Low prevalence of human immunodeficiency virus and hepatitis C virus co-infection in a medium size city in southern Brazil

Dear Editor,

Approximately 35.3 million of people are infected with the human immunodeficiency virus (HIV) worldwide, and 20–30% of them are also contaminated with the hepatitis C virus (HCV). The introduction of highly active antiretroviral therapy increased the survival time and improved the quality of life of HIV-infected individuals, however hepatic diseases related to chronic HCV infection became the main cause of morbidity and mortality in these patients.¹ The present work aimed to study the prevalence and risk factors for HCV infection in a sample of HIV-infected patients from a medium size urban center in the countryside of South Brazil.

Adult individuals with HIV receiving care in a reference outpatient treatment center for HIV testing and AIDS treatment in Cruz Alta (located in the Northwest region of the state of Rio Grande do Sul, Brazil) were consecutively enrolled in the study from July 2011 to August 2012. Socio-demographic and potential risk factors for HIV infection were obtained with a standardized individual questionnaire. General laboratory and clinical data were obtained from the medical records. All participants signed an informed consent form. The study was approved by the Research Ethics Committees of the Universidade Luterana do Brasil.

A total of 148 HIV-infected patients were included in the study. Sixteen patients (10.8%) had anti-HCV and HCV-RNA positive results. A total of 13 patients (81.2%) were infected with HCV genotype 1, and three (18.8%) with genotype 3. Use of intravenous drugs and report of possible HIV acquisition by sharing needles were significantly higher in co-infected than in mono-infected patients (p < 0.001) (Table 1). The time period since HIV diagnosis was longer in co-infected than in mono-infected patients (p = 0.041). A higher proportion of HIV/HCV co-infected patients (100.0%) than mono-infected patients (62.1%) had undergone surgery in the past (p = 0.008). In the multivariate analysis, use of injecting drugs (p = 0.021), surgery history (p < 0.001) and male gender (p < 0.001) were the independent risk factors associated with HIV/HCV coinfection.

Table 1
Distribution of socio-demographic and epidemiological characteristics in HIV-positive patients according to HCV status.

Variable		Total (n = 148)	HCV-negative (n = 132)	HCV-positive (n = 16)	p
Male gender		67 (45.2)	58 (43.9)	9 (56.3)	0.428
Age (years)		41.9 ± 11.9	41.9 ± 12.2	41.6 ± 8.7	0.898
Education level					0.829
	Complete primary education or less	109 (73.6)	97 (73.5)	12 (75.0)
	Secondary or higher education	39 (26.3)	35 (26.5)	4 (25.0)
Sexual orientation a					0.947
	Heterosexual	136 (91.8)	120 (90.9)	16 (100.0)
	Homosexual	6 (4.0)	6 (4.5)	-
	Bisexual	5 (3.3)	5 (3.8)	-
Possible forms of HIV infectiona,b
	Sex	127 (85.8)	112 (84.8)	15 (93.8)	0.577
	Blood transfusion	7 (4.7)	6 (4.5)	1 (6.3)	0.931
	Cutting objects	2 (1.3)	2 (1.5)	-	0.878
	Sharing needles	5 (3.3)	1 (0.8)	4 (25.0)	<0.001
Time since HIV diagnosis (years) a		6.1 ± 5.6	5.7 ± 5.4	8.9 ± 6.1	0.041
Number of sexual partners in the past 12 months a		1.8 ± 2.4	1.8 ± 2.4	2.1 ± 2.2	0.654
Use of condom during last occurrence of sexual intercourse		90 (60.8)	78 (59.1)	12 (75.0)	0.894
Injecting drug use		4 (2.7)	–	4 (25.0)	<0.001
Smoking drug use		22 (14.8)	19 (14.4)	3 (18.8)	0.823
Snorting drug use		24 (16.2)	19 (14.4)	5 (31.3)	0.511
Blood transfusion		38 (25.6)	33 (25.0)	5 (31.3)	0.910
Tattoo		43 (29.0)	35 (26.5)	8 (50.0)	0.120
Piercing		10 (6.7)	7 (5.3)	3 (18.8)	0.123
Surgery		98 (66.2)	82 (62.1)	16 (100.0)	0.008
Endoscopy		34 (22.9)	32 (24.2)	2 (12.5)	0.941
Sharing toothbrushes		19 (12.8)	17 (12.9)	2 (12.5)	0.928
Sharing sharp objects (in salon, manicure, pedicure, barber and personal care)		61 (41.2)	57 (43.2)	4 (25.0)	0.187
Working in the health service		11 (7.4)	9 (6.8)	2 (12.5)	0.686
STD history		46 (31.0)	38 (28.8)	8 (50.0)	0.265
HAART use		111 (75.0)	99 (75.0)	12 (75.0)	0.847

• Note: Variables expressed as number (percentage) or mean ± standard deviation.
• STD, sex transmitted disease; HAART, highly active antiretroviral therapy.
• Bold values are those statistically significant (p<0.05), but this emphasis can be omitted.
• ^a
  Totals do not coincide due to lack of data from certain participants in the study.
• ^b
  Multiple response.

The prevalence of HIV/HCV co-infection varies with the geographic region. In Brazil, reports estimated an average of 20.3% of HIV/HCV co-infection, ranging from 3.3% to 82.4% according to the region.² Epidemiological studies conducted in the capital cities and metropolitan regions from Brazil have demonstrated high HIV/HCV co-infection, mainly associated to injecting drug use.² However, epidemiological reports are sparse from the countryside, limiting a better understanding of these epidemiological aspects in Brazil. The present study focused in the city of Cruz Alta, a medium size urban center with one of the highest incidence rate of HIV/AIDS in Rio Grande do Sul.³ HIV/HCV co-infection frequency was lower than in the two cities of the metropolitan area of the state, Porto Alegre (31.2%) and Canoas (23.8%).⁴,⁵ Interestingly the frequency of injecting drug users was also lower in the investigated population (2.7%) than those reported in other studies.⁴,⁵ The low HIV/HCV co-infection prevalence is probably related to the low frequency of injecting drug users in the community. This epidemiologic knowledge is essential for the development of specific prevention strategies in small and medium size cities from the Brazilian countryside.

Acknowledgement

The authors would like to thank the patients and staff of the Specialized Service (SAE) of Cruz Alta, RS, for their collaboration in the development of this study.

REFERENCES

• ¹
  Operskalski EA, Kovacs A. HIV/HCV co-infection: pathogenesis, clinical complications, treatment, and new therapeutic technologies. Curr HIV/AIDS Rep. 2011;8:12-22.
• ²
  Kuehlkamp VM, Schuelter-Trevisol F.Prevalence of human immunodeficiency virus/hepatitis C virus co-infection in Brazil and associated factors: a review. Braz J Infect Dis. 2013;17:455-63.
• ³
  Ministério da Saúde (Brasil). Secretaria de Vigilãncia em Saúde. Departamento de DST, AIDS e Hepatites Virais. Boletim Epidemiológico – AIDS e DST. Brazil: Ministério da Saúde; ano II, número 1; 2013.
• ⁴
  Wolff FH, Fuchs SC, Barcellos NN, et al. Co-infection by hepatitis C virus in HIV-infected patients in southern Brazil: genotype distribution and clinical correlates. PLoS ONE. 2010;5:e10494.
• ⁵
  Simon D, Michita RT, Béria JU, Tietzmann DC, Stein AT, Lunge VR. Alcohol misuse and illicit drug use are associated with HCV/HIV co-infection. Epidemiol Infect. 2014, http://dx.doi.org/10.1017/S0950268814000041.
  » http://dx.doi.org/10.1017/S0950268814000041

Publication Dates

• Publication in this collection
  Nov-Dec 2014

History

• Received
  30 Apr 2014
• Accepted
  25 July 2014