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Rabaan AA, Bello KE, Radwan Z, Hassouneh AK, Alrasheed HA, Alotaibi J, Basrana B, Zaidan AA, Garout MA, Zaidan TI, Al Amri KA, Alshaikh SA, Al Alawi KH, A. Alalqam R, Tombuloglu H, Bouafia NA. The Dual Burden of Hepatitis B and C Among Drug Users in Asia: The First Systematic Review and Meta-Analysis. Pathogens 2025; 14:360. [PMID: 40333162 PMCID: PMC12030361 DOI: 10.3390/pathogens14040360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2025] [Revised: 03/26/2025] [Accepted: 03/31/2025] [Indexed: 05/09/2025] Open
Abstract
Hepatitis B virus (HBV) and Hepatitis C virus (HCV) contribute significantly to morbidity and mortality among drug users in Asia. This study systematically reviews and analyzes the pooled prevalence of HBV and HCV, considering geographic and methodological variations. A meta-analysis following PRISMA guidelines included data from PubMed, Scopus, and Google Scholar on studies on HBV or HCV or a combination of both within Asia. A random-effects model estimated pooled prevalence, with subgroup analyses by region, study design, diagnostic method, and publication year. A total of 112 studies were analyzed. The pooled HBV prevalence among drug users was 14.3% (95% CI: 11.5-17.6), highest in Malaysia (28.7%) and Vietnam (26.6%). HCV prevalence was 58.6% (95% CI: 54.0-63.0), with the highest rates in Vietnam (63.5%) and China (62.9%). Retrospective studies reported a higher prevalence than cross-sectional ones. The use of ELISA for initial screening followed up by PCR reduced heterogeneity, improving diagnostic accuracy. HBV prevalence declined after 2010, while HCV rates remained persistently high. The high burden of HBV and HCV among drug users in Asia underscores an urgent public health concern. Targeted interventions, including vaccination, harm reduction strategies, and improved access to antiviral treatments, are essential to curbing transmission and enhancing health outcomes.
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Affiliation(s)
- Ali A. Rabaan
- Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran 31311, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
- Department of Public Health and Nutrition, The University of Haripur, Haripur 22610, Pakistan
| | - Kizito E. Bello
- Department of Microbiology, Kogi State (Prince Abubakar Audu) University, Anyigba 10008, Nigeria;
| | - Zaheda Radwan
- Medical Laboratory Department, Mohammed Al-Mana College for Medical Sciences, Dammam 34222, Saudi Arabia;
| | - Amal K. Hassouneh
- Clinical Pharmacy Department, King Saud Medical City, Riyadh 11362, Saudi Arabia;
| | - Hayam A. Alrasheed
- Department of Pharmacy Practice, College of Pharmacy, Princess Nourah bint Abdulrahman University, Riyadh 11671, Saudi Arabia;
| | - Jawaher Alotaibi
- Infectious Diseases Unit, Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh 11564, Saudi Arabia;
| | - Bashayer Basrana
- Department of Infectious Disease, King Abdullah Medical Complex, Jeddah 6725, Saudi Arabia;
| | - Ali A. Zaidan
- Gastroenterology Department, King Fahad Armed Forces Hospital, Jeddah 23831, Saudi Arabia;
| | - Mohammed A. Garout
- Department of Community Medicine and Health Care for Pilgrims, Faculty of Medicine, Umm Al-Qura University, Makkah 21955, Saudi Arabia;
| | - Tasneem I. Zaidan
- Pediatric Infectious Diseases Unit, Pediatric Department, King Abdulaziz Hospital, Jeddah 23831, Saudi Arabia;
| | | | - Sana A. Alshaikh
- Diagnostic Virology Laboratory, Maternity and Children Hospital, Eastern Health Cluster, Dammam 32253, Saudi Arabia;
| | - Kawthar Haider Al Alawi
- Nursing Department of Vaccine Clinic, Hospital: Al Jamaeen Primary Health Care, Dammam 32467, Saudi Arabia;
| | - Razi A. Alalqam
- Department of Medicine, Royal College of Surgeons, D02 YN77 Dublin, Ireland;
| | - Huseyin Tombuloglu
- Department of Genetics Research, Institute for Research and Medical Consultations (IRMC), Imam Abdulrahman Bin Faisal University, Dammam 34221, Saudi Arabia;
| | - Nabiha A. Bouafia
- Infection Prevention and Control Centre of Excellence, Prince Sultan Medical Military City, Riyadh 12233, Saudi Arabia
- Preventive and Community Medicine Department, Faculty of Medicine, University of Sousse, Sousse 4002, Tunisia
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Yang XC, Hong ZP, Wang Y, Meng N, Hu Y, Xiong QY, Qin DW, Shen D, Yang XL. Growth history of hepatitis C virus among HIV/HCV co-infected patients in Guizhou Province. Front Genet 2023; 14:1171892. [PMID: 37347053 PMCID: PMC10280012 DOI: 10.3389/fgene.2023.1171892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/04/2023] [Indexed: 06/23/2023] Open
Abstract
Background: The evolutionary and epidemiological history and the regional differences of various hepatitis C virus (HCV) genotypes are complex. Our aim was to better understand the molecular epidemiology and evolutionary dynamics of HCV among HIV/HCV co-infected individuals in Guizhou Province. This information could contribute to improve HCV prevention and control strategies in Guizhou and surrounding provinces. Methods: The HCV RNA was extracted from the serum of HIV/HCV co-infected patients, and reverse transcription/nested PCR was performed to amplify nucleotide sequences of the C-E1 region. Then, the successfully amplified sequences were selected for phylogenetic analysis. The available C-E1 region reference sequences from the surrounding provinces of Guizhou (Guangxi, Yunnan, Hunan, and Sichuan) were retrieved in GenBank, and the evolutionary analysis by Bayesian Markov chain Monte Carlo (MCMC) algorithm was performed using BEAST software to reconstruct a phylogeographic tree in order to explore their migration patterns. Finally, the epidemiological history of HCV in the Guizhou region was retraced by reconstructing Bayesian skyline plots (BSPs) after excluding sequences from surrounding provinces. Results: Among 186 HIV/HCV co-infected patients, the C-E1 region sequence was successfully amplified in 177 cases. Phylogenetic analysis classified these sequences into six subtypes: 1a, 1b, 3a, 3b, 6a, and 6n. Among them, subtype 6a was the most dominant strain (n = 70), followed by 3b (n = 55), 1b (n = 31), 3a (n = 11), 1a (n = 8), and 6n (n = 2). By reconstructing the phylogeographic tree, we estimated that the 6a strain in Guizhou mainly originated from Yunnan and Guangxi, while the 3b strain emerged due to transmission from the IDU network in Yunnan. Subtypes 1b, 3a, 3b, and 6a, as the major subtypes of HCV in HIV/HCV co-infected individuals in Guizhou, emerged and later grew more rapidly than the national average. Notably, BSPs of the currently prevalent HCV predominant strain subtype 6a in Guizhou have shown a rapid population growth since 2004. Although the growth rate slowed down around 2010, this growth has continued to date. Conclusion: Overall, despite the improvement and implementation of a series of HCV prevention and control policies and measures, a delayed growth pattern may indicate a unique history of the spread of 6a in Guizhou. Its trend as the dominant strain in Guizhou in recent years may continue to increase slowly over subsequent years.
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Affiliation(s)
- Xiu-Cheng Yang
- Department of Infectious Disease Control, Aba Center for Disease Control and Prevention, Aba, Sichuan, China
| | - Zhang-Ping Hong
- Department of Laboratory, Guiyang Medical Center for Public Health, Guiyang, Guizhou, China
| | - Yi Wang
- Department of Laboratory, Guiyang Medical Center for Public Health, Guiyang, Guizhou, China
| | - Nan Meng
- Department of Laboratory, Guiyang Medical Center for Public Health, Guiyang, Guizhou, China
| | - Yong Hu
- School of Public Health, The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, Guizhou, China
| | - Qian-Yu Xiong
- Department of Laboratory, Guiyang Medical Center for Public Health, Guiyang, Guizhou, China
| | - Da-Wen Qin
- School of Public Health, The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, Guizhou, China
| | - Du Shen
- School of Public Health, The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, Guizhou, China
| | - Xing-Lin Yang
- Department of Laboratory, Guiyang Medical Center for Public Health, Guiyang, Guizhou, China
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Artenie A, Stone J, Fraser H, Stewart D, Arum C, Lim AG, McNaughton AL, Trickey A, Ward Z, Abramovitz D, Alary M, Astemborski J, Bruneau J, Clipman SJ, Coffin CS, Croxford S, DeBeck K, Emanuel E, Hayashi K, Hermez JG, Low-Beer D, Luhmann N, Macphail G, Maher L, Palmateer NE, Patel EU, Sacks-Davis R, Van Den Boom W, van Santen DK, Walker JG, Hickman M, Vickerman P. Incidence of HIV and hepatitis C virus among people who inject drugs, and associations with age and sex or gender: a global systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2023; 8:533-552. [PMID: 36996853 PMCID: PMC10817215 DOI: 10.1016/s2468-1253(23)00018-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/26/2023] [Accepted: 01/27/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Measuring the incidence of HIV and hepatitis C virus (HCV) infection among people who inject drugs (PWID) is key to track progress towards elimination. We aimed to summarise global data on HIV and primary HCV incidence among PWID and associations with age and sex or gender. METHODS In this systematic review and meta-analysis, we updated an existing database of HIV and HCV incidence studies among PWID by searching MEDLINE, Embase, and PsycINFO, capturing studies published between Jan 1, 2000, and Dec 12, 2022, with no language or study design restrictions. We contacted authors of identified studies for unpublished or updated data. We included studies that estimated incidence by longitudinally re-testing people at risk of infection or by using assays for recent infection. We pooled incidence and relative risk (RR; young [generally defined as ≤25 years] vs older PWID; women vs men) estimates using random-effects meta-analysis and assessed risk of bias with a modified Newcastle-Ottawa scale. This study is registered with PROSPERO, CRD42020220884. FINDINGS Our updated search identified 9493 publications, of which 211 were eligible for full-text review. An additional 377 full-text records from our existing database and five records identified through cross-referencing were assessed. Including 28 unpublished records, 125 records met the inclusion criteria. We identified 64 estimates of HIV incidence (30 from high-income countries [HICs] and 34 from low-income or middle-income countries [LMICs]) and 66 estimates of HCV incidence (52 from HICs and 14 from LMICs). 41 (64%) of 64 HIV and 42 (64%) of 66 HCV estimates were from single cities rather than being multi-city or nationwide. Estimates were measured over 1987-2021 for HIV and 1992-2021 for HCV. Pooled HIV incidence was 1·7 per 100 person-years (95% CI 1·3-2·3; I2=98·4%) and pooled HCV incidence was 12·1 per 100 person-years (10·0-14·6; I2=97·2%). Young PWID had a greater risk of HIV (RR 1·5, 95% CI 1·2-1·8; I2=66·9%) and HCV (1·5, 1·3-1·8; I2=70·6%) acquisition than older PWID. Women had a greater risk of HIV (RR 1·4, 95% CI 1·1-1·6; I2=55·3%) and HCV (1·2, 1·1-1·3; I2=43·3%) acquisition than men. For both HIV and HCV, the median risk-of-bias score was 6 (IQR 6-7), indicating moderate risk. INTERPRETATION Although sparse, available HIV and HCV incidence estimates offer insights into global levels of HIV and HCV transmission among PWID. Intensified efforts are needed to keep track of the HIV and HCV epidemics among PWID and to expand access to age-appropriate and gender-appropriate prevention services that serve young PWID and women who inject drugs. FUNDING Canadian Institutes of Health Research, Fonds de recherche du Québec-Santé, Canadian Network on Hepatitis C, UK National Institute for Health and Care Research, and WHO.
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Affiliation(s)
- Adelina Artenie
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK.
| | - Jack Stone
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Hannah Fraser
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Daniel Stewart
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; National Public Health Speciality Training Programme, South West, Bristol, UK
| | - Chiedozie Arum
- Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Aaron G Lim
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Anna L McNaughton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Adam Trickey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Zoe Ward
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | | | - Michel Alary
- Centre de recherche du CHU de Québec-Université Laval, Québec City, QC, Canada; Département de médecine sociale et préventive, Université Laval, Québec City, QC, Canada; Institut national de santé publique du Québec, Québec City, QC, Canada
| | - Jacquie Astemborski
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Julie Bruneau
- Département de Médecine Familiale et Médecine d'Urgence, Université de Montréal, Montréal, QC, Canada; Centre Hospitalier de l'Université de Montréal Research Center, Montréal, QC, Canada
| | - Steven J Clipman
- Department of Medicine, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Carla S Coffin
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sara Croxford
- Public Health and Clinical Directorate, UK Health Security Agency, London, UK
| | - Kora DeBeck
- School of Public Policy, Simon Fraser University, Vancouver, BC, Canada; BC Centre on Substance Use, Vancouver, BC, Canada
| | - Eva Emanuel
- Blood Safety, Hepatitis, STI and HIV Division, UK Health Security Agency, London, UK
| | - Kanna Hayashi
- BC Centre on Substance Use, Vancouver, BC, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Joumana G Hermez
- Department of Communicable Diseases, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Daniel Low-Beer
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Niklas Luhmann
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Gisela Macphail
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Infectious Diseases, CUPS Liver Clinic, Calgary, AB, Canada
| | - Lisa Maher
- Kirby Institute for Infection and Immunity, UNSW Sydney, Sydney, NSW, Australia
| | - Norah E Palmateer
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Public Health Scotland, Glasgow, UK
| | - Eshan U Patel
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Rachel Sacks-Davis
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | | | - Daniela K van Santen
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia; School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, Netherlands
| | - Josephine G Walker
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
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Sowndarrajan PT, Shangerganesh L, Debbouche A, Torres DFM. Optimal control of a heroin epidemic mathematical model. OPTIMIZATION 2022; 71:3107-3131. [DOI: 10.1080/02331934.2021.2009823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 11/10/2021] [Indexed: 02/08/2023]
Affiliation(s)
- P. T. Sowndarrajan
- Department of Applied Sciences, National Institute of Technology, Ponda, Goa, India
| | - L. Shangerganesh
- Department of Applied Sciences, National Institute of Technology, Ponda, Goa, India
| | - A. Debbouche
- Department of Mathematics, Guelma University, Guelma, Algeria
- Center for Research and Development in Mathematics and Applications (CIDMA), Department of Mathematics, University of Aveiro, Aveiro, Portugal
| | - D. F. M. Torres
- Center for Research and Development in Mathematics and Applications (CIDMA), Department of Mathematics, University of Aveiro, Aveiro, Portugal
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Guntipalli P, Pakala R, Kumari Gara S, Ahmed F, Bhatnagar A, Endaya Coronel MK, Razzack AA, Solimando AG, Thompson A, Andrews K, Enebong Nya G, Ahmad S, Ranaldo R, Cozzolongo R, Shahini E. Worldwide prevalence, genotype distribution and management of hepatitis C. Acta Gastroenterol Belg 2021; 84:637-656. [PMID: 34965046 DOI: 10.51821/84.4.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Hepatitis C virus (HCV) is one of the leading causes of chronic liver disease, cirrhosis, and hepatocellular carcinoma, resulting in major global public health concerns. The HCV infection is unevenly distributed worldwide, with variations in prevalence across and within countries. The studies on molecular epidemiology conducted in several countries provide an essential supplement for a comprehensive knowledge of HCV epidemiology, genotypes, and subtypes, along with providing information on the impact of current and earlier migratory flows. HCV is phylogenetically classified into 8 major genotypes and 57 subtypes. HCV genotype and subtype distribution differ according to geographic origin and transmission risk category. Unless people with HCV infection are detected and treated appropriately, the number of deaths due to the disease will continue to increase. In 2015, 1.75 million new viral infections were mostly due to unsafe healthcare procedures and drug use injections. In the same year, access to direct-acting antivirals was challenging and varied in developing and developed countries, affecting HCV cure rates based on their availability. The World Health Assembly, in 2016, approved a global strategy to achieve the elimination of the HCV public health threat by 2030 (by reducing new infections by 90% and deaths by 65%). Globally, countries are implementing policies and measures to eliminate HCV risk based on their distribution of genotypes and prevalence.
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Affiliation(s)
- P Guntipalli
- Division of Clinical and Translational Research, Larkin Community Hospital, South Miami, Florida, United States of America
| | - R Pakala
- Division of Clinical and Translational Research, Larkin Community Hospital, South Miami, Florida, United States of America
| | - S Kumari Gara
- Division of Clinical and Translational Research, Larkin Community Hospital, South Miami, Florida, United States of America
| | - F Ahmed
- Division of Clinical and Translational Research, Larkin Community Hospital, South Miami, Florida, United States of America
| | - A Bhatnagar
- Division of Clinical and Translational Research, Larkin Community Hospital, South Miami, Florida, United States of America
| | - M-K Endaya Coronel
- Division of Clinical and Translational Research, Larkin Community Hospital, South Miami, Florida, United States of America
| | - A A Razzack
- Division of Clinical and Translational Research, Larkin Community Hospital, South Miami, Florida, United States of America
| | - A G Solimando
- Department of Biomedical Sciences and Human Oncology, Unit of Internal Medicine and Clinical Oncology, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - A Thompson
- Department of Family Medicine, Mississauga Health Centre, Mississauga, Ontario, Canada
| | - K Andrews
- Department of Mathematics and Natural Sciences, Prince Mohammad Bin Fahad University, Al Khobar, Saudi Arabia
| | - G Enebong Nya
- Department of Gastroenterology, John Hopkins Hospital, Baltimore, Maryland, USA
| | - S Ahmad
- Advent Health Cancer Institute, Division of Oncology, Orlando, FL 32804, USA
| | - R Ranaldo
- Digestive Endoscopy, Department of Internal Medicine, "Mazzolani-Vandini" Hospital, Via Nazionale Ponente, 7, Argenta (Ferrara), Italy
| | - R Cozzolongo
- National Institute of Gastroenterology S. De Bellis, IRCCS Research Hospital, Via Turi 27, 70013 Castellana Grotte, Italy
| | - E Shahini
- National Institute of Gastroenterology S. De Bellis, IRCCS Research Hospital, Via Turi 27, 70013 Castellana Grotte, Italy
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Stability Analysis and Optimal Control of a Fractional Order Synthetic Drugs Transmission Model. MATHEMATICS 2021. [DOI: 10.3390/math9070703] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this work, a fractional-order synthetic drugs transmission model with psychological addicts has been proposed along with psychological treatment. The effects of synthetic drugs are deadly and sometimes even violent. We have studied the local and global stability of the model with different criterion. The existence and uniqueness criterion along with positivity and boundedness of the solutions have also been established. The local and global stabilities are decided by the basic reproduction number R0. We have also analyzed the sensitivity of parameters. An optimal control problem has been formulated by controlling psychological addiction and analyzed by the help of Pontryagin maximum principle. These results are verified by numerical simulations.
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Goldshear JL, Simpson KA, Kral AH, Wenger LD, Bluthenthal RN. Novel Routes of Potential Hepatitis C Virus Transmission among People Who Inject Drugs: Secondary Blood Exposures Related to Injection Drug Use. Subst Use Misuse 2021; 56:751-757. [PMID: 33769203 PMCID: PMC9563097 DOI: 10.1080/10826084.2021.1879149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND The US is in the midst of a national Hepatitis C Virus (HCV) epidemic that appears to be driven by new cases among people who inject drugs (PWID). While HCV transmission among PWID is believed to occur mostly through direct sharing of syringes, some infections may be spread via secondary processes and materials involved in injecting. OBJECTIVES Here, we present the prevalence of secondary blood exposures on clothing and nearby surfaces after injection episodes and examine the correlations of these exposures to lifetime HCV infection among a targeted sample of 553 PWID in Los Angeles and San Francisco, California in 2016-18. RESULTS In multivariate logistic regression models, higher odds of blood on clothing in the last 30 days was significantly (p < 0.05) associated with lifetime positive HCV status, opioids as primary drug, injecting with others, sharing cookers, and receptive syringe sharing. Higher adjusted odds of blood on nearby surfaces in the last 30 days was significantly associated with lifetime positive HCV status, sharing cookers, and receptive syringe sharing. Native American race was associated with significantly lower adjusted odds of both outcome variables. Conclusions/Importance: Results indicate the relevance of physical and social micro-environments to the potential for blood exposures secondary to injection episodes. Individuals with chronic HCV seropositivity are potentially more likely to expose others to blood due to decreases in the blood's ability to clot. This highlights the need for increased HCV testing at harm reduction sites and increased supply of first aid and wound-care materials to help stop potential blood exposures after injection episodes.
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Affiliation(s)
- Jesse L Goldshear
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Kelsey A Simpson
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Alex H Kral
- Behavioral Health Research Division, RTI International, Berkeley, California, USA
| | - Lynn D Wenger
- Behavioral Health Research Division, RTI International, Berkeley, California, USA
| | - Ricky N Bluthenthal
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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8
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Somi MH, Sepehri B, Nikniaz Z, Sedghi R. Efficacy of Sovodak in the Management of Patients Co-infected with HIV/HCV. Adv Pharm Bull 2020; 10:662-665. [PMID: 33072543 PMCID: PMC7539312 DOI: 10.34172/apb.2020.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 01/07/2020] [Accepted: 01/27/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose: Sofosbuvir (SOF) and daclatasvir (DOC) are suggested for the treatment of hepatitis C virus (HCV) in patients with concomitant HCV and human immunodeficiency virus (HIV). In 2016, Sovodak tablet a combination of SOF and DOC was introduced. In the present study we assessed the effectiveness of SOF in the treatment of HCV in patients co-infected with HIV. Methods: A total of 26 HCV patients co-infected with HIV received SOF for 3 months. One patient did not adhere to the drug protocol and was removed from the final analysis. The blood sample for qualitative polymerase chain reaction (PCR) was obtained after treatment and sustained virological response (SVR) was calculated. Results: Twenty five patients finished the study. The mean patients’ age was 44.16±6.21 years. About 72% of participants had HCV genotype 1a, 8% genotype 1b, and 20% genotype 3a. After 3 months of intervention with Sovodak, the SVR12 was about 96%. None of the patients reported any adverse events. Conclusion: For the first time, the results of the present study showed that Sovodak had high SVR12 in HCV patients co-infected with HIV. However, for a precise conclusion, there is a need for larger studies and an equal number of patients with different virus genotypes.
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Affiliation(s)
- Mohammad Hossein Somi
- Liver and gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Bita Sepehri
- Liver and gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zeinab Nikniaz
- Liver and gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Roya Sedghi
- Liver and gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Fang C, Cornell E, Dicken Q, Freccero D, Mattingly D, Smith EL. Coinfection of HIV and hepatitis C increases complication rates after total joint arthroplasty. SICOT J 2020; 6:37. [PMID: 32960168 PMCID: PMC7507831 DOI: 10.1051/sicotj/2020035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 08/30/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION As advances in efficacy of human immunodeficiency virus (HIV) and hepatitis-C virus (HCV) anti-viral medications increase, patients are able to maintain higher quality of lives than ever before. While these patients live longer lives, the unique patient population of those co-infected with both HIV and HCV increases. As these older patients seek orthopaedic care, it is important to understand their unique outcome profile. The purpose of this study was to evaluate the complication rate after total joint arthroplasty (TJA) in patients with HIV and HCV coinfection compared with patients with HIV or HCV only. METHODS A retrospective review of patients undergoing primary total joint arthroplasty (TJA) at our urban, academic hospital between April 2016 and April 2019 was conducted. Patients were stratified into three groups according to viral status: HIV only, HCV only, or HIV and HCV coinfection. Baseline demographics, intravenous drug (IV) use, surgery type, CD4+ count, follow-up and complications were analysed. RESULTS Of the 133 patients included in the study, 28 had HIV, 88 had HCV and 17 were coinfected with both HIV and HCV. Coinfected patients were more likely to have a lower BMI (p < 0.039) and a history of IV drug use (p < 0.018) compared to patients with either HIV or HCV only. Coinfected patients had a higher complication rate (41%) than both HIV only (7%; p < 0.001) and HCV only (12.5%; p < 0.001) patients. DISCUSSION Patients coinfected with HIV and HCV undergoing TJA have a higher complication rate than patients with either infection alone. As this unique population of coinfected patients continues to expand, increasingly they will be under the care of arthroplasty surgeons. Improved awareness and understanding of the baseline demographic differences between these patients is paramount. Recognition of the increased complication rates grants the opportunity to improve their orthopaedic care through preoperative and multidisciplinary management.
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Affiliation(s)
- Christopher Fang
- New England Baptist Hospital, 125 Parker Hill Ave, Boston, 02120 MA, USA
| | - Ella Cornell
- Boston Medical Center, One Boston Medical Center Pl, Boston, 02118 MA, USA
| | - Quinten Dicken
- Boston Medical Center, One Boston Medical Center Pl, Boston, 02118 MA, USA
| | - David Freccero
- Boston Medical Center, One Boston Medical Center Pl, Boston, 02118 MA, USA
| | - David Mattingly
- New England Baptist Hospital, 125 Parker Hill Ave, Boston, 02120 MA, USA
| | - Eric L Smith
- New England Baptist Hospital, 125 Parker Hill Ave, Boston, 02120 MA, USA
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10
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Zhang Y, Gao Z, Wang S, Liu J, Paul N, He T, Liu C, Zhang H, Lv Y, Cao R, Mao W, Wan J, Ma H, Huang M, Liu Y, Wang J, Liao P, Zeng P, He M, Shan H. Hepatitis C virus genotype/subtype distribution and evolution among Chinese blood donors: Revealing recent viral expansion. PLoS One 2020; 15:e0235612. [PMID: 32649673 PMCID: PMC7351211 DOI: 10.1371/journal.pone.0235612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 06/19/2020] [Indexed: 01/30/2023] Open
Abstract
Hepatitis C virus (HCV) genotype (GT) distribution in China shows significant geographical and demographic difference. As a routinely tested virus in Chinese blood bank systems, rare molecular epidemiology research in blood donors is reported. Our purpose is to investigate the HCV GT/subtypes distribution, phylogenetic analysis and population genetics in Chinese blood donors. Anti-HCV screen positive samples and donor demographics were collected. HCV Core and E1 gene fragments were amplified by RT-PCR, followed by sequencing and phylogenetic analysis to determine HCV GTs/subtypes using MEGA 7.0. The population genetics were performed using Arlequin v3.0 and Beast v1.10.4. SPSS Statistics 17.0 software was used to analyze the correlation between HCV GTs/subtypes distribution and demographic characteristics. 419 and 293 samples based on Core and E1 gene respectively were successfully amplified. HCV la, lb, 2a, 3a, 3b, 6a, 6e and 6n were found, and the corresponding proportions were 0.66% (3/455), 58.68% (267/455), 17.80% (81/455) and 5.05% (23/455), 3.52% (16/455), 12.31% (56/455), 0.88% (4/455) and 0.66% (3/455). Samples from Guangxi showed the most abundant genetic diversity with 8 subtypes were found. The number of haplotypes in HCV-1b is higher than 2a and 6a. The negative Tajima's D and Fu's Fs values of HCV-1b, 2a and 6a suggested the population expansion of those HCV subtypes. The distribution of HCV GT showed significant statistical difference by age and ethnicity. Conclusion: An abundance of HCV genetic diversity was found in Chinese blood donors with mainly 1b and then 2a subtype. There were significant geographical and demographic differences in HCV GTs/subtypes among Chinese blood donors. HCV subtype 1b has stronger viability and HCV subtype 6a has experienced significant expansion.
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Affiliation(s)
- Yu Zhang
- The Fourth Affiliated Hospital Zhejiang University School of Medicine, Yiwu, China
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, China
| | - Zhan Gao
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, China
- Sichuan Blood Safety and Blood Substitute International Science and Technology Cooperation Base, Chengdu, China
| | - Shaoli Wang
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, China
- Sichuan Blood Safety and Blood Substitute International Science and Technology Cooperation Base, Chengdu, China
| | - Jing Liu
- The Johns Hopkins Medical Institutions, Baltimore, MD, United States of America
| | - Ness Paul
- The Johns Hopkins Medical Institutions, Baltimore, MD, United States of America
| | - Tao He
- Chongqing Blood Center, Chongqing, China
| | - Cunxu Liu
- Guangxi Blood Center, Liuzhou, Guangxi, China
| | | | - Yunlai Lv
- Luoyang Blood Center, Luoyang, Henan, China
| | - Ru’an Cao
- Mianyang Blood Center, Mianyang, Sichuan, China
| | - Wei Mao
- Chongqing Blood Center, Chongqing, China
| | - Jianhua Wan
- Urumqi Blood Center, Urumqi, Xinjiang, China
| | - Hongli Ma
- Luoyang Blood Center, Luoyang, Henan, China
| | - Mei Huang
- Mianyang Blood Center, Mianyang, Sichuan, China
| | - Yu Liu
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, China
- Sichuan Blood Safety and Blood Substitute International Science and Technology Cooperation Base, Chengdu, China
| | - Jingxing Wang
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, China
- Sichuan Blood Safety and Blood Substitute International Science and Technology Cooperation Base, Chengdu, China
| | - Pu Liao
- The People’s Hospital of Chongqing, Chongqing, China
| | - Peibin Zeng
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Miao He
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, China
- Sichuan Blood Safety and Blood Substitute International Science and Technology Cooperation Base, Chengdu, China
| | - Hua Shan
- Stanford University, Stanford, CA, United States of America
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11
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Wang M, Liao Q, Xu R, Song D, Huang J, You Q, Shan Z, Huang K, Rong X, Fu Y. Hepatitis C virus 3b strains in injection drug users in Guangdong Province, China, may have originated in Yunnan Province. Arch Virol 2019; 164:1761-1770. [DOI: 10.1007/s00705-019-04260-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 03/26/2019] [Indexed: 02/08/2023]
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12
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Granados-García V, Flores YN, Díaz-Trejo LI, Méndez-Sánchez L, Liu S, Salinas-Escudero G, Toledano-Toledano F, Salmerón J. Estimating the prevalence of hepatitis C among intravenous drug users in upper middle income countries: A systematic review and meta-analysis. PLoS One 2019; 14:e0212558. [PMID: 30807590 PMCID: PMC6391024 DOI: 10.1371/journal.pone.0212558] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 02/05/2019] [Indexed: 02/06/2023] Open
Abstract
Aim This systematic review and meta-analysis characterizes the prevalence of hepatitis C virus (HCV) infection among intravenous drug users (IDUs) in upper middle-income countries. Methods Five databases were searched from 1990–2016 for studies that took place in countries with a GDP per capita of $7,000 to $13,000 USD. The data extraction was performed based on information regarding prevalence, sample size, age of participants, duration of intravenous drug use (IDU), recruitment location, dates of data collection, study design, sampling scheme, type of tests used in identifying antibody reactivity to HCV, and the use of confirmatory tests. The synthesis was performed with a random effects model. The Cochrane statistical Q-test was used to evaluate the statistical heterogeneity of the results. Results The 33 studies included in the analysis correspond to a sample of seven countries and 23,342 observations. The point prevalence value estimates and confidence intervals of the random effects model were 0.729 and 0.644–0.800, respectively for all seven countries, and were greatest for China (0.633; 0.522–0.732) as compared to Brazil (0.396; 0.249–0.564). Prevalence for Montenegro (0.416; 0.237–0.621) and Malaysia (0.475; 0.177–0.792) appear to be intermediate. Mexico (0.960) and Mauritania (0.973) had only one study with the largest prevalence. A clear association was not observed between age or duration of IDU and prevalence of HCV, but the data from some groups may indicate a possible relationship. The measures of heterogeneity (Q and I2) suggest a high level of heterogeneity in studies conducted at the country level and by groups of countries. Conclusions In this systematic review and meta-analysis, we found that the pooled prevalence of HCV was high (0.729) among a group of seven upper middle income countries. However, there was significant variation in the prevalence of HCV observed in China (0.633) and Brazil (0.396).
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Affiliation(s)
- Víctor Granados-García
- Unidad de Investigación Epidemiológica y en Servicios de Salud Área Envejecimiento, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Ciudad de México, México
- * E-mail:
| | - Yvonne N. Flores
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Delegación Morelos, Instituto Mexicano del Seguro Social, Cuernavaca, Morelos, México
- UCLA Department of Health Policy and Management, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Ángeles, CA, United States of America
| | - Lizbeth I. Díaz-Trejo
- Centro Nacional de Programas Preventivos y Control de Enfermedades, Secretaría de Salud, Ciudad de México, México
| | - Lucia Méndez-Sánchez
- Unidad de Epidemiología Clínica, Hospital Infantil de México Federico Gómez Instituto Nacional de Salud, Ciudad de México, México
- Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Stephanie Liu
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Delegación Morelos, Instituto Mexicano del Seguro Social, Cuernavaca, Morelos, México
- University of Washington, Department of Epidemiology, School of Public Health, Seattle, WA, United States of America
| | - Guillermo Salinas-Escudero
- Centro de Estudios Económicos y Sociales en Salud, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - Filiberto Toledano-Toledano
- Unidad de Investigación en Medicina Basada en Evidencias, Hospital Infantil de México Federico Gómez Instituto Nacional de Salud, Ciudad de México, México
| | - Jorge Salmerón
- Centro de Investigación en Políticas, Población y Salud, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, México
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Lampejo T, Agarwal K, Carey I. Interferon-free direct-acting antiviral therapy for acute hepatitis C virus infection in HIV-infected individuals: A literature review. Dig Liver Dis 2018; 50:113-123. [PMID: 29233687 DOI: 10.1016/j.dld.2017.11.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 10/29/2017] [Accepted: 11/15/2017] [Indexed: 02/07/2023]
Abstract
Dramatic rises in hepatitis C virus (HCV) coinfection rates in human immunodeficiency virus (HIV)-infected individuals have been observed recently, largely attributable to increasing recreational drug use combined with increased testing for HCV. In the era of direct-acting antiviral (DAA) therapy, treatment of acute HCV infection in HIV-infected individuals with short durations of these drugs may potentially reduce the disease and economic burden associated with HCV infection as well as reducing the likelihood of onward HCV transmission. We performed an extensive literature search of PubMed, Embase and Google Scholar up to 05 September 2017 for clinical trials of acute HCV infection in HIV-infected individuals. In the studies identified, rates of sustained virologic response at 12 weeks post-treatment (SVR12) ranged from 21% with 6 weeks of therapy up to 92% with 12 weeks of therapy with sofosbuvir and ribavirin. Ledipasvir/sofosbuvir for 6 weeks achieved an SVR of 77%. No HIV-related events occurred regardless of whether patients were receiving antiretroviral therapy (ART) and DAAs were well tolerated. Data is currently limited with regards to optimal regimens and durations of therapy, which need to be tailored based on potential interactions with concurrent ART and consideration for the fact that patients with higher baseline HCV RNA levels may require an extended duration of treatment.
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Affiliation(s)
- Temi Lampejo
- Institute of Liver Studies, King's College Hospital, London, United Kingdom.
| | - Kosh Agarwal
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - Ivana Carey
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
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14
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Mahure SA, Bosco JA, Slover JD, Vigdorchik J, Iorio R, Schwarzkopf R. Risk of Complications After THA Increases Among Patients Who Are Coinfected With HIV and Hepatitis C. Clin Orthop Relat Res 2018; 476. [PMID: 29529669 PMCID: PMC6259695 DOI: 10.1007/s11999.0000000000000025] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Individuals coinfected with both hepatitis C virus (HCV) and HIV represent a unique and growing population of patients undergoing orthopaedic surgical procedures. Data regarding complications for HCV monoinfection or HIV monoinfection are robust, but there are no data available, to our knowledge, on patients who have both HCV and HIV infections. QUESTIONS/PURPOSES We sought to determine whether patients with coinfection differed in terms of baseline demographics and comorbidity burden as compared with patients without coinfection and whether these potential differences were translated into varying levels of postoperative complications, mortality, and hospital readmission risk. Specifically, we asked: (1) Are there demonstrable differences in baseline demographic variables between patients infected with HCV and HIV and those who do not have those infections (age, sex, race, and insurance status)? (2) Do patients with HCV and HIV infection differ from patients without those infections in terms of other medical comorbidities? (3) Do patients with HCV/HIV coinfection have a higher incidence of early postoperative complications and mortality than patients without coinfection? (4) Is the frequency of readmission greater for patients with HCV/HIV coinfection than those without? METHODS The New York Statewide Planning and Research Cooperative System (SPARCS) database was used to identify patients undergoing THA between 2010 and 2014. The SPARCS database is particularly useful because it captures 100% of all New York State inpatient admissions while providing detailed demographic and comorbidity data for a large, heterogeneous patient population with long-term followup. Patients were stratified into four groups based on HCV/HIV status: control patients without disease, HCV monoinfection, HIV monoinfection, and coinfection. We sought to determine whether patients coinfected with HCV and HIV would differ in terms of demographics from patients without those infections and whether patients with HCV and HIV would have a greater risk of complications, longer length of stay, and hospital readmission. A total of 80,722 patients underwent THA between 2010 and 2014. A total of 98.55% (79,554 of 80,722) of patients did not have either HCV or HIV, 0.66% (530 of 80,722) had HCV monoinfection, 0.66% (534 of 80,722) HIV monoinfection, and 0.13% (104 of 80,722) were coinfected with both HCV and HIV. Multivariate analysis was performed controlling for age, sex, insurance, residency status, diagnosis, and comorbidities to allow for an equal comparison between groups. RESULTS Patients with coinfection were more likely to be younger, male (odds ratio [OR], 2.90; 95% confidence interval [CI], 2.20-3.13; p < 0.001), insured by Medicaid (OR, 6.43; 4.41-7.55; p < 0.001), have a history of avascular necrosis (OR, 8.76; 7.20-9.53; p < 0.001), and to be homeless (OR, 6.95; 5.31-7.28; p < 0.001) as compared with patients without HIV or HCV. Additionally, patients with coinfection had the highest proportion of alcohol abuse, drug abuse, and tobacco use along with a high proportion of psychiatric disorders, including depression. HCV and HIV coinfection were independent risk factors for increased length of stay (OR, 1.97; 95% CI, 1.29-3.01; p < 0.001), having two or more in-hospital complications (OR, 1.64; 1.01-2.67; p < 0.001), and 90-day readmission rates (OR, 2.97; 1.86-4.77; p < 0.001). CONCLUSIONS As the prevalence of HCV and HIV coinfectivity continues to increase, orthopaedic surgeons will encounter a greater number of these patients. Awareness of the demographic and socioeconomic factors leading to increased complications after THA will allow physicians to consider interventions such as in-hospital psychiatric counseling, advanced discharge planning, and coordination with social work and collaboration with HCV/HIV infectious disease specialists to improve patient health status to improve outcomes and reduce costs. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Siddharth A Mahure
- S. A. Mahure, J. A. Bosco, J. Vigdorchik, R. Schwarzkopf, Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, USA J. D. Slover, Department of Orthopaedic Surgery, Orthopaedic Surgery Service, HJD, NYU Hospital for Joint Diseases, New York, NY, USA R. Iorio, Department of Orthopaedic Surgery, Division of Adult Reconstructive Surgery, NYU Hospital for Joint Diseases, New York, NY, USA
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15
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Platt L, Minozzi S, Reed J, Vickerman P, Hagan H, French C, Jordan A, Degenhardt L, Hope V, Hutchinson S, Maher L, Palmateer N, Taylor A, Bruneau J, Hickman M. Needle syringe programmes and opioid substitution therapy for preventing hepatitis C transmission in people who inject drugs. Cochrane Database Syst Rev 2017; 9:CD012021. [PMID: 28922449 PMCID: PMC5621373 DOI: 10.1002/14651858.cd012021.pub2] [Citation(s) in RCA: 145] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Needle syringe programmes and opioid substitution therapy for preventing hepatitis C transmission in people who inject drugsNeedle syringe programmes (NSP) and opioid substitution therapy (OST) are the primary interventions to reduce hepatitis C (HCV) transmission in people who inject drugs. There is good evidence for the effectiveness of NSP and OST in reducing injecting risk behaviour and increasing evidence for the effectiveness of OST and NSP in reducing HIV acquisition risk, but the evidence on the effectiveness of NSP and OST for preventing HCV acquisition is weak. OBJECTIVES To assess the effects of needle syringe programmes and opioid substitution therapy, alone or in combination, for preventing acquisition of HCV in people who inject drugs. SEARCH METHODS We searched the Cochrane Drug and Alcohol Register, CENTRAL, the Cochrane Database of Systematic Reviews (CDSR), the Database of Abstracts of Reviews of Effects (DARE), the Health Technology Assessment Database (HTA), the NHS Economic Evaluation Database (NHSEED), MEDLINE, Embase, PsycINFO, Global Health, CINAHL, and the Web of Science up to 16 November 2015. We updated this search in March 2017, but we have not incorporated these results into the review yet. Where observational studies did not report any outcome measure, we asked authors to provide unpublished data. We searched publications of key international agencies and conference abstracts. We reviewed reference lists of all included articles and topic-related systematic reviews for eligible papers. SELECTION CRITERIA We included prospective and retrospective cohort studies, cross-sectional surveys, case-control studies and randomised controlled trials that measured exposure to NSP and/or OST against no intervention or a reduced exposure and reported HCV incidence as an outcome in people who inject drugs. We defined interventions as current OST (within previous 6 months), lifetime use of OST and high NSP coverage (regular attendance at an NSP or all injections covered by a new needle/syringe) or low NSP coverage (irregular attendance at an NSP or less than 100% of injections covered by a new needle/syringe) compared with no intervention or reduced exposure. DATA COLLECTION AND ANALYSIS We followed the standard Cochrane methodological procedures incorporating new methods for classifying risk of bias for observational studies. We described study methods against the following 'Risk of bias' domains: confounding, selection bias, measurement of interventions, departures from intervention, missing data, measurement of outcomes, selection of reported results; and we assigned a judgment (low, moderate, serious, critical, unclear) for each criterion. MAIN RESULTS We identified 28 studies (21 published, 7 unpublished): 13 from North America, 5 from the UK, 4 from continental Europe, 5 from Australia and 1 from China, comprising 1817 incident HCV infections and 8806.95 person-years of follow-up. HCV incidence ranged from 0.09 cases to 42 cases per 100 person-years across the studies. We judged only two studies to be at moderate overall risk of bias, while 17 were at serious risk and 7 were at critical risk; for two unpublished datasets there was insufficient information to assess bias. As none of the intervention effects were generated from RCT evidence, we typically categorised quality as low. We found evidence that current OST reduces the risk of HCV acquisition by 50% (risk ratio (RR) 0.50, 95% confidence interval (CI) 0.40 to 0.63, I2 = 0%, 12 studies across all regions, N = 6361), but the quality of the evidence was low. The intervention effect remained significant in sensitivity analyses that excluded unpublished datasets and papers judged to be at critical risk of bias. We found evidence of differential impact by proportion of female participants in the sample, but not geographical region of study, the main drug used, or history of homelessness or imprisonment among study samples.Overall, we found very low-quality evidence that high NSP coverage did not reduce risk of HCV acquisition (RR 0.79, 95% CI 0.39 to 1.61) with high heterogeneity (I2 = 77%) based on five studies from North America and Europe involving 3530 participants. After stratification by region, high NSP coverage in Europe was associated with a 76% reduction in HCV acquisition risk (RR 0.24, 95% CI 0.09 to 0.62) with less heterogeneity (I2 =0%). We found low-quality evidence of the impact of combined high coverage of NSP and OST, from three studies involving 3241 participants, resulting in a 74% reduction in the risk of HCV acquisition (RR 0.26 95% CI 0.07 to 0.89). AUTHORS' CONCLUSIONS OST is associated with a reduction in the risk of HCV acquisition, which is strengthened in studies that assess the combination of OST and NSP. There was greater heterogeneity between studies and weaker evidence for the impact of NSP on HCV acquisition. High NSP coverage was associated with a reduction in the risk of HCV acquisition in studies in Europe.
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Affiliation(s)
- Lucy Platt
- London School of Hygiene and Tropical MedicineDepartment of Social and Environmental Health Research15 ‐ 17 Tavistock PlaceLondonUKWC1H 9SH
| | - Silvia Minozzi
- Lazio Regional Health ServiceDepartment of EpidemiologyVia Cristoforo Colombo, 112RomeItaly00154
| | | | - Peter Vickerman
- University of BristolSchool of Social and Community MedicineBristolUK
| | - Holly Hagan
- New York University College of NursingNew YorkNYUSA
| | - Clare French
- University of BristolSchool of Social and Community MedicineBristolUK
| | - Ashly Jordan
- New York University College of NursingNew YorkNYUSA
| | - Louisa Degenhardt
- UNSWNational Drug and Alcohol Research CentreBuilding R322‐32 King StreetRandwickNSWAustralia2031
| | - Vivian Hope
- Liverpool John Moores UniversityPublic Health InstituteLiverpoolUKL3 2ET
| | | | - Lisa Maher
- Kirby Institute, University of New South WalesSydneyAustralia
| | | | | | - Julie Bruneau
- University of MontrealDepartment of Family and Emergency MedicineMontrealCanada
| | - Matthew Hickman
- University of BristolSchool of Social and Community MedicineBristolUK
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16
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O'Keefe D, Stoové M, Doyle J, Dietze P, Hellard M. Injecting drug use in low and middle-income countries: Opportunities to improve care and prevent harm. J Viral Hepat 2017. [PMID: 28632952 DOI: 10.1111/jvh.12741] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Inadequate response to injecting drug use (IDU) is a significant problem the world over. Low levels of funding, political inaction, poor levels of health service coverage, high prevalence and incidence of IDU-related blood-borne viruses (BBVs) and ongoing stigmatization/marginalization affect people who inject drugs (PWID) regardless of the income status of the country they reside in. These barriers and system failings are, however, exacerbated in low and middle-income countries (LMICs), meaning that the potential consequences of inaction are more pressing. In this narrative review, we describe the levels of IDU and IDU-specific BBV prevalence in LMICs; levels of harm reduction implementation; the consequences of late or insufficient response, the shortcomings of data collection and dissemination; and the barriers to effective LMIC harm reduction implementation. We also exemplify cases where IDU-related harms and BBV epidemics have been successfully curtailed in LMICs, showing that effective response, despite the barriers, is possible. In conclusion, we suggest four key priorities on the basis of the review: confirming the presence or absence of IDU in LMICs, improving the collection and dissemination of national IDU-specific data, increasing the level of harm reduction programme implementation in LMICs, and increasing both national and international advocacy for PWID and attendant public health interventions.
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Affiliation(s)
- D O'Keefe
- Burnet Institute, Melbourne, Vic., Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - M Stoové
- Burnet Institute, Melbourne, Vic., Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - J Doyle
- Burnet Institute, Melbourne, Vic., Australia.,Department of Infectious Diseases, Central Clinical School, Monash University, Melbourne, Vic., Australia.,Department of Infectious Diseases, Alfred Hospital, Melbourne, Vic., Australia
| | - P Dietze
- Burnet Institute, Melbourne, Vic., Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - M Hellard
- Burnet Institute, Melbourne, Vic., Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia.,Department of Infectious Diseases, Alfred Hospital, Melbourne, Vic., Australia
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17
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Mahure SA, Bosco JA, Slover JD, Vigdorchik JM, Iorio R, Schwarzkopf R. Coinfection with Hepatitis C and HIV Is a Risk Factor for Poor Outcomes After Total Knee Arthroplasty. JB JS Open Access 2017; 2:e0009. [PMID: 30229221 PMCID: PMC6133098 DOI: 10.2106/jbjs.oa.17.00009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background As medical management continues to improve, orthopaedic surgeons are likely to encounter a greater proportion of patients who have coinfection with human immunodeficiency virus (HIV) and hepatitis-C virus (HCV). Methods The New York Statewide Planning and Research Cooperative System (SPARCS) database was used to identify patients undergoing total knee arthroplasty between 2010 and 2014. Patients were stratified into 4 groups on the basis of HCV and HIV status. Differences regarding baseline demographics, length of stay, total charges, discharge disposition, in-hospital complications and mortality, and 90-day hospital readmission were calculated. Results Between 2010 and 2014, a total of 137,801 patients underwent total knee arthroplasty. Of those, 99.13% (136,604) of the population were not infected, 0.62% (851) had HCV monoinfection, 0.20% (278) had HIV monoinfection, and 0.05% (68) were coinfected with both HCV and HIV. Coinfected patients were more likely to be younger, female, a member of a minority group, homeless, and insured by Medicare or Medicaid, and to have a history of substance abuse. HCV and HIV coinfection was a significant independent risk factor for increased length of hospital stay (odds ratio [OR], 2.9; 95% confidence interval [CI], 1.75 to 4.81), total hospital charges in the 90th percentile (OR, 2.02; 95% CI, 1.12 to 3.67), ≥2 in-hospital complications (OR, 2.04; 95% CI, 1.04 to 3.97), and 90-day hospital readmission (OR, 3.53; 95% CI, 2.02 to 6.18). Conclusions Patients coinfected with both HCV and HIV represent a rare but increasing population of individuals undergoing total knee arthroplasty. Recognition of unique baseline demographics in these patients that may lead to suboptimal outcomes will allow appropriate preoperative management and multidisciplinary coordination to reduce morbidity and mortality while containing costs. Level of Evidence Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
| | - Joseph A Bosco
- Hospital for Joint Diseases, NYU Langone Medical Center, New York, NY
| | - James D Slover
- Hospital for Joint Diseases, NYU Langone Medical Center, New York, NY
| | | | - Richard Iorio
- Hospital for Joint Diseases, NYU Langone Medical Center, New York, NY
| | - Ran Schwarzkopf
- Hospital for Joint Diseases, NYU Langone Medical Center, New York, NY
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Assessment of HCV genotypes in Yunnan Province of Southwest China. Virus Genes 2016; 53:190-196. [PMID: 28012010 DOI: 10.1007/s11262-016-1420-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 12/07/2016] [Indexed: 01/30/2023]
Abstract
Recently, we reported that the frequency of hepatitis C virus (HCV) genotypes and subtypes has rapidly changed among intravenous drug users (IDUs) in Yunnan Province over the last 5 years; this is especially true for subtype 6a which has increased in frequency from 5 to 15%. Here, we assessed 120 HCV-positive plasma samples from the general population (GP). HCV NS5B fragments were amplified and sequenced by PCR. We identified four HCV genotypes (1, 2, 3 and 6) and seven HCV subtypes (1b, 2a, 3a, 3b, 6a, 6n, and 6k) in this population. Genotype 3 was predominant, with a distribution frequency of 0.484, followed by genotype 1 (0.283), genotype 6 (0.133) and genotype 2 (0.100). HCV subtypes 3b (frequency 0.292) and 1b (frequency 0.283) were the most common subtypes. A comparison of the current data with previous results reported for IDUs showed that the distribution frequencies of genotypes 1, 2 and 6 were significantly different between patients in the GP and IDUs (P < 0.05). Among the HCV subtypes, the distribution frequencies of 1b, 2a, 6a, and 6n were significantly different between patients in the GP and IDU groups (P < 0.05). Moreover, Phylogenetic analyses showed that HCV subtype 6a strains isolated from IDUs and the GP were intermixed and not separately clustered. HCV subtype 6a was predominant not only among IDUs but also among those in the GP in the Guangdong Province and Vietnam. However, HCV subtype 6a was predominant only among IDUs and not among those in the GP in the Yunnan and Guangxi Provinces. Our results indicate that the HCV subtype 6a could rapidly spread across China.
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Tengan FM, Ibrahim KY, Dantas BP, Manchiero C, Magri MC, Bernardo WM. Seroprevalence of hepatitis C virus among people living with HIV/AIDS in Latin America and the Caribbean: a systematic review. BMC Infect Dis 2016; 16:663. [PMID: 27829381 PMCID: PMC5103446 DOI: 10.1186/s12879-016-1988-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 10/29/2016] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Studies have shown that the immunosuppression induced by the human immunodeficiency virus (HIV) accelerates the natural history of liver disease associated with hepatitis C virus (HCV), with 3- to 5-fold higher odds of coinfected individuals developing cirrhosis. However, estimates of the seroprevalence of hepatitis C among people living with HIV/acquired immune deficiency syndrome (AIDS) (PLHA) in Latin America and the Caribbean (LAC) are widely variable. METHODS We performed a systematic review to estimate the seroprevalence of HCV among PLHA. We searched studies on HIV and HCV infections in LAC included in the PubMed, LILACS and Embase databases in December of 2014 with no time or language restrictions. The following combinations of search terms were used in the PubMed and Embase databases: (HIV OR Acquired Immunodeficiency Syndrome Virus OR AIDS OR HTLV OR Human Immunodeficiency Virus OR Human T Cell) AND (HCV OR HEPATITIS C OR HEPATITIS C VIRUS OR HEPACIVIRUS) AND (name of an individual country or territory in LAC). The following search terms were used in the LILACS database: (HIV OR AIDS OR Virus da Imunodeficiencia Humana) AND (HCV OR Hepatite C OR Hepacivirus). An additional 11 studies were identified through manual searches. A total of 2,380 publications were located, including 617 duplicates; the remaining articles were reviewed to select studies for inclusion in this study. RESULTS A total of 37 studies were selected for systematic review, including 23 from Brazil, 5 from Argentina, 3 from Cuba, 1 from Puerto Rico, 1 from Chile, 1 from Colombia, 1 from Mexico, 1 from Peru and 1 from Venezuela. The estimated seroprevalence of HCV infection varied from 0.8 to 58.5 % (mean 17.37; median 10.91), with the highest in Argentina and Brazil and the lowest in Venezuela and Colombia. CONCLUSIONS Investigation of HCV infection among PLHA and of HIV infection among people living with HCV is highly recommended because it allows for better follow up, counseling and treatment of HIV/HCV-coinfected patients. Future studies with larger sample sizes are needed in both South and Central America to understand and address the risk factors associated with the acquisition of infection.
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Affiliation(s)
- Fatima Mitiko Tengan
- Department of Infectious and Parasitic Diseases, School of Medicine, University of São Paulo (Universidade de São Paulo - USP), São Paulo, Brazil. .,Laboratory of Viral Medical Research in Hepatology (Laboratório de Investigação Médica em Hepatologia por vírus - LIM-47), Clinical Hospital, School of Medicine, USP, São Paulo, Brazil.
| | - Karim Yakub Ibrahim
- Department of Infectious and Parasitic Diseases, School of Medicine, University of São Paulo (Universidade de São Paulo - USP), São Paulo, Brazil.,Laboratory of Viral Medical Research in Hepatology (Laboratório de Investigação Médica em Hepatologia por vírus - LIM-47), Clinical Hospital, School of Medicine, USP, São Paulo, Brazil
| | - Bianca Peixoto Dantas
- Laboratory of Viral Medical Research in Hepatology (Laboratório de Investigação Médica em Hepatologia por vírus - LIM-47), Clinical Hospital, School of Medicine, USP, São Paulo, Brazil
| | - Caroline Manchiero
- Laboratory of Viral Medical Research in Hepatology (Laboratório de Investigação Médica em Hepatologia por vírus - LIM-47), Clinical Hospital, School of Medicine, USP, São Paulo, Brazil
| | - Mariana Cavalheiro Magri
- Laboratory of Viral Medical Research in Hepatology (Laboratório de Investigação Médica em Hepatologia por vírus - LIM-47), Clinical Hospital, School of Medicine, USP, São Paulo, Brazil
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Oliver NT, Hartman CM, Kramer JR, Chiao EY. Statin drugs decrease progression to cirrhosis in HIV/hepatitis C virus coinfected individuals. AIDS 2016; 30:2469-2476. [PMID: 27753678 PMCID: PMC5290260 DOI: 10.1097/qad.0000000000001219] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Chronic HIV/hepatitis C virus (HCV) coinfection carries increased risk of cirrhosis, hepatocellular carcinoma, and death. Due to anti-inflammatory properties, 3-hydroxy-3methylglutaryl coenzyme A (HMG-CoA) inhibitors (statins) may be useful adjunctive therapy to reduce liver disease progression. METHODS Clinical information was extracted from the Veterans Affairs HIV and HCV Clinical Case Registries (1999-2010). HIV-related variables included combination antiretroviral therapy era of diagnosis, CD4 cell count, and percentage time with undetectable HIV viral load. Metabolic variables included diabetes, low high-density lipoprotein (HDL), and hypertension. Statin use was measured as percentage time with active prescription (time-updated throughout the follow-up period). Cox proportional hazards analysis was used to determine risk factors for cirrhosis (International Classification of Diseases-9 or aminotransferase-to-platelet ratio index >2) overall and in groups stratified by alanine aminotransferase (ALT) level above and below 40 IU/l. RESULTS The cohort included 5985 HIV/HCV coinfected veterans. The majority was black race, and the mean age at index date was 45 years. Statin use was significantly protective of cirrhosis for patients with ALT 40 IU/l or less; for every 30% increase in time on statin, there was a 32% decreased risk of developing cirrhosis (hazard ratio 0.68, 95% confidence interval 0.47-0.98). Diabetes and low HDL were significantly associated with cirrhosis in patients with ALT greater than 40 IU/l (hazard ratio 1.15, P < 0.04 and hazard ratio 1.3, P < 0.0001). CONCLUSION Statin drug use is beneficial in mitigating the risk of liver disease progression for HIV/HCV coinfected patients without advanced liver disease. Low HDL and diabetes in coinfected patients with abnormal ALT have greater risk of cirrhosis development.
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Affiliation(s)
- Nora T Oliver
- aDepartment of Medicine, Section of Infectious Diseases and Health Services Research, Baylor College of Medicine bCenter for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
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Wu Z, Cui L, Zhao W, Yang D, Chen H, Wang R, Wang X, Zhang L, He T. Molecular epidemiology of hepatitis C infections in Ningxia, China: genotype, phylogeny and mutation analysis. Virol J 2016; 13:172. [PMID: 27756381 PMCID: PMC5070218 DOI: 10.1186/s12985-016-0635-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 10/12/2016] [Indexed: 02/07/2023] Open
Abstract
Background Current prevalence and genotype distribution of hepatitis C virus (HCV) infection remain unknown in Ningxia, northwest China. Methods From June to December 2013, 13,022 individuals were screened in Ningxia HIV/AIDS Sentinel Surveillance System, with their demographic features collected and serum samples tested for HCV antibody. Sero-positive drug users were further subjected to sequencing of NS5B and Core regions of HCV. Results The anti-HCV prevalence was 0.34 % among individuals without history of drug use, while it was 15.80 % among drug users. Of 79 NS5B sequences amplified from drug users, 64 (81.0 %) were male and 51 (64.0 %) were injection drug users (IDUs). Subtype 3a (40.5 %) and 1b (25.3 %) were the most predominant subtypes, followed in frequency by 3b (10.1 %) and 2a (7.6 %). Subtype distribution has no significant difference between injection and non-injection drug users. Based on phylogeographic analysis, HCV strains in Ningxia IDUs were mainly originated from two sites, Yunnan province (in southwest China bordering Myanmar, also known as Burma) and Xinjiang Autonomous Region (in northwest China on the border of Central Asia), which are the two major drug trafficking originates in China. Previously reported drug-resistance mutations were also scanned in this treatment-naïve population. Amino acid substitutions (C316N) associated with direct anti-viral agents (DAA) resistance were identified in the NS5B region in seven samples. Conclusion This study is the first to reveal the existence of multiple genotypes of HCV in Ningxia, an inland province in northwest China, suggesting the rapid spreading of the virus. Electronic supplementary material The online version of this article (doi:10.1186/s12985-016-0635-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Zhonglan Wu
- Ningxia Center for Disease Control and Prevention, Ningxia, 750001, China
| | - Lijia Cui
- Tsinghua University School of Medicine, Beijing, 100084, China
| | - Weiming Zhao
- Ningxia Medical University School of Public Health and Management, Ningxia, 750001, China
| | - Dongzhi Yang
- Ningxia Center for Disease Control and Prevention, Ningxia, 750001, China
| | - Hui Chen
- Ningxia Center for Disease Control and Prevention, Ningxia, 750001, China
| | - Ruiqing Wang
- Wuzhong Center of Disease Control and Prevention, Ningxia, 751100, China
| | - Xuemin Wang
- Ningxia Center for Disease Control and Prevention, Ningxia, 750001, China
| | - Linqi Zhang
- Comprehensive AIDS Research Center, and Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Tsinghua University School of Medicine, Beijing, 100084, China
| | - Tianhua He
- Tsinghua University School of Medicine, Beijing, 100084, China.
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Wan Z, Chen Q, Chen X, Duo L, Li P, Zheng YT, Zhang C. HCV Diversity among Chinese and Burmese IDUs in Dehong, Yunnan, China. PLoS One 2016; 11:e0163062. [PMID: 27657722 PMCID: PMC5033387 DOI: 10.1371/journal.pone.0163062] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 09/01/2016] [Indexed: 01/13/2023] Open
Abstract
HCV transmission is closely associated with drug-trafficking routes in China. Dehong, a prefecture of Yunnan, is the important trade transfer station linking Southeast Asia and China, as well as the drug-trafficking channel linking “Golden triangle” and other regions of China and surrounding countries. In this study, we investigated the HCV genotype diversity among IDUs in Dehong based on 259 HCV positive samples from 118 Chinese and 141 Burmese IDUs. HCV genotypes were determined based on the phylogenies of C/E2 and NS5B genomic sequences. Six HCV subtypes, including 1a, 1b, 3a, 3b, 6n and 6u, were detected. Interestingly, 4 HCV sequences from Burmese IDUs did not cluster with any known HCV subtypes, but formed a well-supported independent clade in the phylogenetic trees of both C/E2 and NS5B, suggesting a potential new HCV subtype circulating in Dehong. Subtype 3b was the predominant subtype, followed by subtypes 6n and 6u. Comparison showed that Dehong had a unique pattern of HCV subtype distribution, obviously different from other regions of China. In particular, HCV subtypes 6u and the potential new HCV subtype had a relatively high prevalence in Dehong, but were rarely detected in other regions of China. There was no significant difference in HCV subtype distribution between Burmese and Chinese IDUs. Few HCV sequences from Burmese and Chinese IDUs clustered together to form transmission clusters. Furthermore, about half of HCV sequences from Burmese IDUs formed small transmission clusters, significantly higher than that from Chinese IDUs (p<0.01). These suggest that the Chinese and Burmese IDUs were relatively isolated from each other in injection drug use behavior and the Burmese IDUs might prefer to inject drugs themselves together. The unique genotype distribution and complex diversity of genotype 6 among IDUs may be associated with the special geographical position of Dehong.
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Affiliation(s)
- Zhenzhou Wan
- Pathogen Diagnostic Center, CAS Key Laboratory of Molecular Virology & Immunology, Institut Pasteur of Shanghai, Chinese Academy of Sciences, Shanghai 200031, China
- Medical Laboratory of Taizhou Fourth People’s Hospital, Taizhou, Jiangsu 225300, China
| | - Qianqian Chen
- Pathogen Diagnostic Center, CAS Key Laboratory of Molecular Virology & Immunology, Institut Pasteur of Shanghai, Chinese Academy of Sciences, Shanghai 200031, China
| | - Xin Chen
- Key Laboratory of Animal Models and Human Disease Mechanisms of Chinese Academy of Sciences & Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming 650223, China
- Kunming College of Life Science, University of Chinese Academy of Sciences, Kunming, Yunnan 650204, China
| | - Lin Duo
- The Second People’s Hospital of Yunnan Province, Kunming, Yunnan 650031, China
| | - Peilu Li
- Pathogen Diagnostic Center, CAS Key Laboratory of Molecular Virology & Immunology, Institut Pasteur of Shanghai, Chinese Academy of Sciences, Shanghai 200031, China
| | - Yong-Tang Zheng
- Key Laboratory of Animal Models and Human Disease Mechanisms of Chinese Academy of Sciences & Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming 650223, China
- * E-mail: (CZ); (YZ)
| | - Chiyu Zhang
- Pathogen Diagnostic Center, CAS Key Laboratory of Molecular Virology & Immunology, Institut Pasteur of Shanghai, Chinese Academy of Sciences, Shanghai 200031, China
- * E-mail: (CZ); (YZ)
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Afzali H, Momen-Heravi M, Farokhzad A. Epidemiological Distribution and Genotype Characterization of the Hepatitis C Virus Among HIV Patients in Kashan, Iran. HEPATITIS MONTHLY 2016; 16:e30459. [PMID: 27642343 PMCID: PMC5018303 DOI: 10.5812/hepatmon.30459] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Revised: 04/12/2016] [Accepted: 05/28/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Parenteral transmission is a common route of transmission for both human immunodeficiency virus (HIV) and hepatitis C virus (HCV); therefore, hepatitis C viral infection is highly prevalent among people infected with HIV. OBJECTIVES This study was designed to examine the epidemiology and describe the clinical manifestation as well as the HCV genotypes in patients from the city of Kashan, Iran, who are coinfected with HIV and HCV. PATIENTS AND METHODS This descriptive study was conducted in 2014 in the city of Kashan. The population consisted of all the HIV-infected patients who were referred to the behavioral counseling center and jail in Kashan. Demographic information and HCV- and HIV-related risk behaviors were obtained through the use of an interviewer-assisted questionnaire. After the participants gave written informed consent to participate, 10 cc venous blood samples were collected. The serum samples were screened for HCV infection using an enzyme-linked immunosorbent assay (ELISA). In the event of a positive test for HCV, the RNA was then amplified by polymerase chain reaction (PCR) amplification. The HCV subtypes were determined via the direct sequencing of the amplicons. All data analysis was performed using SPSS version 16.0 for the descriptive statistics, and then the chi-square test and Pearson coefficient were performed for additional analysis. RESULTS The results of the analysis indicated that 54 (85%) of the 63 HIV-infected patients were males who were also HCV positive and who had less than a high school level education. There was a significant association between HCV infection and both occupation (P < 0.0001) and level of education (P < 0.05). All the HIV/HCV coinfected cases had a history of illicit drug use, while 92.6% had a history of imprisonment and 40.7% had high risk sexual contacts. Overall, genotype 1 was found in 75.9% of HCV patients, while genotype 3 was found in 24.1%. Some 94.4% of HCV patients had subtype A. There were no clinical symptoms of chronic hepatitis C. CONCLUSIONS The majority of HIV-infected persons in the city of Kashan were also HCV positive. Genotype 1 was the predominant type, alongside subtype A. Considering the high prevalence of HCV among the HIV-infected persons, as well as the impact of occupation, education, illicit drug use, and imprisonment on the incidence of both infections, health policy makers must introduce health programs and plans to reduce the prevalence of these infections.
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Affiliation(s)
- Hasan Afzali
- Associate Professor, Department of Infectious Disease, School of Medicine, Kashan University of Medical Sciences, Kashan, IR Iran
| | - Mansooreh Momen-Heravi
- Associate Professor, Department of Infectious Disease, Social Determinants of Health (SDH) Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
- Corresponding Author: Mansooreh Momen-Heravi, Associate Professor, Department of Infectious Disease, Social Determinants of Health (SDH) Research Center, Kashan University of Medical Sciences, Kashan, IR Iran. Tel: +98-9133611017, E-mail:
| | - Asefeh Farokhzad
- Infectious Disease Specialist, Department of Infectious Disease, School of Medicine, Kashan University of Medical Sciences, Kashan, IR Iran
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Berenguer J. Is response to anti-HCV treatment predictive of mortality in HCV/HIV coinfected people? Future Virol 2016. [DOI: 10.2217/fvl-2016-0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Juan Berenguer
- Unidad de Enfermedades Infecciosas/VIH (4100), Hospital General Universitario Gregorio Marañón, Doctor Esquerdo 46, 28007 Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
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Abadie R, Welch-Lazoritz M, Gelpi-Acosta C, Reyes JC, Dombrowski K. Understanding differences in HIV/HCV prevalence according to differentiated risk behaviors in a sample of PWID in rural Puerto Rico. Harm Reduct J 2016; 13:10. [PMID: 26956029 PMCID: PMC4784433 DOI: 10.1186/s12954-016-0099-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 03/02/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Blood contained in needles and injection equipment has been identified as a vector for HIV and HCV transmission among people who inject drugs (PWID). Yet, there is often a wide discrepancy in prevalence for both viruses. While microbiological differences between viruses influence prevalence, other variables associated with the way drugs are acquired and used, also play a role. METHODS Respondent-driven sampling (RDS) methods recruited a sample of 315 current intravenous drug users in rural Puerto Rico. Information about type and frequency of use, HIV and HVC risk behaviors (sharing needles, cookers, cotton, and water), sexual behaviors, and alcohol use was collected. HIV and HCV statuses were assessed via rapid antibody tests. T tests compare means of participants who tested positive (reactive) to those who tested negative. Logistic regression analyses were used to validate the association of the risk factors involved. RESULTS Tests showed a significant difference in HIV (6%) and HCV (78.4%) prevalence among a population of current PWID. The main risk behaviors in HCV transmission are the sharing of injection "works", (e.g., cookers, cotton, and water). Sharing works occurred more than twice as often as the sharing of needles, and HCV+ and HCV- individuals reported the same needle sharing habits. CONCLUSIONS Washing and rinsing injection works with water seems to prevent HIV transmission, but it is unable to prevent HCV infection. While education about the need to clean injection equipment with bleach might be beneficial, equipment sharing--and the subsequent risk of HVC--might be unavoidable in a context where participants are forced to pool resources to acquire and use intravenous drugs.
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Affiliation(s)
- Roberto Abadie
- Department of Sociology, University of Nebraska-Lincoln, 206 Benton Hall, Lincoln, NE, 68588, USA.
| | - Melissa Welch-Lazoritz
- Department of Sociology, University of Nebraska-Lincoln, 206 Benton Hall, Lincoln, NE, 68588, USA.
| | - Camila Gelpi-Acosta
- Social Science Department, LaGuardia Community College, 31-10 Thomson Ave., Long Island City, NY, 11101, USA.
| | - Juan Carlos Reyes
- Department of Biostatistics and Epidemiology, University of Puerto Rico, 365067, San Juan, PR, 00936, USA.
| | - Kirk Dombrowski
- Department of Sociology, University of Nebraska-Lincoln, 206 Benton Hall, Lincoln, NE, 68588, USA.
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Folch C, Casabona J, Espelt A, Majó X, Meroño M, Gonzalez V, Wiessing L, Colom J, Brugal MT. High Prevalence and Incidence of HIV and HCV Among New Injecting Drug Users With a Large Proportion of Migrants--Is Prevention Failing? Subst Use Misuse 2016; 51:250-60. [PMID: 26820260 DOI: 10.3109/10826084.2015.1092991] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The aim of this study was to assess differences in the prevalence of HIV and HCV infection and associated risk factors between new (injecting for ≤5 years) and long-term injectors and to estimate HIV/HCV incidence among new injectors. METHODS Cross-sectional study among people who inject drugs (PWID) who attended harm reduction centers in Catalonia in 2010-11. Anonymous questionnaires and oral fluid samples were collected. Poisson regression models were applied to determine the association between HIV/HCV infection and risk factors. RESULTS Of the 761 participants, 21.4% were new injectors. New injectors were younger than long-term injectors (mean age = 31.6 vs. 37.8) and were more likely to be immigrants (59.0% vs. 33.4%). HIV and HCV prevalence was 20.6% and 59.4% among new injectors, and estimated HIV and HCV incidence 8.7 and 25.1 /100 person-years, respectively. Among new injectors, HIV infection was associated with homelessness (PR = 3.10) and reporting a previous sexually transmitted infection (PR = 1.79). Reporting front/backloading (PR = 1.33) and daily injection (PR = 1.35) were risk-factors for HCV infection. For long-term injectors, HIV risk factors were: having shared syringes (PR = 1.85), having injected cocaine (PR = 1.38), reporting front/backloading (PR = 1.30) and ever having been in prison (PR = 2.03). CONCLUSION A large proportion of PWID in Catalonia are new injectors, a subgroup with a high level of both sexual and parenteral exposure and a high incidence rate of HIV/ HCV infections. It is important to improve early diagnosis of these infections among this group, in particular among migrants. To identify and address risk factors for homelessness PWID should be a priority.
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Affiliation(s)
- Cinta Folch
- a Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Agéncia de Salut Pública de Catalunya (ASPC), Generalitat de Catalunya , Badalona , Spain.,b CIBER Epidemiología y Salud Pública (CIBERESP) , Spain.,c Fundació Institut d'Investigació Germans Trias i Pujol (IGTP) , Badalona , Spain
| | - Jordi Casabona
- a Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Agéncia de Salut Pública de Catalunya (ASPC), Generalitat de Catalunya , Badalona , Spain.,b CIBER Epidemiología y Salud Pública (CIBERESP) , Spain.,c Fundació Institut d'Investigació Germans Trias i Pujol (IGTP) , Badalona , Spain.,d Departament de Pediatria, d'Obstetrícia i Ginecologia i de Medicina Preventiva i de Salut Pública, Facultat de Medicina, Universitat Autònoma de Barcelona , Bellaterra (Cerdanyola del Vallés) , Spain
| | - Albert Espelt
- b CIBER Epidemiología y Salud Pública (CIBERESP) , Spain.,e Agéncia de Salut Pública de Barcelona , Spain.,f Departament de Psicologia i Metodologia de les Ciéncies de la Salut, Universitat Autònoma de Barcelona , Bellaterra (Cerdanyola del Vallés) , Spain
| | - Xavier Majó
- g Subdirecció General de Drogodependéncies, Agéncia Salut Pública de Catalunya (ASPC), Departament de Salut de la Generalitat de Catalunya
| | | | - Victoria Gonzalez
- a Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Agéncia de Salut Pública de Catalunya (ASPC), Generalitat de Catalunya , Badalona , Spain.,b CIBER Epidemiología y Salud Pública (CIBERESP) , Spain.,i Microbiology Service, Hospital Universitari Germans Trias i Pujol , Badalona , Spain
| | - Lucas Wiessing
- j European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) , Lisbon , Portugal
| | - Joan Colom
- g Subdirecció General de Drogodependéncies, Agéncia Salut Pública de Catalunya (ASPC), Departament de Salut de la Generalitat de Catalunya
| | - M Teresa Brugal
- b CIBER Epidemiología y Salud Pública (CIBERESP) , Spain.,e Agéncia de Salut Pública de Barcelona , Spain
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Zhou K, Hu F, Wang C, Xu M, Lan Y, Morano JP, Lemon SM, Tucker JD, Cai W. Genotypic distribution and hepatic fibrosis among HIV/HCV co-infected individuals in Southern China: a retrospective cross-sectional study. BMC Infect Dis 2015; 15:401. [PMID: 26424404 PMCID: PMC4589973 DOI: 10.1186/s12879-015-1135-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 09/21/2015] [Indexed: 02/06/2023] Open
Abstract
Background End-stage liver disease and hepatocellular carcinoma due to hepatitis C virus (HCV) co-infection are increasingly common causes of death among HIV-infected individuals. However, there are few clinical investigations of HIV/HCV co-infected individuals from low and middle-income nations. Here, we compare the epidemiology of HCV-infected and HIV/HCV co-infected individuals in Southern China and examine hepatic fibrosis scores in co-infected individuals. Methods We conducted a retrospective cross-sectional study of treatment-naïve HIV/HCV co-infected and HCV mono-infected subjects. Bivariate and multivariate models were used to examine the association between demographics and HCV genotype. Among co-infected individuals, we also studied the relationship between fibrosis scores derived from non-invasive studies and HCV genotype. Results Data were collected from 175 HCV-infected individuals, including 89 (51 %) HIV/HCV co-infected individuals. HIV/HCV co-infection was correlated with intravenous drug use (AOR 46.25, p < 0.001) and not completing high school (AOR 17.39, p < 0.001) in a multivariate model. HIV/HCV co-infected individuals were more likely to be infected with HCV genotype 6a (p < 0.0001) or 3a (p < 0.023), whereas increased fibrosis (FIB-4 score) was associated with HCV genotype 3a infection (β 2.18, p < 0.001). Discussion Our results suggest that intravenous drug use is driving HIV/HCV co-infection in Southern China. While additional studies are needed, HCV genotype 6a is more common and genotype 3a appears to be associated with more severe hepatic fibrosis in co-infected individuals. Conclusions Future HIV/HCV co-infection research in China should focus on at risk populations, HCV testing uptake, and genotype-specific treatment. Electronic supplementary material The online version of this article (doi:10.1186/s12879-015-1135-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kali Zhou
- Guangzhou Eighth People's Hospital, Guangzhou, China.
| | - Fengyu Hu
- Guangzhou Eighth People's Hospital, Guangzhou, China.
| | - Charles Wang
- UNC-Project - China, Division of Infectious Diseases, Department of Medicine, UNC Chapel Hill School of Medicine, Chapel Hill, NC, USA. .,Department of Medicine, Division of Gastroenterology Providence, Brown University School of Medicine, Rhode Island, USA.
| | - Min Xu
- Guangzhou Eighth People's Hospital, Guangzhou, China.
| | - Yun Lan
- Guangzhou Eighth People's Hospital, Guangzhou, China.
| | - Jamie P Morano
- University of South Florida, Morsani College of Medicine, USF International, Tampa, FL, USA.
| | - Stanley M Lemon
- UNC-Project - China, Division of Infectious Diseases, Department of Medicine, UNC Chapel Hill School of Medicine, Chapel Hill, NC, USA. .,Division of Infectious Diseases, Department of Medicine, UNC Chapel Hill School of Medicine, Chapel Hill, NC, USA.
| | - Joseph D Tucker
- Guangzhou Eighth People's Hospital, Guangzhou, China. .,UNC-Project - China, Division of Infectious Diseases, Department of Medicine, UNC Chapel Hill School of Medicine, Chapel Hill, NC, USA.
| | - Weiping Cai
- Guangzhou Eighth People's Hospital, Guangzhou, China.
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Lu L, An Y, Zou J, Gu L, Zhao Z, Zhang X, Li C, Kurihara C, Hokari R, Itakura J, Kurosaki M, Izumi N, Fu Y, Nakano T, Kato T, Negro F, Chen G. The evolutionary patterns of hepatitis C virus subtype 2a and 6a isolates linked to an outbreak in China in 2012. Virology 2015; 485:431-8. [PMID: 26343863 DOI: 10.1016/j.virol.2015.08.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 07/29/2015] [Accepted: 08/10/2015] [Indexed: 02/06/2023]
Abstract
UNLABELLED An HCV outbreak occurred in 2012 in China, affecting hundreds of patients. We characterized HCV subtype 2a and 6a sequences from 60 and 102 patients, respectively, and co-analyzed them with 82 local controls and 103 calibrating references. The close grouping of the patients׳ sequences contrasted sharply with the diversity of local controls. Scaled by the calibrating references, the emergence of patients׳ isolates was estimated at 2-5 years before sampling. In contrast, the controls intermingled with the calibrating references that were much older. For both subtypes, the major and minor clusters could be defined, with the closeness to indicate linked transmission. CONCLUSION HCV sequences from the study patients grouped into three subtype 2a and two subtype 6a clusters, in addition to three 6a solitary branches, representing descendants of eight earlier strains that were distinct and otherwise sporadic. Due to iatrogenic transmission through reusing needles, five strains were highly selected and preferentially spread.
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Affiliation(s)
- Ling Lu
- Laboratory for Hepatology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China; The Center for Viral Oncology, Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, KS, United States of America.
| | - Yuling An
- Department of Liver Transplantation, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Ji Zou
- Laboratory for Hepatology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Lin Gu
- Laboratory for Hepatology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zhixin Zhao
- Laboratory for Hepatology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xiaohong Zhang
- Laboratory for Hepatology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Chunhua Li
- The Center for Viral Oncology, Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Chie Kurihara
- Department of Internal Medicine, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Ryota Hokari
- Department of Internal Medicine, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Jun Itakura
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Musashino, Tokyo, Japan
| | - Masayuki Kurosaki
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Musashino, Tokyo, Japan
| | - Namiki Izumi
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Musashino, Tokyo, Japan
| | - Yongshui Fu
- Guangzhou Blood Center, Guangzhou, Guangdong, China
| | - Tatsunori Nakano
- Department of Internal Medicine, Fujita Health University, Nanakuri Sanatorium, Tsu, Mie, Japan
| | - Takanobu Kato
- Department of Virology II, National Institute of Infectious Diseases, Shinjyuku, Tokyo, Japan
| | - Francesco Negro
- Divisions of Gastroenterology and Hepatology and of Clinical pathology, University, Hospitals, Geneva, Switzerland
| | - Guihua Chen
- Department of Liver Transplantation, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.
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Gallay PA, Bobardt MD, Chatterji U, Trepanier DJ, Ure D, Ordonez C, Foster R. The Novel Cyclophilin Inhibitor CPI-431-32 Concurrently Blocks HCV and HIV-1 Infections via a Similar Mechanism of Action. PLoS One 2015; 10:e0134707. [PMID: 26263487 PMCID: PMC4532424 DOI: 10.1371/journal.pone.0134707] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 07/13/2015] [Indexed: 12/17/2022] Open
Abstract
HCV-related liver disease is the main cause of morbidity and mortality of HCV/HIV-1 co-infected patients. Despite the recent advent of anti-HCV direct acting antivirals (DAAs), the treatment of HCV/HIV-1 co-infected patients remains a challenge, as these patients are refractory to most therapies and develop liver fibrosis, cirrhosis and liver cancer more often than HCV mono-infected patients. Until the present study, there was no suitable in vitro assay to test the inhibitory activity of drugs on HCV/HIV-1 co-infection. Here we developed a novel in vitro "co-infection" model where HCV and HIV-1 concurrently replicate in their respective main host target cells--human hepatocytes and CD4+ T-lymphocytes. Using this co-culture model, we demonstrate that cyclophilin inhibitors (CypI), including a novel cyclosporin A (CsA) analog, CPI-431-32, simultaneously inhibits replication of both HCV and HIV-1 when added pre- and post-infection. In contrast, the HIV-1 protease inhibitor nelfinavir or the HCV NS5A inhibitor daclatasvir only blocks the replication of a single virus in the "co-infection" system. CPI-431-32 efficiently inhibits HCV and HIV-1 variants, which are normally resistant to DAAs. CPI-431-32 is slightly, but consistently more efficacious than the most advanced clinically tested CypI--alisporivir (ALV)--at interrupting an established HCV/HIV-1 co-infection. The superior antiviral efficacy of CPI-431-32 over ALV correlates with its higher potency inhibition of cyclophilin A (CypA) isomerase activity and at preventing HCV NS5A-CypA and HIV-1 capsid-CypA interactions known to be vital for replication of the respective viruses. Moreover, we obtained evidence that CPI-431-32 prevents the cloaking of both the HIV-1 and HCV genomes from cellular sensors. Based on these results, CPI-431-32 has the potential, as a single agent or in combination with DAAs, to inhibit both HCV and HIV-1 infections.
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Affiliation(s)
- Philippe A. Gallay
- Department of Immunology & Microbial Science, The Scripps Research Institute, La Jolla, California, United States of America
| | - Michael D. Bobardt
- Department of Immunology & Microbial Science, The Scripps Research Institute, La Jolla, California, United States of America
| | - Udayan Chatterji
- Department of Immunology & Microbial Science, The Scripps Research Institute, La Jolla, California, United States of America
| | - Daniel J. Trepanier
- Ciclofilin Pharmaceuticals Inc., San Diego, California, United States of America
| | - Daren Ure
- Ciclofilin Pharmaceuticals Inc., San Diego, California, United States of America
| | - Cosme Ordonez
- Ciclofilin Pharmaceuticals Inc., San Diego, California, United States of America
| | - Robert Foster
- Ciclofilin Pharmaceuticals Inc., San Diego, California, United States of America
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Ju W, Yang S, Feng S, Wang Q, Liu S, Xing H, Xie W, Zhu L, Cheng J. Hepatitis C virus genotype and subtype distribution in Chinese chronic hepatitis C patients: nationwide spread of HCV genotypes 3 and 6. Virol J 2015; 12:109. [PMID: 26206422 PMCID: PMC4513753 DOI: 10.1186/s12985-015-0341-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 07/10/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) genotype and subtype are related to disease progression and response to antiviral therapy. Current HCV genotype and subtype distribution data, especially for genotypes 3 and 6, are limited in China. Our purpose was to investigate the current HCV genotype and subtype distributions in chronic hepatitis C patients in China. METHODS Chronic hepatitis C patients (n = 1012) were enrolled, and demographic information and possible transmission risk factors were collected. Serum samples were subjected to reverse-transcription polymerase chain reaction, followed by direct DNA sequencing and phylogenetic analysis of the NS5B and core/E1 regions to determine HCV genotypes/subtypes. The geographical distributions of HCV genotypes/subtypes were analyzed. Demographic information and transmission risk factors were compared between different HCV genotypes/subtypes. RESULTS Four genotypes and seven subtypes of HCV were detected in 970 patients. Subtypes 1b, 2a, 3a, 6a, 3b, 6n, and 1a were detected at frequencies of 71.96%, 19.90%, 3.20%, 2.16%, 1.96%, 0.41%, and 0.41%, respectively. Genotypes 3 and 6 showed an increasingly wide geographic distribution over time. Patients with subtypes 1b and 2a were older than those with 3a, 3b, 6a, and 6n subtypes (p < 0.05 in all subtypes). More genotype 1 and 2 patients underwent blood transfusion than those with genotype 3 (all p < 0.05). More genotype 3 and 6 patients had a history of intravenous drug use than those with genotypes 1 and 2 (all p < 0.05). CONCLUSIONS Though subtypes 1b and 2a are still the most prevalent HCV subtypes in China, genotype 3 and 6 HCV infections have already spread nationwide from southern and western China.
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Affiliation(s)
- Wei Ju
- Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, 8 East Jingshun Street, Chaoyang District, Beijing, 100015, China.
| | - Song Yang
- Center of Hepatology, Beijing Ditan Hospital, Capital Medical University, 8 East Jingshun Street, Chaoyang District, Beijing, 100015, China.
| | - Shenghu Feng
- Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, 8 East Jingshun Street, Chaoyang District, Beijing, 100015, China.
| | - Qi Wang
- Center of Hepatology, Beijing Ditan Hospital, Capital Medical University, 8 East Jingshun Street, Chaoyang District, Beijing, 100015, China.
| | - Shunai Liu
- Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, 8 East Jingshun Street, Chaoyang District, Beijing, 100015, China.
| | - Huichun Xing
- Center of Hepatology, Beijing Ditan Hospital, Capital Medical University, 8 East Jingshun Street, Chaoyang District, Beijing, 100015, China.
| | - Wen Xie
- Center of Hepatology, Beijing Ditan Hospital, Capital Medical University, 8 East Jingshun Street, Chaoyang District, Beijing, 100015, China.
| | - Liying Zhu
- Department of Infectious Diseases, The Fourth Hospital of Harbin Medical University, 37 Yiyuan Street, Nangang District, Harbin, 150081, China.
| | - Jun Cheng
- Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, 8 East Jingshun Street, Chaoyang District, Beijing, 100015, China.
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Zhou W, Wang X, Zhou S, Xie N, Liu P, Luo L, Peng J, Liu M, Desrosiers A, Schottenfeld R, Chawarski MC. Hepatitis C seroconversion in methadone maintenance treatment programs in Wuhan, China. Addiction 2015; 110:796-802. [PMID: 25529103 PMCID: PMC4598328 DOI: 10.1111/add.12836] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 01/16/2014] [Accepted: 12/10/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIMS To decrease infectious disease transmission, China is expanding methadone maintenance treatment (MMT). This study evaluated the prevalence of hepatitis C virus (HCV) infection at MMT entry, seroconversion rates after admission and potential risk factors for HCV seroconversion during MMT in Wuhan, China. DESIGN Cross-sectional survey of all patients entering MMT and prospective follow-up of patients HCV seronegative at admission. SETTING All MMT clinics in Wuhan, China. PARTICIPANTS A total of 12 755 opiate-dependent individuals entering MMT between May 2006 and June 2011; 1200 participants HCV seronegative at admission were followed. MEASUREMENTS Serological tests for HCV and self-report data on risk behaviors at MMT admission; urine toxicology results and repeated assessments of serological status and risk behaviors during treatment on patients HCV seronegative at admission. FINDINGS HCV seroprevalence at admission was 72.1% [95% confidence interval (CI) = 71.3-72.9%] and 555/1200 (46.3%, 95% CI = 43.5-49.1%) patients seroconverted to HCV during MMT. The mean time to HCV seroconversion was 3 (95% CI = 2.84-3.07) years with a cumulative seroconversion rate of 34.5 (95% CI = 31.5-36.9) per 100 person-years. Significant predictors of HCV conversion included injection drug use in the past 30 days [relative hazard (RH) 2.0, 95% CI: 1.6 - 2.4, P=0.002] and the rate of opiate-positive urine tests during MMT (RH 2.0, 95% CI = 1.3-3.1, P<0.001). CONCLUSIONS Methadone maintenance treatment patients in Wuhan, China show a high prevalence of hepatitis C virus at admission (72.1%) and a high rate of seroconversion during treatment (46.3%). Seroconversion is associated with continuing injection drug use.
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Affiliation(s)
- Wang Zhou
- Wuhan Center for Disease Control and Prevention, Wuhan, Hubei, PR China
| | - Xia Wang
- Wuhan Center for Disease Control and Prevention, Wuhan, Hubei, PR China
| | - Sheng Zhou
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, USA
| | - Nianhua Xie
- Wuhan Center for Disease Control and Prevention, Wuhan, Hubei, PR China
| | - Pulin Liu
- Wuhan Center for Disease Control and Prevention, Wuhan, Hubei, PR China
| | - Li Luo
- Wuhan Center for Disease Control and Prevention, Wuhan, Hubei, PR China
| | - Jinsong Peng
- Wuhan Center for Disease Control and Prevention, Wuhan, Hubei, PR China
| | - Manqing Liu
- Wuhan Center for Disease Control and Prevention, Wuhan, Hubei, PR China
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Nadol P, O’connor S, Duong H, Le LVN, Thang PH, Tram TH, Ha HTT, Mcconnell MS, Partridge J, Kaldor J, Law M, Nguyen TA. Findings from integrated behavioral and biologic survey among males who inject drugs (MWID) - Vietnam, 2009-2010: evidence of the need for an integrated response to HIV, hepatitis B virus, and hepatitis C virus. PLoS One 2015; 10:e0118304. [PMID: 25692469 PMCID: PMC4333571 DOI: 10.1371/journal.pone.0118304] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 01/14/2015] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Given the overlapping modes of transmission of HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV), understanding the burden and relationship of these infections is critical for an effective response. Representative data on these infections among males who inject drugs (MWID), the key high-risk population for HIV in Vietnam, are currently lacking. METHODS Data and stored specimens from Vietnam's 2009-2010 Integrated Biologic and Behavioral Survey, a cross-sectional study among high-risk populations, were used for this analysis. Plasma samples were tested for HIV, HBV, and HCV using commercial assays. A questionnaire was administered to provide demographic, behavior, and service-uptake information. Provincial-level analyses were conducted to profile MWID enrollees and to provide estimates on the prevalence of HIV, HBV, and HCV infection. RESULTS Among 3010 MWID sampled across 10 provinces, the median (range) HIV prevalence was 28.1% (1.0%-55.5%). Median prevalence for current HBV infection (HBsAg+) was 14.1% (11.7%-28.0%), for previous exposure to HBV (total anti-HBc+) was 71.4% (49.9%-83.1%), and for current or past HCV infection (HCV Ag/Ab+) was 53.8% (10.9%-80.8%). In adjusted analysis, HBsAg+ (aOR: 2.09, 1.01-4.34) and HCV Ag/Ab+ (aOR: 19.58, 13.07-29.33) status were significantly associated with HIV infection; the association with total anti-HBc+ approached significance (aOR: 1.29, 0.99-1.68). CONCLUSION The prevalence and association between HIV, HBV, and HCV are high among MWID in Vietnam. These findings indicate the need for integrated policies and practice that for the surveillance, prevention, screening, and treatment of both HIV and viral hepatitis among MWID in Vietnam.
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Affiliation(s)
- Patrick Nadol
- U.S. Centers for Disease Control and Prevention, Division of Global HIV/AIDS, Hanoi, Vietnam
- Kirby Institute for Infection and Immunity, University of New South Wales, Sydney, Australia
| | - Siobhan O’connor
- U.S. Centers for Disease Control and Prevention, Division of Viral Hepatitis, Atlanta, Georgia, United States of America
| | - Hao Duong
- U.S. Centers for Disease Control and Prevention, Division of Global HIV/AIDS, Hanoi, Vietnam
| | - Linh-Vi N. Le
- U.S. Centers for Disease Control and Prevention, Division of Global HIV/AIDS, Hanoi, Vietnam
| | - Pham Hong Thang
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Tran Hong Tram
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | | | - Michelle S. Mcconnell
- U.S. Centers for Disease Control and Prevention, Division of Global HIV/AIDS, Hanoi, Vietnam
| | - Jeff Partridge
- U.S. Centers for Disease Control and Prevention, Division of Influenza Control, Atlanta, Georgia, United States of America
| | - John Kaldor
- Kirby Institute for Infection and Immunity, University of New South Wales, Sydney, Australia
| | - Matthew Law
- Kirby Institute for Infection and Immunity, University of New South Wales, Sydney, Australia
| | - Tuan Anh Nguyen
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
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Coppola N, Martini S, Pisaturo M, Sagnelli C, Filippini P, Sagnelli E. Treatment of chronic hepatitis C in patients with HIV/HCV coinfection. World J Virol 2015; 4:1-12. [PMID: 25674512 PMCID: PMC4308522 DOI: 10.5501/wjv.v4.i1.1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 09/30/2014] [Accepted: 10/27/2014] [Indexed: 02/05/2023] Open
Abstract
Hepatitis C virus (HCV) infection is one of the most frequent causes of comorbidity and mortality in the human immunodeficiency virus (HIV) population, and liver-related mortality is now the second highest cause of death in HIV-positive patients, so HCV infection should be countered with adequate antiviral therapy. In 2011 began the era of directly acting antivirals (DAAs) and the HCV NS3/4A protease inhibitors telaprevir and boceprevir were approved to treat HCV-genotype-1 infection, each one in combination with pegylated interferon alfa (Peg-IFN) + ribavirin (RBV). The addition of the first generation DAAs, strongly improved the efficacy of antiviral therapy in patients with HCV-genotype 1, both for the HCV-monoinfected and HIV/HCV coinfected, and the poor response to Peg-IFN + RBV in HCV/HIV coinfection was enhanced. These treatments showed higher rates of sustained virological response than Peg-IFN + RBV but reduced tolerability and adherence due to the high pill burden and the several pharmacokinetic interactions between HCV NS3/4A protease inhibitors and antiretroviral drugs. Then in 2013 a new wave of DAAs arrived, characterized by high efficacy, good tolerability, a low pill burden and shortened treatment duration. The second and third generation DAAs also comprised IFN-free regimens, which in small recent trials on HIV-positive patients have shown comforting preliminary results in terms of efficacy, tolerability and adherence.
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Zhou Y, Sun L, Wang X, Zhou L, Li J, Liu M, Wang F, Peng J, Gui X, Zhao H, Reichenbach N, Zhou D, Ho WZ. Heroin use promotes HCV infection and dysregulates HCV-related circulating microRNAs. J Neuroimmune Pharmacol 2015; 10:102-10. [PMID: 25572448 DOI: 10.1007/s11481-014-9577-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 12/23/2014] [Indexed: 01/22/2023]
Abstract
Hepatitis C virus (HCV) infection is common among injection drug users (IDUs). There is accumulating evidence that circulating microRNAs (miRNAs) are associated with HCV infection and disease progression. The present study was undertaken to determine the in vivo impact of heroin use on HCV infection and HCV-related circulating miRNA expression. Using the blood specimens from four groups of the study subjects (HCV-infected individuals, heroin users with/without HCV infection, and healthy volunteers), we found that HCV-infected heroin users had significantly higher viral load than HCV-infected non-heroin users (p = 0.0004). Measurement of HCV-related circulating miRNAs in plasma showed that miRs-122, 141, 29a, 29b, and 29c were significantly increased in the heroin users with HCV infection, whereas miR-351, an HCV inhibitory miRNA, was significantly decreased in heroin users as compared to control subjects. Further investigation identified a negative correlation between the plasma levels of miR-29 family members and severity of HCV infection based on aspartate aminotransferase to platelet ratio index (APRI). In addition, heroin use and/or HCV infection also dysregulated a panel of plasma miRNAs. Taken together, these data for the first time revealed in vivo evidence that heroin use and/or HCV infection alter circulating miRNAs, which provides a novel mechanism for the impaired innate anti-HCV immunity among IDUs.
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Affiliation(s)
- Yu Zhou
- Department of Pathology and Laboratory Medicine, Temple University School of Medicine, 3500 N. Broad St., Philadelphia, PA, 19140, USA
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Xiaoli W, Lirong W, Xueliang W, Jinsong L, Hengxin L, Wei J. Risk Factors of Hepatitis C Virus Infection in Drug Users From Eleven Methadone Maintenance Treatment Clinics in Xi'an, China. HEPATITIS MONTHLY 2014; 14:e19601. [PMID: 25598787 PMCID: PMC4286713 DOI: 10.5812/hepatmon.19601] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 09/30/2014] [Accepted: 11/08/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND Hepatitis C virus (HCV) infection rates in drug users vary among different regions of China. Drug users who are unaware of their HCV serostatus tend to engage in more risky behaviors. OBJECTIVES This prospective study aimed to assess risk factors of HCV infection in drug users among 11 methadone maintenance treatment (MMT) clinics in Xi'an, China. PATIENTS AND METHODS Baseline characteristics and drug use information of patients were collected upon enrollment in the study and anti-HCV tests were performed within one month after the enrollment. Data on daily medication, monthly random urine morphine test results, illicit drug use and MMT retention time were recorded during a 5-year follow-up. RESULTS Of 10243 patients, 58.0% had positive results for anti-HCV. Injection drug use, longer duration of drug abuse, older age, female gender, unmarried status and unemployment were independent risk factors of HCV infection. Urine test positivity rate was lower (14.8% vs. 16.7%, χ(2) = 100.235, P < 0.05), but MMT retention rate was higher (log-rank χ(2) = 4.397, P < 0.05) in the anti-HCV positive group than anti-HCV negative one. However, multivariate regression revealed no significant association between anti-HCV serostatus and either MMT retention time or illicit drug use. CONCLUSIONS The major risk factor of HCV infection was injection drug use. The patient's awareness of his or her HCV status had a minor effect in reduction of illicit drug use and improvement in MMT retention. Therefore, adequate counseling is necessary for drug users in MMT clinics in Xi'an.
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Affiliation(s)
- Wei Xiaoli
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
- Xi’an Center for Disease Control and Prevention, Xi’an, China
| | - Wang Lirong
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Wang Xueliang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
- Corresponding Author: Wang Xueliang, Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China. Tel: +86-2982655108, Fax: +86-2982655103, E-mail:
| | - Li Jinsong
- Xi’an Center for Disease Control and Prevention, Xi’an, China
| | - Li Hengxin
- Xi’an Center for Disease Control and Prevention, Xi’an, China
| | - Jia Wei
- Methadone Maintenance Therapy Clinic, Xi’an Mental Health Center, Xi’an, China
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Clausen LN, Lundbo LF, Benfield T. Hepatitis C virus infection in the human immunodeficiency virus infected patient. World J Gastroenterol 2014; 20:12132-12143. [PMID: 25232248 PMCID: PMC4161799 DOI: 10.3748/wjg.v20.i34.12132] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 04/02/2014] [Accepted: 06/26/2014] [Indexed: 02/06/2023] Open
Abstract
Human immunodeficiency virus (HIV) and hepatitis C virus (HCV) share the same transmission routes; therefore, coinfection is frequent. An estimated 5-10 million individuals alone in the western world are infected with both viruses. The majority of people acquire HCV by injection drug use and, to a lesser extent, through blood transfusion and blood products. Recently, there has been an increase in HCV infections among men who have sex with men. In the context of effective antiretroviral treatment, liver-related deaths are now more common than Acquired Immune Deficiency Syndrome-related deaths among HIV-HCV coinfected individuals. Morbidity and mortality rates from chronic HCV infection will increase because the infection incidence peaked in the mid-1980s and because liver disease progresses slowly and is clinically silent to cirrhosis and end-stage-liver disease over a 15-20 year time period for 15%-20% of chronically infected individuals. HCV treatment has rapidly changed with the development of new direct-acting antiviral agents; therefore, cure rates have greatly improved because the new treatment regimens target different parts of the HCV life cycle. In this review, we focus on the epidemiology, diagnosis and the natural course of HCV as well as current and future strategies for HCV therapy in the context of HIV-HCV coinfection in the western world.
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Increased prevalence of hepatitis C virus subtype 6a in China: a comparison between 2004-2007 and 2008-2011. Arch Virol 2014; 159:3231-7. [PMID: 25085624 PMCID: PMC4221604 DOI: 10.1007/s00705-014-2185-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Accepted: 07/16/2014] [Indexed: 02/07/2023]
Abstract
Different hepatitis C virus (HCV) genotypes exhibit differences in disease pathogenesis and progression, as well as disease outcomes and response to therapy. Tracking the change of HCV genotypes in various epidemiological settings is critical for both disease surveillance and the development of improved antiviral treatment. Here, we tracked the changes in the prevalence of the HCV genotypes in China between 2004-2007 and 2008-2011. HCV-RNA-positive sera were collected from volunteer blood donors during the period 2008-2011. The genotypes were determined by phylogenic analysis using the NS5B and E1 sequences. Geographical and demographic distribution patterns related to the HCV genotypes obtained in 2008-2011 were compared with our previous study, which recorded data in the period 2004-2007. Pearson chi-square test and t-test were used to statistically analyze the results. In 2008-2011, HCV subtypes 1b and 6a were detected in 43.8 % (184/420) and 34.3 % (144/420), respectively. The male/female ratio was found to be higher for HCV genotype 6 than for genotypes 1 and 2. When compared with the period of 2004-2007, although no significant difference was found in gender or age for genotypes 1, 2, 3 and 6, the subtype 6a frequency was significantly increased from 11 % to 26.5 % in the blood donors from outside of Guangdong Province in 2008-2011. A pattern of increase in HCV subtype 6a was found in blood donors outside of Guangdong Province, indicating that HCV subtype 6a has rapidly spread from Guangdong to other regions of China over the past 10 years.
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Dong C, Huang ZJ, Martin MC, Huang J, Liu H, Deng B, Lai W, Liu L, Yang Y, Hu Y, Qin G, Zhang L, Song Z, Wei D, Nan L, Wang Q, Deng H, Zhang J, Wong FY, Yang W. The impact of social factors on human immunodeficiency virus and hepatitis C virus co-infection in a minority region of Si-chuan, the People's Republic of China: a population-based survey and testing study. PLoS One 2014; 9:e101241. [PMID: 24988219 PMCID: PMC4079678 DOI: 10.1371/journal.pone.0101241] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Accepted: 06/04/2014] [Indexed: 11/30/2022] Open
Abstract
Background While many human immunodeficiency virus (HIV) studies have been performed in Liangshan, most were focused only on HIV infection and based on a sampling survey. In order to fully understand HIV and hepatitis C virus (HCV) prevalence and related risk factors in this region, this study implemented in 2009, included a survey, physical examination, HIV and HCV test in two towns. Methods All residents in two towns of the Butuo county were provided a physical examination and blood tests for HIV and HCV, and then followed by an interview for questionnaire. Results In total, 10,104 residents (92.4%) were enrolled and 9,179 blood samples were collected for HIV and HCV testing, 6,072 were from individuals >14 years old. The rates of HIV, HCV, and HIV/HCV co-infection were 11.4%, 14.0%, and 7.7%, respectively for >14-year-old residents. The 25–34 yr age group had the highest prevalence of HIV, HCV, and HIV/HCV co-infections, reaching 24.4%, 26.2% and 16.0%, respectively. Overall, males had a much higher prevalence of all infections than females (HIV: 16.3% vs. 6.8%, HCV: 24.6% vs. 3.9%, HIV/HCV co-infected: 14.7% vs. 1.1%, respectively; P = 0.000). Approximately half of intravenous drug users tested positive for HIV (48.7%) and 68.4% tested positive for HCV. Logistic regression analysis showed that five factors were significantly associated with HIV and HCV infection: gender (odds ratio [OR] = 5.8), education (OR = 2.29); occupation (student as reference; farmer: OR = 5.02, migrant worker: OR = 6.12); drug abuse (OR = 18.0); and multiple sexual partners (OR = 2.92). Knowledge of HIV was not associated with infection. Conclusion HIV and HCV prevalence in the Liangshan region is very serious and drug use, multiple sexual partners, and low education levels were the three main risk factors. The government should focus on improving education and personal health awareness while enhancing drug control programs.
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Affiliation(s)
- Caiting Dong
- Department of HIV Control and Prevention, Si-chuan Center for Disease Control and Prevention, Chengdu, China
| | - Z. Jennifer Huang
- Department of International Health, Georgetown University, Washington DC, United States of America
| | - Maria C. Martin
- Department of Pediatrics - Adolescent & Young Adult Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Jun Huang
- Department of HIV Control and Prevention, Si-chuan Center for Disease Control and Prevention, Chengdu, China
| | - Honglu Liu
- Department of HIV Control and Prevention, Si-chuan Center for Disease Control and Prevention, Chengdu, China
| | - Bin Deng
- Department of HIV Control and Prevention, Si-chuan Center for Disease Control and Prevention, Chengdu, China
| | - Wenhong Lai
- Department of HIV Control and Prevention, Si-chuan Center for Disease Control and Prevention, Chengdu, China
| | - Li Liu
- Department of HIV Control and Prevention, Si-chuan Center for Disease Control and Prevention, Chengdu, China
| | - Yihui Yang
- Department of HIV Control and Prevention, Si-chuan Center for Disease Control and Prevention, Chengdu, China
| | - Ying Hu
- Department of HIV Control and Prevention, Si-chuan Center for Disease Control and Prevention, Chengdu, China
| | - Guangming Qin
- Department of HIV Control and Prevention, Si-chuan Center for Disease Control and Prevention, Chengdu, China
| | - Linglin Zhang
- Department of HIV Control and Prevention, Si-chuan Center for Disease Control and Prevention, Chengdu, China
| | - Zhibin Song
- Department of HIV Control and Prevention, Liangshan Prefecture Health Bureau, Xichang, Si-chuan, China
| | - Daying Wei
- Department of HIV Control and Prevention, Lianshan Center for Disease Control and Prevention, Xichang, Si-chuan, China
| | - Lei Nan
- Department of HIV Control and Prevention, Lianshan Center for Disease Control and Prevention, Xichang, Si-chuan, China
| | - Qixing Wang
- Department of HIV Control and Prevention, Lianshan Center for Disease Control and Prevention, Xichang, Si-chuan, China
| | - Hongxia Deng
- Department of HIV Control and Prevention, Butuo Health Bureau, Butuo, Si-chuan, China
| | - Jianxun Zhang
- Department of HIV Control and Prevention, Butuo Health Bureau, Butuo, Si-chuan, China
| | - Frank Y. Wong
- Department of Behavioral Sciences and Health Education, Emory University, Atlanta, Georgia, United States of America
| | - Wen Yang
- Department of HIV Control and Prevention, Si-chuan Center for Disease Control and Prevention, Chengdu, China
- * E-mail:
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Abstract
HCV and HIV co-infection is associated with accelerated hepatic fibrosis progression and higher rates of liver decompensation and death compared to HCV monoinfection, and liver disease is a leading cause of non-AIDS-related mortality among HIV-infected patients. New insights have revealed multiple mechanisms by which HCV and HIV lead to accelerated disease progression, specifically that HIV infection increases HCV replication, augments HCV-induced hepatic inflammation, increases hepatocyte apoptosis, increases microbial translocation from the gut and leads to an impairment of HCV-specific immune responses. Treatment of HIV with antiretroviral therapy and treatment of HCV have independently been shown to delay the progression of fibrosis and reduce complications from end-stage liver disease among co-infected patients. However, rates of sustained virologic response with PEG-IFN and ribavirin have been significantly inferior among co-infected patients compared with HCV-monoinfected patients, and treatment uptake has remained low given the limited efficacy and tolerability of current HCV regimens. With multiple direct-acting antiviral agents in development to treat HCV, a unique opportunity exists to redefine the treatment paradigm for co-infected patients, which incorporates data on fibrosis stage as well as potential drug interactions with antiretroviral therapy.
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Thong VD, Akkarathamrongsin S, Poovorawan K, Tangkijvanich P, Poovorawan Y. Hepatitis C virus genotype 6: virology, epidemiology, genetic variation and clinical implication. World J Gastroenterol 2014; 20:2927-2940. [PMID: 24659883 PMCID: PMC3961978 DOI: 10.3748/wjg.v20.i11.2927] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 01/06/2014] [Accepted: 01/19/2014] [Indexed: 02/07/2023] Open
Abstract
Hepatitis C virus (HCV) is a serious public health problem affecting 170 million carriers worldwide. It is a leading cause of chronic hepatitis, cirrhosis, and liver cancer and is the primary cause for liver transplantation worldwide. HCV genotype 6 (HCV-6) is restricted to South China, South-East Asia, and it is also occasionally found in migrant patients from endemic countries. HCV-6 has considerable genetic diversity with 23 subtypes (a to w). Although direct sequencing followed by phylogenetic analysis is the gold standard for HCV-6 genotyping and subtyping, there are also now rapid genotyping tests available such as the reverse hybridization line probe assay (INNO-LiPA II; Innogenetics, Zwijnaarde, Belgium). HCV-6 patients present with similar clinical manifestations as patients infected with other genotypes. Based on current evidence, the optimal treatment duration of HCV-6 with pegylated interferon/ribavirin should be 48 wk, although a shortened treatment duration of 24 wk could be sufficient in patients with low pretreatment viral load who achieve rapid virological response. In addition, the development of direct-acting antiviral agents is ongoing, and they give high response rate when combined with standard therapy. Herein, we review the epidemiology, classification, diagnosis and treatment as it pertain to HCV-6.
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Javanbakht M, Mirahmadizadeh A, Mashayekhi A. The long-term effectiveness of methadone maintenance treatment in prevention of hepatitis C virus among illicit drug users: a modeling study. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e13484. [PMID: 24719731 PMCID: PMC3965864 DOI: 10.5812/ircmj.13484] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 09/06/2013] [Accepted: 10/07/2013] [Indexed: 11/25/2022]
Abstract
Background: Chronic infection with hepatitis C virus (HCV) is increasingly recognized as a major global health problem. Illicit injection drug use is an important risk factor for the rising hepatitis C virus (HCV) prevalence in IR Iran. Objectives: The objective of this study was to determine the long-term effectiveness (total quality adjusted life years (QALYs) gained) of methadone maintenance treatment (MMT program) in prevention of HCV infection among injecting drug users (IDUs). Materials and Methods: A number of Markov models were developed to model morbidity and mortality among IDUs. The input data used in modeling were collected by a self-reported method from 259 IDUs before registration and one year after MMT and also from previous studies. One way and probabilistic sensitivity analyses were done to show the effects of uncertainty in parameters on number of life years and QALYs saved. The expected consequences were estimated using a life-time time horizon for the two strategies including implementation and not implementation of the MMT program. Results: Our model estimated that total number of discounted life years lived per IDU with and without the MMT program would be 5.15 (5.05 - 5.25) and 4.63 (4.42 - 4.81), respectively. The model also estimated that total number of discounted QALYs lived per IDU with and without the MMT program would be 4.11 (3.86 - 4.41) and 2.45 (2.17 - 2.84). Simulation results indicated that all differences in life years and QALYs lived between the two strategies were statistically significant (p < 0.001). Based on our model, total discounted life years and QALYs saved in a cohort of 1000 IDUs were 1790 (1520 - 2090) and 1590 (1090- 2090), respectively. Conclusions: Considering the high prevalence of illicit injecting drug use in Iran and MMT effectiveness in prevention of HCV infection, it is necessary to develop MMT centers at regional and national levels.
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Affiliation(s)
- Mehdi Javanbakht
- Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, IR Iran
| | | | - Atefeh Mashayekhi
- Health Management and Economics Research Center, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, IR Iran
- Corresponding Author: Atefeh Mashayekhi, Health Management and Economics Research Center, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, IR Iran. Tel: +98-2144017935, Fax: +98-2144017935, E-mail:
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Hepatitis C virus genotype diversity among intravenous drug users in Yunnan Province, Southwestern China. PLoS One 2013; 8:e82598. [PMID: 24358211 PMCID: PMC3866230 DOI: 10.1371/journal.pone.0082598] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 10/25/2013] [Indexed: 12/21/2022] Open
Abstract
Background Recently, high proportions (15.6%–98.7%) of intravenous drug users (IDUs) in China were found to be positive for hepatitis C virus (HCV). Yunnan Province is located in southwestern China and borders one of the world's most important opium-producing regions, thus it is an important drug trafficking route to other regions of China. Methodology/Principal Findings Here, we assessed 100 HCV-positive plasma samples from IDUs who were enrolled through the Kunming Center for Disease Control and Prevention in 2012. HCV C/E1 fragments were PCR-amplified and sequenced. We identified eight HCV subtypes (1a, 1b, 3a, 3b, 6a, 6n, 6u and 6v), of which genotype 6 was most predominant (frequency, 47%) followed by genotypes 3 (41%) and 1 (12%). HCV subtypes 6n (30%) and 3b (29%) were most common and were identified in 59% of the IDUs. We compared HCV genotypes among IDUs in Yunnan Province with those from other regions and found that the distribution patterns of HCV genotypes in Yunnan Province were similar to those in southern China, but different from those in eastern China. However, the distribution patterns of HCV subtypes varied among Yunnan Province and southern China, despite the shared similar genotypes. A comparison of the current data with those previously reported showed that the frequency of HCV genotype 6 increased from 25% to 47% within 5 years, especially subtypes 6a (5% to 15%) and 6n (11.2% to 30%). In contrast, the frequencies of subtypes 3b and 1b decreased by almost 50% within 5 years. Conclusion/Significance Our results provided further information to support the assertion that drug trafficking routes influence HCV transmission patterns among IDUs in Yunnan Province. The frequency of HCV genotypes and subtypes changed rapidly among IDUs in Yunnan Province and subtypes 6a and 6n may have originated in Vietnam and Myanmar, respectively.
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Wang J, Liu J, Huang Y, Wright DJ, Li J, Zhou Z, He W, Yang T, Yao F, Zhu X, Wen G, Bi X, Tiemuer MHL, Wen X, Huang M, Cao R, Yun Z, Lü Y, Ma H, Guo N, Yu Q, Ness P, Shan H. The persistence of hepatitis C virus transmission risk in China despite serologic screening of blood donations. Transfusion 2013; 53:2489-97. [DOI: 10.1111/trf.12297] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 05/03/2013] [Accepted: 05/05/2013] [Indexed: 12/22/2022]
Affiliation(s)
- Jingxing Wang
- Institute of Blood Transfusion; Chinese Academy of Medical Sciences; Chengdu P.R. China
- Johns Hopkins School of Medicine; Baltimore Maryland
- Westat, Inc.; Rockville Maryland
- Guangxi Blood Center; Liuzhou Guangxi P.R. China
- Kunming Blood Center; Kunming Yunnan P.R. China. Urumqi Blood Center; Urumqi Xinjiang P.R. China. Mianyang Blood Center; Mianyang Sichuan P.R. China. Luoyang Blood Center; Luoyang Henan P.R. China. Johns Hopkins School of Public Health; Baltimore Maryland
| | - Jing Liu
- Institute of Blood Transfusion; Chinese Academy of Medical Sciences; Chengdu P.R. China
- Johns Hopkins School of Medicine; Baltimore Maryland
- Westat, Inc.; Rockville Maryland
- Guangxi Blood Center; Liuzhou Guangxi P.R. China
- Kunming Blood Center; Kunming Yunnan P.R. China. Urumqi Blood Center; Urumqi Xinjiang P.R. China. Mianyang Blood Center; Mianyang Sichuan P.R. China. Luoyang Blood Center; Luoyang Henan P.R. China. Johns Hopkins School of Public Health; Baltimore Maryland
| | - Yi Huang
- Institute of Blood Transfusion; Chinese Academy of Medical Sciences; Chengdu P.R. China
- Johns Hopkins School of Medicine; Baltimore Maryland
- Westat, Inc.; Rockville Maryland
- Guangxi Blood Center; Liuzhou Guangxi P.R. China
- Kunming Blood Center; Kunming Yunnan P.R. China. Urumqi Blood Center; Urumqi Xinjiang P.R. China. Mianyang Blood Center; Mianyang Sichuan P.R. China. Luoyang Blood Center; Luoyang Henan P.R. China. Johns Hopkins School of Public Health; Baltimore Maryland
| | - David J. Wright
- Institute of Blood Transfusion; Chinese Academy of Medical Sciences; Chengdu P.R. China
- Johns Hopkins School of Medicine; Baltimore Maryland
- Westat, Inc.; Rockville Maryland
- Guangxi Blood Center; Liuzhou Guangxi P.R. China
- Kunming Blood Center; Kunming Yunnan P.R. China. Urumqi Blood Center; Urumqi Xinjiang P.R. China. Mianyang Blood Center; Mianyang Sichuan P.R. China. Luoyang Blood Center; Luoyang Henan P.R. China. Johns Hopkins School of Public Health; Baltimore Maryland
| | - Julin Li
- Institute of Blood Transfusion; Chinese Academy of Medical Sciences; Chengdu P.R. China
- Johns Hopkins School of Medicine; Baltimore Maryland
- Westat, Inc.; Rockville Maryland
- Guangxi Blood Center; Liuzhou Guangxi P.R. China
- Kunming Blood Center; Kunming Yunnan P.R. China. Urumqi Blood Center; Urumqi Xinjiang P.R. China. Mianyang Blood Center; Mianyang Sichuan P.R. China. Luoyang Blood Center; Luoyang Henan P.R. China. Johns Hopkins School of Public Health; Baltimore Maryland
| | - Zhongmin Zhou
- Institute of Blood Transfusion; Chinese Academy of Medical Sciences; Chengdu P.R. China
- Johns Hopkins School of Medicine; Baltimore Maryland
- Westat, Inc.; Rockville Maryland
- Guangxi Blood Center; Liuzhou Guangxi P.R. China
- Kunming Blood Center; Kunming Yunnan P.R. China. Urumqi Blood Center; Urumqi Xinjiang P.R. China. Mianyang Blood Center; Mianyang Sichuan P.R. China. Luoyang Blood Center; Luoyang Henan P.R. China. Johns Hopkins School of Public Health; Baltimore Maryland
| | - Weilan He
- Institute of Blood Transfusion; Chinese Academy of Medical Sciences; Chengdu P.R. China
- Johns Hopkins School of Medicine; Baltimore Maryland
- Westat, Inc.; Rockville Maryland
- Guangxi Blood Center; Liuzhou Guangxi P.R. China
- Kunming Blood Center; Kunming Yunnan P.R. China. Urumqi Blood Center; Urumqi Xinjiang P.R. China. Mianyang Blood Center; Mianyang Sichuan P.R. China. Luoyang Blood Center; Luoyang Henan P.R. China. Johns Hopkins School of Public Health; Baltimore Maryland
| | - Tonghan Yang
- Institute of Blood Transfusion; Chinese Academy of Medical Sciences; Chengdu P.R. China
- Johns Hopkins School of Medicine; Baltimore Maryland
- Westat, Inc.; Rockville Maryland
- Guangxi Blood Center; Liuzhou Guangxi P.R. China
- Kunming Blood Center; Kunming Yunnan P.R. China. Urumqi Blood Center; Urumqi Xinjiang P.R. China. Mianyang Blood Center; Mianyang Sichuan P.R. China. Luoyang Blood Center; Luoyang Henan P.R. China. Johns Hopkins School of Public Health; Baltimore Maryland
| | - Fuzhu Yao
- Institute of Blood Transfusion; Chinese Academy of Medical Sciences; Chengdu P.R. China
- Johns Hopkins School of Medicine; Baltimore Maryland
- Westat, Inc.; Rockville Maryland
- Guangxi Blood Center; Liuzhou Guangxi P.R. China
- Kunming Blood Center; Kunming Yunnan P.R. China. Urumqi Blood Center; Urumqi Xinjiang P.R. China. Mianyang Blood Center; Mianyang Sichuan P.R. China. Luoyang Blood Center; Luoyang Henan P.R. China. Johns Hopkins School of Public Health; Baltimore Maryland
| | - Xiangming Zhu
- Institute of Blood Transfusion; Chinese Academy of Medical Sciences; Chengdu P.R. China
- Johns Hopkins School of Medicine; Baltimore Maryland
- Westat, Inc.; Rockville Maryland
- Guangxi Blood Center; Liuzhou Guangxi P.R. China
- Kunming Blood Center; Kunming Yunnan P.R. China. Urumqi Blood Center; Urumqi Xinjiang P.R. China. Mianyang Blood Center; Mianyang Sichuan P.R. China. Luoyang Blood Center; Luoyang Henan P.R. China. Johns Hopkins School of Public Health; Baltimore Maryland
| | - Guoxin Wen
- Institute of Blood Transfusion; Chinese Academy of Medical Sciences; Chengdu P.R. China
- Johns Hopkins School of Medicine; Baltimore Maryland
- Westat, Inc.; Rockville Maryland
- Guangxi Blood Center; Liuzhou Guangxi P.R. China
- Kunming Blood Center; Kunming Yunnan P.R. China. Urumqi Blood Center; Urumqi Xinjiang P.R. China. Mianyang Blood Center; Mianyang Sichuan P.R. China. Luoyang Blood Center; Luoyang Henan P.R. China. Johns Hopkins School of Public Health; Baltimore Maryland
| | - Xinhong Bi
- Institute of Blood Transfusion; Chinese Academy of Medical Sciences; Chengdu P.R. China
- Johns Hopkins School of Medicine; Baltimore Maryland
- Westat, Inc.; Rockville Maryland
- Guangxi Blood Center; Liuzhou Guangxi P.R. China
- Kunming Blood Center; Kunming Yunnan P.R. China. Urumqi Blood Center; Urumqi Xinjiang P.R. China. Mianyang Blood Center; Mianyang Sichuan P.R. China. Luoyang Blood Center; Luoyang Henan P.R. China. Johns Hopkins School of Public Health; Baltimore Maryland
| | - Mei-hei-li Tiemuer
- Institute of Blood Transfusion; Chinese Academy of Medical Sciences; Chengdu P.R. China
- Johns Hopkins School of Medicine; Baltimore Maryland
- Westat, Inc.; Rockville Maryland
- Guangxi Blood Center; Liuzhou Guangxi P.R. China
- Kunming Blood Center; Kunming Yunnan P.R. China. Urumqi Blood Center; Urumqi Xinjiang P.R. China. Mianyang Blood Center; Mianyang Sichuan P.R. China. Luoyang Blood Center; Luoyang Henan P.R. China. Johns Hopkins School of Public Health; Baltimore Maryland
| | - Xiuqiong Wen
- Institute of Blood Transfusion; Chinese Academy of Medical Sciences; Chengdu P.R. China
- Johns Hopkins School of Medicine; Baltimore Maryland
- Westat, Inc.; Rockville Maryland
- Guangxi Blood Center; Liuzhou Guangxi P.R. China
- Kunming Blood Center; Kunming Yunnan P.R. China. Urumqi Blood Center; Urumqi Xinjiang P.R. China. Mianyang Blood Center; Mianyang Sichuan P.R. China. Luoyang Blood Center; Luoyang Henan P.R. China. Johns Hopkins School of Public Health; Baltimore Maryland
| | - Mei Huang
- Institute of Blood Transfusion; Chinese Academy of Medical Sciences; Chengdu P.R. China
- Johns Hopkins School of Medicine; Baltimore Maryland
- Westat, Inc.; Rockville Maryland
- Guangxi Blood Center; Liuzhou Guangxi P.R. China
- Kunming Blood Center; Kunming Yunnan P.R. China. Urumqi Blood Center; Urumqi Xinjiang P.R. China. Mianyang Blood Center; Mianyang Sichuan P.R. China. Luoyang Blood Center; Luoyang Henan P.R. China. Johns Hopkins School of Public Health; Baltimore Maryland
| | - Ru'an Cao
- Institute of Blood Transfusion; Chinese Academy of Medical Sciences; Chengdu P.R. China
- Johns Hopkins School of Medicine; Baltimore Maryland
- Westat, Inc.; Rockville Maryland
- Guangxi Blood Center; Liuzhou Guangxi P.R. China
- Kunming Blood Center; Kunming Yunnan P.R. China. Urumqi Blood Center; Urumqi Xinjiang P.R. China. Mianyang Blood Center; Mianyang Sichuan P.R. China. Luoyang Blood Center; Luoyang Henan P.R. China. Johns Hopkins School of Public Health; Baltimore Maryland
| | - Zhongqiao Yun
- Institute of Blood Transfusion; Chinese Academy of Medical Sciences; Chengdu P.R. China
- Johns Hopkins School of Medicine; Baltimore Maryland
- Westat, Inc.; Rockville Maryland
- Guangxi Blood Center; Liuzhou Guangxi P.R. China
- Kunming Blood Center; Kunming Yunnan P.R. China. Urumqi Blood Center; Urumqi Xinjiang P.R. China. Mianyang Blood Center; Mianyang Sichuan P.R. China. Luoyang Blood Center; Luoyang Henan P.R. China. Johns Hopkins School of Public Health; Baltimore Maryland
| | - Yunlai Lü
- Institute of Blood Transfusion; Chinese Academy of Medical Sciences; Chengdu P.R. China
- Johns Hopkins School of Medicine; Baltimore Maryland
- Westat, Inc.; Rockville Maryland
- Guangxi Blood Center; Liuzhou Guangxi P.R. China
- Kunming Blood Center; Kunming Yunnan P.R. China. Urumqi Blood Center; Urumqi Xinjiang P.R. China. Mianyang Blood Center; Mianyang Sichuan P.R. China. Luoyang Blood Center; Luoyang Henan P.R. China. Johns Hopkins School of Public Health; Baltimore Maryland
| | - Hongli Ma
- Institute of Blood Transfusion; Chinese Academy of Medical Sciences; Chengdu P.R. China
- Johns Hopkins School of Medicine; Baltimore Maryland
- Westat, Inc.; Rockville Maryland
- Guangxi Blood Center; Liuzhou Guangxi P.R. China
- Kunming Blood Center; Kunming Yunnan P.R. China. Urumqi Blood Center; Urumqi Xinjiang P.R. China. Mianyang Blood Center; Mianyang Sichuan P.R. China. Luoyang Blood Center; Luoyang Henan P.R. China. Johns Hopkins School of Public Health; Baltimore Maryland
| | - Nan Guo
- Institute of Blood Transfusion; Chinese Academy of Medical Sciences; Chengdu P.R. China
- Johns Hopkins School of Medicine; Baltimore Maryland
- Westat, Inc.; Rockville Maryland
- Guangxi Blood Center; Liuzhou Guangxi P.R. China
- Kunming Blood Center; Kunming Yunnan P.R. China. Urumqi Blood Center; Urumqi Xinjiang P.R. China. Mianyang Blood Center; Mianyang Sichuan P.R. China. Luoyang Blood Center; Luoyang Henan P.R. China. Johns Hopkins School of Public Health; Baltimore Maryland
| | - Qilu Yu
- Institute of Blood Transfusion; Chinese Academy of Medical Sciences; Chengdu P.R. China
- Johns Hopkins School of Medicine; Baltimore Maryland
- Westat, Inc.; Rockville Maryland
- Guangxi Blood Center; Liuzhou Guangxi P.R. China
- Kunming Blood Center; Kunming Yunnan P.R. China. Urumqi Blood Center; Urumqi Xinjiang P.R. China. Mianyang Blood Center; Mianyang Sichuan P.R. China. Luoyang Blood Center; Luoyang Henan P.R. China. Johns Hopkins School of Public Health; Baltimore Maryland
| | - Paul Ness
- Institute of Blood Transfusion; Chinese Academy of Medical Sciences; Chengdu P.R. China
- Johns Hopkins School of Medicine; Baltimore Maryland
- Westat, Inc.; Rockville Maryland
- Guangxi Blood Center; Liuzhou Guangxi P.R. China
- Kunming Blood Center; Kunming Yunnan P.R. China. Urumqi Blood Center; Urumqi Xinjiang P.R. China. Mianyang Blood Center; Mianyang Sichuan P.R. China. Luoyang Blood Center; Luoyang Henan P.R. China. Johns Hopkins School of Public Health; Baltimore Maryland
| | - Hua Shan
- Institute of Blood Transfusion; Chinese Academy of Medical Sciences; Chengdu P.R. China
- Johns Hopkins School of Medicine; Baltimore Maryland
- Westat, Inc.; Rockville Maryland
- Guangxi Blood Center; Liuzhou Guangxi P.R. China
- Kunming Blood Center; Kunming Yunnan P.R. China. Urumqi Blood Center; Urumqi Xinjiang P.R. China. Mianyang Blood Center; Mianyang Sichuan P.R. China. Luoyang Blood Center; Luoyang Henan P.R. China. Johns Hopkins School of Public Health; Baltimore Maryland
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Alavian SM, Mirahmadizadeh A, Javanbakht M, Keshtkaran A, Heidari A, Mashayekhi A, Salimi S, Hadian M. Effectiveness of Methadone Maintenance Treatment in Prevention of Hepatitis C Virus Transmission among Injecting Drug Users. HEPATITIS MONTHLY 2013; 13:e12411. [PMID: 24069039 PMCID: PMC3782738 DOI: 10.5812/hepatmon.12411] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 06/29/2013] [Accepted: 07/15/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Injecting drug users (IDUs) are a major and most important risk factor for rising hepatitis C virus (HCV) prevalence in Iran. OBJECTIVES The objective of this study was to determine the effectiveness of methadone maintenance treatment (MMT) in prevention of HCV infection transmission among IDUs. PATIENTS AND METHODS A mathematical modeling has been used to estimate number of HCV infections averted. The input parameters used in the model were collected by self-reported method from 259 IDUs before registering and one year after MMT. Nonparametric statistical tests have been used to compare risky injecting and sexual behaviors among IDUs before and after participating in MMT program. Deterministic sensitivity analyses were done to show the effects of parameters' uncertainty on outcome. RESULTS Of the 259 participants, 98.4% (255) were men, the mean age ± SD was 33.1 ± 7.58 years and HCV prevalence was 50%. The studied IDUs reported lower rate of risky injecting and sexual behavior after participation in MMT program. The cumulative incidence of HCV per 100 IDUs due to sharing injection and unsafe sexual contact with MMT program were 13.84 (95% CI: 6.17 -21.51), 0.0003 (0.0001 - 0.0005) and without it 36.48 (25.84 - 47.11) and 0.0004 (0.0002-0.0006) respectively. CONCLUSIONS The MMT program is an effective intervention to prevent HCV infection transmission, although it is essential to compare its effectiveness with other interventions before implementing it in nationwide.
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Affiliation(s)
- Seyed Moayed Alavian
- Baqiatallah Research Center for Gastrointestinal and Liver Diseases, Baqiatallah University of Medical Sciences, Tehran, IR Iran
- Middle East Liver Disease Center, Tehran, IR Iran
| | | | - Mehdi Javanbakht
- Health Management and Economics Research Center, School of Health Management and Information Sciences, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Ali Keshtkaran
- Health Management and Social Development Research Center, Golestan University of Medical Sciences, Gorgan, IR Iran
| | - Alireza Heidari
- Health Management and Social Development Research Center, Golestan University of Medical Sciences, Gorgan, IR Iran
| | - Atefeh Mashayekhi
- Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, IR Iran
| | - Shima Salimi
- Middle East Liver Disease Center, Tehran, IR Iran
| | - Mohammad Hadian
- Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, IR Iran
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Qi H, Zhao K, Xu F, Zhang X, Zhang Z, Yang L, Li C, Liang X, Guo W, Chen S, Liu Z, Zhang W, Yu XF. HIV-1 diversity, drug-resistant mutations, and viral evolution among high-risk individuals in phase II HIV vaccine trial sites in southern China. PLoS One 2013; 8:e68656. [PMID: 23869225 PMCID: PMC3711821 DOI: 10.1371/journal.pone.0068656] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Accepted: 06/03/2013] [Indexed: 11/21/2022] Open
Abstract
HIV-1 prevalence in Guangxi, China, has been growing since 1996, when the first case was reported. Over half of HIV-1 positive patients in Guangxi Province were injecting drug users (IDUs), possibly because of the province’s location near drug-trafficking routes. Since a phase II HIV vaccine trial is ongoing there, a current characterization of the subtypes of HIV-1 among IDUs in Guangxi would provide critical information for future HIV vaccine trials, as well as further control and prevention of HIV-1 transmission. Thus, we conducted a molecular epidemiological investigation of HIV-1 samples from 2008–2010 among IDUs in multiple cities in Guangxi Province. Our results, based on the gag/pol fragment, indicated a very high proportion (78.47%) of HIV-1 CRF08_BC recombinants, some CRF01_AE (15.38%) recombinants, and a low proportion of CRF07_BC (6.15%) recombinants among the IDUs. The high proportion of CRF08 HIV-1 strains among recent IDUs matches the vaccine candidate constructs. However, future vaccine development should also incorporate CRF01-targeted vaccine candidates. Distinct Env sequence evolution patterns were observed for CRF08_BC and CRF01_AE, indicating that different local selection pressures have been exerted on these two HIV-1 subtypes. Unique drug-resistant mutations were also detected, and our data indicate that HIV treatment programs should consider pre-existing drug-resistant mutations.
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Affiliation(s)
- Haiyan Qi
- Cancer Institute, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Ke Zhao
- Institute of Virology and AIDS Research, First Hospital of Jilin University, Changchun, Jilin, China
| | - Fei Xu
- Cancer Institute, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xuzhao Zhang
- Cancer Institute, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Zhiyong Zhang
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Li Yang
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Chunling Li
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Xu Liang
- Centers for Disease Control and Prevention, Baise, Guangxi, China
| | - Weigui Guo
- Centers for Disease Control and Prevention, Beihai, Guangxi, China
| | - Shihai Chen
- Centers for Disease Control and Prevention, Nanning, Guangxi, China
| | - Zhihao Liu
- Centers for Disease Control and Prevention, Baise, Guangxi, China
| | - Wenyan Zhang
- Institute of Virology and AIDS Research, First Hospital of Jilin University, Changchun, Jilin, China
| | - Xiao-Fang Yu
- Cancer Institute, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Institute of Virology and AIDS Research, First Hospital of Jilin University, Changchun, Jilin, China
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail:
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High prevalence of HIV, syphilis and HCV, and low methadone maintenance treatment in a migrant population in Beijing. J Addict Med 2013; 6:311-7. [PMID: 23041679 DOI: 10.1097/adm.0b013e31826c1135] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To provide evidence for policy makers for human immunodeficiency virus (HIV) prevention and control, we investigated HIV, syphilis, and hepatitis C virus (HCV) infection and the availability of methadone maintenance treatment (MMT) among migrant drug users in Beijing. METHODS A total of 222 participants from 3 main communities where drug abusers reside were interviewed, completed a questionnaire, and were screened for HIV using enzyme-linked immunosorbent assay, confirmed by Western blot. Descriptive statistics, χ tests, and binary logistic regression models were used to analyze differences in HIV and sexually transmitted diseases among different subpopulations. RESULTS The prevalence of HIV and syphilis in the migrant population was much higher than in permanent residents (43.0% vs 2.1% and 13.3% vs 4.3%, respectively). The HIV-infected cases in the migrant population were 33-fold higher than in permanent residents. Compared with permanent residents, the availability of MMT was much lower in the migrant population (21.9% vs 70.2%), and they were less knowledgeable about MMT (37.0% vs 84.0%). Even for those who were knowledgeable about MMT, methadone treatment was still lower (46.8% vs 82.3%). Compared with the MMT group, higher infection rates of HIV and HCV were found in the no-MMT group (36.7% vs 10.6% and 64.8% vs 50.0%, respectively). Education and employment status contributed to the different distributions between permanent residents and the migrant population and the MMT and no-MMT groups. CONCLUSIONS The prevalence of HIV, syphilis, and HCV infection was higher, and the use of MMT was lower in the migrant population. The migrant population is a noticeable challenge for HIV prevention and control in Beijing.
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Ng MH, Chou JY, Chang TJ, Lee PC, Shao WC, Lin TY, Chen VCH, Gossop M. High prevalence but low awareness of hepatitis C virus infection among heroin users who received methadone maintenance therapy in Taiwan. Addict Behav 2013; 38:2089-93. [PMID: 23403277 DOI: 10.1016/j.addbeh.2013.01.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 11/30/2012] [Accepted: 01/10/2013] [Indexed: 01/20/2023]
Abstract
BACKGROUND This study investigates the prevalence and correlates of hepatitis C virus (HCV) infections among heroin dependent individuals who received methadone maintenance therapy in Taiwan. Also, we investigate users' awareness of HCV. METHODS Participants were 773 heroin users entering the methadone maintenance treatment (MMT) program at Tsaotun Psychiatric Center in Taiwan. The presence of HCV antibodies was detected. Multivariate logistic regression was used to identify the relationship between HCV infection and correlates. RESULTS The prevalence of HCV infection was 90.8%. All participants who were HIV-positive were also infected with HCV. Multivariate logistic regression analysis showed that the route of heroin administration (injection), HIV-infection, and criminal records were significantly related to HCV infection. Few (34.8%) HCV positive heroin users were aware of their infection. CONCLUSION An extremely high prevalence of HCV infection but low awareness of their infection status was found among MMT patients in Taiwan. These findings highlight the importance of education regarding risky behaviors and the necessity for HCV treatment for this population in Taiwan.
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Affiliation(s)
- Mei-Hing Ng
- Tsaotun Psychiatric Center Department of Health, Nan-Tou 542, Taiwan.
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Kielland KB, Skaug K, Amundsen EJ, Dalgard O. All-cause and liver-related mortality in hepatitis C infected drug users followed for 33 years: a controlled study. J Hepatol 2013; 58:31-7. [PMID: 22960427 DOI: 10.1016/j.jhep.2012.08.024] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Revised: 08/22/2012] [Accepted: 08/27/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS The course of chronic hepatitis C virus (HCV) in injecting drug users (IDUs) has not been well described. The aim of this study was to compare long-term all-cause and liver-related mortality among anti-HCV positive IDUs with and without persisting HCV infection. METHODS A retrospective-prospective controlled cohort design was applied. All IDUs admitted to resident drug treatment (1970-1984) and with available stored sera were screened for anti-HCV antibody. Anti-HCV positive individuals were further tested for the presence of HCV RNA. All-cause and liver-related mortality was compared between HCV RNA positive (n=328) and HCV RNA negative individuals (n=195). The observation was accomplished through register linkage to national registers. Mean observation time was 33 years. RESULTS All-cause mortality rate was 1.85 (95% CI 1.62-2.11) per 100 person-years, male 2.11 (95% CI 1.84-2.46), female 1.39 (95% CI 1.07-1.79). Mortality rates were not influenced by persisting HCV infection. Main causes of death were intoxications (45.0%), suicide (9.1%), and accidents (8.2%). Liver disease was the cause of death in 7.5% of deaths among HCV RNA positive subjects. Five of 13 deaths among male IDUs with persisting HCV infection occurring after the age of 50 years were caused by liver disease. CONCLUSIONS The all-cause mortality in IDUs is high and with no difference between HCV RNA positive and HCV RNA negative individuals, the first three decades after HCV transmission. However, among IDUs with chronic HCV infection who have survived until 50years of age, HCV infection emerges as the main cause of death.
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Affiliation(s)
- Knut Boe Kielland
- Innlandet Hospital Trust, Centre for Addiction Issues, PO Box 104, N-2381 Brumunddal, Norway.
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Zhuang X, Wang Y, Chow EPF, Liang Y, Wilson DP, Zhang L. Risk factors associated with HIV/HCV infection among entrants in methadone maintenance treatment clinics in China: a systematic review and meta-analysis. Drug Alcohol Depend 2012; 126:286-95. [PMID: 22726912 DOI: 10.1016/j.drugalcdep.2012.05.028] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Revised: 05/21/2012] [Accepted: 05/21/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Methadone maintenance treatment (MMT) has rapidly expanded in China, from 8 pilot sites to 696 clinics covering 27 provinces, during 2004-2010. This study evaluates the demographic characteristics and drug use behaviors associated with Human Immunodeficiency Virus (HIV) and Hepatitis C Virus (HCV) infections among MMT entrants through a systematic review and meta-analysis of published literature. METHODS Thirty-nine eligible articles (1 in English and 38 in Chinese) were selected for this review. We extracted the relevant indicator information from all eligible studies and performed meta-analyses, by stratifying according to sex of the participants, age groups and drug use behaviors. Five provinces (i.e., Yunnan, Guizhou, Sichuan, Guangxi and Xinjiang) with the population size of HIV-infected drug users greater than 10,000 were defined as high transmission areas (HTAs) for HIV infection; whereas the remaining twenty-six Chinese provinces were considered as low transmission areas (LTAs). RESULTS The odds of being infected by HIV among male drug users were significantly higher than for females in high transmission areas (OR=1.49, 95% CI: 1.11-1.99, k=9), while the opposite results were observed in low transmission areas (OR=0.46, 0.27-0.79, k=11). In comparison, no significant differences in risk behaviors were found between sexes in HTAs and LTAs. Younger age was not associated with risk of HIV infection, but was associated with higher risk of HCV infection (<30 years OR=1.88; 30-40 years OR=2.21, compared with >40 years, k=17). Risk of HIV infection was higher among injectors than non-injectors (OR=4.29, 2.70-6.79, k=14) and for those who inject, there was greater risk among sharers than non-sharers (OR=2.47, 1.44-4.23, k=4). Similar patterns were also observed in HCV infection (injectors: OR=10.82, 7.60-15.40; sharers: OR=3.41, 2.56-4.54, k=7). CONCLUSIONS Characteristics of MMT entrants positive for HIV or HCV in China vary by disease types, geographical region, sex, age, and injecting behavior. These factors need to be considered in targeted interventions for MMT participants, such as age-specific health education and psychological treatment, antiretroviral therapy and needle-syringe exchange programs.
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Affiliation(s)
- Xun Zhuang
- School of Public Health, Nantong University, Nantong, 9 Seyuan Road, Nantong, Jiangsu Province 226019, China
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Ji ZH, Li CY, Lv YG, Cao W, Chen YZ, Chen XP, Tian M, Li JH, An QX, Shao ZJ. The prevalence and trends of transfusion-transmissible infectious pathogens among first-time, voluntary blood donors in Xi'an, China between 1999 and 2009. Int J Infect Dis 2012. [PMID: 23195637 DOI: 10.1016/j.ijid.2012.10.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES The prevalence of infectious diseases is increasing in developing countries, and this may threaten the biological safety of donated blood. This study analyzed trends in the prevalence of transfusion-transmissible infectious pathogens among Chinese, first-time, voluntary blood donors from 1999 to 2009 to evaluate the potential for disease transmission. METHODS From 1999 to 2009, all first-time donors at the Xi'an Blood Service (XBS) were screened for hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), and syphilis infections using enzyme-linked immunosorbent assays (ELISA); results were confirmed using alternative commercial kits. The prevalence and temporal trends were analyzed using the Cochran-Armitage trend test and other appropriate methods. RESULTS From 1999 to 2009, 263 299 first-time blood donors were analyzed. The overall prevalence rates were 1.16% for HBV, 0.51% for HCV, 0.02% for HIV, and 0.31% for syphilis. There was a significant decrease in the trend for HBV and HCV infections, while a significant increase was found for syphilis. The prevalence of HIV infection remained low and stable during the study period. CONCLUSIONS These findings suggest that HBV infection is the primary threat to blood safety, while the increasing prevalence of syphilis might also be a potential threat.
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Affiliation(s)
- Zhao-Hua Ji
- Department of Epidemiology, School of Public Health, The Fourth Military Medical University, No. 17, Changle West Road, Xi'an, China 710032
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