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Year : 2003  |  Volume : 21  |  Issue : 4  |  Page : 268-270

Seroprevalence of anti-HCV and hepatitis B surface antigen in HIV infected patients

Department of Microbiology, Indira Gandhi Medical College and Mayo Hospital, Nagpur - 400 018, Maharashtra, India

Correspondence Address:
Department of Microbiology, Indira Gandhi Medical College and Mayo Hospital, Nagpur - 400 018, Maharashtra, India

 ~ Abstract 

Human immunodeficiency virus (HIV) is known to influence the natural history of infections with certain hepatitis viruses and interactions between HIV and hepatitis viruses may potentiate HIV replication. There is high degree of epidemiological similarity between hepatitis B virus and HIV as regard to high-risk group and route of transmission. Transmission of hepatitis C virus (HCV) through blood transfusion and intravenous drug abuse is well documented. Present study deals with the study of concurrent infection of HBV and HCV with HIV infection. In the study of 110 HIV seropositive patients, 34(30.4%) were positive for HBV and 8(7.27%) for HCV. The difference of concomitant infection was highly significant compared to controls. (p value < 0.0001). Heterosexual high risk behaviour was observed in 89(80.91%) of 110 HIV positive patients, out of which 23(25.8%) and 5(5.62%) were HBsAg and anti-HCV positive respectively. History of transmission was unclear in remaining patients. Concomitant infection of HIV and HBV was found to be significantly more in the symptomatic group (40.68%) compared to asymptomatic group (19.6%). As HIV infection is known to affect the natural history of both HBV and HCV infection, screening of their concurrent association is necessary.

How to cite this article:
Tankhiwale S S, Khadase R K, Jalgoankar S V. Seroprevalence of anti-HCV and hepatitis B surface antigen in HIV infected patients. Indian J Med Microbiol 2003;21:268-70

How to cite this URL:
Tankhiwale S S, Khadase R K, Jalgoankar S V. Seroprevalence of anti-HCV and hepatitis B surface antigen in HIV infected patients. Indian J Med Microbiol [serial online] 2003 [cited 2020 Nov 28];21:268-70. Available from:

Human Immunodeficiency Virus (HIV) infection appears to influence the natural history of infections with certain hepatitis viruses. Interactions between the HIV and concurrent infections with hepatitis viruses may alter the natural history and treatment response of both diseases.[1] There is high degree of epidemiological similarity between the hepatitis B virus (HBV) and HIV as regard to high risk groups, routes of transmission and the presence of virus in the body fluids.[2]
Recently infection with hepatitis C virus (HCV) is being recognised as an important problem. Blood transfusion is well documented route of transmission of HCV. A large number of HCV infections have been associated with intravenous drug abuse or administration of blood products.[3] The importance of sexual trasmission of HCV is still debated.
Co-infection of HIV with HBV and/or HCV is known to result in higher viral load of hepatitis virus and greater liver damage.[1]
The studies of association of HBV and HCV in HIV cases are rare in India. Therefore the present study was undertaken to look at the prevalence HCV and HBV in different groups and different stages of HIV infected patients.

 ~ Materials and methods Top

This study was carried out in the department of Microbiology, Indira Gandhi Medical College and Mayo General Hospital, Nagpur from August 2001 to July 2002. Clinically suspected indoor and outdoor patients were tested for HIV antibodies and HIV infection was confirmed by using 3ERS (ELISA, Rapid, Simple) format. (ELISA, Labsystem OY, Finland; Combaid, Span Diagnostic Ltd, India; HIV Tridot, J Mitra & Co., India). One hundred and ten HIV positive cases were classified into the various stages of HIV infection on clinical basis according to the CDC classification system, 1999.[4] Sera of 110 HIV positive cases were subjected for testing of anti-HCV antibody (anti-HCV) and hepatitis B surface antigen (HBsAg). A total of hundred healthy donors were included as controls and their serum samples were simultaneously screened for anti-HCV and HBsAg. Anti HCV antibody was detected by using third generation ELISA kit (ERBA Biochem, Japan). HBsAg was detected by third generation ELISA kit (General Biological Corporation, Taiwan, ROC). Samples positive for HBsAg and/or anti HCV antibody by first test were retested for confirmation of results.

 ~ Results Top

Eighty nine of the 110 HIV positive patients gave history of heterosexual high risk behaviour. Of these 23(25.8%) and 5(5.6%) were positive for HBV and HCV respectively. None of these patients gave history of parenteral transmission.
Thirty four (30.9%) and eight (7.27%) out of 110 HIV infected individuals were positive for HBsAg and anti-HCV antibody respectively. In normal healthy controls the positivity was 3% and 0% respectively. The difference is highly significant showing increased incidence of association and co-infection by these viruses. Four of these patients were infected with both HBV and HCV. Prevalence of HBsAg, anti HCV antibody in different stages of HIV infection is shown in the [Table - 1].

 ~ Discussion Top

HIV shares common route of infection with HBV and HCV.[5] HIV and HBV are known to be transmitted sexually. Sexual transmission of HCV appears to be less efficient means, certainly less efficient than is the case for HIV-1.[6] However sexual transmission of HCV has been documented.[7] It is therefore not surprising to find that some patients with HIV are co-infected with HBV and/or HCV. [7],[8]
It was observed in the present study that the incidence of co-infection rises with disease progression. Significant difference of co-infection was observed between the symptomatic (stage IV) and asymptomatic groups (stage II) of HIV infected patients.
The co-infection has pronounced effect on the natural history of these infections. Although the effect of HBV infection on HIV infection is uncertain, HIV appears to have marked influence on the natural history of HBV infection. HBV is not directly cytopathic to liver cells, hepatic necrosis is being mediated by Th1 lymphocytes induced cytotoxic T lymphocytes (CTL). Therefore any process which affects quantity and quality of CTL response will have a bearing on the outcome of liver damage in HBV infections. Further, in HIV-HBV co-infection, there is an increase in persistence of HBV,[9] increase in HBV viral load[10],[11] and increase in the incidence of HBV reactivation and reinfection.[12] However, despite an increase in HBV DNA load hepatic necrosis is less as the activity and number of CTL are reduced by the presence of HIV.[1]
Until recently, the effect of HIV on HCV infection has not been investigated. Patients with HIV died long before their liver disease became problematic. With successful therapy of HIV, it is becoming clear that HCV may lead to early onset of advanced liver disease.[5] It is known that HCV clearance is associated with the development and persistence of strong virus specific response by CTL and Th. The loss of these cells has been linked to the re-emergence of viraemia.[13]
It is thus clear that apart from other infections, HIV infected individuals have a high probability of getting co-infected with HBV and/or HCV. HIV disease progression and enhanced immunosupression has a direct bearing on the natural history and pathogenesis of these infections. Sexual transmission of both HBV and HCV also appears to be significant and is of epidemiological importance in the light of heterosexual transmission of HIV in India. Monitoring of HIV infected patients for concurrent infection with HBV and HCV is therefore necessary. 

 ~ References Top

1.Brendon Mc Carron, Thyagarajan SP. HIV and hepatotropic viruses: interactions and treatment. Indian J Med Microbiol 1998;16(1):4-11.  Back to cited text no. 1    
2.Rustgi VK, Hoofnagle JH, Gerin JL, Glemann EP, Reichert CM, Cooper JN, Macher AM. Hepatitis B virus infection in the acquired immunodeficiency symdrome. Annual Intern Med 1984;101:795-797.  Back to cited text no. 2    
3.Alter MJ, Hadler SC, Judson FN, Mares A, Alexander WJ, Hu PY, Miller JK, et al. Risk factors for Acute Non A- Non B hepatitis in the United States and association with hepatitis C virus infection. JAMA 1990;264:2231-2235.  Back to cited text no. 3    
4.Brettle RP. HIV staging and Definitions 1. HIV/AIDS, the centre for Disease control. Clinical staging system for HIV. March 22, 1999. Available at: Accessed March 12, 2003.   Back to cited text no. 4    
5.Cropley I, Main J. Hepatitis C virus infection: co-infection with HIV and HBV. Baillieres Best Pract Res Clin Gastroenterol 2000;14(2):265-275.  Back to cited text no. 5    
6.Wyld R, Robertson JR, Brettle RP, Mellor J, Prescott L, Simmonds P. Absence of hepatitis C virus transmission but frequent transmission of HIV-1 from sexual contact with doubly infected individuals. J Infect 1997;35:163-166.  Back to cited text no. 6    
7.Fainboim H, Gonzalez J, Fassio E, Martinez A, Otegni L, Eposto M, Cahn P, et al. Prevalence of hepatitis viruses in an antihuman immunodeficiency virus positive population from Argentina: A multricentric study. J Viral Hepat 1999;6(1):53-57.  Back to cited text no. 7    
8.Catalan-Soares BC, Almeida RT, Carneiro Proietti AB. Prevalence of HIV-1/2, HTLV-I/II, hepatitis B virus (HBV), hepatitis C virus (HCV), Treponema pallidum and Trypanosoma cruzi among prison inmates at Manhuacu, Minas Gerais State, Brazil. Rev Soc Bras Med Trop 2000;33(1):27-30.  Back to cited text no. 8    
9.Bodsworth NJ, Cooper DA, Donovan B. The influence of human immunodeficiency virus type 1 infection on the development of the hepatitis B virus carrier state. J Infect Dis 1991;163:1138-1140.  Back to cited text no. 9    
10.Krogsgaard K, Lindhardt BO, Nielson JO, Andersson P, Kryger P, Aldershvile J, Gerstoft J, Pedersen C. The influence of HTLV-III infection on the natural history of hepatitis B virus infection in male homosexual HBs Ag carriers. Hepatology 1987;7:37-41.  Back to cited text no. 10  [PUBMED]  
11.Bodsworth N, Donovan B, Nightigale BN. The effect of concurrent human immunodeficiency virus infection on chronic hepatitis B. A study of 150 homosexual men. J Infect Dis 1989;160:577-582.  Back to cited text no. 11    
12.Levy P, Marcellin P, Martinot PM, Degott C, Nataf J, Benhamou JP. Clinical course of spontaneous reactivation of hepatitis B virus infection in patients with chronic hepatitis B. Hepatology 1990;12:570-574.  Back to cited text no. 12    
13.Lauer GM, Walker BD. Hepatitis C virus infection. N Eng J Med 2001;345(1):41-52.  Back to cited text no. 13    
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2004 - Indian Journal of Medical Microbiology
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