According to a meta-analysis of almost 800 studies published in the the advance online edition of February 24 the The Lancet there is a serious picture of co-infection of HIV and HCV that begins to become severe.
The analysis found that the overall probability of people living with HIV being infected with HCV is about 6%, but good quality data is lacking for many countries.
HIV and HCV are both bloodborne viruses that are transmitted in a similar way. HCV is a virus and we are made aware of it because they can live longer on surfaces and equipment used to inject drugs while HIV is more easily transmitted through sex.
Around the world there are approximately 37 millions of people living with HIV and 115 millions of 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 of 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 better estimate 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 initiation of antiretroviral therapy (ART), and reporting regional and national strategies for HCV screening and management, according to press release from University of Bristol.
The study authors searched for 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 of 2002 and 1 of January of 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 population sample sizes with HIV over fifty individuals and recruited participants based on the status of HIV infection or other behavioral characteristics. Editorials or comments that do not contain primary data, HCV samples, or HIV / HCV coinfected individuals, samples rely only 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 the HIV / regional burden of HCV infection was derived by applying estimates of prevalence of infection to published numbers of HIV-positive individuals. The researchers then performed a meta-analysis to estimate HCV prognoses among HIV-positive compared to HIV-negative people
- Among HIV-positive individuals, the likelihood of HIV / HCV co-infection was:
- 2,4% for the general population of samples;
- 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 overall prevalence of infection among HIV positive people was estimated to be 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, a little 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 their 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 - because of their high HIV burden.
"We found a consistent 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 within reach of these approaches are necessary for [people who inject drugs] and [among men who have sex with men] because stigmatization and other factors may limit their access to services for testing and treatment."
"The study shows that it is not just people living with HIV who are at a much greater risk of HCV infection, groups such as people who inject drugs have an extremely high prevalence of HCV infection - over 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 HCV HIV programs worldwide, especially among high-vulnerability groups, as a first step towards 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 underway in the HCV virus outbreak in people with HIV infection, especially in Eastern European countries (Translator's note: Eastern Europe and the entire continent of Asia function as a cauldron, in other words, a panela of pressure on the HCV and HIV epidemics 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 unfoldings of unknowable dimensions), "added Vickermanfrom Peter of the University of Bristol.
"It also shows the need for scale prevention interventions 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 Accompanying Comment that the confidence intervals of the estimates are broad, 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 were variable," acknowledged author Platt Amendment on the release. "Improved HCV and HIV surveillance is imperative to help define the epidemiology of infection and to inform appropriate policies for testing, prevention, treatment and care of people in need."
In addition, the estimates depend on the presence of 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 are about 25%, and slightly lower for people with HIV, but Cooke and Hallet have noted that studies of high-burden HIV + populations suggest that perhaps only half of people with HCV antibodies have currently 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 higher proportion of individuals with HCV- attributable to morbidity and mortality, as suggested by Cooke and Hallet. Targeting the co-infected population with HIV / HCV "could be an initial way to begin the major" upgrade "(...) of HCV treatment." As well as being highly effective with high cure rates for more than 90% , with new interferon-free treatments that are almost as effective in patients with HIV and relatively easy to do with HAART, "celebrated by Cooke and Hallett. In addition to using the HIV treatment program infrastructure to treat people infected with HIV / HCV, "the global community needs to leverage and emulate the greatest success of the global AIDS response to ensure greater access to HIV treatment. HCV for all. "
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 the twenty-third of February of two thousand and 16; reviewed by Mara Macedo
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