Prevalence of hepatitis B, hepatitis C, and GB virus C/hepatitis G virus infections in liver disease patients and inhabitants in Ho Chi Minh, Vietnam

Abstract

The prevalence of hepatitis B virus (HBV), hepatitis C virus (HCV), and GB virus C or hepatitis G virus (GBV-C/HGV) infections was determined in 289 patients with liver disease in Ho Chi Minh City and 890 healthy inhabitants of its rural area, Dalat City, Vietnam, respectively. Serum HCV RNA and GBV-C/HGV RNA were detected by reverse transcription-polymerase chain reaction (RT-PCR). HBsAg, HCV antibodies, and GBV-C/HGV RNA were detected in 139 (47%), 69 (23%), and ten (3%) subjects, respectively, often accompanied by elevated serum levels of alanine aminotransferase. HBsAg and HCV antibodies or HCV antibodies and GBV-C/HGV RNA were detectable simultaneously in 8% and 2% of the patients, respectively. In the inhabitants, HBsAg, HCV antibodies, and GBV-C/HGV RNA were found in 51 (5.7%), nine (1.0%), and 11 (1.2%) subjects, respectively. Thus, the prevalence of HBsAg, HCV antibodies, and GBV-C/HGV RNA was significantly higher in liver disease patients than those in the general population. In the samples from 69 patients and nine inhabitants who were seropositive for HCV antibodies, HCV RNA was detectable in 42 (61%) and 4 (44%), respectively. In patients with liver disease, ten belonged to HCV genotype 1a, ten to HCV 1b, three to HCV 2a, four to HCV 2b, and two to HCV 3a by PCR with genotype-specific primers. Nine patients had mixed genotypes, and the remaining four were not classified. Of the GBV-C/HGV RNA-positive individuals, two patients and two inhabitants were positive for HBsAg, while none of the residents had HCV antibodies, although six HCV antibodies (60%) and four HCV RNA (40%) were found in patients. When a phylogenetic tree of GBV-C/HGV was constructed based on the nucleotide sequences, the 21 isolates were classified into at least two genotypes; four isolates belonged to G2, and 17 to G3. The results indicate that in Ho Chi Minh HCV infection prevails with broad distribution of genotypes together with HBV infection among patients with liver disease. This study suggests that GBV-C/HGV infection occurs independently in the two different districts in association with HCV infection.

Epidemiology, Responses, and Way Forward

“…Moreover, 34.8% to 80% of patients with liver cancer can be attributable to HBV. 8,9,11,17,27,41 For the association between HCV and liver cancer, there are very limited data and only 1 study has reported that 14% of liver cancer was due to HCV infection. 17 Mathematical models estimate nationally that by 2013, the number of people with chronic HBV infection will reach its peak at 8.6 million cases and then decrease to 8 million by 2025, as a direct impact of the universal infant vaccination.…”

“…22 The HBsAg prevalence among the subpopulations was also reported by various studies in Vietnam. The HBsAg prevalence ranged from 8.1% to 17.6% among health care workers and was also high among blood donors, people with liver diseases, people who inject drugs (PWIDs) and female sex workers ([FSWs]; Tables 1 and 2) 22,9,11,23,6,18,14 The available data suggest that hepatitis B virus (HBV) is a major cause of liver disease and liver cancer in Vietnam. Between 30.1% and 87.6% of liver cirrhosis cases and 34.8% and 80% of hepatocellular carcinoma can be attributed to HBV infection.…”

“…Our review found that the reported HBsAg prevalence in general population ranged from 5.7% to 24.7% in Vietnam, with most reporting the prevalence from 10% to 20%. 7,9,10,11,13,17,22 The value was much higher for the indicators of past infection: the anti-HBs ranged from 16% to 40% and anti-HBc from 50% to 75%. 22,10,13 There are an estimated 8.4 million people living with chronic hepatitis B in Vietnam.…”

“…Some studies found that the anti-HCV prevalence in the general population ranges from 0.38% to 1.7% 5,6,8,27 in the Northern provinces of Vietnam and 1.0% to 4.3% in the Southern provinces. 5,6,9,10,27 The studies also suggested urban populations tend to have higher prevalence compared with the rural population (Table 1). 27 The most affected are men, between the ages of 15 and 59 years, living in urban areas.…”

“…Among blood donors, patients with liver diseases, 5,6,8,9,11,27 and hospitalized nonliver disease patients, the prevalence was higher from the general population (Tables 1 and 2). 5,6,8,9,11,27 The most important risk factor was injecting drugs, as it relates to the transmission through sharing of needles and syringes. 17 In addition, repeated blood donation 6 and history of surgery, acupuncture, medical injections, and dental treatment were also reported risk factors for HCV infection in Vietnam.…”