Abstract
In contrast with global trends, HIV prevalence in Kazakhstan and other Central Asian countries has been rising in recent years. In this study, we analyzed hepatitis B (HBV), hepatitis C (HCV), tuberculosis (TB) and sexually-transmitted (STI) co-infections among 500 HIV positive study participants recruited from all regions of Kazakhstan. Among our study participants, 27%, 8%, 2%, and 5% were coinfected with, respectively, HCV, TB, HBV, and STI. A considerable proportion of the study participants was also found with triple or quadruple infections of HCV/TB (12%), TB/STI (0.8%), HCV/STI (2%), HCV/HBV (1%), HBV/TB (0.4%), HBV/STI (0.2%), HBV/HCV/TB (0.4%), HBV/HCV/STI (0.2%), or HCV/TB/STI (0.2%). Strong associations were found of certain age groups, duration of HIV infection, and practices of injection drug use and sexual contact with PLWH, with co-infections of HIV/HCV and HIV/TB. The odds of having death was 4.07 times higher with TB/HIV as compared to other co-infections. Co-occurrence of HIV with HCV, HBV, and TB infections among participants of this study highlights the necessity of regular screening for HCV infection among HIV infected patients, together with implementation of vigilant vaccination protocols against HBV and TB. Additionally, persons who inject drugs especially need to be focused for harm reduction efforts that include opiate substitution therapy, needle or syringe exchange programs, regular screening, and increased availability of ART and direct acting antivirals.
Highlights
Owing to improved preventive measures, the rates of new HIV infections declined from 2.8 million in 2000 to 1.7 million in 2019 w orldwide[1]
The participants were registered with Republican Center for Prevention and Control of AIDS, Almaty, Kazakhstan, asked to signed an informed consent if they were interested in the study and responded to an orally administered questionnaire about their medical history, risk behavior, and existing co-infections, including hepatitis B/C, tuberculosis, and sexually transmitted infections
Samples were representative of 13 regions of Kazakhstan: Akmola (6%), Aktobe (1%), Atyrau (0.6%), East Kazakhstan (2%), Karaganda (21%), Kostanay (0.4%), Kyzylorda (3%), Mangystau (5%), North Kazakhstan (2%), Pavlodar (13%), Turkistan (9%), West Kazakhstan (3%), Zhambyl (6%); and 2 cities with status of State, i.e., Almaty (26%) and Nur-Sultan (2%) (Fig. 1B and Table 1)
Summary
Owing to improved preventive measures, the rates of new HIV infections declined from 2.8 million in 2000 to 1.7 million in 2019 w orldwide[1]. The HIV epidemic in Eastern Europe and Central Asia is prevalent mainly in high-risk populations: People who inject drugs (PWID), men who have sex with men (MSM), transgender people, sex workers, prisoners, and their sexual partners comprise 95% of new infections in this r egion[1,3]. The dissolution of Soviet Union gave rise to a regional financial crisis in 1 9915, leading to a decline in per capita income, increased rate of unemployment, and consequent renascence of shadow economy Aftermath of this situation was observed as, among other things, penetration of corruption through the infrastructure responsible for the governance of law, education and healthcare, illegal production and trafficking of opiates leading to noticeable increases in the number of PWID, contributing to the expansion of HIV epidemics in the region[6]. We show an analysis of associations between these co-infections and factors such as gender, risk behaviors, and travel
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