HIV/hepatitis C virus co-infection in drug users: risk behavior and prevention

Hagan, Holly; Thiede, Hanne; Jarlais, Don C. Des

doi:10.1097/01.aids.0000192090.61753.d4

Cited by 64 publications

(47 citation statements)

References 84 publications

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“…During the year of 2006, the perinatal HIV transmission rate in the cohort of 600 (9 cases were out of state residents) HIV exposed birth events followed was 1.7 %. Maternal age of 35 years or older and IDU were the strongest predictors of HCV seropositivity, consistent with the existing body of research [16].…”

Section: Discussionsupporting

confidence: 87%

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Hepatitis C Seroprevalence Among HIV-Infected Childbearing Women in New York State in 2006

Ghazaryan

Smith

Parker

et al. 2015

Matern Child Health J

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Objective To identify factors associated with maternal hepatitis C virus (HCV) seroprevalence and transmission of HCV as identified by qualitative HCV ribonucleic acid (RNA) in the infants of human immunodeficiency virus (HIV) infected women delivering in New York State (NYS) in 2006. Study Design In this retrospective cohort study of HIV-exposed infants born in NYS, leftover infant plasma from HIV diagnostic testing was deidentified and tested for HCV. If HCV antibodies were detected, a second specimen collected when the infant was [2 months old was tested for HCV qualitative RNA. Multivariate logistic regression was used to identify factors associated with HCV seropositivity. Results In a final sample of 553 live birth events with perinatal HIV exposure, 21 (3.8 %) of tested infant specimens had HCV antibodies indicative of maternal HCV seropositivity.Maternal age at delivery of [35 years, Hispanic ethnicity, white race and injection drug use (IDU) were significantly associated with HCV seropositivity in multivariate analysis. No cases of HCV vertical transmission were identified among HCV exposed infant specimens. Conclusions This statewide population-based study of HIV-infected childbearing women shows HCV seroprevalence of 3.8 %. Maternal age of [35 years and IDU are the strongest predictors of HCV seropositivity. Although no viral transmission was documented, more comprehensive longitudinal testing would be required to conclude that HCV transmission did not occur. SignificanceThis statewide population-based study of HIV-infected childbearing women shows HCV seroprevalence of 3.8 %.The study results help in better understanding of the overall epidemiology of HCV and reinforce the current HCV screening recommendations among pregnant women infected with HIV. The identified seroprevalence of HCV may raise awareness among health care providers and ensure appropriate HCV screening and early identification of HCV among HIV infected women of childbearing age (15-45 years old).

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Section: Discussionsupporting

confidence: 87%

“…Both HCV and HIV are readily transmitted through injection-drug use, and about one-fourth of all HIV patients are also coinfected with HCV [15,16]. This unique statewide population-based study of a cohort of HIV-infected childbearing women showed HCV seroprevalence of 3.8 %.…”

Section: Discussionmentioning

confidence: 75%

Hepatitis C Seroprevalence Among HIV-Infected Childbearing Women in New York State in 2006

Ghazaryan

Smith

Parker

et al. 2015

Matern Child Health J

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“…Although such a protective response is difficult to evaluate in humans, two reports have demonstrated that high-risk IDUs who have already resolved one HCV infection are less likely to be reinfected than individuals who are HCV naïve, despite repeated high-risk exposures (21,38). IDUs currently represent the main reservoir of HCV (2,23). Although this group represents a major public health hazard, they have limited access to treatment.…”

Section: Discussionmentioning

confidence: 99%

Early Interferon Therapy for Hepatitis C Virus Infection Rescues Polyfunctional, Long-Lived CD8 ⁺ Memory T Cells

Badr

Bédard

Abdel-Hakeem

et al. 2008

J Virol

124

130

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The majority of acute hepatitis C virus (HCV) infections progress to chronicity and progressive liver damage. Alpha interferon (IFN-␣) antiviral therapy achieves the highest rate of success when IFN-␣ is administered early during the acute phase, but the underlying mechanisms are unknown. We used a panel of major histocompatibility complex class I tetramers to monitor the phenotypic and functional signatures of HCVspecific T cells during acute HCV infection with different infection outcomes and during early IFN therapy. We demonstrate that spontaneous resolution correlates with the early development of polyfunctional (IFN-␥-and IL-2-producing and CD107a ؉ ) virus-specific CD8 ؉ T cells. These polyfunctional T cells are distinguished by the expression of CD127 and Bcl-2 and represent a transitional memory T-cell subset that exhibits the phenotypic and functional signatures of both central and effector memory T cells. In contrast, HCV-specific CD8 ؉ T cells in acute infections evolving to chronicity expressed low levels of CD127 and Bcl-2, exhibited diminished proliferation and cytokine production, and eventually disappeared from the periphery. Early therapeutic intervention with pegylated IFN-␣ rescued polyfunctional memory T cells expressing high levels of CD127 and Bcl-2. These cells were detectable for up to 1 year following discontinuation of therapy. Our results suggest that the polyfunctionality of HCV-specific T cells can be predictive of the outcome of acute HCV infection and that early therapeutic intervention can reconstitute the pool of long-lived polyfunctional memory T cells.Hepatitis C virus (HCV) infection resolves spontaneously during the acute phase in a minority of infected individuals while the majority develop persistent viremia and chronic hepatitis over a period of years or decades (28). Understanding the immune response leading to spontaneous resolution during acute HCV infection has been hampered by the asymptomatic nature of the disease. Studies in the chimpanzee model and high-risk populations like intravenous drug users (IDUs) or healthcare workers following HCV exposure have demonstrated the absolute requirement for the CD8 ϩ and CD4 ϩ HCV-specific T-cell responses to prevent viral persistence (reviewed in reference 12 and 50). A cellular immune response is induced in most infected individuals, resulting in spontaneous resolution or transient control of viremia. However, this response is not sustained in individuals who develop viral persistence. The inefficiency of this initial immune response and viral recurrence in individuals who progress to chronic infection are likely due to the loss of CD4 ϩ T-cell help (16,20,56,57) and the rapid emergence of viral escape mutants in targeted CD8 ϩ cytotoxic T lymphocyte epitopes (9). Individuals who spontaneously resolve HCV infection develop long-lived memory Tcell responses (54) that can be protective upon reexposure (51). In contrast, cellular immune responses are mostly undetectable in the blood of persistently infected individuals and are ...

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“…8 In HIV-infected individuals, untreated acute HCV typically progresses to chronic HCV, a leading cause of non-AIDS-related morbidity and mortality for HIV-infected persons in the highly active antiretroviral therapy (HAART) era. 9 In addition to classic risk factors for acute HCV among HIV-infected women and heterosexual men, reported risk factors among HIV-infected MSM include traumatic sexual practices (e.g., unprotected anal intercourse, use of sex toys, digital-manual insertion), and having a history of or concurrent STI.…”

Section: Introductionmentioning

confidence: 99%

Acute Hepatitis C Virus in an HIV Clinic: A Screening Strategy, Risk Factors, and Perception of Risk

Taylor

DeLong

Maynard

et al. 2011

AIDS Patient Care and STDs

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Acute hepatitis C virus (HCV) infection is being acquired undetected among HIV-infected individuals. A practical way to regularly screen HIV-infected patients for acute HCV irrespective of perceived risk or symptoms is needed. We piloted implementation of an acute HCV screening strategy using routine HIV clinical care schedules and the least costly blood tests, in a Rhode Island HIV care center. Study participants had ongoing HCV risk, completed questionnaires encompassing risk behaviors and perception of risk, and were screened with quarterly alanine aminotransferase (ALT). ALT rise triggered HCV RNA testing, with pooled rather than individual specimen HCV RNA testing for underinsured participants. Participants were primarily older, collegeeducated men who have sex with men (MSM) with history of sexually transmitted infection other than HIV. One of 58 participants developed acute HCV in 50 person-years of observation for an annual incidence of 2.0% per year (95% confidence interval [CI] 0.05-11.1%). The majority (54%) of MSM did not perceive that traumatic sexual and drug practices they were engaging in put them at risk for HCV. Unprotected sex often occurred under the influence of drugs or alcohol. Self-reported HCV risk and participation in several risk behaviors declined during the study. It was possible to collect frequent ALTs in a busy HIV clinic with 71% of total projected ALTs obtained and 88% of participants having at least one ALT during the 9-month follow-up period. All instances of ALT rise led to reflexive HCV RNA testing. Tracking quarterly ALT for elevation to systematically prompt HCV RNA testing before seroconversion is a promising approach to screen for acute HCV in a real-world HIV clinical setting.

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HIV/hepatitis C virus co-infection in drug users: risk behavior and prevention

Cited by 64 publications

References 84 publications

Hepatitis C Seroprevalence Among HIV-Infected Childbearing Women in New York State in 2006

Hepatitis C Seroprevalence Among HIV-Infected Childbearing Women in New York State in 2006

Early Interferon Therapy for Hepatitis C Virus Infection Rescues Polyfunctional, Long-Lived CD8 ⁺ Memory T Cells

Acute Hepatitis C Virus in an HIV Clinic: A Screening Strategy, Risk Factors, and Perception of Risk

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HIV/hepatitis C virus co-infection in drug users: risk behavior and prevention

Cited by 64 publications

References 84 publications

Hepatitis C Seroprevalence Among HIV-Infected Childbearing Women in New York State in 2006

Hepatitis C Seroprevalence Among HIV-Infected Childbearing Women in New York State in 2006

Early Interferon Therapy for Hepatitis C Virus Infection Rescues Polyfunctional, Long-Lived CD8 + Memory T Cells

Acute Hepatitis C Virus in an HIV Clinic: A Screening Strategy, Risk Factors, and Perception of Risk

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Early Interferon Therapy for Hepatitis C Virus Infection Rescues Polyfunctional, Long-Lived CD8 ⁺ Memory T Cells