Hepatitis C Virus Serostatus Research Articles

HIV and HCV Serostatus and Knowledge Among Patients in Urban Versus Rural Methadone Maintenance Clinics in Kunming

The purpose of this study was to document the prevalence of Human Immunodeficiency Virus (HIV) and Hepatitis C Virus (HCV) among urban and rural methadone maintenance treatment (MMT) patients and to examine differences in knowledge of HIV and HCV among this population. We compared 147 MMT patients attending urban versus rural clinics in Kunming, Yunnan, China, concerning their serostatus and knowledge of HIV and HCV. The rates of HIV and HCV seropositive status were higher among rural patients. Both urban and rural patients showed limited HIV and HCV knowledge. Recent opioid injection and geographic area were strong predictors of HIV and HCV serostatus. The lack of knowledge of HIV and HCV among both urban and rural MMT patients suggests the need to strengthen current HIV and HCV education programs in MMT clinics. In addition, prevention programs should take into consideration geographic characteristics of the target population.

Hepatitis C Virus Serosorting in People Who Inject Drugs: Sorting Out the Details

Hepatitis C Virus Serosorting in People Who Inject Drugs: Sorting Out the Details

Influence of hepatitis C virus infection and high virus serum load on biliary complications in liver transplantation

Biliary complications (BCs) and recurrent hepatitis C virus (HCV) infection are among the major causes of morbidity and graft loss following liver transplantation. The influence of HCV on BCs has not been definitely clarified. We performed a retrospective cohort study to analyze risk factors and outcome of post orthotopic liver transplantation (OLT) BCs in 352 liver transplant recipients over 12years in Munich, Germany (n=84 with HCV; living donor and re-OLT were excluded). BCs diagnosed with imaging techniques and abnormal liver enzyme pattern, requiring an intervention, were considered. In a multivariate analysis, HCV serostatus and a high pre-and post-surgery HCV RNA serum load were independent risk factors for anastomotic strictures. HCV positivity and BCs alone did not alter graft loss. HCV-positive patients with BCs, however, had a significantly worse graft outcome (P=0.02). Non-anastomotic strictures, bile leaks, and the number of interventions needed to treat bile leaks led to worse graft outcome in all patients. HCV positivity and a high HCV RNA serum load were risk factors for anastomotic strictures. BCs and HCV had an additive effect on graft loss.

Trends in mortality according to hepatitis C virus serostatus in the era of combination antiretroviral therapy

To study trends in overall deaths and cause-specific deaths stratified by hepatitis C virus (HCV) serostatus in a cohort of combination antiretroviral (cART)-naive HIV-infected patients in Spain. We analyzed data from 1997 to 2008 in two calendar periods: 1997-2003 and 2004-2008. Deaths were ascertained through cohort reporting and a cross-match with the Spanish National Death Index. We used Poisson regression to model mortality rates and risk factors. We analyzed 5974 HIV-positive cART-naive patients: 2471 (1497 HCV positive) in the period 1997-2003, and 3503 (689 HCV positive) in the period 2004-2008. A total of 232 deaths (158 during the first period, and 74 during the second period) were detected during 19 416 person-years of follow-up; the death rate was 12.9 of 1000 person-years. Crude overall death rates [95% confidence interval (CI)] were 16.5 (14.2-19.1) in 1997-2003 and 8.5 (6.7-10.6) in 2004-2008. The incidence rate ratio (IRR) (95%CI) in 2004-2008 taking 1997-2003 as a reference was 0.51 (0.39-0.67). When we stratified by HCV serostatus, the overall death IRR (95% CI) taking 1997-2003 as reference was 0.52 (0.32-0.85) for HCV-negative patients and 1.27 (0.90-1.79) for HCV-positive patients. When we considered cause-specific deaths (liver-related, AIDS-related, and nonliver-related/non-AIDS-related), findings were similar to those for overall-deaths. Taking the first years of the cART era as a reference, we observed a decrease in overall and cause-specific mortality. This decrease was only observed in HCV-negative patients.

Use of hepatitis C-positive donors in transplantation

Transplantation (Tx) is a therapeutic alternative intervention for terminal organ dysfunction, fatal disease or, in some cases, to improve the quality of life and reduce the risk of complications from chronic diseases. One of the major limitations in performing transplants is obtaining donor organs because of the difficulties in the process of organ donation of deceased donors and the unavailability of compatible living donors. In Brazil, there are many more patients on waiting lists, especially for liver and kidney transplants, than the number of procedures performed. Therefore, non-ideal donors are sometimes considered for transplantation, including those with a higher risk of primary graft dysfunction and infection transmission, such as hepatitis C virus (HCV)-seropositive donors. HCV-seropositive donors have routinely been used by a few groups or in cases of extreme urgency. However, the safety of transplantation from HCV-positive donors has not been clearly determined and may vary according to the type of transplant. To establish a set of recommendations, we performed an analysis based on the data available in the literature. The following items were considered according to the type of transplantation: 1) the position on the list, 2) the urgency of transplantation, 3) the HCV infection status of the donor (serology, viral replication and histological activity), 4) the HCV infection status of the recipient (serology, viral replication and histological activity) and 5) the safety data available regarding the use of HCV-seropositive donors. We analyzed liver, kidney, heart, lung and hematopoietic stem cell transplants (HSCTs). The IDSA (Infectious Diseases Society of America) rating system was used to establish levels of evidence. 1. Liver Transplantation Chronic liver disease due to HCV accounts for almost one-half of liver Tx indications. The risk of the histological recurrence of hepatitis after transplantation is approximately 70%. The graft and recipient survival is lower compared with other etiologies. Descriptive and comparative studies and case-control analyses have shown that the use of seropositive donors for seropositive recipients does not interfere with graft or patient survival. 2. Kidney Transplantation Some descriptive studies have shown that the use of seropositive donors for seropositive recipients does not interfere with graft or patient survival. However, one publication described five cases of discordant donor and recipient genotypes: in three of these cases, elevated enzyme levels and genotype substitution or association were observed in the recipient after transplant. 3. Heart Transplantation Little data are available regarding heart Tx. One multicenter study reported a lower survival rate in patients who received organs from seropositive donors, regardless of the HCV serostatus of the recipient. 4. Lung Transplantation Little data are also available regarding lung Tx. However, in a multicenter survey, 72% of the participating groups considered the use of HCV-seropositive donors for HCV-seropositive recipients. Nevertheless, there have been no descriptions of liver disease progression or graft and patient survival in positive viremia recipients. It is important to consider that treatment with interferon-gamma is usually not recommended after lung Tx due to the high risk of acute cellular rejection. 5. Hematopoietic Stem Cell Transplantation (HSCT) In HSCT, there have been reports of a significantly increased risk of hepatitis in HCV-seronegative recipients of seropositive donors, especially when there is evidence of viral replication. Because HSCT often involves situations in which there is an imminent risk of death and the need for an HLA-matched living donor, the decision should be based on the urgency of the Tx and level of viremia in the donor.

Intra-Individual Variability Across Neurocognitive Domains in Chronic Hepatitis C Infection: Elevated Dispersion is Associated With Serostatus and Unemployment Risk

Approximately one-third of persons infected with the hepatitis C virus (HCV) evidence mild cognitive impairment that is consistent with frontostriatal systems dysfunction, including cognitive dyscontrol, and impacts everyday functioning. The present study examined the effects of HCV on neurocognitive dispersion, or within-person variability in neurocognitive performance across domains, which may be a function of poor sustained cognitive control. High dispersion was also hypothesized to increase risk for unemployment. The study sample included 37 individuals with HCV infection (HCV+) and 45 demographically comparable uninfected comparison participants (HCV−). Dispersion was operationalized as an intra-individual standard deviation (ISD) calculated across the demographically adjusted T-scores of 13 standard neuropsychological tests. Multiple linear regression and logistic regression approaches were used to evaluate associations between dispersion and HCV serostatus and employment status, respectively. HCV serostatus was significantly associated with higher dispersion, independent of mean level of neurocognitive ability, psychiatric factors, and liver disease severity. Within the HCV+ group, higher dispersion was associated with an increased risk of unemployment among individuals with higher overall mean neurocognitive ability. Increased neurocognitive dispersion among HCV+ individuals may indicate vulnerability to cognitive dyscontrol expressed as poor regulation of performance across tasks. Higher dispersion may manifest as functional difficulties in daily life, particularly among neurocognitively normal HCV-infected persons, which speaks to the potential clinical value of considering intra-individual variability when evaluating risk for everyday function problems in this population.

Development of multiplex serological assays to detect oncoviral infections

Serological markers of infection (antibodies or antigens) of viruses that cause cancer are most often detected using ELISA-based methodologies. In many cases, multiple markers of infection must be assessed to determine a final sero-status. Volume requirements and costs of reagents for single analyte ELISAs are high and studies which include multiple viruses can require milliliters of plasma, often not available from archived cohorts. Thus, we sought to develop a Luminex® bead-based customizable panel initially including Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), Epstein-Barr Virus (EBV) and often the concomitant infection, Human Immunodeficiency Virus (HIV) to reduce sample volume requirements, overall cost and increase flexibility. Peptides, antigens and antibodies were sourced from multiple manufacturers and tested for suitability in this platform. Where necessary, suitable reagents were designed and produced in-house. The HCV assay multiplexes four HCV peptides designed to detect antibodies raised to HCV Core (2), HCV NS4, HCV NS5 gene regions. The HBV assay multiplexes a HBV early antigen peptide, a recombinant HBV core protein and either a recombinant HBV surface antigen or an antibody specific for HBV surface antigen to assess HBV infection. The EBV assay multiplexes peptides specific to viral capsid antigen, EBNA-1 and early antigen (Cyto-Barr, Zuidhorn, The Netherlands). HIV-1 assay development is ongoing and the list of antigens to be included in the assay has not been finalized. These assays can be run singly or with any combination (multi-plex) of the above listed targets. Each target has been independently validated using samples of known molecular and serological status to determine specificity (false positive versus false negative) and re-evaluated under multiplex conditions to confirm assay performance. In addition, where possible, samples were assayed on commercial testing platforms as well as our multiplex assay to assess concordance (94-99%). Dependent on the panel selected and the expected antibody titers in a particular population, plasma or serum volumes in the range of 10 µL to 125 µL per subject would be required to determine the HBV, HCV, EBV and/or HIV serostatus of a subject. This assay platform is inherently flexible and the benefits include amenability to expansion to include other oncogenic viruses as well as screening large epidemiological cohorts or smaller subsets of samples in an economical and high throughput manner.

Prevalence of HBsAg, HCV and HIV Antibodies Among Infertile Couples in Ahvaz, South-West Iran

: Background: Without doubt the problem of infertility is important not just for the individual couple, but in many cases it has a wider effect on human life which may lead to social disorganization if not addressed in the future if not addressed in the future.Objectives: Since the screening of the hepatitis B surface antigen (HBsAg), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) antibodies of infertile couples has not been studied in our area; this study was conducted to determine the prevalence of HBsAg, HCV & HIV antibodies among infertile couples.Patients and Methods: This was a retrospective cross sectional study and its setting was an in vitro fertilization (IVF) ward. The population study included all of the couples (712) admitted to the infertility center of Ahvaz Imam Khomeini Hospital in 2007-2008 (12 month period). Intervention was an analysis of the data containing the patients’ demographic characteristics and included their HBsAg, HCV and HIV serostatus, which were routinely screened during this period. The main outcome measure was the prevalence of HBsAg, HCV and HIV antibodies among the infertile couples referred to the infertility center.Results: The age range of the men and women was 18 to 62 years and 16 to 46 years respectively. 11 (0. 77 %) of the infertile couples, including 6 (0. 8) women and 5 (0. 7%) men were HBsAg positive. 9 (0. 63 %) infertile couples, 6 (0. 8) women and 3 (0. 4%) men were HCV antibody positive. No cases of HIV were observed in this study.Conclusions: Although the frequencies of hepatitis B and C infections found in this study were small, it still seems logical from the statistical analysis to screen for both viruses as well as for HIV, while a future study using a larger sample size of infertile couples is also recommended. Implication for health policy/practice/research/medical education:The present study determined some critical information about the prevalence of HBsAg, HCV & HIV antibodies among infertile couples in southern Iran. Please cite this paper as:Nikbakht R, Saadati N, Firoozian F. Prevalence of HBsAg, HCV and HIV Antibodies Among Infertile Couples in Ahvaz, South-West Iran. Jundishapur J Microbiol. 2012;5(2):393-7. DOI: 10.5812/jjm.2809 Copyright © 2012 Kowsar Corp. All rights reserved.

Transmission of Hepatitis C virus among spouses in Cameroon and the Central African Republic

Heterosexual transmission of hepatitis C virus (HCV) is uncommon, with few studies undertaken in Central Africa. To determine the frequency of inter-spouse HCV transmission, cross-sectional studies of elderly individuals in Ebolowa, Cameroon and Nola, Central African Republic, in which, respectively, 24 and 83 long-term couples had been identified, were examined further. Blood samples were tested for antibody to HCV. Anti-HCV positive samples were genotyped by phylogenetic analysis of a fragment of the NS5B gene. In Nola, 4 out of 9 (44.4%) wives of anti-HCV positive husbands and 1 out of 74 (1.4%) wives of anti-HCV negative husbands were anti-HCV positive (P < 0.001); in Ebolowa, the corresponding proportions were 10 out of 15 (66.7%) and 3 out of 9 (33.3%) (P = 0.21). After adjustment for age and site-specific risk factors of HCV infection, HCV seropositivity of the wives remained associated with their husbands' HCV serostatus, significantly so in Nola (P = 0.003) and marginally in Ebolowa (P = 0.06). In 7 out of 14 concordant seropositive couples, the genotype could be determined in both spouses. Four couples were infected with different genotypes, while three were infected with the same genotype. Thus, serological concordance between the spouses was related to a combination of infections acquired independently and inter-spouse transmission. It could not be determined whether inter-spouse transmission occurred sexually, through blood-blood contact, or otherwise. Inter-spouse transmission may have contributed to the high prevalence among elderly populations of Central Africa since some patients infected during healthcare subsequently transmitted the virus to their spouse.

Hepatitis C virus co-infection increases neurocognitive impairment severity and risk of death in treated HIV/AIDS

Previous studies have reported that hepatitis C virus (HCV) co-infection worsens neurocognitive status among individuals with human immunodeficiency virus (HIV)-1 infection. We assessed the prevalence of neurologic disorders and the severity of HIV-associated neurocognitive impairment among HIV-infected individuals in two centralized HIV clinics in Alberta, Canada from 1998 to 2010 based on their HCV serostatus. Of 456 HIV-infected persons without concurrent substance abuse, 91 (20.0%) were HCV seropositive. Of 58 neurologic disorders identified in the cohort, HIV/HCV co-infected individuals exhibited a higher prevalence of multiple neurologic disorders compared to HIV-infected individuals (60.4% vs. 46.6%, p < 0.05) and a higher frequency of seizures (28.6% vs. 17.8%, p < 0.05). Unlike HIV mono-infected persons, the risk of seizures was independent of immune status in HIV/HCV co-infected individuals ( p < 0.05). Symptomatic HIV-associated neurocognitive disorders (sHAND) were more severe among HIV/HCV co-infected persons ( p < 0.05). HCV co-infection was associated with an increased mortality rate (24.2% vs. 14.5%, p < 0.05) with a mortality hazard ratio of 2.38 after adjusting for demographic and clinical variables. Our results indicate that the presence of HCV co-infection among HIV-infected individuals increased neurologic disease burden and risk of death, underscoring HCV's capacity to affect the nervous system and survival of HIV-infected persons.

Risk factors associated with Hepatitis C among female substance users enrolled in community-based HIV prevention studies

BackgroundHepatitis C virus (HCV) infection is one of the most frequent chronic blood-borne infections in the United States. The epidemiology of HCV transmission is not completely understood, particularly in women and minorities.FindingsWe examined the HCV associated risk factors in substance abusing females involved in National Institute on Alcohol Abuse and Alcoholism (NIAAA) and National Institute on Drug Abuse (NIDA) funded HIV prevention studies of street recruited women. As a part of the 12 month follow-up, participants were interviewed about substance use and sexual risk behaviors, including drug implement sharing practices, tattoos, body piercing and blood transfusions and the sharing of personal hygiene equipment including tweezers, toothbrushes and razors. Urine and blood testing for HCV antibody (Ab), HIV and sexually transmitted diseases (STDs) was conducted at the time of assessment.Among 782 predominantly African American women, 162 (21%) tested positive for HCV Ab. Older age (p < 0.001), history of injection drug use (p < 0.001), lifetime crack cocaine use (p = 0.004) and having a tattoo (p = 0.01) were significantly associated with HCV Ab positivity. Other risk factors previously reported in association with HCV Ab positivity such as sexual risk behaviors were not significantly associated with the presence of a positive HCV Ab.ConclusionsThis large community based sample of predominantly African American substance abusing women showed high prevalence of HCV Ab positivity and low awareness of their HCV serostatus. Our study demonstrated that in addition to intravenous drug use (IDU), other factors were significantly associated with HCV Ab positivity such as having a tattoo and a lifetime history of crack use. Other potential routes of HCV transmission should be further studied among high risk female populations.

Evaluation of a new, rapid test for detecting HCV infection, suitable for use with blood or oral fluid

The availability of a highly accurate, rapid, point-of-care test for hepatitis C virus (HCV) may be useful in addressing the problem of under-diagnosis of HCV, by increasing opportunities for testing outside of traditional clinical settings. A new HCV rapid test device (OraQuick ® HCV Rapid Antibody Test), approved recently in Europe for use with venous blood, fingerstick blood, serum, plasma, or oral fluid was evaluated in a multi-center study and performance compared to established laboratory-based tests for detection of HCV. The HCV rapid test was evaluated in prospective testing of subjects with signs and/or symptoms of hepatitis, or who were at risk for hepatitis C using all 5 specimen types. Performance was assessed relative to HCV serostatus established by laboratory methods (EIA, RIBA and PCR) approved in Europe for diagnosis of hepatitis C infection. Sensitivity to antibody in early infection was also compared to EIA in 27 seroconversion panels. In addition, the reliability of the oral fluid sample for accurate detection of anti-HCV was assessed by studying the impact of various potentially interfering conditions of oral health, use of oral care products and consumption of food and drink. In this large study of at-risk and symptomatic persons, the overall specificities of the OraQuick ® HCV Rapid Antibody Test were equivalent (99.6–99.9%) for all 5 specimen types and the 95% CIs substantially overlapped. Overall sensitivities were virtually identical for venous blood, fingerstick blood, serum and plasma (99.7–99.9%). Observed sensitivity was slightly lower for oral fluid at 98.1% though the upper CI (99.0%) was equal to the lower CI for venous blood and fingerstick blood. Most of the HCV positive subjects which gave nonreactive results in oral fluid had serological and virological results consistent with resolved infection. Sensitivity for anti-HCV in early seroconversion was virtually identical between the HCV rapid test and EIA. Detection of anti-HCV in oral fluid appeared generally robust to conditions of oral health, consumption of food and drink and use of oral care products. The OraQuick ® HCV Rapid Antibody Test demonstrated clinical performance that was equivalent to current laboratory-based EIA. This new, HCV rapid test appears suitable as an aid in the diagnosis of HCV infection and may increase testing opportunities due to its simplicity and flexibility to use multiple specimen types, including fingerstick blood and oral fluid.

Kidney Grafts From HCV-Positive Donors: Advantages and Disadvantages

The Organ Procurement and Transplantation Network database (2001–2006) was reviewed for kidney transplant (KT) recipients, to evaluate the effects of use of grafts from donors positive for hepatitis C virus (HCV) on recipient outcome. Data for 76,787 de novo adult KT recipients were included in the analysis. Serologic tests revealed HCV positivity in 6.25% of cadaver kidneys and 2.97% of living-donor kidneys. Median follow-up in patients still alive was 36 months. At multivariable Cox regression analysis in recipients of cadaver kidney, HCV serostatus was significantly associated with overall and graft survival (both P < .001), with a hazard ratio for HCV-positive patients of 1.43 for overall survival and 1.48 for graft survival. Similar results were obtained for living-donor kidney recipients. Recipients of HCV-positive organs tended to be male and African American and to have a shorter waiting time. Infection was the most commonly reported cause of death in recipients of organs from HCV-positive donors. In patients willing to accept HCV-positive grafts (929 [25.6%]), waiting time was significantly shortened ( P < .001). However, this benefit was offset by decreased patient survival ( P < .001) and graft survival ( P = .007).

Combined effects of alcohol and hepatitis C: A secondary analysis of alcohol use biomarkers and high-risk behaviors from two medication trials for alcohol dependence

Objectives The goal of this secondary analysis was to examine the combined effects of HCV infection and recent alcohol use on baseline biologic markers of alcohol consumption in two outpatient medication trials for alcohol dependence. In addition, the relationship between Hepatitis C virus (HCV) infection and behavioral risk factors for HCV infection in these clinical populations were examined. Methods Data ( n = 345) from two randomized, placebo-controlled trials of naltrexone and psychosocial treatment for alcohol dependence (Study I, n = 212) and comorbid alcohol and cocaine dependence (Study II, n = 133) were used to examine baseline measures of HCV risk behaviors (injection drug use, needle sharing), and biomarkers of alcohol use (AST, ALT, GGT and CDT) were compared by HCV serostatus first within each study and then across studies. Results Although groups had differing sociodemographic profiles (as indicated by race, marital status, level of education) subjects in Study I exhibited no statistically significant differences from the Study II cohort in HCV prevalence (12.7 vs. 20.0%, p = 0.07), lifetime history of injection drug use (13.8 vs. 22.0%, p = 0.74), lifetime history of needle sharing (9.1 vs. 18.0%, p = 0.62). As such, the data from both studies were analyzed together. Regardless of drinking status, HCV infection was significantly associated with an upward shift in the baseline level of ALT, AST, and GGT ( p < 0.006 for all measures) and a downward shift in baseline CDT ( p = 0.002). When using standard laboratory cutoff values to determine clinically significant elevations, HCV seropositivity was significantly associated with elevations in ALT, AST, GGT ( p < 0.001), and with decreases in CDT ( p = .002). Conclusions These data emphasize the importance of evaluating HCV infection and HCV risk behaviors at intake in medication trials for alcohol dependence and also raise questions regarding the use of cutoff scores for ALT, AST, GGT and CDT levels as biologic markers of alcohol use in subjects when HCV status is unknown.

Risk of Developing Specific AIDS‐Defining Illnesses in Patients Coinfected with HIV and Hepatitis C Virus With or Without Liver Cirrhosis

There are few data concerning the risk of specific opportunistic diseases in patients with and without hepatitis C virus (HCV) infection. We evaluated the correlation between the occurrence of different AIDS-defining illnesses (ADIs) and chronic HCV infection or HCV-related liver cirrhosis in a large Italian cohort of human immunodeficiency virus (HIV)-infected subjects. Subjects were stratified into 2 groups: patients without HCV coinfection and with persistently normal aminotransferase levels and patients with HCV coinfection. The patients with HCV coinfection were stratified according to the diagnosis of liver cirrhosis. The incidences of new ADIs were calculated as the number of events per 1000 person-years of follow-up. The rates in the 2 groups were compared using a Poisson regression model adjusted for potential confounders. We observed a total of 496 ADIs among 5397 patients with 25,105 person-years of follow-up (50% tested positive for HCV). HCV coinfection was associated with increased risk of developing an ADI (adjusted relative rate [ARR], 2.61; 95% confidence interval [CI], 1.88-3.61), specifically bacterial infection (ARR, 3.15; 95% CI, 1.76-5.67), HIV-related disease (ARR, 2.68; 95% CI, 1.03-6.97), and mycotic disease (ARR, 3.87; 95% CI, 2.28-6.59) but not non-Hodgkin lymphoma (ARR, 0.88; 95% CI, 0.22-3.48). The rate of mycotic infection, bacterial infection, toxoplasmosis, and HIV-related ADI among patients with cirrhosis were significantly higher than that among HIV-monoinfected patients, and the risk was greater than that estimated for HCV antibody-positive patients without cirrhosis. HIV-related bacterial and mycotic infections are strongly associated with positive HCV serostatus and HCV-related cirrhosis. Clinicians should take into account these data when making decisions on initiation of antiretroviral therapy for HCV-coinfected individuals.

Hepatitis C Virus Coinfection Does Not Influence the CD4 Cell Recovery in HIV-1-Infected Patients With Maximum Virologic Suppression

Conflicting data exist whether hepatitis C virus (HCV) affects the CD4 cell recovery in patients with HIV starting antiretroviral treatment. To investigate the influence of HCV coinfection on the CD4 recovery in patients with maximum virologic suppression within the EuroSIDA cohort. Patients tested for anti-HCV antibodies and with at least 2 consecutive HIV viral loads (VLs) <50 copies per milliliter after starting combination antiretroviral therapy were eligible for inclusion. For each pair of VL <50 copies per milliliter, the annual change in CD4 count was calculated and compared between (1) HCV-seronegative vs. HCV-seropositive patients, (2) HCV genotypes 1-4 in HCV-RNA+ patients, and (3) viremic vs. aviremic (HCV-RNA < 615 IU/mL) in HCV-seropositive patients. Results were adjusted for known confounders. Four thousand two hundred eight patients were included, representing 39,474 pairs of HIV VL measurements with VL <50 copies per milliliter and 12,492 person-years of follow-up. The unadjusted annual change in CD4 count for HCV-seropositive and HCV-seronegative patients was 35.5 cells per milliliter (95% confidence interval 27.2 to 43.9) and 38.3 cells per milliliter (95%confidence interval 34.8 to 41.9), respectively. After adjustment, there was no difference in CD4 change when comparing, according to HCV serostatus (P = 0.17), between genotypes (P = 0.23) or when comparing HCV viremic vs. aviremic patients (P = 0.57). Adjusting additionally for HCV treatment and HCV-RNA VL did not change the findings. HCV serostatus did not influence the CD4 recovery in patients with HIV with maximum virologic suppression after starting combination antiretroviral therapy. Furthermore, no difference in CD4 gain was found when comparing distinct HCV genotypes in HCV-RNA+ patients or when comparing HCV viremic vs. aviremic HCV-seropositive patients.

Hepatitis C and HIV Prevalence Using Oral Mucosal Transudate, and Reported Drug Use and Sexual Behaviours of Youth in Custody in British Columbia

Youth in custody have high-risk drug use and sexual behaviours. HIV prevalence in this population was assessed in British Columbia (BC) in 1994 but hepatitis C virus (HCV) prevalence has never been measured. We sought to determine: 1) the performance of the OraSure, a non-invasive device for oral mucosal transudate (OMT) specimen collection, to detect HCV and HIV antibodies; 2) the prevalence of HCV and HIV among youth in custody; and 3) the factors associated with intravenous drug use and sex for trade. OraSure was validated in 110 adults with known HIV and HCV sero-status. Nurses administered an anonymous survey and collected OMT samples from youth aged 14-19 years in BC youth custody centres. Antibody detection in OMT had 96.4% sensitivity for HIV and 94.6% for HCV. 417 youth were enrolled; 22% were female; 48% reported Aboriginal ethnicity. Although 98.3% reported ever using drugs, <8% reported injection drug use (IDU). IDU was independently associated with age of first sexual intercourse (inverse association) and sex for trade (sex in exchange for money, drugs, food or shelter) (OR 4.28; 95% CI: 1.56-11.75). Females were >9 times more likely to report sex for trade. Five Aboriginal youth were identified with HCV; prevalence estimate 1.2% (95% CI: 0.53-2.77%); 3 reported injecting drugs, the other 2 reported using cocaine/crack and sharing non-injection drug paraphernalia. Two youth were identified with HIV, prevalence estimate 0.48% (95% CI: 0.14%-1.72%). IDU, HCV and HIV prevalence remain low. Interventions are needed to prevent transition to IDU and further opportunities for prevention and harm reduction should be explored while the youth are in custody.

Using hepatitis C virus and herpes simplex virus-2 to track HIV among injecting drug users in New York City

Objective To explore the potential utility of hepatitis C virus (HCV) seroprevalence as a biomarker for injection risk, and herpes simplex virus-2 (HSV-2) as a biomarker for sexual risk among injecting drug users (IDUs). We examined the relationships between HCV and HIV and between HSV-2 and HIV among injecting drug users in New York City relative to the large-scale implementation of syringe exchange in the mid-1990s. Methods 397 injecting drug users were recruited from a drug detoxification program in New York from 2005 to 2007. Informed consent was obtained, a questionnaire covering demographics, drug use and HIV risk was administered. Blood samples were tested for antibody to HIV, HCV and HSV-2. Results Among all subjects, HIV prevalence was 17%, HCV prevalence 72% and HSV-2 prevalence 48%. Among IDUs who began injecting before 1995, HIV was 28%, HCV serostatus was strongly associated with HIV serostatus (AOR = 8.96, 95% CI 1.16–69.04) and HSV-2 serostatus was not associated with HIV serostatus (AOR = 1.31, 95% CI 0.64–2.67). Among subjects who began injecting in 1995 or later, HIV was 6%, HCV was not associated with HIV (AOR = 1.04, 95% CI 0.27–4.08) and HSV-2 serostatus was strongly related to HIV serostatus (AOR = 10.71, 95% CI 1.18–97.57). Conclusions HCV and HSV-2 HCV and HSV-2 may provide important new tools for monitoring evolving HIV epidemics among IDUs. Reconsideration of the current CDC hierarchical transmission risk classification system may also be warranted.

Transitions to Injecting and Risk of Hepatitis C Transmission among Ethnic Vietnamese Heroin Smokers in Melbourne, Australia

Background and Aims: To examine factors associated with transition from non-injecting to injecting routes of drug administration and testing antibody positive to hepatitis C virus (HCV) among ethnic Vietnamese heroin users in Melbourne, Australia. Methods: In a cross-sectional convenience survey, sample recruited by peer-workers using snowball sampling technique with a finger prick blood collection. Two-hundred ethnic Vietnamese heroin users were recruited and interviews conducted mainly in Footscray, an area of high ethnic Vietnamese residency with a prominent street based drug market. A structured questionnaire was administered. Measures included patterns of drug use, transition from smoking to injecting and vice versa, injection related risk behaviours and HCV sero-status. Results: Ninety-three percent of the sample commenced drug use by non-injecting routes of administration. More than a half had made the transition from smoking to injecting and almost two thirds of participants had ever injected. The factors associated with making this transition included being male and a longer duration of use. Prevalence of exposure to HCV among injectors was over 50%. Factors associated with being HCV positive were longer duration of injecting, sharing injecting equipment and being older. Conclusions: Smoking heroin is a common route of drug administration among heroin users of Vietnamese ethnicity in this study. The transition from smoking to injecting was very common in the sample. The need for targeted harm reduction initiatives is indicated, and these must take into account patterns of heroin use as well as the social context

Seroprevalence of HCV Infection in Homeless Baltimore Families

Our objective was to investigate hepatitis C virus (HCV) seroprevalence in homeless caregivers and their children 2-18 years of age living in a family. During a 30-month period from October 2001 through April 2004 in Baltimore, 170 caregivers enrolled and 168 of these accepted testing for antibody to HCV (anti-HCV), as did all 336 children and adolescents enrolled. Main results. None of the children younger than 18 years old were HCV seropositive; in striking contrast, however, 32 (19%) caregivers were seropositive. Most (59%) were previously unaware of their HCV serostatus. History of ever injecting drugs was the strongest predictor of HCV seropositive status in the caregivers, reported by 14% overall, and by 71% of HCV positives. Conclusion. The homeless families were very receptive to our HCV seroprevalence study and are likely also to be receptive to shelter-based HCV prevention programs for young children and adolescents as well as for adults.