Hiv/hcv Coinfection

Gazeta Médica da Bahia 2009;79 (Supl.2):24-27 © 2009 Gazeta Médica da Bahia. Todos os direitos reservados. Epidemiology Around one third of HIV patients worldwide suffer from chronic hepatitis C (HCV). HIV and HCV are transmitted by percutaneous exposure to contaminated blood, through sexual intercourse, and to a lesser extent, from mother to infant. The prevalence of HCV infection varies with the mode of transmission of HIV. HCV has been reported in up to 90% of HIV-infected hemophiliacs and 90% of HIV-positive injection drug users (IDU). In contrast, the incidence of HCV infection among HIV-infected homosexual men has increased recently, and unprotected anal intercourse, traumatic sexual practices, and concomitant sexually transmitted diseases have been the main risk factors for HCV acquisition. Several outbreaks of acute hepatitis C among men who have sex with men (MSM) have recently been reported in Berlin, London, Paris and Amsterdam. On the other hand, the rates of coinfection vary considerably, both between and within countries, depending on rates of IDU within the population studied. In the United States,a cross-sectional analysis of two large HIV trials (n=1687 subjects) demonstrated that the overall prevalence of HCV coinfection was 16.%. Approximately 80% of these patients were infected with HCV genotype 1, and 75% had high HCV RNA levels (ie, >800,000 IU/mL)(1). Similar HCV prevalence rates have been demonstrated among HIV-infected populations in France, Germany, Switzerland and Greece. We studied the prevalence of HCV infection in a series of 892 HIV positive Argentinian patients detecting 30% of anti-HCV+ (ELISA) and 20% of HCV RNA+ (PCR)(2); an eloquent difference in comparison with the 0.6-0.9% prevalence of HCV infection among the control general population in Argentina. The most prevalent HCV genotypes among coinfected individuals were type 1 (80%), 3 (12%) and 4 (6%). We found no case bearing genotype 2. One other investigation comparing the virological characteristics of HIV-HCV coinfected patients vs. HCV monoifected patients, we detected significantly higher viral load and higher fibrosis score in HIV/ HCV coinfected patients. In addition, a higher prevalence of genotype 1a and 3a (40% and 20% respectively) was also reported. Lastly, genotype 1 HCV coinfected patients had a significantly higher HCV viral load (p <0.05) compared with that of the other HCV genotypes(3). A vast majority of our studied population was represented by IDUs. This data coincides with information from european and asiatic investigators who also reported a predominance of genotype 1 and 3 in intravenous drug abusers associated a higher HCV viral load in HIV-HCV coinfected patients when compared with HCV monoinfected patients.