Hepatitis C virus seropositivity in a South African Cohort of HIV co‐infected, ARV naïve patients is associated with renal insufficiency and increased mortality

Abstract

HIV is known to affect the epidemiology, transmission, pathogenesis and natural history of HCV infection whilst studies on the effects of HCV on HIV have shown conflicting results and are confounded by the influence of intravenous drug use and antiretroviral therapy. This study was conducted in KwaZulu-Natal Province in South Africa where HIV is predominantly a sexually transmitted infection. Intravenous drug use is rare in this region and the study population was naïve to antiretroviral therapy. For this study, specimens from selected sentinel sites submitted to a central laboratory for routine HIV testing were screened for anti-HCV IgG antibodies. HIV positive HCV-positive patients were compared to HIV-positive HCV-negative patients in a subgroup of patients within this cohort in order to determine if HCV sero-prevalence was associated with clinical outcomes in a linked anonymous retrospective chart survey. The prevalence of HCV was 6.4% and that of HIV, 40.2% (n = 1,937). There was a significantly higher prevalence of HCV among HIV infected patients as compared to HIV negative patients (13.4% vs. 1.73% respectively) (n = 1,937, P < 0.001). HCV-HIV co-infected patients had significantly increased mortality (8.3 vs. 21%) (n = 162, P < 0.02). A significant association was found between HCV serostatus and abnormal urea levels (15.4 vs. 7.3 mmol/L, n = 134, P < 0.001) and creatinine levels (252.2 vs. 144.4 micromol/L, n = 134, P < 0.01). This study has found that hepatitis C co-infection is more common in HIV positive individuals and is associated with an increased mortality and renal morbidity.

Anti-HCV antibody among newly diagnosed HIV patients in Ughelli, a suburban area of Delta State Nigeria

“…This figure is much lower than the figure obtained in our study (15.0%) (Figure 1). Our figure is also higher than what was obtained in similar studies in Kenya, East Africa (10.0%), Senegal, West Africa (1.6%) and South Africa (13.4%) [36][37][38] but lower than that of another Eastern Africa state, Tanzania (18.1%) 39 . The difference in prevalence could be due to differences in social behaviour of the individuals involved in this study and population size of the individual countries 40 …”

The advent of successful organ transplantation in the Irish HIV positive cohort

“…Historically, HIV co-infection causes poorer outcomes in HCV positive patients, with higher rates of chronic HCV infection, cirrhosis, carcinoma and a poorer response to interferon therapy compared with non-HIV infected patients [23][24][25][26]. HCV recurs universally post-transplant and is associated with rapid progress of cirrhosis [27].…”

Antiretroviral treatment interruptions and risk of non-opportunistic diseases

“…There is also a higher incidence of hepatocellular carcinoma in the co-infected population [34,35]. In a demographic population in Africa with little or no intravenous drug abuse, the prevalence of co-infection with hepatitis C was higher in the HIV-positive versus HIV-negative population, suggesting that HIV infection may mute the host response to hepatitis C [36]. In fact, one study found a decrease in IFN-γ production by hepatitis C-infected CD4+ T-lymphocytes [37].…”