Co-Infection by Hepatitis C Virus in HIV-Infected Patients in Southern Brazil: Genotype Distribution and Clinical Correlates

et al. (2010) Co-Infection by Hepatitis C Virus in HIV-Infected Patients in Southern Brazil: Genotype Distribution and Clinical Correlates. PLoS ONE 5(5): e10494. doi:10.1371/journal.pone.0010494 Co-Infection by Hepatitis C Virus in HIV-Infected Patients in Southern Brazil: Genotype Distribution and Clinical Correlates Fernando H. Wolff 0 Sandra C. Fuchs 0 Ne mora N. T. Barcellos 0 Paulo Ricardo de Alencastro 0 Maria Letcia R. Ikeda 0 Aja cio B. M. Branda o 0 Maicon Falavigna 0 Fla vio D. Fuchs 0 John E. Tavis, Saint Louis University, United States of America 0 1 National Institute of Science and Technology for Health Technology Assessment (IATS)-CNPq , Porto Alegre, Rio Grande do Sul , Brazil , 2 Post-graduate Program in Medical Sciences, School of Medicine, Federal University of Rio Grande do Sul , Porto Alegre, Rio Grande do Sul, Brazil, 3 Post-Graduate Program in Epidemiology , School of Medicine, Federal University of Rio Grande do Sul , Porto Alegre, Rio Grande do Sul , Brazil , 4 Therapeutic Attention Service, Sanato rio Partenon Hospital , Porto Alegre, Rio Grande do Sul , Brazil , 5 School of Medicine, Federal University of Health Sciences of Porto Alegre , Porto Alegre, Rio Grande do Sul , Brazil , 6 Centre for AIDS Studies of Rio Grande do Sul (Centro de Estudos em AIDS do Rio Grande do Sul - CEARGS) , Porto Alegre, Rio Grande do Sul , Brazil , 7 Division of Cardiology, Hospital de Cl nicas de Porto Alegre , Porto Alegre, Rio Grande do Sul , Brazil Background: Prevalence rates of Hepatitis C Virus (HCV) co-infection, the distribution of HCV genotypes, and the frequency of spontaneous resolution of hepatitis C in patients infected with the Human Immunodeficiency Virus (HIV) have a worldwide disparity. The purpose of this study is to investigate the prevalence of HCV antibodies (anti-HCV) in patients with HIV, the proportion and correlates of infection by different HCV genotypes, and rates of spontaneous resolution of HCV infection. Methods: A cross-sectional study was conducted among 1143 HIV patients under follow-up in a HIV/AIDS outpatient reference center of the Brazilian public health system. From 357 anti-HCV positive patients, a consecutive sample of 227 individuals HCV treatment-nave was interviewed and 207 was tested for HCV-RNA and genotypes. Results: Anti-HCV was detected in 357 patients (31.2%). HCV-RNA was undetectable in 16.4% of 207 anti-HCV positive individuals. Genotype 1 was diagnosed in 81.5% of the sample, genotype 2 in 1.7% and genotype 3 in 16.2%. Male gender was the unique characteristic associated with higher prevalence of genotype 1 HCV. Conclusions: Co-infection by HCV is frequent among patients with HIV in our State, and it is particularly high the infection by HCV genotype 1. Further investigation is necessary to explain the important regional variation in the proportion of infection by the different HCV genotypes and to better understand rates of spontaneous HCV clearance. - Funding: This study was funded by a grant from the Ministry of Health/Secretariat of Health Surveillance/Nacional STD and AIDS Programme (MOH/SHS/NAP); Coordinating Agency for Advanced Training of Graduate Personnel (CAPES); the National Council for Scientific and Technological Development (CNPq); and Graduate Program in Medical Sciences, Universidade Federal do Rio Grande do Sul. This study was supported, in part, by the National Institute of Science and Technology for Health Technology Assessment (IATS) - CNPq/Brazil. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist. It has been estimated that 38.6 million people are infected by the human immunodeficiency virus (HIV) worldwide, and 45 million are also infected with hepatitis C virus (HCV) [1]. In Brazil, about 0.5% of the adult population is infected with HIV [1] and among those attending the public health services, 16% HIVHCV co-infection rate had been reported in outpatient care centers [2,3], 42% in HIV-HCV anonymous testing centers [4], and 54% for patients HIV infected in infectious diseases clinics [5]. The survival of HIV infected patients has markedly improved since the introduction of highly active antiretroviral treatment (HAART). [6] While treatment of HIV-HCV co-infected patients has lower rates of sustained virological response (SVR), it might also be complicated by adverse effects and drug interaction. Therefore, the selection of patients with a favorable risk/benefit ratio to respond to treatment is necessary. The best predictor of treatment effectiveness is the HCV genotype and, consequently, it becomes a key factor to support therapeutic decisions. [711] Besides the treatment issues, geographical distribution of HCV genotypes might help to elucidate new routes of infection among HIV infected patients. This study investigated the prevalence of HCV antibodies (antiHCV) in patients with HIV, the proportion and correlates of infection by different HCV genotypes, and rates of undetectable HCV-RNA in anti-HCV positive patients treatment-nave (hepatitis C spontaneous resolution). Study design This cross-sectional study was conducted in a public reference center for HIV testing and treatment in Porto Alegre, southern Brazil. Patients were referred by primary care doctors or anonymous testing centers. The routine protocol for evaluation of patients included complete medical history and physical examination, basic hematological and biochemical tests, toxoplasmosis screening test, PPD skin test, chest X-ray, CD4, HIV viral load, hepatitis B surface antigen (HBsAg) and hepatitis C antibodies (anti-HCV). Anti-HCV was performed using third-generation enzyme-linked immunosorbent assays (ELISA-3 HepanostikaH - BioMerrie). Participants A registry of 3490 patients with HIV infection was launched in 1996 in our center, comprising all patients with at least one appointment with the infectious diseases doctor. All records were retrieved and the follow-up of surviving participants was updated until 2006. The eligibility criteria included patients aged 18 years or older, who had at least one appointment in the previous 12 months and were co-infected by HCV. The final sample comprised 1143 HIV patients actively under follow-up. All patients with an anti-HCV positive test were consecutively interviewed from March-2005 to September-2006, during the routine visit to the attending physician. Patients who did not complete the study protocol at that day were re-scheduled to prevent losses. Data collection Interviewers were trained and certified to conduct the data collection, and quality control was carried out at random by one of the investigators. Patients were interviewed using a standardized questionnaire, which included questions pertaining demographic (gender, age, skin color) and behavioral (alcohol consumption, tattooing, sharing personal (...truncated)