Hepatitis C Virus Coinfection Research Articles

Examining disparities in the receipt of curative treatment for hepatocellular cancer (HCC): A multicenter retrospective study from 2016-2023.

1582 Background: Prior studies suggested disparities in hepatocellular cancer (HCC) treatment and outcomes based on region, race, and socioeconomic status. After the implementation of the Affordable Care Act, including Michigan’s Medicaid Expansion in 2014, there’s increased interest in how these changes affect HCC care. The study examines factors influencing curative treatment receipt and existing disparities, as a step toward intervention strategies. Methods: This is a retrospective study of HCC patients at 6 community-based (4 university-affiliated) hospitals, in Michigan from Jan 2016-Sep 2023. Patients without imaging or histologic confirmation were excluded. Factors associated with receiving curative treatment were determined using both univariate and multivariable logistic regressions. Analysis was done using SPSS 28, with a p-value<0.05 indicating statistical significance. Results: Of 680 HCC patients screened, 347 were analyzed. The mean age was 70 years, and 71% were male. 78.3% were White and 16.9% Black. 53.9% had private insurance and 35% had government insurance. Primary HCC etiologies were alcohol and hepatitis C virus (HCV) infection; 74.4% had cirrhosis. Barcelona Clinic Liver Cancer (BCLC) stages varied: A (10.6%), B (28.2%), C (36.4%), and D (24.8%). 59.4% underwent curative treatment (4.6% resection, 30.3% liver-directed, 13.3% systemic, 10.1% combination), while 38.3% had best supportive care. Univariate analysis identified many factors associated with receipt of curative treatment, including race (White>Black), insurance (private>government), earlier BCLC stages, ECOG 0/1/2, Child-Pugh A, lower MELD-Na score (mean=12), <400 alpha-fetoprotein levels, and better liver function (Bilirubin, INR, albumin). Tumor characteristics, such as smaller size, absence of metastasis, and absence of portal vein thrombosis, were also associated with receipt of curative treatment. Overall, the one-year survival rate was 64% for those who had curative treatment and 35% for best supportive care. All with p-value<0.05. Multivariable analysis showed Black patients (OR: 0.21, CI: 0.051-0.881) with larger tumors (OR:0.89, CI: 0.783-1.00) and lower albumin levels (OR:3.81, CI: 1.649-8.805) at presentation were less likely to receive curative treatment than White. Black patients were also diagnosed at a younger age (66.7 vs. 71.0 years, p=0.01), more advanced BCLC stages C/D (74% vs. 57%, p=0.04) on presentation, and HCV coinfection (58% vs. 32%, p<0.001) than White. Median survival for Black and White were 757 days and 823 days, respectively (p=0.89). Conclusions: Black patients with larger tumors and low albumin are less likely to receive curative treatment than White. HCV coinfection in the Black population suggests a focus area for early intervention. Further investigation of HCC disparities across various settings is warranted.

Seroprevalence and co-infection of HBV, HCV, and HIV among patients visiting selected hospitals in Anyigba, Kogi State

ABSTRACT Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), and Human Immunodeficiency Virus (HIV) remain a public health challenge globally. This study determined the prevalence and coinfection of HBV, HCV, and HIV among patients visiting Maria Goretti Hospital, Grimard Catholic Hospital, and Good News Hospital Anyigba, Kogi State. In a cross-sectional study, sera samples collected from 400 consenting patients were screened for HBV, HCV, and HIV using commercial immunodiagnostic test kits. Of the 400 subjects, 12 (3.0%), 4 (1.0%), and 16 (4.0%) were infected with HBV, HCV, and HIV, respectively. One participant was co-infected with HCV and HIV, while none was simultaneously infected with HBV and HIV. Participants aged 11–20 years had higher hepatitis B-surface antigenemia, while ages 21–30 years and 31–40 years had higher prevalence of HCV and HIV, respectively. Contrary to HBV and HCV positivity, HIV seropositivity was significantly predicted by the ages of exposure (p = 0.002). Males and females were equally infected with HBV (3.0% each), while more males than females were infected with HCV (1.5%) and HIV (4.6%). However, the difference between the occurrence of viral infections and patients’ sex was not significant (p > 0.05). The single participants were more predisposed to HBV while the married subjects had more HCV and HIV mono-infection. However, neither the occurrence of HBV nor HCV or HIV was significantly predicted by the marital status of the individuals (p > 0.05). Subjects with no formal education had a higher positivity rate of HCV and HIV compared to other levels of education, while the tertiary level of education had higher exposure to HBsAg. Occupationally, students were more predisposed to HBV and HCV, while the unemployed participants were more predisposed to HIV. However, neither education nor the occupation of participants was significantly related to any of the viral infections (p > 0.05). Lack of knowledge of disease prevention significantly influenced the occurrence of HBV (p = 0.02), HCV (p = 0.04), and HIV (p = 0.04). Conclusively, the status of HBV, HCV, and HIV infection is low compared with findings of previous epidemiological studies in the area. However, the continuous circulation of the three viral infections and the high disease occurrence in the poorly informed participants suggest the need for increased public health education about infection control and prevention strategies in the area.

Seroprevalence of Hepatitis B and C Viruses and Their Associated Factors Among Military Personnel at Military Camps in Central Gondar, Ethiopia: A Cross-Sectional Study.

Globally, viral hepatitis is a leading cause of death and is highly prevalent in Ethiopia. Military personnel are more vulnerable to hepatitis B virus (HBV) and hepatitis C virus (HCV) infections, and there are no data on such populations in the study area. Therefore, this study aimed to determine the seroprevalence of HBV and HCV infections and their associated factors among military personnel in military camps in Central Gondar, Ethiopia. This institutional-based cross-sectional study was conducted with 277 military personnel from April to August 2022 at military camps in Central Gondar, Ethiopia. A systematic random sampling technique was used to select the study participants. Sociodemographic and other relevant data were collected using a structured questionnaire. Five milliliters of venous blood were collected using a vacutainer tube and tested for hepatitis B surface antigens and anti-hepatitis C virus antibodies using an enzyme-linked immunosorbent assay. Data were analyzed using STATA version 14 software and logistic regression models were used to determine the association between HBV/HCV infection and risk factors. Out of 277 participants, the overall seroprevalence of HBV and HCV infections was 19 (6.9%) and 9 (3.3%), respectively. The rate of HBV and HCV co-infection was 2 (0.7%). Having multiple sexual partners (p = 0.048), frequent alcohol use (p = 0.034), hospitalization (p = 0.014), and history of receiving injections from traditional practitioners (p = 0.040) were significant predictors of HBV infection. In contrast, a history of blood transfusion (p = 0.048) and sexually transmitted infections (p = 0.039) were significant risk factors for HCV infection. An intermediate prevalence of HBV and HCV infections was observed among the military personnel. Continuous screening, adherence to healthcare service guidelines, and strengthening of vaccination are crucial for preventing HBV and HCV infections.

Seroprevalence and risk factors of HBV, HCV and HIV among hemodialysis patients: a multicenter cross-sectional study from Damascus Syria

ObjectiveThe aim of this study is to determine the prevalence rates of hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) infections among hemodialysis (HD) patients as well as to identify associated risk factors.MethodologyA multicenter cross-sectional study involved patients who had been on HD for at least three months. The study was conducted at five HD centers in Damascus, Syria from August 2019 to September 2021. HBsAg, HCV-Ab and HIV (antibody/antigen) seropositivity were identified using the third generation ELISA technique. Patients’ information was extracted from their records and by face-to-face interview. Multiple logistic regression models were applied to identify risk factors associated with HBV or HCV seropositivity. The significance level was set at 5%.ResultsA total of 637 patients were included in the study with a mean age (SD) of 50.5 (15.6) years and 56.7% of them were men. The dialytic age ranged from one to thirty years with a mean (SD) of 6.10 (5.6) years. The prevalence of positive hepatitis B surface antigen, anti-HCV, co-infection of HBV and HCV, and anti-HIV (antibody/antigen) were 3.2%, 22.1%, 0.7%, and 0%, respectively. After controlling for co-variables, hepatitis B vaccine was the only predictor of seropositivity of HBV (OR: 0.15, 95% CI: 0.057–0.393, P < 0.001), as it significantly protected against contracting HBV. On the other hand, the dialytic age (OR: 1.42, 95% CI: 1.12–1.94, P = 0.032) and the dialysis center were significant factors affecting the prevalence of HCV.ConclusionsThe prevalence of HCV and HBV infections among HD patients in Damascus, Syria has decreased remarkably compared with the results from 2001. Nevertheless, it is still considered relatively high. Thus, there is an urgent need to strengthen the prevention and control measures for viral infection transmission in HD centers in Damascus.

Characteristics of Hepatitis B Virus, Hepatitis C Virus, and Syphilis Coinfection in People With HIV/AIDS Contracted Through Different Sources: Retrospective Study.

The burden of hepatitis B virus (HBV), hepatitis C virus (HCV), and syphilis coinfections remains disproportionately high among people living with HIV/AIDS. Hubei province is located in central China, where there are distinct regional characteristics of the distribution of people living with HIV/AIDS acquired via diverse transmission routes and the AIDS epidemic itself. We aimed to estimate the magnitude of HBV, HCV, or syphilis coinfections among people living with HIV/AIDS with blood-borne transmission, which includes former paid blood donors, contaminated blood recipients, and intravenous drug users, as well as among people with sex-borne HIV transmission (including heterosexual people and men who have sex with men) and people with mother-to-child HIV transmission. From January 2010 to December 2020, people living with HIV/AIDS were tested for hepatitis B surface antigen (HBsAg), HCV antibodies, and syphilis-specific antibodies. The positive patients were further tested for HBV markers, HBV DNA, and HCV RNA, and received a rapid plasma reagin circle card test. All people living with HIV/AIDS were first divided into transmission groups (blood, sex, and mother-to-child); then, people with blood-borne HIV transmission were divided into former paid blood donors, contaminated blood recipients, and intravenous drug users, while people with sex-borne HIV transmission were divided into heterosexual people and men who have sex with men. Among 6623 people living with HIV/AIDS, rates of chronic HCV infection were 80.3% (590/735) in former paid blood donors, 73.3% (247/337) in intravenous drug users, 57.1% (444/777) in contaminated blood recipients, 19.4% (21/108) in people with mother-to-child HIV transmission, 8.1% (240/2975) in heterosexual people, and 1.2% (21/1691) in men who have sex with men. Chronic HBV infection rates were similar among all people with blood-borne HIV transmission. However, compared to heterosexual people, the chronic HBV infection rate was greater in men who have sex with men (213/1691, 12.6% vs 308/2975, 10.4%; χ21=5.469; P=.02), although HBV exposure was less common (827/1691, 48.9% vs 1662/2975, 55.9%; χ21=20.982; P<.001). Interestingly, the combination of HBsAg and hepatitis B e antigen (HBeAg) was found in 11 patients with sex-borne HIV transmission, but in 0 people with blood-borne HIV transmission (11/196, 5.6% vs 0/521, 0%; χ21=29.695, P<.001). In people with sex-borne HIV transmission, the proportions of patients with a syphilis titer ≥1:16 and neurosyphilis were 8.6% (105/1227) and 7.8% (37/473), respectively, whereas these values were 0 in people with blood-borne HIV transmission. In people living with HIV/AIDS, HCV transmission intensity was significantly associated with specific exposure modes of blood or sexual contact. The rate of chronic HBV infection among men who have sex with men was higher than in any other population. Attention should be paid to the high prevalence of neurosyphilis in people living with HIV/AIDS who contract HIV by sexual intercourse.

HIV-Infected Hepatic Stellate Cells or HCV-Infected Hepatocytes Are Unable to Promote Latency Reversal among HIV-Infected Mononuclear Cells.

Due to a common mode of transmission through infected human blood, hepatitis C virus (HCV) and human immunodeficiency virus (HIV) co-infection is relatively prevalent. In alignment with this, HCV co-infection is associated with an increased size of the HIV reservoir in highly active antiretroviral therapy (HAART)-treated individuals. Hence, it is crucial to comprehend the physiological mechanisms governing the latency and reactivation of HIV in reservoirs. Consequently, our study delves into the interplay between HCV/HIV co-infection in liver cells and its impact on the modulation of HIV latency. We utilized the latently infected monocytic cell line (U1) and the latently infected T-cell line (J-Lat) and found that mediators produced by the infection of hepatic stellate cells and hepatocytes with HIV and HCV, respectively, were incapable of inducing latency reversal under the studied conditions. This may favor the maintenance of the HIV reservoir size among latently infected mononuclear cells in the liver. Further investigations are essential to elucidate the role of the interaction between liver cells in regulating HIV latency and/or reactivation, providing a physiologically relevant model for comprehending reservoir microenvironments in vivo.

Seroepidemiology of Asymptomatic Plasmodium falciparum CoInfections with Hepatitis B And C Virus among Blood Donors in Modakeke Area Office, Ile Ife, Osun State, Nigeria

Despite the remarkable achievements in the reduction of malaria mortality, the disease had remained the most common cause of morbidity and mortality. Infection with hepatitis B virus (HBV) and hepatitis C virus (HCV) might associate with increased mortality rate as the infections may predisposes to the development of serious liver diseases such as liver cirrhosis, liver failure and hepatocellular carcinoma (HCC). The aim of the present study was to determine the Asymptomatic Plasmodium falciparum co-infections with hepatitis B and C viruses among blood donors in Modakeke Area Office, Ile Ife, Osun State, Nigeria. The study was conducted in Modakeke Area Office, Ile Ife, Osun State. The study was conducted in Modakeke health facility, Ile Ife, Osun State. Five (5) ml of venous blood was obtained from each of 400 blood donors into plain bottles and labeled accordingly. Thick and thin films of the donor’s blood samples were made on slides dried for five minutes at 37°C then stained using Giemsa stain. The slides were then examined microscopically for presence and densities of malaria parasites. Species identification and determination of the Hematological parameters were also conducted on the slides. Sera were separated from the remaining aliquots of the blood and screened for hepatitis-B and C surface antigens (HBsAg and anti-HCV). The overall mean parasitaemia of malarious blood donors was 786.20µl/blood while that of blood donors with hepatitis virus infection was 53 representing 13.3% of the total donor examined. Donors infected with HBV, HCV and co-infection of HBV and HCV had viraemia of 25 (6.3%), 21 (5.3%) and 7(1.8%) respectively. Among the age groups, high prevalence of Hepatitis viral infection rate of 57.9% was recorded among aged group 18-26 years. The infection rate of 15.8%, 13.6% and 10.5% of HBV, HCV was recorded from age group 18-26years respectively. The highest co-infection rate of HBV and HCV of 18.8% was recorded from age group 54-62years, while high mean malaria parasitaemia of 1,882.78 (µl of blood) was also recorded among donors aged 18-26 years. High hepatitis viral infection rate of 22.2% with 16.7% of HCV were recorded among females, while 6.3% of HBV and 1.9% of co-infection was observed among males and the mean malaria parasitaemia of 2,382.80 µl of blood was observed among females. High prevalence of Hepatitis infection rate of 17.1%, 8.6% of HCV, (6.3%) of HBV and 2.3% of co-infection were recorded among single donors. The mean malaria parasitaemia of 786.89 (µl of blood) was observed among married donors, there was significant difference between marital status and hepatitis infection (p= 0.0043) and between HCV (p=0.009). High prevalence of hepatitis viraemia of 21.4% and co-infection 5.6% was recorded among artisans, while 14.6% HBV infection rate was recorded among civil servants and 14.3% of HCV was recorded among donors who are farmers. The mean malaria parasitaemia of 1,150.15 µl/blood was recorded among donors who are traders. Donors that have acquired primary education have high prevalence of hepatitis infection rate of 38.5%, with 15.4% of HBV and (23.1%) co-infection (HBVand HCV). HCV (6.7%) was high among donors with secondary education; high mean malaria parasitaemia of 2,096.84 µl of blood was recorded among donors with primary education. Blood B+ve had high hepatitis viral infection rate of 21.7%, HCV 13.0% and co-infection of 5.8% while 7.8% of HBV was recorded among O+ve donors. The mean malaria parasitaemia of 1,378.50 (µl of blood) was recorded among B-ve donors. The total mean PCV in the study was 42.63, White blood cell count was 5,281.25, lymphocytes count was 42.88, eosinophils was 1.53 and neutrophil count was 55.72. The total percentage of elevated AST was 5.0%, ALT was 6.0% and ALB was 10.5%. There was significant difference between malaria and ALT (p=0.000) also, there was significant difference between HCV and ALB (p=0.000). There was significant difference between HBV and AST (p=0.001), ALT (p=0.028) and ALB (p=0.028).The hepatitis viral infection had significant difference with ALB (p=0.000). The logistic regression shows that there was an association between hepatitis viral infection and aged group 27-35years (p=0.022), female (p=0.006), trading (p=0.001), tertiary (p=0.003) A+ve (p=0.018) and B+ve (p=0.001). In conclusion, Although, the prevalence of malaria was low, while that of hepatitis viral infection was high in the local government area, critical screening of blood donors is of prime importance because they serve as an asymptomatic reservoirs and a potential source of transmission of these infections. The strengthening of creating awareness on the general public regarding Malaria, HBV and HCV transmission and prevention should be embarked on.

Emicizumab Prophylaxis in People with Moderate or Mild Hemophilia A Aged ≥40 Years, with and without Comorbidities - Findings from the Phase III HAVEN 6 Study

Background: Emicizumab is a bispecific antibody licensed by the FDA and other regulatory authorities for prophylaxis in people of all ages with hemophilia A (HA) of any severity, with or without factor (F)VIII inhibitors (label varies by country). Few data exist specifically on older people with HA (PwHA), particularly those with comorbidities, such as cardiovascular (CV) conditions, hepatitis, and human immunodeficiency virus (HIV), and in people with moderate or mild HA. Therefore, we present a post hoc analysis of PwHA aged ≥40 years from the HAVEN 6 study (NCT04158648), which was conducted to evaluate the safety and efficacy of emicizumab in people with non-severe HA without FVIII inhibitors. Methods: HAVEN 6 is a global, multicenter, open-label, single-arm, Phase III trial conducted in individuals of all ages with a diagnosis of moderate (FVIII activity ≥1%-≤5%) or mild (FVIII &amp;gt;5%-&amp;lt;40%) HA without FVIII inhibitors, warranting prophylaxis as assessed by the investigator (Negrier et al. Lancet Haematol 2023). As a loading dose, emicizumab was administered subcutaneously once weekly at 3mg/kg for 4 weeks. This was then followed by the participant's choice of maintenance dose, which included the options of 1.5mg/kg weekly, 3mg/kg every 2 weeks, or 6mg/kg every 4 weeks. The primary study objective was safety, including thromboembolic events (TEs) and thrombotic microangiopathy (TMA). The primary efficacy endpoint was the annualized bleed rate (ABR) for treated bleeds. An age cut-off of ≥40 years was selected for this exploratory analysis in order to obtain a population with a high proportion of PwHA with comorbidities. In this analysis, comorbidities included CV risk factors (past medical history of CV disease; hypertension; hyperlipidemia; diabetes; body mass index ≥30kg/m 2), HIV, and current or previous history of hepatitis C virus (HCV) infection. Results: At data cut-off (Oct 30, 2021), 72 participants were enrolled in HAVEN 6. Of these, 16 individuals were aged ≥40 years and were included in this analysis; among the 16 participants aged ≥40 years, 8 (50%) were aged ≥50 years. The median (range) age was 50.5 (41-71) years and all were male. Ten (62.5%) participants had moderate HA and 6 (37.5%) had mild HA. Prior to study entry, 6 (37.5%) participants had been receiving prophylactic FVIII, while the other 10 (62.5%) had been receiving episodic FVIII infusions. In the 24 weeks prior to study entry, the median (range) number of bleeds reported by these 16 participants was 3.5 (0-60) and the mean (SD) was 7.4 (14.5), with two individuals experiencing ≥9 bleeds. Nine (56.3%) of the 16 participants had at least one CV risk factor, with 5 (31.3%) having two or more. Three (18.8%) individuals had HCV only, 1 (6.3%) had HIV only, and 2 (12.5%) had HCV and HIV co-infection. Five (31.3%) of the 16 participants did not have any of the comorbidities defined in this analysis. At the data cut-off, the median (range) duration of emicizumab exposure for the 16 participants aged ≥40 years was 1.09 (0.61-1.72) years. Fifteen (93.8%) of the 16 participants experienced ≥1 adverse event (AE) during the study. Three (18.8%) individuals experienced a serious AE and 1 (6.3%) a Grade 3/4 AE; all were deemed unrelated to emicizumab ( Table 1). There were no fatal AEs, AEs leading to withdrawal from treatment or dose modification/interruption, or TMAs. One individual, who had no CV risk factors or HIV/HCV infection, experienced a TE (Grade 1 thrombosed hemorrhoids); this was deemed unrelated to emicizumab. Three participants experienced a total of six treatment-related AEs; three of these were local injection-site reactions, with the other three being fatigue, head discomfort, and accidental overdose. During the study, the mean (95% confidence interval) ABR for treated bleeds for the 16 participants aged ≥40 years was 1.03 (0.03, 5.62), which is similar to that recorded for the overall population of HAVEN 6 (0.94 [0.02, 5.48]; Table 2). A total of 11 (68.8%) participants had zero bleeds during the study, which is comparable with the 66.7% reported for the total population. Conclusions: The small number of individuals aged ≥40 years included in the current analysis is a limitation that precludes drawing firm conclusions from the data. However, the safety and efficacy of emicizumab in these participants did not differ notably from those observed in the overall population of people with moderate or mild HA in HAVEN 6.

Interaction between hepatitis B, hepatitis C and smoking in the development of hepatocellular carcinoma: a systematic review and meta-analysis.

This meta-analysis reports the relationship between hepatitis B virus (HBV), hepatitis C virus (HCV), smoking and their combined impact on the development of hepatocellular carcinoma (HCC). We conducted a systematic search of PubMed, Web of Science and Scopus databases up to 15 July 2023. Observational studies investigating the association between HBV, HCV and smoking in the development of HCC were included. We assessed between-study heterogeneity using the I2 statistics. The effect sizes were estimated as odds ratio (OR) with 95% confidence intervals (CIs) using a random-effects model. Out of 20794 studies identified in the initial search, 32 observational studies involving 22282 participants met the inclusion criteria. Our meta-analysis showed that the combined impact of HBV and smoking was associated with an OR of 19.81 (95% CI: 14.77, 26.58), HCV and smoking was associated with an OR of 24.86 (95% CI: 12.41, 49.79), and coinfection of HBV and HCV was associated with an OR of 32.58 (95% CI: 20.57, 51.60). Our findings indicate a significant interaction between HBV, HCV and smoking in the development of HCC and highlight the importance of addressing smoking cessation and viral hepatitis prevention and treatment as potential strategies for reducing HCC.

Coinfection of HCV among HIV-infected patients: Across-sectional study in rivers State, Nigeria

Background: Hepatitis C virus (HCV) has emerged as the cause of the second major epidemic of viral infection after human immunodeficiency virus (HIV) within the past two decades. HCV is the cause of more than three-quarters of liver-relate deaths in HIV-seropositive individuals and it is remarkable that today approximately one-quarter of HIV-infected individuals Aim: this study aimed at determining the prevalence of coinfection patterns of HCV among HIV infected individual in Rivers State, Nigeria. Materials and methods: A retrospective survey conducted on 350 HIV infected individual attending ART clinic at Rivers State University Teaching Hospital, Port Harcourt, Nigeria. Sociodemographic data were collected based on interviewer-based questionnaire, and clinical history was obtained from participants' medical records. Antibody analyses for HCV were done using ELISA method. Results: The prevalence of hepatitis C virus coinfection among HIV positive individual was 6(4.0%), The prevalence of HCV and HIV positive individual with regards to age was high within the age of 21 -40 5(2.4%). Prevalence based on gender was females 4(1.1%) and males 2(1.4%), prevalence of HIV/HCV co-infection with respect to marital status was high among the single 6(4.9%), prevalence of HIV/HCV co-infection with respect educational status was high with tertiary 3(3.5%) than the secondary 3(1.6%). The prevalence among the different occupational groups, business had the highest co-infection rate (1.1%) followed closely by Working class (0.8%). Higher HIV/HCV co-infection was observed among those with CD4 cell count 350-499 cells/μl (4.6%). Conclusion: However, the low burden of this hepatotropic virus coinfection calls for continued need to screen for HCV among individual infected with HIV before the start of ART.

T-Cell Exhaustion in HIV-1/Hepatitis C Virus Coinfection Is Reduced After Successful Treatment of Chronic Hepatitis C.

T-cell responses during chronic viral infections become exhausted, which is reflected by upregulation of inhibitory receptors (iRs) and increased interleukin 10 (IL-10). We assessed 2 iRs-PD-1 (programmed cell death protein 1) and Tim-3 (T-cell immunoglobulin and mucin domain-containing protein 3)-and IL-10 mRNAs in peripheral blood mononuclear cells (PBMCs) and their soluble analogs (sPD-1, sTim-3, and IL-10) in plasma in chronic HIV-1/hepatitis C virus (HCV) coinfection and explored the effect of HCV treatment on these markers. We also aimed to establish whether iR expression may be determined by the HCV CD8+ T-cell immunodominant epitope sequence. Plasma and PBMCs from 31 persons with chronic HIV-1/HCV coinfection from the Swiss HIV Cohort Study were collected before and after HCV treatment. As controls, 45 persons who were HIV-1 negative with chronic HCV infection were recruited. Exhaustion markers were assessed by enzyme-linked immunosorbent assay in plasma and by quantitative reverse transcription polymerase chain reaction in PBMCs. Analysis of an HCV epitope sequence was conducted by next-generation sequencing: HLA-A*02-restricted NS31073-1081 and NS31406-1415 and HLA-A*01-restricted NS31436-1444. The study revealed higher plasma sPD-1 (P = .0235) and IL-10 (P = .002) levels and higher IL-10 mRNA in PBMCs (P = .0149) in HIV-1/HCV coinfection. A decrease in plasma sPD-1 (P = .0006), sTim-3 (P = .0136), and IL-10 (P = .0003) and Tim-3 mRNA in PBMCs (P = .0210) was observed following successful HCV treatment. Infection with the HLA-A*01-restricted NS31436-1444 ATDALMTGY prototype variant was related to higher sTim-3 levels than infection with the ATDALMTGF escape variant (P = .0326). The results underscore the synergistic effect of coinfection on expression of exhaustion markers, their reduction following successful HCV treatment and imply that iR levels may operate on an epitope-specific manner.

An Example of the Importance of Electronic Health Records from Mogadishu, Somalia: Hepatitis B Prevalence and Co-infections with Hepatitis C

The epidemiology of hepatitis B virus (HBV) and hepatitis C virus (HCV) has been discussed in detail from different aspects around the world. Current epidemiological data has critical importance in the planning and carrying out of public health policies for the prevention of transmission and spread of these infections, and the treatment of chronic infections, and to reduce the burden and mortality associated with complications such as cirrhosis and liver cancer by national health authorities and international health institutions, especially the World Health Organization. Elimination of a social health problem is possible by first raising awareness, then determining the dimensions of the problem, and planning and implementing interventions for a solution. Somalia was in the position of a region where access to diagnosis and treatment for many life-threatening diseases was difficult, aside from the monitoring of public health criteria due to the unstable situations that has continued for more than 40 years. Until recently, basic health parameters and epidemiological predictions in Somalia were monitored through estimates based on data from neighboring countries or on data obtained from small groups from Somalia immigrants settled different parts of the world. However, this situation is changing rapidly. A tertiary education and research hospital established in the capital, Mogadishu, with the coordination of the Türkiye and Somalia governments, and which has become the largest health center in the country today; contributes to understanding the extent of the serious health problems faced by the country by pioneering specialized training and scientific studies, in addition to providing health care. Electronic health records have been kept regularly since 2015 in this hospital, where hundreds of thousands of patients receive treatment or undergo health checks every year and it has been the source of numerous retrospective epidemiological studies some of which have exceeded 100 thousand cases, in different age groups and sub-populations. These studies include human immunodeficiency virus (HIV) prevalence and complications, HCV prevalence and genotype distribution, prevalence and epidemiology of parasitic infections, incidence of tuberculosis and related complications, cancer incidence and distribution, causes of blindness, thyroid diseases, antibiotic resistance profiles, and the epidemiology of various organ-specific diseases. Dozens of studies using the hospital records were included in the scientific literature between 2020 and 2023. In this study, a four-year period between November 2015 and November 2019, HBV serological test results of more than 100,000 different patients are presented. HBsAg and anti-HBs seropositivity for all age groups was found to be 8.1% (9,405/115,946) and 32.7% (25,988/79,410), respectively. When the anti-HCV test results of HBsAg positive patients were examined, the rate of HCV co-infections was found to be 0.9% (82/9,405). HBsAg and anti-HBs seropositivity were significantly higher in males than females (p&lt;0.001). HBV, HCV, and co-infection incidence tended to decrease. Conversely, vaccination rates (especially in children under one year of age) tended to increase. While the comprehensive data presented in this study provide us with important and new information about the prevalence and co-infection rates of viral hepatitis in the country, many topics including HBV genotypes, hepatitis D frequency, access to treatment rates, complication rates, and HBV vaccination rates are still waiting to be researched in Somalia. In the region where it is not possible to carry out field studies, epidemiological data provided by electronic health records have become a country's window to the world.

Hepatitis C virus/Hepatitis B virus coinfection: Current prospectives.

In endemic areas, hepatitis C virus (HCV)/hepatitis B virus (HBV) coinfection is common, and patients with coinfection have a higher risk of developing liver disease such as hepatocellular carcinoma, liver fibrosis and cirrhosis. In such cases, HCV predominates, and HBV replication is suppressed by HCV. HCV core proteins and interferons that are activated by HCV are responsible for the suppression of HBV. Immunosuppression is also seen in patients with HCV and HBV coinfections. A decrease in HCV-neutralizing antibody response and circulation of Th1-like Tfh cells is observed in patients with HCV and HBV coinfection. Both viruses interacted in the liver, and treatment of HCV/HBV coinfection is genotype-based and complex due to the interaction of both viruses. In HCV-dominant cases, direct-acting antiviral drugs and peg interferon plus ribavirin are used for the treatment, with continuous monitoring of AST and ALT. HBV-dominant cases are less common and are treated with peg interferon and nucleoside nucleotide analogues with monitoring of AST and ALT. The SVR rate in HCV-HBV coinfection is higher than that in monoinfection when treated with direct-acting antiviral drugs. But there is a risk of reactivation of HBV during and after therapy. The rate of reactivation is lower in patients treated with direct-acting antiviral drugs as compared to those treated with peg interferon plus ribavirin. Biomarkers of HBV such as HBcrAg, HBV DNA and HBVpg RNA are not effective in the prediction of HBV reactivation; only the hepatitis B surface antigen titre can be used as a biomarker for HBV reactivation. HCV can also be reactive, but this is found in very rare cases in which HBV is present and is treated first.

Seroprevalence of Hepatitis B and C co-infection in HIV seropositive and HIV seronegative cases in a Tertiary care hospital in Southern Haryana

HBV (Hepatitis B virus) and HCV (Hepatitis C virus) are the causative agents of acute as well as chronic hepatitis. Nearly, two billion people are suffering with HBV and approximately 170 million people are infected with HCV infection around the world. While patients who are infected with HIV (Human Immunodeficiency Virus) 2-4 million are found to be having chronic HBV co-infection and 4-5 million are having HCV coinfection. Due to common mode of transmission of HIV, HBV and HCV like using shared needles, syringes, other injectable devices, sexual intercourse, or even mother to baby transmission, it is common to see HBV and HCV co-infection in HIV positive individuals. This was a hospital based observational cross-sectional study. This study was conducted in Department of Microbiology, SHKM GMC, Nalhar, Nuh, Haryana. It was for one year. The sample size for HIV seropostive cases was 80 including 40 HIV positive and 40 HIV negative samples. Seroprevalence of HBV and HCV was identified on HIV positive and HIV negative samples. Seroprevalence of HBV and HCV was found to be higher in HIV positive individuals than HIV negative individuals. In HIV positive patients 10% individuals were HBsAg positive, 5% were HBeAg positive, 10% were positive by HBV RT-PCR. None of the HIV negative were coinfected with HBV. Similarly HCV-HIV coinfection was seen in 12.5% of individuals with Rapid test, ELISA and RT-PCR. None of the HIV negative were coinfected with HCV. In HIV positive individuals HBV and HCV coinfection was seen and Co-infection of HBV and HCV was absent in HIV negative individuals. Regular screening is recommended for HBV and HCV in HIV positive individuals.

HCV Co-Infection and Its Genotypic Distribution in HIV-Infected Patients in Nepalese Population.

Hepatitis C Virus (HCV) co-infection and its genotypic distribution in people living with Human Immunodeficiency Virus (HIV) show global inconsistency. Therefore, the present study aimed to investigate the prevalence and genotypic distribution patterns of HCV, along with viral load, in people living with HIV. This cross-sectional study was conducted at SRL Diagnostics Nepal, Pvt. Ltd. in 203 HIV-seropositive patients attending the Tribhuvan University Teaching Hospital (TUTH), Maharajgunj, Kathmandu, Nepal from October 2021 to May 2022. The viral load and HCV genotypes were estimated from RNA extracted from the blood sample (plasma) of PLHIV by using a standard Q-PCR protocol. HCV infection was considered as a core variable, whereas covariates used for this study were duration of HIV infection, age, sex, and ART regimen. Out of total 203 PLHIV, the estimated prevalence of HCV co-infection was 115 (56.6%). Male gender was a unique characteristic associated with a high prevalence of HCV co-infection compared to females. The HCV viral load among PLHIV ranged from 34 to 3,000,000 IU/mL. Among HCV co-infected PLHIV, 56 (48.69%) had a low level of HCV viral load. Interestingly, only 3 (2.6%) patients had an HCV viral load higher than 3,000,000 IU/mL. Diverse HCV genotypes were found in the population, including genotypes 1, 1a, 3a, 5a, and 6. However, genotype 3 was the most prevalent HCV variant among HCV-co-infected PLHIV, with a distribution of 36 (61.1%) and viral load ranging from 34 to 3000 IU/mL. HCV co-infection is frequent in the Nepalese population of people living with HIV, particularly due to HCV genotypic variant 3. The findings of this study could be useful for the management and clearance of the HCV co-infection in PLHIV, aiming to provide a good quality of life.

Outcome of direct-acting antiviral treatment in patients with hepatitis C virus/hepatitis B virus coinfection

BackgroundOral direct-acting antiviral (DAA) regimens for chronic hepatitis C virus (HCV) infection have greatly improved treatment efficacy, with sustained virological response (SVR) rates of > 95% for HCV monoinfected patients. However, hepatitis B virus (HBV)/HCV coinfection is more complex than monoinfection with HBV or HCV alone. We evaluated the SVR rate at 12 weeks post-treatment with DAAs in patients with HCV/HBV and evaluated the rate of HBV reactivation during and 6 months after treatment.ResultsAmong the included patients, 191 (95.5%) achieved SVR. Older age, low platelet count, high serum creatinine, and higher liver stiffness value measured by fibroscan were predictors of failure to achieve SVR. The 16 patients (8%) with HBV reactivation patients had significantly higher ALT and serum creatinine and a high HCV RNA viral load at baseline compared with that of those without HBV reactivation.ConclusionPatients who received DAAs to treat HCV/HBV coinfection showed a high SVR. However, it is important to be aware of the potential risk for HBV reactivation during and after treatment with DAAs.

Concordance of Ethyl Glucuronide, Blood Alcohol Content, and Self-Reported Alcohol Use in Russian Women with HIV and Hepatitis C Virus Co-Infection.

Problematic alcohol use is prevalent in Russia and is deleterious for individuals with HIV and Hepatitis C Virus (HCV). Ethyl glucuronide (EtG) and blood alcohol content (BAC) provide objective biomarkers of drinking that can be compared to self-reported alcohol use. This paper describes patterns of alcohol use measured by biomarkers and self-report along with concordance across measures. Participants were Russian women with HIV and HCV co-infection (N = 200; Mean age = 34.9) from two Saint Petersburg comprehensive HIV care centers enrolled in an alcohol reduction intervention clinical trial. Measures were: (a) urine specimen analyzed for EtG; (b) breathalyzer reading of BAC; and (c) self-reported frequency of drinking, typical number of drinks consumed, and number of standard drinks consumed in the past month. At baseline, 64.0% (n = 128) had a positive EtG (> 500 ng/mL) and 76.5% (n = 153) had a positive breathalyzer reading (non-zero reading). There was agreement between EtG and BAC (kappa = 0.66, p < .001; Phi coefficient = 0.69, p < .001); self-reported alcohol measures were positively correlated with positive EtG and BAC (p's < 0.001). There was concordance between EtG and BAC measures, which have differing alcohol detection windows. Most participants endorsed frequent drinking at high quantities, with very few reporting no alcohol consumption in the past month. Concordance between biomarkers and self-reported alcohol use suggests that underreporting of alcohol use was minimal. Results highlight the need for alcohol screening within HIV care. Implications for alcohol assessment within research and clinical contexts are discussed.

Trends in hepatitis C virus coinfection and its cascade of care among adults living with HIV in Asia between 2010 and 2020.

Chronic hepatitis C virus (HCV) infection contributes to substantial morbidity and mortality among adults living with HIV. Cascades of HCV care support monitoring of program performance, but data from Asia are limited. We assessed regional HCV coinfection and cascade outcomes among adults living with HIV in care from 2010-2020. Patients ≥18 years old with confirmed HIV infection on antiretroviral therapy (ART) at 11 clinical sites in Cambodia, China, India, Indonesia, South Korea, Thailand and Vietnam were included. HCV- and HIV-related treatment and laboratory data were collected from those with a positive HCV antibody (anti-HCV) test after January 2010. An HCV cascade was evaluated, including proportions positive for anti-HCV, tested for HCV RNA or HCV core antigen (HCVcAg), initiated on HCV treatment, and achieved sustained virologic response (SVR). Factors associated with screening uptake, treatment initiation, and treatment response were analyzed using Fine and Gray's competing risk regression model. Of 24,421 patients, 9169 (38%) had an anti-HCV test, and 971 (11%) had a positive result. The proportion with positive anti-HCV was 12.1% in 2010-2014, 3.9% in 2015-2017, and 3.8% in 2018-2020. From 2010 to 2014, 34% with positive anti-HCV had subsequent HCV RNA or HCVcAg testing, 66% initiated HCV treatment, and 83% achieved SVR. From 2015 to 2017, 69% with positive anti-HCV had subsequent HCV RNA or HCVcAg testing, 59% initiated HCV treatment, and 88% achieved SVR. From 2018 to 2020, 80% had subsequent HCV RNA or HCVcAg testing, 61% initiated HCV treatment, and 96% achieved SVR. Having chronic HCV in later calendar years and in high-income countries were associated with increased screening, treatment initiation or achieving SVR. Older age, injecting drug use HIV exposure, lower CD4 and higher HIV RNA were associated with reduced HCV screening or treatment initiation. Our analysis identified persistent gaps in the HCV cascade of care, highlighting the need for focused efforts to strengthen chronic HCV screening, treatment initiation, and monitoring among adult PLHIV in the Asia region.

Efficacy and safety of pan-genotypic sofosbuvir and velpatasvir in patients with hepatitis C and HIV coinfection ondolutegravir-based antiretroviral therapy.

Hepatitis C virus (HCV) infection is more prevalent in people living with HIV-AIDS (PLHA) and portends a poorer prognosis. Pharmacokinetic studies suggest the absence of significant interaction between velpatasvir and dolutegravir which has been recently recommended as part of preferred first-line antiretroviral therapy (ART) regimens by WHO. However, clinical data on the use of velpatasvir-based regimen in PLHA taking dolutegavir is lacking. Hence, we aimed to assess the efficacy and safety of sofosbuvir and velpatasvir (SOF + VEL) in HCV and HIV coinfected patients on dolutegravir-based ART. Forty-five consecutive PLHA with HCV coinfection on dolutegravir-based ART were prospectively enrolled. All patients were treated SOF + VEL for 12 weeks. Complete haemogram, liver and renal function tests were assessed at baseline, 4 weeks and at end of treatment. Sustained virological response (SVR) was assessed at 12 weeks after end of treatment. The majority were males (95.5%) with a mean age of 32.8 ± 12.3 years. Cirrhosis was present in 6 (13.3%) patients. All patients completed 12 weeks of therapy with SOF + VEL, but SVR could not be assessed in two patients. Forty-two (97.7%) of the remaining 43 patients attained SVR-12. SVR-12 rate was 97.7% and 93.3% by per protocol and intention to treat analysis, respectively. No grade III/IV adverse events were reported, and there was no worsening of blood counts, liver or renal function test parameters. The pan-genotypic regimen of SOF + VEL is safe and effective in PLHA with HCV coinfection who are on dolutegravir-based ART.

Functional exhaustion of CD4&lt;sup&gt;+&lt;/sup&gt;T cells in HIV/HCV coinfected HAART-treated patients

Infection with hepatitis C virus (HCV) is common among HIV-positive patients, with up to 50% of them being coinfected in Russia. While highly active antiretroviral therapy (HAART) suppresses HIV replication and restores the immune system of HIV-infected subjects, HCV coinfection interferes with CD4+T cell regeneration and increases the risk of patients’ morbidity and mortality. During HAART, HIVinfection progression and the immune system restoration efficiency largely depend on immune activation and CD4+T cell exhaustion. This study determined the level of activation, exhaustion, and cytokine production in CD4+T cells obtained from the peripheral blood of HAART-treated HIV/HCV coinfected and HIV monoinfected subjects. The study comprised 11 HIV/HCV coinfected individuals and 10 HIV monoinfected patients receiving HAART for more than two years, with a control group of 10 volunteers without the signs of HIV or HCV infections. Compared with healthy controls, HIV/HCV coinfected patients had an increased frequency of activated CD38+HLA-DR+ CD4+T lymphocytes (p &lt; 0.05), a higher level of CD4+T cell exhaustion determined according to the TIGIT expression density per cell (p &lt; 0.05), and a greater proportion of interferon-gamma (IFNγ)-producing CD4+T lymphocytes following activation (p &lt; 0.05). The frequency of IFNγ-producing CD4+T cells in the donors’ blood positively correlated with the proportion of activated CD4+T cells (R = 0.514, p &lt; 0.01). Despite having a large number of IFNγ-producing CD4+T lymphocytes, the HIV/HCV coinfected patients’ average production of IFNγ by CD4+T cells was significantly lower than that in healthy controls (p &lt; 0.05). The IFNγ production in CD4+T lymphocytes did not depend on activation (p &gt; 0.05). However, a negative correlation was established between the IFNγ production and the level of CD4+T cell exhaustion (R = -0.400, p &lt; 0.05). The letter was also found to inversely correlate with the CD4+T cell counts in the donors’ peripheral blood (R = -0.598, p &lt; 0.01). These data suggest that HCV coinfection leads to pronounced functional exhaustion of CD4+T cells and may aggravate the course of HIVinfection in patients receiving HAART.