title: Prevalence of hepatitis B and C viruses in HIV-positive patients in China: a cross-sectional study.
abstract: BACKGROUND
  Liver 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.
  
  
  METHODS
  HIV-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.
  
  
  RESULTS
  Of 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).
  
  
  CONCLUSIONS
  HBV 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.
authors.affiliation: Department of Infectious Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Xie
authors.affiliation: Department of Infectious Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Han
authors.affiliation: Department of Infectious Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
authors.forename: Zhifeng
authors.initials: Z
authors.lastname: Qiu
authors.affiliation: Department of Infectious Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
authors.forename: Yijia
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Infectious Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
authors.forename: Yanling
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Infectious Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
authors.forename: Xiaojing
authors.initials: X
authors.lastname: Song
authors.affiliation: Department of Infectious Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
authors.forename: Huanling
authors.initials: H
authors.lastname: Wang
authors.affiliation: Division of Infectious Diseases, Johns Hopkins Hospital, Johns Hopkins University School of Medicine Baltimore, MA, USA; litsh@263.net.
authors.forename: Chloe L
authors.initials: CL
authors.lastname: Thio
authors.affiliation: Department of Infectious Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China; litsh@263.net.
authors.forename: Taisheng
authors.initials: T
authors.lastname: Li
mesh_terms: D000328:Adult; D002681:China / Q000453:epidemiology; D060085:Coinfection / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006509:Hepatitis B / Q000453:epidemiology*; D006514:Hepatitis B Surface Antigens / Q000032:analysis; D006526:Hepatitis C / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence
chemical_list: D006514:Hepatitis B Surface Antigens
keywords: CD4 + T cell count; HIV; co-infection; hepatitis B virus; hepatitis C virus; liver disease; prevalence