Hepatitis C virus (HCV) infects an estimated 170 million persons worldwide and thus represents a viral pandemic, one that is five times as widespread as infection with the human immunodeficiency virus type 1 (HIV-1). The institution of blood-screening measures in developed countries has decreased the risk of transfusion-associated hepatitis to a negligible level, but new cases continue to occur mainly as a result of injection-drug use and, to a lesser degree, through other means of percutaneous or mucous-membrane exposure. Progression to chronic disease occurs in the majority of HCV-infected persons, and infection with the virus has become the main indication . . .

https://www.nejm.org/doi/pdf/10.1056/NEJM200107053450107?listPDF=true

Hepatitis C Virus Infection

Hepatitis C is of concern both to industrialized and developing countries. Preliminary unpublished estimates of the global burden of disease (GBD) attributable to HCV-related chronic liver disease seem to be substantial. Therefore, the reduction of global mortality and morbidity related to chronic hepatitis C should be a concern to public health authorities, and primary, secondary and tertiary prevention activities should be implemented and monitored in each country, with precise targets set to be reached. In order to decide on national health policies, there is a need to estimate the burden of disease, globally, regionally and nationally. To evaluate the GBD, three components have to be assessed: 1) The global, regional and national burden of morbidity and mortality associated with HCV infection, based on prevalence, incidence, transmission and economics; 2) The natural history of HCV infection, including ‘healthy individuals’; and 3) The areas for which more research is needed. A working group was created to assist the World Health organization (WHO) in estimating the GBD associated with HCV infection.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1478-3231.2008.01934.x

The global burden of hepatitis C.

https://www.natap.org/2013/HCV/510300409_ftp.pdf

Liver fibrosis progression in human immunodeficiency virus and hepatitis C virus coinfected patients

https://www.journal-of-hepatology.eu/article/S0168-8278(97)80001-3/pdf

Human immunodeficiency virus infection modified the natural history of chronic parenterally-acquired hepatitis C with an unusually rapid progression to cirrhosis

Liver disease caused by chronic hepatitis B virus (HBV) infection is currently an important cause of morbidity and mortality among HIV-infected patients in the western world where classical opportunistic complications of severe immunodeficiency have declined dramatically as a result of the widespread use of potent antiretroviral therapies. Over the past few years several consensus reports have addressed the issue of viral hepatitis and HIV co-infection. However as a result of the larger impact of hepatitis C virus (HCV) they have focused mainly on HIV and HCV co-infection whereas only a few reports have devoted particular attention to hepatitis B. There are several reasons to highlight HBV in HIV positive individuals. (excerpt)

Care of patients with chronic hepatitis B and HIV co-infection: recommendations from an HIV-HBV International Panel.

The aim of the present study was to investigate the possible role of human immunodeficiency virus (HIV) infection in the natural course of chronic hepatitis C. Seventy-six adult patients with chronic parenterally acquired hepatitis C virus (HCV) infection examined from 1989 to 1993 were enrolled; of these 32 (42.1 %) were HIV positive and 44 (57.9 %) were HIV negative. Serum HCV RNA quantitation was carried out by polymerase chain reaction in a well-characterized group (n=20; 11 HIV positive and 9 HIV negative). Distribution of histological findings in liver biopsies from both HIV-infected and noninfected patients was similar. However, within 15 years after initial HCV infection, 8 of 32 (25 %) HIV-positive patients developed cirrhosis, in comparison with only 2 of 31 (6.5 %) patients in the HIV-negative group (p<0.05); similar incidences of cirrhosis were found in both patient groups within 5 and 10 years after HCV infection. Most of the HIV-negative cirrhotic patients (9 of 11) developed cirrhosis in a time interval longer than 15 years. Finally, HCV load was almost ten times higher (1 10-fold dilution) in the HIV-positive group, but this difference did not reach statistical significance in this small study population. These results suggest that HIV infection can alter the natural course of chronic parenterally acquired hepatitis C, causing an unusually rapid progression to cirrhosis.

Influence of human immunodeficiency virus type 1 infection on the natural course of chronic parenterally acquired Hepatitis C

. Objectives. To define the role that sexual transmission plays in the spread of hepatitis C virus (HCV) infection, and to examine the influence of coexistent human immunodeficiency virus (HIV) infection on this mode of transmission.



Design. A multicentre, seroprevalence study of anti-HCV performed in the stable heterosexual partners (SHP) of index cases reactive for anti-HCV.



Setting. Department of Internal Medicine and Section of Gastroenterology of three University Hospitals, Spain.



Subjects. A total of 423 stable heterosexual partners of index cases reactive for anti-HCV. This included a group of 142 intravenous drug users (IVDU), 120 of whom were coinfected with HIV. Additionally, 2886 first-time voluntary blood donors selected at random were included to compare the prevalence of anti-HCV.



Main outcome measures. Serum samples were screened for anti-HCV by a commercially available, second-generation enzyme-linked immunoassay. Tests repeatedly reactive for anti-HCV were analysed by a four-antigen, recombinant immunoblot assay. Anti-HIV was tested by enzyme immunoassay and Western blot was used for confirmation of positive cases.



Results. The prevalence of anti-HCV, was 7.1% in SHP and 1.2% in random donors (P < 0.001). This prevalence was higher in SHP of index cases co-infected with HIV in comparison with that shown in the SHP of index cases only reactive for the anti-HCV (9.1 vs. 6.3%; P = 0.2), particularly when a younger and more homogeneous group such as the SHP of IVDU index cases was considered alone (9.2 vs. 0%; P = 0.1). However, the SHP of IVDU index cases coinfected with HIV were almost three times more likely to be infected with HIV than HCV (24.2 vs. 9.2%).



Conclusions. These data suggest that HCV infection may be sexually transmitted but with low efficiency, and this could be increased in the presence of coexistent HIV infection in the index case.

Heterosexual transmission of hepatitis C virus and the possible role of coexistent human immunodeficiency virus infection in the index case. A multicentre study of 423 pairings

. Objectives. To investigate the concordance of antihepatitis C virus (anti-HCV) reactivity by a second-generation enzyme immunoassay (EIA-2) and by a four-antigen recombinant immunoblot assay (4-RIBA) in homosexual men, in comparison with that found in other sexually active groups and blood donors.



Design. Prospective study.



Setting. Tertiary referral centre, Seville, Spain.



Subjects. A total of 1203 subjects were studied. Eight hundred and three were sexually active individuals: 547 female prostitutes, 88 heterosexual men who had frequent sexual intercourse with prostitutes, and 168 homosexual men. All of them denied blood transfusion and parenteral drug use. In addition, 400 voluntary blood donors were selected at random.



Main outcome measures. All serum samples were screened for anti-HCV by EIA-2 and repeatedly reactive sera were tested by 4-RIBA. Homosexual men were also screened for anti-human immunodeficiency virus (anti-HIV), hepatitis B virus (HBV) markers and gammaglobulin concentration. Finally, serum samples from homosexual men reactive for anti-HCV by EIA-2 were analyzed for HCV-RNA by polymerase chain reaction (PCR).



Results. Concordance between EIA-2 and 4-RIBA in female prostitutes (71.4%), clients of prostitutes (75.0%), and blood donors (83.3%) was significantly higher than in homosexual men (38.8%) (P < 0.04). In this collective the concordance between 4-RIBA and PCR was 85.7% for positive cases and 88.8% for negative ones, and EIA-2 ratios in reactive sera were significantly higher in 4-RIBA confirmed cases (P < 0.0001). No correlation between false positive EIA-2 results and presence of HIV infection, HBV markers or hypergammaglobulinaemia was found in homosexual men by univariate analysis.



Conclusions. There is a high level of non-specific anti-HCV reactivity by EIA-2 amongst homosexual men in comparison with that found in other sexually active groups and blood donors. The true prevalence of HCV infection amongst homosexual men could be even lower than previously described.

High rate of nonspecific anti-hepatitis C reactivity amongst homosexual men in comparison with that found in other sexually active groups and blood donors

[Serum expression of human immunodeficiency virus antigen(s) in persons at risk. Evidence of disappearance of HIV-Ag during the developmental course of patients with acquired immunodeficiency syndrome].

B. Soto

Papers

Influence of human immunodeficiency virus type 1 infection on the natural course of chronic parenterally acquired Hepatitis C

Heterosexual transmission of hepatitis C virus and the possible role of coexistent human immunodeficiency virus infection in the index case. A multicentre study of 423 pairings

High rate of nonspecific anti-hepatitis C reactivity amongst homosexual men in comparison with that found in other sexually active groups and blood donors

[Serum expression of human immunodeficiency virus antigen(s) in persons at risk. Evidence of disappearance of HIV-Ag during the developmental course of patients with acquired immunodeficiency syndrome].