected from various HIV monitoring points in Liuzhou and Qinzhou (Guangxi, China). In addition, 41 patients with only hepatitis C were recruited from a hospital clinic (First Affiliated Hospital of Guangxi Medical University, Nanning, China). HCV antibodies in patient serum samples were detected by ELISA. HCV RNA expression was detected using nested polymerase chain reaction (PCR), HCV RNA levels in the serum were evaluated using quantitative fluorescence PCR, and HCV genotypes were confirmed using restriction fragment length polymorphism. The infection rate of HCV in the HIV-infected people was 48.67%. The anti-HCV positive rate differed between routes of disease transmission: Anti-HCV positive rate was 63.7% among drug users, 34.96% among sex-transmitted persons and 1.37% among other persons. In the anti-HCV-negative group, the HCV RNA-positive rate was 26.62%. In the anti-HCV-positive group, HCV RNA positive rate was 78.08%. HCV RNA level of HIV/HCV coinfected patients was higher than those infected with HCV alone, and there was no difference of anti-HCV-positive rate among different levels of HCV RNA. HCV genotypes of HIV/HCV coinfected persons showed diversity across Guangxi, and the predominant ones were the 1b and mixed subtypes. The predominant HCV genotypes were 6a, mixed subtypes and 3b amongst patients that contracted HCV via drug use-related routes of transmission. The patients with HCV transmission routes other than drug-related routes possessed 1b and 1a+1b genotypes. In conclusion, there was a large proportion of HIV infected persons with mixed HCV infection in the Guangxi province of China. The present results show that 26.62% of HCV-infected persons will be fail to be diagnosed with hepatitis C virus coinfection if we simply use ELISA to detect HCV antibody. The predominant HCV genotypes were 1b, mixed, 6a and 3b in HIV/HCV coinfected persons.

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“…HCV mono-infected individuals in China do not have access to the same education and preventative services as HIV-infected individuals, leading to continued high-risk behaviors and acquisition of co-infection. While China’s needle exchange programs [ 36 , 37 ] and methadone maintenance programs [ 38 , 39 ] have achieved success, HIV and HCV testing delays are still common at methadone maintenance programs [ 40 , 41 ]. The structure of methadone maintenance programs in China, however, is a strong foundation on which to build testing of high-risk drug users, link them to care, and initiate therapy.…”

Section: Discussionmentioning

confidence: 99%

Genotypic distribution and hepatic fibrosis among HIV/HCV co-infected individuals in Southern China: a retrospective cross-sectional study

Zhou

Wang

et al. 2015

BMC Infect Dis

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BackgroundEnd-stage liver disease and hepatocellular carcinoma due to hepatitis C virus (HCV) co-infection are increasingly common causes of death among HIV-infected individuals. However, there are few clinical investigations of HIV/HCV co-infected individuals from low and middle-income nations. Here, we compare the epidemiology of HCV-infected and HIV/HCV co-infected individuals in Southern China and examine hepatic fibrosis scores in co-infected individuals.MethodsWe conducted a retrospective cross-sectional study of treatment-naïve HIV/HCV co-infected and HCV mono-infected subjects. Bivariate and multivariate models were used to examine the association between demographics and HCV genotype. Among co-infected individuals, we also studied the relationship between fibrosis scores derived from non-invasive studies and HCV genotype.ResultsData were collected from 175 HCV-infected individuals, including 89 (51 %) HIV/HCV co-infected individuals. HIV/HCV co-infection was correlated with intravenous drug use (AOR 46.25, p < 0.001) and not completing high school (AOR 17.39, p < 0.001) in a multivariate model. HIV/HCV co-infected individuals were more likely to be infected with HCV genotype 6a (p < 0.0001) or 3a (p < 0.023), whereas increased fibrosis (FIB-4 score) was associated with HCV genotype 3a infection (β 2.18, p < 0.001).DiscussionOur results suggest that intravenous drug use is driving HIV/HCV co-infection in Southern China. While additional studies are needed, HCV genotype 6a is more common and genotype 3a appears to be associated with more severe hepatic fibrosis in co-infected individuals.ConclusionsFuture HIV/HCV co-infection research in China should focus on at risk populations, HCV testing uptake, and genotype-specific treatment.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-015-1135-1) contains supplementary material, which is available to authorized users.

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HIV and Hepatitis C Virus Testing Delays at Methadone Clinics in Guangdong Province, China

Cited by 7 publications

References 31 publications

Baseline HCV Antibody Prevalence and Risk Factors among Drug Users in China’s National Methadone Maintenance Treatment Program

Baseline HCV Antibody Prevalence and Risk Factors among Drug Users in China’s National Methadone Maintenance Treatment Program

Detection and analysis of hepatitis C virus in HIV-infected patients in the Guangxi province of China

Genotypic distribution and hepatic fibrosis among HIV/HCV co-infected individuals in Southern China: a retrospective cross-sectional study

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