According to a meta-analysis of studies published almost 800the advance online edition of February 24 the The Lancetthere is an HIV severe state of coinfection and HCV that starts to become severe.
The analysis showed that the overall probability of people with HIV become infected with HCV is about 6%, but lacks good quality data for many countries.
HIV and HCV are either blood-borne viruses that are transmitted similarly. HCV is a virus and were sensitized to it because they can live longer on surfaces and equipment used to inject drugs, while HIV is more easily transmitted through sex.
Throughout the world there are approximately 37 million people living with HIV and 115 million people with antibodies to hepatitis C virus, indicating past or present infection. It is well known that many people are infected with the virus both, but precise estimates have been difficult to find.
Lucy Platt from the School of Hygiene and Tropical Medicine in London and colleagues conducted a systematic review and a meta-analysis that helps to get a better estimate of the number of people with dual serology for HIV / HCV.
The study was sponsored by the World Health Organization (WHO), which commissioned an update of its guidelines on screening for infection and the start of antiretroviral therapy (ART), and inform regional and national strategies for screening HCV and management, according topress release from the University of Bristol.
The authors searched medical databases including MEDLINE, EMBASE and CINAHL +, POPLINE, information from across Africa, Global Health, Web of Science, the Cochrane Library and other databases, looking for studies published between January 2002 and 1º January 2015 indicated that the prevalence of HIV and HCV. In addition to the identified 31,767 quotes, 783 studies met the inclusion criteria, resulting in 902 estimates of prevalence of HIV / HCV immunodeficiency.
studies have included population sample sizes with HIV and more than fifty individuals recruited participants based on the status of HIV infection or other behavioral characteristics. Editorials or comments that do not contain primary data, samples of HCV or co-infected individuals with HIV / HCV samples depend only on auto infection status reports and sample populations with other comorbidities or interventions that place them at increased risk of infection They were excluded.
The populations were categorized according to HIV exposure and burden of HIV / regional HCV infection was derived by applying the estimates of prevalence of infection to published figures of HIV-positive individuals. The researchers then did a meta-analysis to estimate HCV prognosis among HIV-positive compared to HIV negative people
- Among HIV-positive individuals the likelihood of co-infection HIV / HCV was:
- 2,4% for the general population samples;
- 4,0% for pregnant women or people exposed through heterosexual contact;
- 6,4% formen who have sex with men;
- 82,4% for people who inject drugs.
- Taking into account the relative size of these populations, the overall prevalence of infection among HIV positive people was estimated at 6,2%, with an interquartile range (IQR) of 3,4% to 11,9%.
- The chances of HCV infection were 5,8 times higher for people living with HIV compared to their HIV-negative counterparts.
- Worldwide, the researchers estimated that there are approximately 2,278,400 co-infected HIV / HCV (IIQ 4,417,000 1,271,300 to).
- Of these, a little more than half or 1,362,700 1,381,800 847,700 IIQ (To) are people who inject drugs.
- Eastern Europe and Central Asia that contributed most to this total - an estimate of cases (IIQ 404,100 607,700 to 746,500) or 27% - due to its high concentration of injecting drug users.
- Sub-Saharan Africa also showed a large number of cases - 199,100 429,600 (IQI to 2,155,900) or 19% of the total - due to its high load of HIV.
"We found a consistent higher prevalence of HCV in HIV-infected than HIV-negative individuals in all vulnerable groups and regions, but especially in [people who inject drugs]," the study authors concluded. "Oriented and the scope of these approaches are necessary for [people who inject drugs] and [among men who have sex with men] because stigma and other factors may limit their access to services for testing and treatment."
"The study shows that not only are people living with HIV who are at much higher risk of HCV infection,groups such as people who inject drugs have extremely high prevalence of HCV infection - More than 80%, "Philippa Easterbrook of the Global Programme of hepatitis said at Bristol University, in a press release. "There is a need to carry out routine tests for the diagnosis of infection in HIV-HCV programs in the world, especially among high vulnerability groups as a first step to access new and highly curative treatments for HCV."
"This study shows how important the control and prophylaxis in the population of injecting drug use that is underway in the HCV epidemic in people with HIV infection, especially in Eastern European countries (translator's note: Eastern Europe and the entire Asian continent act as a melting pot, rather, a pressure cooker with respect to HCV and HIV epidemics about to explode, especially with this humanitarian crisis that is generated by the civil war in Syria and chaos that ISIS spreads these regions with consequences and ramifications of unknowable dimensions) l, "added Peter Vickermanfrom the University of Bristol.
"It also shows the need for ema scale prevention interventions such as exchange programs and distribution of needles and syringes and opioid substitution treatment and access to treatment for HIV and HCV, to reduce morbidity and new infections . "
As for limitations, Graham Cooke and Timothy Hallett of Imperial College London observed in aAccompanying Commentthe confidence intervals of the estimates are broad, reflecting "the lack of high quality data from population studies."
"Despite a systematic search of published and unpublished literature, the estimates were identified in only 45% of the countries and the quality of the studies was variable," he acknowledged the author Platt Amendment in the release. "Improving HCV and HIV surveillance is essential to help define the epidemiology of infection and inform appropriate policies for testing, prevention, treatment and care for people in need."
Additionally, the estimates depend on the presence of specific antibody to HCV and some people infected with hepatitis C virus, either naturally or with treatment. The most commonly cited figure for the proportion of people who are tested spontaneously HCV is about 25%, and slightly lower for people with HIV, but Cooke and Hallet noted that high load studies populations HIV + suggest that perhaps only half of people with HCV antibodies present have detectable viral load of HCV and therefore could benefit from treatment.
While the population of coinfected is a small part of all people with hepatitis C in the world - probably less than 5% - can count for a higher proportion of individuals with HCV-attributable morbidity and mortality, as suggested by Cooke and Hallet. Targeting the population coinfected with HIV / HCV "could be an early form to get the biggest" upgrade "(...) of the HCV treatment." As well as being highly effective with high cure rates for over 90% with new treatments free interferon that are almost as effective in patients with HIV and relatively easy to make with ART, "concluded by Cooke and Hallet s. In addition to using the infrastructure of treatment programs for HIV in order to treat co-infected people with HIV / HCV, "the world community must leverage and emulate the most successful global response against AIDS to ensure greater access to treatment HCV for everyone. "
Translated from the original English located in More Than 2 Million People Worldwide Are coinfected with HIV and Hepatitis C written by Liz Highleyman on February 23 two thousand and 16; reviewed by Mara Macedo