According to a meta-analysis of almost 800 studies published in the advance of the February 24th online edition of The Lancet there is a serious condition of HIV and HCV co-infection that starts to become severe.
The analysis found that the overall probability of people with HIV being infected with HCV is about 6%, but good quality data is lacking for many countries.
HIV and HCV are both blood-borne viruses that are transmitted in a similar way. HCV is a virus and we are sensitized to it because they can live longer on surfaces and equipment used to inject drugs, while HIV is more easily transmitted through sex.
Worldwide, there are approximately 37 million people living with HIV and 115 million people with antibodies to the hepatitis C virus, indicating past or present infection. It is well known that many people are infected with the virus from both, but accurate estimates have been difficult to find.
Lucy Platt from the London School of Hygiene and Tropical Medicine and colleagues conducted a systematic review and meta-analysis to help obtain a better estimate of the number of people with dual HIV / HCV serology.
The study was sponsored by the World Health Organization (WHO), which commissioned an update of its guidelines on screening for infection and the initiation of antiretroviral therapy (ART), and informing regional and national strategies for screening HCV and management, according to press release from University of Bristol.
The study authors searched medical bases 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 January 1, 2015 that indicated the prevalence of HIV and HCV. In addition to the 31,767 citations identified, 783 studies met the inclusion criteria, resulting in 902 estimates of prevalence of HIV / HCV immunodeficiency.
Included studies had sample sizes of HIV population over fifty individuals and recruited participants based on HIV infection status or other behavioral characteristics. Editorials or comments that do not contain primary data, samples of HCV or individuals co-infected with HIV / HCV, samples only depend on self-reported infection status and samples from populations with other comorbidities or interventions that place them at increased risk of infection were excluded.
Populations were categorized according to HIV exposure and HIV / regional burden of HCV infection was derived by applying infection prevalence estimates to published numbers of HIV positive individuals. The researchers then did a meta-analysis to estimate HCV prognosis among HIV positive people compared to HIV negative people.
- Among HIV positive individuals the probability of HIV / HCV co-infection was:
- 2,4% for the general sample population;
- 4,0% for pregnant women or people exposed through heterosexual contact;
- 6,4% for men who have sex with men;
- 82,4% for people who inject drugs.
- Taking into account the relative size of these populations, the global prevalence of infection among HIV positive people was estimated at 6,2%, with an interquartile range (IIQ) 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.
- Across the world, researchers estimated that there are approximately 2,278,400 of people co-infected with HIV / HCV (IIQ 4,417,000 1,271,300 for).
- Of these, just over half or 1,362,700 1,381,800 847,700 IIQ (Para), are people who inject drugs.
- Eastern Europe and Central Asia 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 had a large number of cases - 199,100 429,600 (IIQ for 2,155,900) or 19% of the total - due to its high HIV burden.
"We found a consistently higher prevalence of HCV in HIV-infected individuals than HIV-negative individuals in all vulnerable groups and regions, but especially in [people who inject drugs]," the study authors concluded. "Targeted and reaching these approaches are necessary for [people who inject drugs] and [among men who have sex with men] because stigmatization and other factors can limit their access to services for testing and treatment."
“The study shows that it’s not just people living with HIV who are at a much higher risk of HCV infection, groups such as people who inject drugs have an extremely high prevalence of HCV infection - more than 80%, ”Philippa Easterbrook of the Global Hepatitis Program said at the University of Bristol in a press release. "There is a need for routine testing for the diagnosis of infection in HIV HCV programs around the world, especially among the most vulnerable groups, as a first step in accessing new and highly curative treatments for HCV."
“This study shows how important is the control and prophylaxis in the population of injecting drug use that is ongoing in the HCV epidemic in people with HIV infection, especially in Eastern European countries (translator's note: Eastern Europe and the entire Asian continent works like a cauldron, in other words, a pressure cooker regarding the HCV and HIV epidemics that are about to explode, especially with this humanitarian crisis that is generated by the civil war in Syria and the chaos that ISIS spreads in these regions with consequences and consequences of unknowable dimensions) l, ”added Vickermanfrom Pedro from the University of Bristol.
”It also shows the need for preventive interventions on a scale, such as needle and syringe exchange and distribution programs as well as opioid replacement therapies, as well as access to HIV and HCV treatment, to reduce morbidity and new infections. . ”
As for the limitations, Graham Cooke and Timothy Hallett of Imperial College London noted in a Follow-up comment that the confidence intervals of the estimates are wide, reflecting “the scarcity of high-quality data from population studies.”
"Despite a systematic search of published and unpublished literature, estimates were identified in only 45% of countries and the quality of studies was variable," acknowledged author Platt Amendment in the release. "Improving HCV and HIV surveillance is imperative to help define the epidemiology of the infection and inform appropriate policies for testing, prevention, treatment and care for people in need."
In addition, estimates depend on the presence of the HCV-specific antibody and some people infected with the hepatitis C virus, either naturally or with treatment. The most commonly cited figures for the proportion of people who test spontaneously for HCV is about 25%, and slightly lower for people with HIV, but Cooke and Hallet noted that studies of high-burden HIV + populations suggest that perhaps only half of people with HCV antibodies currently have detectable HCV viral load and therefore could benefit from treatment.
While the co-infected population is a small part of all people with the hepatitis C virus worldwide - probably less than 5% - it can count for a greater proportion of individuals with HCV - attributable to morbidity and mortality, as suggested by Cooke and Hallet. Targeting the HIV / HCV co-infected population "could be an initial way to begin the biggest" upgrade "(...) of HCV treatment." As well as being highly effective with high cure rates of over 90%, with new treatments with free interferon that are almost as effective in HIV patients and relatively easy to get on ART, ”celebrated by Cooke and Hallet s. In addition to using the HIV treatment program infrastructure to treat people co-infected with HIV / HCV, “the world community needs to leverage and emulate the most successful global response to AIDS to ensure greater access to HIV treatment. HCV for everyone. ”
Translated from the original in English located at More Than 2 Million People Worldwide Are coinfected with HIV and Hepatitis C written by Liz Highleyman on the twenty-third of February two thousand and sixteen; reviewed by Mara Macedo
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