Prevalence of hepatitis B and C viruses in HIV‐positive patients in China: a cross‐sectional study

Abstract

IntroductionLiver disease related to hepatitis B (HBV) and hepatitis C (HCV) may temper the success of antiretroviral therapy (ART) in China. Limited data exist on their prevalence in HIV-positive Chinese. A multi-centre, cross-sectional study was carried out to determine the prevalence and disease characteristics of HBV and HCV co-infection in HIV-positive patients across 12 provinces.MethodsHIV-positive ART-naïve patients were recruited from two parent cohorts established during November 2008–January 2010 and August 2012–September 2014. Hepatitis B surface antigen (HBsAg), hepatitis B e antigen and HCV antibody (anti-HCV) status were retrieved from parent databases at the visit prior to ART initiation. HBV DNA was then determined in HBsAg+ patients. HCV RNA was quantified in anti-HCV+ patients. Aspartate aminotransferase-to-platelet ratio index (APRI) and the fibrosis-4 (FIB4) were calculated. Chi-square test, Kruskal–Wallis test and logistic regression were used for statistical analysis, as appropriate.ResultsOf 1944 HIV-positive patients, 186 (9.5%) were HIV–HBV co-infected and 161 (8.3%) were HIV–HCV co-infected. The highest HIV–HBV prevalence (14.5%) was in Eastern China while the highest HIV–HCV prevalence was in the Central region (28.2%). HIV–HBV patients had lower median CD4 + T cell count (205 cells/μL) than either HIV monoinfected (242 cells/μL, P=0.01) or HIV–HCV patients (274 cells/μL, P=0.001). Moderate-to-significant liver disease was present in >65% of the HIV–HCV, ~35% of the HIV–HBV and ~20% of the HIV monoinfected patients. Independent associations with moderate-to-significant liver disease based on APRI included HBV (Odds ratio, OR 2.37, P < 0.001), HCV (OR 9.64, P<0.001), CD4 count≤200 cells/μL (OR 2.55, P<0.001) and age ≥30 years (OR 1.80, P=0.001).ConclusionsHBV and HCV prevalence is high in HIV-positive Chinese and differs by geographic region. HBV and HCV co-infection and HIV monoinfection are risks for moderate-to-significant liver disease. Only HIV–HBV is associated with greater HIV-related immunosuppression. Incorporating screening and management of hepatitis virus infections into Chinese HIV programmes is needed.

HIV-hepatitis B virus coinfection

“…For example in Vietnam, the prevalence of chronic HBV in HIV-infected individuals who inject drugs or who are sex workers (SW), is 28% and 15% respectively [50] . The prevalence of HIV-HBV co-infection overall in China has been estimated at 10% but varies between regions from 5 to 15% [25] . Accurate data are still lacking for coinfection in many parts of the world, however rates appear to be highest in parts of West and South Africa (Figure 1).…”

Sero-prevalence and Correlates of Hepatitis B and C Co-infection Among HIV-infected Individuals in Two Regional Hospitals in Cameroon

“…With increasing access to antiretroviral therapy (ART), the burden of viral hepatitis in resource limited settings is expected to increase as is now the case in Europe and North America [11, 12]. There is therefore the concern that if this is not addressed, hepatitis virus related disease may threaten the success of ART programs in developing countries [12].…”

“…There is therefore the concern that if this is not addressed, hepatitis virus related disease may threaten the success of ART programs in developing countries [12]. Understanding the prevalence and disease characteristics of HBV and HCV coinfection with HIV is thus essential [13].…”

Liver fibrosis after antiretroviral therapy in a longitudinal cohort of sexually infected HIV patients in eastern China

“…We observed that one-third of the HIV-infected patients were living with liver fibrosis before ART and the majority of them had attenuated or stabilized liver fibrosis after ART. In a multicenter cross-sectional study of HIV-positive ARTnaïve patients across twelve provinces in China, the proportion of participants with liver fibrosis or FIB-4 ≥ 1.45 was 26.2% (12). Recently, Ding et al reported that the prevalence of liver fibrosis was as high as 42.5% among 3900 HIV-infected ART-naïve patients in OR, odds ratio; CI, confidence interval.…”

“…In China, common risk factors for liver disease such as alcohol use, HBV and HCV infections are more prevalent in HIV-infected patients than those without HIV infection (9)(10)(11)(12). All-cause mortality was also higher in HIV-infected patients with HBV and/or HCV coinfection(s) than in those with HIV only, although ART has generally increased life expectancy of HIV-infected patients (13).…”