Research Article: Different HCV Genotype Distributions of HIV-Infected Individuals in Henan and Guangxi, China

Date Published: November 30, 2012

Publisher: Public Library of Science

Author(s): Di Tian, Lin Li, Yongjian Liu, Hanping Li, Xiaoyuan Xu, Jingyun Li, Jason Blackard. http://doi.org/10.1371/journal.pone.0050343

Abstract

Due to shared transmission routes, hepatitis C virus (HCV) infection is highly prevalent among people infected with human immunodeficiency virus (HIV). Highly active antiretroviral therapy (HAART) is associated with hepatotoxicity, leading to the negative effects on patients with HIV/HCV co-infection. In order to provide valuable information for HCV management in this particular population, we investigated the HCV genotypes in HIV-infected individuals from Henan and Guangxi, the two provinces with the most HIV-infected cases in China.

Individuals, who acquired HIV infection through various risk routes, were recruited from Henan and Guangxi. Test of antibodies against HCV (anti-HCV) was conducted, and detection of HCV RNA was performed by PCR amplification. HCV subtypes were determined by direct sequencing of amplicons, followed by phylogenetic analysis.

We recruited a total of 1,112 HIV-infected people in this present study. Anti-HCV was detected from 218 (50.1%) patients from Henan and 81 (12.0%) patients from Guangxi, respectively. The highest prevalence of HIV/HCV co-infection was observed from FBDs (former blood donors) (87.2%) in Henan and IDUs (intravenous drug users) (81.8%) in Guangxi, respectively. The seroprevalence rate of HCV among people with sexual contact was significantly higher in Henan than in Guangxi (18.7% vs. 3.5%, P<0.05). The positive rate of HCV RNA in Henan and Guangxi was 30.6% (133/435) and 11.2% (76/677), respectively. Moreover, we found that 20 anti-HCV negative samples were HCV positive by PCR amplification. HCV subtype 1b (52.7%) was predominant in Henan, followed by subtype 2a (41.9%). The most frequently detected subtypes in Guangxi were 6a (35.6%) and 3b (32.9%). The HCV genotype distributions were different in HIV-infected people from Henan and Guangxi. HIV/HCV co-infection was not only linked to the transmission routes, but also associated with the geographic position.

Partial Text

Hepatitis C virus (HCV) is a single, positive-stranded RNA virus, and it belongs to the Flaviviridae family [1]. HCV infection is the most important factor causing chronic hepatitis, liver cirrhosis and hepatocellular carcinoma, affecting more than 170 million people worldwide [2]. Due to shared transmission routes and common risk factors, HCV infection is frequently associated with the human immunodeficiency virus (HIV) infection, with a prevalence of approximately 20% to 25% of the HIV-positive population [3]. Since the introduction of highly active antiretroviral therapy (HAART) in the 1990s, the survival rate in HIV-positive individuals has been increasing. Although people with HIV/HCV co-infection have more rapid progression to cirrhosis and hepatocellular carcinoma [3], [4], HCV-induced liver disease is a major cause of morbidity and mortality in HIV-infected people [5]. Several studies have revealed that HAART is associated with an increased risk of antiretroviral-related hepatotoxicity and drug-induced liver injury (DILI) in people with HIV/HCV co-infection [6]. Therefore, it is necessary to screen HCV infection among HIV-infected people [7], especially given a potential treatment for HIV infection.

In China, the reported incidence rate of HCV infection is low (<1%) in the general populations [23], [28]. Since HIV and HCV have similar transmission routes, the incidence rate of HCV/HIV co-infection is apparently high among HIV-infected people, regardless of the route of HIV acquisition. In the present study, we found that the seroprevalence rate of HCV in HIV-infected people was 26.9% (299/1,112). This prevalence was significantly higher than those reported data in the general populations. However, it was lower than the reported data (57%) in a previous study [16]. The prevalence of HCV infection varies with the mode of HIV transmission [29]. Between 1992 and 1995, uncontrolled blood collection from FBDs in the central Chinese provinces of Henan, Anhui and Shanxi caused the second major epidemic in China [25]. The HIV/HCV co-infection rate (163/187, 87.2%) among FBDs observed in this study was higher than that reported by Zhang et al. (82.2%) and lower than that reported by Shang et al. (96.6%) [16], [23]. Although paid blood donation is the predominant mode of HIV transmission in Henan, HIV infection is frequently detected in cases of transfusion, sexual contact and perinatal exposure. We detected a high prevalence of HIV/HCV co-infection (57.6%) among people with HIV infection through transfusion in Henan. A high HCV prevalence of 18.7% was also observed in individuals who acquired HIV infection through sexual contact. Our results were consistent with the published data, suggesting that HCV transmission through sexual contact is efficient [23]. Our study also indicated that HCV infection was relatively rare through perinatal exposure, with a prevalence of 5.9% for HIV/HCV co-infection. A recent meta-analysis demonstrated that the risk of vertical transmission of HCV is enhanced by HIV co-infection [30]. To better understand the effect of HIV infection on HCV vertical transmission, large-scale investigations should be performed among mothers with HIV/HCV co-infection or HCV mono-infection. The HCV prevalence in HIV-positive people in Guangxi showed a large variation, ranging from 3.5% in people with sexual contact to 81.8% in IDUs. Interestingly, the proportion of HIV-infected people with sexual contact who were anti-HCV positive was lower in Guangxi than in Henan (18.7% vs. 3.5%, P<0.05), suggesting that the HIV/HCV co-infection rate was not only related to the transmission routes, but also associated with the geographic position. Taken together, our study revealed that the HCV genotype distributions in HIV-infected people between Henan and Guangxi are different. In Henan, HIV/HCV co-infection is frequent in FBDs and people who acquired HIV infection through transfusion or sex contact. HCV subtypes 1b and 2a appear to be the predominant subtypes in HIV infection from various transmission routes. However, HIV/HCV co-infection is mainly associated with intravenous drug use in Guangxi, and the predominant HCV subtypes are 3b and 6a. These results also suggested that HIV/HCV co-infection is not only linked to the transmission mode, but also associated with geographic position. Due to the high HCV prevalence among HIV-infected patients and hepatotoxicity of HAART, systematic HCV screening becomes an important consideration when an antiretroviral therapy is given [37]. Source: http://doi.org/10.1371/journal.pone.0050343