Prevalence and Risk Factors of HBV and HCV Co-Infection Among People Living with HIV in an Egyptian Setting

Abstract

Background: Human Immune Deficiency Virus (HIV), Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) infections constitute a global health concern. They share common modes of transmission, increasing the likelihood of co-infection. Co-infection accelerates viral replication, promotes the progression of chronic liver diseases and challenges antiviral therapy. There are no available data addressing the magnitude of chronic viral hepatitis co-infection in people living with HIV in Egypt. Nor is there a mandate for HCV/HBV screening. This cross-sectional study provides needed data on HBV and/or HCV co-infection in Egyptian people living with HIV.

Subjects and methods: The study was conducted at the HIV clinic in Alexandria Fever Hospital. The investigation included 168 confirmed HIV cases. All cases were interviewed and tested for HCV-Ab and HBsAg by ELISA.

Results: There were 52 (31%) persons who were anti-HCV positive. 40 of them had detectable HCV RNA (76.9%). HIV/HCV co-infection was significantly higher among males (40.7%) compared to only (10.9%) among females (OR = 3). History of imprisonment (OR = 4.84, CI: 1.33-17.62), accidental puncture with protruding needle contaminated with blood (OR = 3.35, CI: 0.99-11.72), alcohol use (OR = 3.03, CI: 1.13-8.09) and male gender (OR = 2.96, CI: 0.99-8.88) were all significant predictors for HIV/HCV co-infection. On the other hand, HIV/HCV co-infection was inversely associated with high education level (OR = 0.28, CI: 0.10-0.76). HBsAg was detected in 4 (2.4%), and anti-HBc in 49 (29.2%) of HIV patients. Previous HBV infection (positive anti-HBc/negative anti-HBs) was significantly associated with a history of female genital mutilation circumcision, injection drug use, invasive procedures, non-specific fatigue and HCV-Ab seropositivity.

Conclusion: Egyptian people living with HIV have an increased frequency of HCV antibody and HCV infection compared to the general population indicating a higher risk of infection and suggest a higher risk of HCV exposure. Past or present HBV co-infections are also elevated. Routine screening of these viruses in the management protocol of people living with HIV in Egypt is recommended.

Keywords: Hepatitis B virus; co-infection; epidemiology; hepatitis C virus; human immune deficiency virus; risk factors..