In the Journals

Global HIV/HCV burden exceeds 2 million, driven by PWID

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March 10, 2016

A recently published meta-analysis estimates that nearly 2.3 million people may be coinfected with HIV and hepatitis C virus, with more than half of these cases occurring among people who inject drugs.

In addition, researchers determined that people with HIV are nearly six times as likely to be infected with HCV than those who are HIV-negative, and that the burden of these diseases is greatest in eastern Europe and central Asia.

“As people living with HIV live longer, HCV-related liver disease in coinfected patients is becoming a major cause of morbidity and mortality,” the researchers wrote. “Reliable estimates are needed to establish the scale of the public health problem posed by HCV coinfection and to inform regional and national strategies for hepatitis screening and management.”

Burden greatest in eastern Europe, central Asia

The researchers searched eight databases for studies published between Jan. 1, 2002 and Jan. 28, 2015 that reported the incidence of HCV and HIV. These were rated based on numerous merits, including sample size, whether the study reported on risk factors, and the type of diagnostic assay used. Studies receiving higher quality scores were included in the final analysis. Patient populations were classified by country and by major HIV risk categories (eg, men who have sex with men, persons who inject drugs [PWID]). Using these data, the researchers estimated the prevalence and global burden of HCV seropositivity in people living with HIV.

Of the 31,767 studies identified by the researchers, 783 studies including 902 estimates were included in the final analysis. In patients with HIV, the prevalence of coinfection was 2.4% (IQR, 0.8-5.8) in general population samples. The prevalence of coinfection among MSM with HIV was estimated to be 6.4% (IQR, 3.2-10) and for PWID, 82.4% (IQR, 55.2-88.5). The analysis also revealed that people with HIV were 5.8 times more likely to have HCV than people without HIV (95% CI, 4.5-7.4).

The researchers estimated that 2,278,400 (IQR, 1,271,300-4,417,000) people are HIV/HCV coinfected globally, and of whom 1,362,7000 are PWID. Eastern Europe and central Asia accounted for 27% (607,700; IQR, 404,100-746,500) of this global burden, while south, west, east and central Africa comprised 19% (429,000; IQR, 199,100-2,155,900).

“Targeted and outreach approaches are needed for PWID and MSM because stigmatization and other factors might limit their access to services for testing and treatment,” the researchers wrote. “Improvement of country-level data for prevalence of HCV in all populations is needed to help them to define their epidemiology and inform policies for hepatitis C testing, prevention, care and treatment. This is particularly important in countries with growing populations of PWID and concentrated HIV epidemics in PWID and MSM.”

Incidence estimates guide global response

In a related commentary, Graham S. Cooke, PhD, MRCP, and Timothy B. Hallett, PhD, both of the Imperial College London, were cautious due to the wide confidence intervals of the estimates and their reliance on the presence of HCV antibodies, as opposed to detectable virus. Regardless, they wrote that analyses such as these are necessary to shape global efforts against HCV.

“The coinfected population is a small proportion of those infected with HCV worldwide, probably less than 5%, although potentially a greater proportion of individuals with HCV-attributable morbidity and mortality,” they wrote. “However, targeting the HIV/HCV coinfected population could be an initial way to begin the scale-up of … HCV treatment.

“Major international agencies have shown willing to support programs in coinfection and, in addition to using the infrastructure of HIV programs to treat HIV/HCV coinfected individuals, the global community needs to leverage and emulate the wider success of the AIDS response to ensure greater access to HCV treatment for all.” – by Dave Muoio

Disclosures: Platt reports no relevant financial disclosures. Please see the full study and commentary for a list of Cooke, Hallett and the other researchers’ relevant financial disclosures.

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