Human Immunodeficiency Virus Hepatitis C Virus Research Articles

Genotype Variation of HIV/HCV Co-infections in Karachi, Pakistan

Human Immunodeficiency Virus (HIV) and Hepatitis C Virus (HCV) are among major health issues that affect a large section of the world's population. While HCV affects around 170 million people worldwide, HIV affects 3% of the global population, with 10 million HCV cases documented in Pakistan alone. Co-infection with HIV and HCV results in a variety of genotypic patterns, with significant global heterogeneity in the incidence of spontaneous resolution of hepatitis C and the distribution of HCV genotypes among co-infected individuals. Co-infection is usually transmitted by sexual contact, contaminated blood supplies, and mother-to-child transmission, with high-risk populations like intravenous drug users (IDUs), and men who have sex with men (MSM) having increased vulnerability. This study, conducted in Karachi, Pakistan, aimed to explore the predominant genotypes and viral load of HIV and HCV. The genetic features of the HIV Gag and HCV NS5b genes were examined using genotyping techniques and phylogenetic methodology. The study revealed that out of the 150 individuals examined, 70 were diagnosed with HIV alone, 55 with HCV only, and 25 had both HIV and HCV infections concurrently. Furthermore, genetic analysis demonstrated that HIV-1 subtype A1 was the predominant genotype, with subtype C closely following. In the case of HCV, genotype 3a was the most prevalent in both mono- and co-infected individuals. Notably, individuals with dual infections exhibited limited genotypic variability for each virus. In the case of HIV co-infection, there was an elevation in viral load, while HCV demonstrated lower viremia relative to mono-infection. In conclusion, the study revealed the predominance of HIV-1 subtype A1 and HCV genotype 3a, as well as an elevated level of HIV and a lowered level of HCV in co-infection.

Seroprevalence of Hepatitis B, Hepatitis C, and HIV Infections Among Pregnant Women and Newborns in Mogadishu, Somalia: A Four-Year Retrospective Study

In Somalia, the prevalence of hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) infections have different distributions according to gender, age, geographical regions of the country with different conditions, and subgroups of the population which have different characteristics or a specific disease. After the increasing number of general prevalence studies across the country in recent years, the need to examine the prevalence of relevant viral infections in subgroups of the society, which are especially important for public health, has arisen. In this study, it was aimed to investigate the frequency and epidemiological characteristics of HBV, HCV, and HIV infections in pregnant women and children under one year of age who admitted to our hospital. In our study, between 2015-November and 2019-November, 4,274 pregnant women (Group 1; mean age of 26.3±5.697 and an age range of 15-49) who were followed up or delivered in our hospital, 1,534 non-pregnant female patients with various diseases (Group 2; mean age 34.5±12.589 years, age range 15-95), and 1,059 infants under one age were retrospectively investigated. Newborn (<1 month) in the third group were also examined as a subgroup. The seroprevalence of anti-HBs, HBsAg, anti-HCV, and anti-HIV, which are viral infection markers, in pregnant women were found as 17.2% (n=644), 2.8% (n=116), 0.17% (n=7), and 0.14% (n=6), respectively. In non-pregnant women, the seroprevalence of anti-HBs, HBsAg, and anti-HCV were found as 27% (n=324), 6.4% (n=95), and 1% (n=14), respectively, and these rates were significantly higher than in pregnant women (Group 1) (p<0.001). The anti-HIV seropositivity rate in non-pregnant women (Group 2) was 0.07% (n=1), and this value was lower than the incidence in pregnant women (p=0.6881). In infants (Group 3), the seroprevalence of anti-HBs, HBsAg, anti-HCV, and anti-HIV was found as 35.6% (n=320), 0.8% (n=9), 1.4% (n=14), and 0.4% (n=4), respectively. High anti-HBs seropositivity was associated with the vaccination campaign carried out across the country and in our hospital. While HBsAg seroprevalence in infants was very low compared to hospital-wide data (0.8% vs. 8.1%), anti-HCV seroprevalence (1.4%) was similar to hospital-wide data (1.41%). Anti-HIV seroprevalence in infants (0.4%) was higher than both hospital-wide data (0.32%) and prevalence data for under 15s (0.15%). The high rate of anti-HBs due to vaccination was also notable in the newborns subgroup, however three (1.09%) newborn babies were HBsAg positive, indicating vertical maternal transmission. Similarly, two out of four HIV-infected infants (50%) were diagnosed in the neonatal period, indicating mother-to-child transmission. Our study data show that in Mogadishu, a region where access to treatment is easier than in the rest of the country, the impact of HBV infection tends to decrease, however HBV and HCV infections and HIV infections, although at low prevalence, continue to be transmitted from mothers to their babies. We think that the results of this study are valuable, especially in terms of revealing the changing trends in the epidemiology of infections in the region.

MicroRNA signature from extracellular vesicles of HCV/HIV co-infected individuals differs from HCV mono-infected

Hepatitis C virus (HCV) coinfection with human immunodeficiency virus (HIV) has a detrimental impact on disease progression. Increasing evidence points to extracellular vesicles (EVs) as important players of the host-viral cross-talk. The microRNAs (miRNAs), as essential components of EVs cargo, are key regulators of normal cellular processes and also promote viral replication, viral pathogenesis, and disease progression. We aimed to characterize the plasma-derived EVs miRNA signature of chronic HCV infected and HIV coinfected patients to unravel the molecular mechanisms of coinfection. EVs were purified and characterized from 50 plasma samples (21 HCV mono- and 29 HCV/HIV co-infected). EV-derived small RNAs were isolated and analyzed by massive sequencing. Known and de novo miRNAs were identified with miRDeep2. Significant differentially expressed (SDE) miRNA identification was performed with generalized linear models and their putative dysregulated biological pathways were evaluated. Study groups were similar for most clinical and epidemiological characteristics. No differences were observed in EVs size or concentration between groups. Therefore, HCV/HIV co-infection condition did not affect the concentration or size of EVs but produced a disturbance in plasma-derived EVs miRNA cargo. Thus, a total of 149 miRNAs were identified (143 known and 6 de novo) leading to 37 SDE miRNAs of which 15 were upregulated and 22 downregulated in HCV/HIV co-infected patients. SDE miRNAs regulate genes involved in inflammation, fibrosis, and cancer, modulating different biological pathways related to HCV and HIV pathogenesis. These findings may help to develop new generation biomarkers and treatment strategies, in addition to elucidate the mechanisms underlying virus–host interaction.Key messagesHCV and HCV/HIV displayed similar plasma-EV size and concentration.EVs- derived miRNA profile was characterized by NGS.37 SDE miRNAs between HCV and HCV/HIV were observed.SDE miRNAs regulate genes involved in inflammation, fibrosis and cancer.

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.

Serial changes in renal indices in chronic HCV patients with and without HIV co-infection receiving sofosbuvir and tenofovir-based therapies.

Sofosbuvir (SOF) is authorized for hepatitis C virus (HCV) patients. The nephrotoxicity of SOF on HCV mono-infected and HCV-human immunodeficiency virus (HIV) individuals receiving antiretroviral therapy (ART) remains controversial. A prospective study including 159 HCV mono-infected and 124 HCV-HIV individuals (47 were ART naïve and 77 were tenofovir [TDF]-based ART) who presented with an estimated glomerular filtration rate (eGFR) ≥30ml/min/1.73m2 at baseline and were treated with SOF-daclatasvir for 12weeks. The eGFR was estimated using the Chronic Kidney Disease Epidemiology Collaboration equation over the study period. HCV patients had a progressive decline in median levels of eGFR compared with HCV-HIV patients who were ART naïve and those receiving TDF-based ART during and after discontinuing SOF-DAC treatment (96, 109 and 114 at baseline vs 94, 117 and 108 at the end of treatment [EOT]) vs 95, 114 and 115ml/min/1.73m2 at 12weeks after treatment [SVR12], respectively). Moreover, the rate of eGFR stage worsening was more pronounced in HCV mono-infected compared with HCV-HIV individuals who were ART naïve and those receiving TDF-based ART (21.4% vs 8.5% and 14.3% at EOT; 21.4% vs 2.1% and 6.5% at SVR12, respectively). Multivariable regression analysis showed that baseline variables were not independent predictors of eGFR stage worsening either at EOT or SVR12. Because the changes in eGFR were minimal and not of clinical significance, and TDF was not associated with an increase in renal dysfunction, SOF-based direct-acting antivirals could be safely used in HCV mono-infected and HCV-HIV individuals, even in those on TDF-based ART.

Diabetes, hepatitis C and human immunodeficiency virus influence hypertension risk differently in cohorts of haemophilia patients, veterans and the general population.

The reasons for the high prevalence of hypertension in persons with haemophilia (PWH) are poorly understood. To examine the roles of diabetes, Hepatitis C Virus (HCV) and Human Immunodeficiency Virus (HIV) in the etiology of hypertension for PWH. Retrospective cross-sectional design. Adult PWH (n=691) were divided into two groups: (A) free of diabetes, HCV and HIV; (B) with diabetes and/or HCV positivity and/or HIV positivity. Each group was matched by race and age with random samples from the general population of the US (National Health and Nutrition Examination Surveys, NHANES) and outpatients at the Veterans Affairs Medical Center (VAMC) in San Diego. Generalized additive models (GAMs) were fitted for graphical analysis of hypertension risk over the lifespan. In Group A, PWH had the highest prevalence of hypertension compared to NHANES and VAMC, especially in young adults. In Group B, diabetes increased the risk of hypertension for all three cohorts (PWH, NHANES and VAMC), especially for PWH. In PWH, hypertension risk was also increased by HIV, in NHANES by HCV, and in VAMC by HCV and HIV. Diabetes conferred the greatest risk of hypertension for all three cohorts. However, curves of hypertension in relation to age revealed that diabetes, HCV and HIV modulated hypertension risk differently in PWH. PWH experienced a disproportionally high risk increase with diabetes. Therefore, haemophilia care should include screening for hypertension and diabetes at a young age.

Nucleic acid testing identifies high prevalence of blood borne viruses among approved blood donors in Mozambique.

BackgroundAlthough blood transfusion is an intervention that saves lives, it poses significant risks to the blood receivers, including the transmission of bloodborne pathogens. We aimed at determining the prevalence of Human Immunodeficiency Virus (HIV), Hepatitis B virus (HBV), and Hepatitis C virus (HCV) in candidates approved for blood donation, and in samples considered to be negative in reference blood banks in Mozambique.MethodsA cross-sectional study was performed between November 2014 and October 2015 in Maputo and Beira cities. Demographic information was obtained from all consenting blood donors using a structured questionnaire. Plasma samples were screened for HIVAb/Ag combinations, HBsAg and Anti-HCV. Blood donors considered to be negative by serological testing were re-tested in pools of six plasma samples using nucleic acid testing (NAT).ResultsMost blood donors were male 2,320 (83.4%) with an age range of 18 to 34 years. The overall seroprevalence of HIV, HBV and HCV infections among blood donors approved for donation was 4.6% (127; 95% CI 3.8–5.4), 4.5% (124; 95% CI 3.7–5.3) and 0.4% (11; 95% CI 0.2–0.7), respectively. The overall frequency by NAT of HIV RNA, HBV DNA, and HCV RNA in serologically negative blood donor samples was 2.6 per 1000 blood donors (7; 95% CI 1.1–5.4); 12.5 per 1000 blood donors (33; 95% CI 8.6–17.5) and 2.6 per 1000 blood donors (6; 95% CI 1.0–5.7), respectively.ConclusionOur results show high seroprevalence of HIV and HBV infections in blood donors approved for donation, and high frequency of molecular biomarkers of HIV, HBV, and HCV in blood considered to be safe. These results suggest the need for a new blood screening policy in Mozambique, including the use of NAT to detect infectious blood donations during the immunologically negative window.

The treatment choices and outcome of hepatocellular carcinoma in hemophilic patients with human immunodeficiency virus/hepatitis C virus (HIV/HCV) coinfection due to contaminated blood products in Japan.

Human immunodeficiency virus (HIV) and hepatitis C virus (HCV) coinfection through unheated blood product for hemophilia caused in early 1980s has been significantly serious problem in Japan. After the development of HIV treatment in 1990s, HCV-related hepatocellular carcinoma (HCC) has been one of the most significant problem in these population. Treatment choices for HCC might be limited in hemophilia patients because of their bleeding tendency. The aim of this study was to elucidate the treatment choices and outcome of HCC in hemophilic patients coinfected with HIV/HCV due to contaminated blood products. We asked 444 Japanese centers that specialize in treating HIV patients for participation, whether they have HIV/HCV coinfected cases with HCC, and the patient characteristics, treatments for HCC and survival after treatments were retrospectively reviewed according to each institutional medical records. Of 444 centers, 139 centers (31%) responded to the first query, and 8 centers (1.8%) ultimately provided 26 cases of HCC in coinfected hemophilic patients, diagnosed between December 1999 and December 2017. All 26 were male hemophilic patients, with a median age at HCC diagnosis of 49 (range, 34-73) years. Thirteen cases (50%) were HCV-RNA positive, and 14 cases (54%) had a solitary tumor. Even in the cases of Child-Pugh grade A, only 1 case underwent resection, and 18 cases (69%) did not receive the standard treatment recommended by the Japanese Society of Hepatology. Hemophilic HCC patients with HIV/HCV coinfection may not routinely receive standard treatment due to their bleeding tendency and several complications related to HIV/HCV coinfection.

Role of direct and indirect social and spatial ties in the diffusion of HIV and HCV among people who inject drugs: a cross-sectional community-based network analysis in New Delhi, India.

People who inject drugs (PWID) account for some of the most explosive human immunodeficiency virus (HIV) and hepatitis C virus (HCV) epidemics globally. While individual drivers of infection are well understood, less is known about network factors, with minimal data beyond direct ties. 2512 PWID in New Delhi, India were recruited in 2017-19 using a sociometric network design. Sampling was initiated with 10 indexes who recruited named injection partners (people who they injected with in the prior month). Each recruit then recruited their named injection partners following the same process with cross-network linkages established by biometric data. Participants responded to a survey, including information on injection venues, and provided a blood sample. Factors associated with HIV/HCV infection were identified using logistic regression. The median age was 26; 99% were male. Baseline HIV prevalence was 37.0% and 46.8% were actively infected with HCV (HCV RNA positive). The odds of prevalent HIV and active HCV infection decreased with each additional degree of separation from an infected alter (HIV AOR: 0.87; HCV AOR: 0.90) and increased among those who injected at a specific venue (HIV AOR: 1.50; HCV AOR: 1.69) independent of individual-level factors (p<0.001). In addition, sociometric factors, for example, network distance to an infected alter, were statistically significant predictors even when considering immediate egocentric ties. These data demonstrate an extremely high burden of HIV and HCV infection and a highly interconnected injection and spatial network structure. Incorporating network and spatial data into the design/implementation of interventions may help interrupt transmission while improving efficiency. National Institute on Drug Abuse and the Johns Hopkins University Center for AIDS Research.

Direct-Acting Antivirals in the Treatment of Hepatitis C Virus (HCV)/Human Immunodeficiency Virus (HIV) Co-infected Patients: Real-Life Experience From Nepal.

BackgroundDirect-acting antivirals (DAA) have revolutionized the treatment of chronic hepatitis C patients. However, the real-life data regarding its use in a human immunodeficiency virus (HIV) co-infection from a developing country is lacking. We aimed to see the efficacy of DAA in hepatitis C virus (HCV)/HIV co-infected populations.MethodsIn this prospective, observational, intention-to-treat study from Nepal, treatment-naïve patients undergoing treatment for chronic HCV in HIV co-infected individuals with DAA were studied. Patients on nevirapine were switched to efavirenz or atazanavir. Patients received sofosbuvir/ledipasvir or sofosbuvir/daclatasvir with or without ribavirine. Sustained virological response (SVR) at week 12, adverse events, and treatment compliance were evaluated. Treatment efficacy was compared between cirrhotic and non-cirrhotic patients.ResultsOf 218 patients presenting with an anti-HCV report, 181 (83%) had detectable HCV RNA. Eighty-five (85; 47%) patients were having ART at presentation. Three patients could not complete treatment due to gall stone pancreatitis and 82 completed treatment. Twenty-nine (29; 35%) were cirrhotic at presentation. Fifty-one (51; 62%) patients were genotype 3, 27 (33%) were genotype 1, three (4%) were mixed 1a/3, and one (1%) was 6. Seventy-four (74; 90%) had SVR12. Non-cirrhotics had 96% SVR compared to 79% in cirrhotics. SVR in genotype 3 was 88% while it was 93% in genotype 1.ConclusionsReal-life experience showed that the DAAs are equally effective in HCV HIV co-infected patients. In non-cirrhotic patients, the result is comparable to mono-infected patients. Genotype 3 co-infected are also difficult-to-treat patients. DAA treatment is well-tolerated in HCV/HIV co-infected patients, and there was no dropout during treatment.

Evaluating the Effectiveness of the AIDS Education and Training Center (AETC) National Human Immunodeficiency Virus/Hepatitis C Virus (HCV) Curriculum.

BackgroundPeople with human immunodeficiency virus (PWHIV) who have hepatitis C virus (HCV) coinfection are at a higher risk of progression of liver disease than the general population. Direct acting antivirals provide a therapeutic option for HCV cure, however access to HCV specific care for PWHIV can be challenging. A paucity of specialist providers is a barrier to this care.ObjectivesThis study aims to assess knowledge gained about HIV/HCV coinfection among health care providers.MethodsAIDS Education Training Centers (AETC) have developed a modular national HIV/HCV coinfection curriculum consisting of a free selfdirected online curriculum to educate health care providers, including nonspecialist providers, involved in the care of PWHIV on HCV care and management. The effectiveness of this curriculum was evaluated with pre and post module assessment completion by learners compared with a paired t-test.Results716 people received links to the curriculum and 277 modules were completed by 221 unique individuals. 86% completed one module, 9% complete 2 modules, and the remaining 5% completed between 3 and all 6 modules. There were statistically significant increases in knowledge in the epidemiology module.

Mother-to-Child Transmission of Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) Among Pregnant Women with Dual or Triplex Infections of HIV, HBV and HCV in Nigeria: A Systematic Review

Background: There is no previous systemic review on mother-to-child transmission (MTCT) rate of human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) among pregnant women with dual or triplex infections of HIV, HBV and HCV. The aim of this study was to systematically review the literature and identify MTCT rates and factors associated with MTCT of HIV, HBV and HCV among pregnant women and their infant pairs with dual or triplex infections of HIV, HBV and HCV in Nigeria. Methods: A systematic review was done using PRISMA guidelines. Searches were conducted on 19th February 2021 in PubMed, Google Scholar and CINAHL to identify studies published from 1st February 2001 until 31st January 2021 using keywords including ‘MTCT,’ ‘co-infection,’ ‘dual infection,’ ‘triplex infection,’ ‘HIV,’ ‘HBV,’ and ‘HCV’. Studies that reported MTCT rate of at least any of HIV, HBV and HCV and/or its associated factors with them among pregnant women and their infant pairs with dual and triplex infections of HIV, HBV and HCV in Nigeria irrespective of publication status or language were eligible. If there was no eligible study, studies on mono-infection (HIV or HBV or HCV) population were eligible for narrative synthesis only. Studies were excluded if they were abstracts only or published prior to February 2001. The data from these studies were extracted independently by two authors with disagreements resolved by a third author and consensus reached. The protocol was prospectively registered in the PROSPERO database, ID: CRD42020202070. Findings: The search identified 891 reports. After screening titles and abstracts, 25 full-text articles were assessed for eligibility and none of the studies was included for quantitative synthesis in the systematic review. We identified one relevant large national ongoing study. We have included a comprehensive narrative account of 18 studies where we identified a MTCT rate analysis of HIV (median MTCT rate at birth: 2.18%; range: 0.0% to 9.6%; 5,863 participants; 15 studies) and HBV (median MTCT rate at birth: 51.6%; range: 42.86% to 72.0%; 433 participants; three studies) among mother-infant pairs with mono-infection of HIV and HBV respectively, as this forms the only evidence base in this area. Interpretation: Currently, we found no reliable evidence to inform decisions on the rate of MTCT transmission of HIV, HBV and HCV among mother-infant pairs with dual or triplex infection of HIV, HBV and HCV in Nigeria since the only present study is ongoing. This important topic has been addressed in few studies involving an entirely mono-infection population for HIV or HBV but not HCV. Future research needs to focus on the MTCT rates among mother-infant pairs with dual or triplex infections of HIV, HBV and HCV. Funding: TETFund National Research Fund 2019 (Grant number TETFund/DR&D/CE/NRF/STI/33). Declaration of Interest: We declare no competing interests.

Mathematical Modelling of HIV-HCV Coinfection Dynamics in Absence of Therapy.

Globally, it is estimated that of the 36.7 million people infected with human immunodeficiency virus (HIV), 6.3% are coinfected with hepatitis C virus (HCV). Coinfection with HIV reduces the chance of HCV spontaneous clearance. In this work, we formulated and analysed a deterministic model to study the HIV and HCV coinfection dynamics in absence of therapy. Due to chronic stage of HCV infection being long, asymptomatic, and infectious, our model formulation was based on the splitting of the chronic stage into the following: before onset of cirrhosis and its complications and after onset of cirrhosis. We computed the basic reproduction numbers using the next generation matrix method. We performed numerical simulations to support the analytical results. We carried out sensitivity analysis to determine the relative importance of the different parameters influencing the HIV-HCV coinfection dynamics. The findings reveal that, in the long run, there is a substantial number of individuals coinfected with HIV and latent HCV. Therefore, HIV and latently HCV-infected individuals need to seek early treatment so as to slow down the progression of HIV to AIDS and latent HCV to advanced HCV.

Hepatitis (C) Virus, Hepatitis (B) Virus and Human Immunodeficiency (HIV) Virus Coinfection and Their Impact Outcome on the Liver

Background: Hepatitis C virus (HCV), hepatitis B virus (HBV) and human immunodeficiency virus (HIV) are the commonest chronic viral infections worldwide, they share most common routes of infections, they are hepatotropic viruses and their combined infections had bad outcome on the liver. Objective: To evaluate the risk of coinfection of the liver by both HCV, HBV and HIV on the liver outcome. Patients and Methods: This is a retrospective study of 241 patients attending different fever hospitals coinfected by HCV and or HBV with HIV but not HCV or HBV without HIV infections. Result: There was significant difference between male 59.8% and female 40.2%, age of patients, also there was significant difference as regard liver enzymes, cirrhosis, splenomegaly, international normalization ratio in triplet coinfections. Conclusion: There is high risk on liver outcome in the presence of coinfection between HCV or HBV and HIV.

Hepatitis (C) Virus, Hepatitis (B) Virus and Human Immunodeficiency (HIV) Virus Coinfection and Their Impact Outcome on the Liver

Background: Hepatitis C virus (HCV), hepatitis B virus (HBV) and human immunodeficiency virus (HIV) are the commonest chronic viral infections worldwide, they share most common routes of infections, they are hepatotropic viruses and their combined infections had bad outcome on the liver. Objective: To evaluate the risk of coinfection of the liver by both HCV, HBV and HIV on the liver outcome. Patients and Methods: This is a retrospective study of 241 patients attending different fever hospitals coinfected by HCV and or HBV with HIV but not HCV or HBV without HIV infections. Result: There was significant difference between male 59.8% and female 40.2%, age of patients, also there was significant difference as regard liver enzymes, cirrhosis, splenomegaly, international normalization ratio in triplet coinfections. Conclusion: There is high risk on liver outcome in the presence of coinfection between HCV or HBV and HIV.

Assessment of Key Elements in the Innate Immunity System Among Patients with HIV, HCV, and Coinfections of HIV/HCV

Coinfection of Hepatitis C virus (HCV) with human immunodeficiency virus (HIV) has a higher risk of mortality than HCV or HIV monoinfection. HCV and HIV infections are specified by systemic inflammation, but the inflammation process in HCV/HIV coinfection is much complicated and is not well characterized. The aim of this study was to analyze the expression of TLR-3, TLR-7, IL-10, IFN-1 (IFN-α, IFN-β), and TNF-α in HIV, HCV and HIV/HCV co-infected patients. Forty-five patients including HIV group (n=15), HCV group (n=15), HIV/HCV coinfection group (n=15) and healthy control group (n=15) participated. Peripheral blood mononuclear cells (PBMCs) were obtained. PBMC-RNA, HCV and HIV RNA were extracted from all subjects and cDNA was synthesized. The viral load analyzed by reverse transcription-quantitative PCR (RT-qPCR), and the expression levels of IFN-α, IFN-β, TLR-3, TLR-7, TNF, and IL-10 mRNA were quantified in PBMCs. The levels of IFN-I, IL-10, and TNF-α were overexpressed in all patients' groups (p<0.05), TLR-7 was upregulated in all groups, but this upregulation was not statistically significant (p>0.05). TLR-3 showed a decrease in all patient groups (p<0.05). The statistical analysis demonstrated that TLR-3 has a negative correlation with HIV load, whereas other genes positively correlated with HIV load. In addition, TLR-3, TNF-α, and IFN-I were negatively correlated with HCV load, whereas TLR-7 and IL-10 s were positively correlated with HCV load. Our results showed a significant relationship between the expression level of innate immunity genes and inflammation in HCV, HIV, and HIV/HCV coinfected patients.

Safely restarting GI endoscopy in the era of COVID-19

<h3>Background:</h3> The factors that influence liver fibrosis progression in patients co-infected with human immunodeficiency virus/hepatitis C virus (HIV/HCV) are not completely understood. It is not known if insulin resistance (IR),...

Sustained Virologic Suppression After 4 Weeks of Ledipasvir/Sofosbuvir in Human Immunodeficiency Virus (HIV)/Hepatitis C Virus (HCV) Co-Infection

Patient: Male, 28-year-oldFinal Diagnosis: HCV infectionSymptoms: Not applicableMedication: —Clinical Procedure: —Specialty: Infectious DiseasesObjective:Unusual or unexpected effect of treatmentBackground:Short-course hepatitis C (HCV) treatment with direct-acting antivirals (DAA) under 8 weeks in duration has resulted in variable efficacy rates in HCV mono-infection. Further, DAA courses under 8 weeks in duration have not been studied in HIV/HCV co-infection. We present a case report of 12-week sustained virologic suppression after treatment interruption of ledipasvir/sofosbuvir at 4 weeks in a patient with HIV/HCV co-infection.Case Report:A 28-year-old male patient diagnosed with well-controlled HIV infection and HCV co-infection (treatment-naïve, genotype 1a, unknown hepatic fibrosis) started a 12-week course of ledipasvir/sofosbuvir (LDV/SOF) for HCV treatment. The patient completed only 4 weeks of LDV/SOF before returning for follow-up 7 weeks after initiation. Ledipasvir/sofosbuvir treatment was discontinued. Sustained virologic suppression at 12 weeks was observed after completion of a short, 4-week course of LDV/SOF.Conclusions:Compared to currently recommended treatment durations, clinical trials of short-course DAA treatments of less than 8 weeks have not demonstrated successful rates of SVR12. However, in cases of DAA interruption or incomplete treatment, clinicians may choose to assess for SVR12 prior to continuing or restarting the full treatment course.

High prevalence of injection drug use and blood-borne viral infections among patients in an urban emergency department.

The opioid epidemic has led to an increase in the number of persons who inject drugs, and this population accounts for 12% of new human immunodeficiency virus (HIV) and 60% of new hepatitis C virus (HCV) infections in the United States annually. While persons who inject drugs disproportionately utilize the emergency department (ED), accurate data is lacking on the prevalence and patterns of injection drug use, and prevalence of co-occurring HIV and HCV infections among ED patients. The primary outcome was to assess the prevalence of injection drug use and co-occurring HIV and HCV infection among patients presenting to an urban ED. This was a cross sectional study conducted at an urban ED, with an annual census of 65,000 visits. A closed-response questionnaire was developed based on publicly available validated surveys to assess patterns of injection drug use and HIV and HCV infection status, and administered by trained research assistants to all registered adult patients during 4-hour blocks of time. Of the 2,319 eligible patients, 2,200 (94.9%) consented and completed the survey. 241 (11.0%) had ever used injection drugs, 103 (4.7%) currently used injection drugs, and 138 (6.3%) formerly used injection drugs. White patients age 25 to 34 years and white patients age 55 to 64 years had the highest prevalence of current (25.6%) and former (27.1%) injection drug use, respectively. Persons who use injection drugs had a higher prevalence of HCV infection (52.7% vs. 3.4%) and HIV infection (6.2% vs. 1.8%) than the rest of the population. A high prevalence of ED patients report injection drug use, and this population self-reports a high prevalence of HIV and HCV infection. Emergency departments are in a unique position to engage with this population with regards to substance use treatment and linkage to care for HIV and HCV infection.

ISSUES OF EPIDEMIOLOGY AND PATHOGENESIS OF HIVHCV COINFECTION

General characteristic of hepatitis C virus (HCV) and features of the course of co-infection with human immunodeficiency virus (HIV) was presented. Epidemiologic aspects of these diseases were considered in key populations. Special focus was on pathogenetic components of pathogenic mechanisms in HIV-infected patients with chronic hepatitis C (CHC).