HIV/HCV coinfection in Infectious Disease Units in Mozambique and Brazil: a comparative study

Abstract

The prevalence of human immunodeficiency virus/ hepatitis C virus (HIV/HCV) coinfection has been reported for Brazil and for some Sub-Saharan African countries but no data is available from Mozambique. Here we report preliminary prevalence data and present the profile of HIV/HCV coinfected patients from an Infectious Disease Unit in Maputo Mozambique and from an equivalent Infectious Disease Unit in Belo Horizonte Brazil. Three hundred patients attending an outpatient clinic in Mozambique and 300 from an outpatient clinic in Brazil within the age range of 18 to 65 years were selected for this study between November 2006 and July 2007. A standardized sociodemographic and epidemiological questionnaire was used to record the information which subsequently was transferred to a database in the Epi-Info software. Serum from Mozambicans and Brazilians was stored at -20oC. HIV infection was diagnosed by an ELISA technique (enzyme-linked immunosorbent assay) and was confirmed by Western blotting and HCV was diagnosed by the ELISA MEIA (AxSYMG HCV 3.0) and confirmed by a polymerase chain reaction (PCR) (Amplicor 3.0 Roche). Sequencing and genotyping were then performed to identity virus subtypes using an automatic sequencer (Applied Biosystems). The prevalences of HIV/HCV coinfection in Mozambicans and Brazilians were 15.7% and 10% respectively (p = 0.04). Coinfection was also more frequent among Mozambican women and this roughly coincided with the gender distribution of HIV infection in Mozambique (3:1 female/male ratio in the age range of 20 to 24 years). The mean T CD4+ cell counts were: 253 cells/mm3 (SD = 169) and 400 (SD = 244) for Mozambicans and Brazilians respectively (p < 0.01). The risk factors for HCV infection among Mozambicans and Brazilians were respectively: 0% and 40% for illegal intravenous drug use; 14.9% and 20% for blood transfusion; 0% and 16% for homosexual activity; 100% and 76.6% for heterosexual activity; 8.5% and 36.6% for other factors (tattooing piercing imprisonment and occupational risk). The HCV genotypes identified in Mozambique were 1a 2a 4 and 5a whereas in Brazil they were 1a 1b and 3a. In short the prevalence of hepatitis C among HIV-infected patients was higher among Mozambicans. The unexpected differences in the data on homosexual behavior and in the use of illegal intravenous drugs between the populations evaluated raise the issue of the quality of the information obtained in the African country. There was a marked difference in HCV genotypes between the study groups. Preliminary analysis on the treatment of hepatitis C in the two populations revealed that only 8.5% of the Mozambicans and 10% of the Brazilians presenting HIV/HCV coinfection would be eligible candidates for hepatitis C treatment. (full-text)