Prevalence of occult hepatitis B & C in HIV patients infected through sexual transmission.
BACKGROUND
Prevalence of Hepatitis B virus (HBV) and Hepatitis C virus (HCV) markers including active and occult infection has not been described in diverse cohorts among HIV-infected patients in India. Earlier studies have explained the role of HBV/HCV co-infection in cohorts of injection drug users (IDUs) but the sexual co-transmission of HBV/ HCV is not completely understood.


OBJECTIVE
The objective of this study was to assess the prevalence of occult HBV & HCV infection in HIV positive sexually acquired transmission risk group.


METHODS
58 sexually acquired HIV positive patients were taken up for the study of occult HBV/HCV co-infection. Data on demographics, sexual behaviour, sexually transmitted diseases (STD), medical history, laboratory tests viz., serum ALT and CD4 count were recorded. HBV serology included HBsAg, anti HBs, IgG anti HBc and HBV DNA (PCR). HCV serology included anti HCV & HCV RNA (RT-PCR).


RESULTS
Occult HBV infection (HBV DNA) was observed in 12.2% (7/58 with HBsAg -ve and IgG anti HBc +ve subjects) while an overall prevalence of HBV DNA was 13.7% (12% occult & 1.7% in HBsAg+ve patients). Out of 58 HIV positive patients 29.3% demonstrated reactivity for any marker of past or current HBV infection. (HBsAg 1.7%, anti HBs 10.3% anti HBc IgG 17.2%). 4/58 (6.8%) revealed anti HCV positivity along with HCV RNA positivity by RT-PCR while 6/58 (10.3%) individuals revealed an occult HCV infection (anti HCV negative). The overall HCV RNA prevalence was 17.2%. 2 out of 58 (3.4%) individuals were positive for occult infection of both HBV DNA & HCV RNA (Triple infection HIV/HBV/ HCV). The HBV/HCV co-infected group (n = 18) showed a significantly high ALT (114.3 + 12.3 U/I) & low CD4 count (202.5 + 33.7 cells/mm3). The percent prevalence of HBV/ HCV co-infection was higher in the illiterate group, in men less than 30 years of age, and in those who were married and exhibited polygamous activity.


CONCLUSIONS
The study demonstrated that in HIV infected patients testing only serological viral markers like HBsAg, antiHBcIgG & anti HCV, fails to identify the true prevalence of co-infection with HBV & HCV. Qualitative PCR for HBV DNA & HCV RNA detects co-infection in patients who are negative for serological markers. Also, in subjects who had only a sexual risk factor for parenterally transmitted infections, HIV may enhance the sexual transmission of HBV and HCV.
Rai
Ramesh Roop
RR
Department of Gastroenterology, SMS Hospital & Medical College, Jaipur.
Mathur
Anjali
A
Mathur
Dinesh
D
Udawat
Harsh P
HP
Nepalia
Subhash
S
Nijhawan
Sandeep
S
Mathur
Amit
A
D000328:Adult; D000914:Antibodies, Viral / Q000032:analysis; D004279:DNA, Viral / Q000032:analysis; D018562:Disease Transmission, Infectious; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006678:HIV / Q000235:genetics / Q000276:immunology; D015658:HIV Infections / Q000635:transmission* / Q000821:virology; D016174:Hepacivirus / Q000235:genetics / Q000276:immunology; D006509:Hepatitis B / Q000150:complications / Q000453:epidemiology* / Q000635:transmission; D006514:Hepatitis B Surface Antigens / Q000032:analysis; D006515:Hepatitis B virus / Q000235:genetics / Q000276:immunology; D006526:Hepatitis C / Q000150:complications / Q000453:epidemiology* / Q000635:transmission; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D012367:RNA, Viral / Q000032:analysis; D012189:Retrospective Studies; D020133:Reverse Transcriptase Polymerase Chain Reaction
D000914:Antibodies, Viral; D004279:DNA, Viral; D006514:Hepatitis B Surface Antigens; D012367:RNA, Viral