.hiv / Aids In The Merger Of Hbv And Hcv Infection In Epidemiological Studies

Hepatitis B virus(HBV) and hepatitis C virus(HCV) are common among patients with human immunodeficiency virus(HIV) infection because of shared ways of viral transmission.Since the decline in HIV-related morbidity and mortality after introduction of highly active antiretroviral therapy(HAART),liver disease caused by HBV and/or HCV has become a major cause of morbidity and mortality among HIV-infected patients.Since the first AIDS case was reported in the United States in 1981, 199 countries/regions had reported HIV infection or AIDS patients around the world.It has been estimated that more than 70 million people have been infected with the HIV,and more than 30 million have died from AIDS globally.Of the 2 billion people who have been infected with the HBV, more than 350 million have chronic infections.An estimated 170 million persons are chronically infected with HCV and 3 to 4 million persons are newly infected each year.By the end of 2007,the estimated results showed approximately 700,000 are now HIV positive(range 550,000-850,000).The HIV infection rate among China' s population is 0.05 per cent(range 0.04%-0.07%).The estimated number of AIDS cases is 85,000(range 80,000-90,000).Now the HIV epidemic in China is at the rapid expansion phase,and it is estimated that it increases by about 30 percent every year.In China,the HBV and HCV prevalence is high.The HBsAg and anti-HCV positive among the general population is 9.09%and 3.2%,respectively. An estimated 130 million chronic HBV infections and 40 million HCV infections are in China.Because of shared routes of transmission,coinfection with hepatitis B virus(HBV) and hepatitis C virus(HCV) is common in HIV-infected persons. Serologic evidence of past exposure or current HBV infection is found in 90%to 95%of HIV-infected individuals。Among HIV-infected persons,10% to 15%are chronic carriers of HBV.Occult HBV infections in HIV infected persons are common,because HIV infected patients are immune dysfunction and HBV replication can not be inhibited and cleared.The prevalence of occult HBV in HIV infected patients has been controversial,varied from 0 to 51.2%,and even occult HBV among the HIV infected patients with anti-hbc alone is up to 89.5%.One-quarter to one-third of HIV-seropositve individuals are co-infected with HCV.It is estimated that there are about 10 million cases of HIV-HCV coinfection worldwide.HIV infection modifies the natural history of HCV infection,which can accelerate the progression to fibrosis,cirrhosis and hepatocellular. HIV-infected individuals show a quantitative depletion of CD4+ T cells and immune dysfunction,which lead to increase the replication of virus of hepatitis,secrete inflammatory cytokines and activate lymphomononuclear cells in the liver,and ultimately result in fibrosis, cirrhosis and hepatocellular carcinoma.Now liver disease has become the leading cause of death of HIV infected patients.In addition,the genotype of HCV plays an important role in the progression of liver disease and can predict the prognosis.HCV genotype 1 may represent a more aggressive strain,which is less respond to interferon treatment than HCV genotype 2 or 3.Treatment of HCV is more complicated in HIV-infected patients due to bone marrow suppression,drug interactions,HAART-related hepatotoxicity and other reasons.The study used molecular biology techniques to invest the prevalence of HBV and/or HCV,occult HBV and HCV genotype distribution in HIV-infected persons.Provide theoretical basis for prevention and treatment of HBV and/or HCV in HIV infected persons.The contents of this study are:(1):Study on HIV/AIDS Subjects co-infected with HBV and/or HCV in Shanghai(2):The Epidemic Analysis of Occult Hepatitis B Virus in HIV-Infected Patients(3):Molecular epidemiology of HCV co-infection in 201 HIV patients in Shanghai Part One:Study on HIV/AIDS Subjects co-infected with HBV and/or HCV in Shanghaiobjective:To analyse the epidemiology of HIV/AIDS co-infected with HBV and/or HCV.Methods:Microparticle enzyme immunoassay(MEIA) was used to detect HBV serological immune indicators (HBsAg,anti—HBs,HBeAg,anti—HBe,anti—HBc) and Enzyme linked immuneosorbent assay(ELISA) to HCV antibody in 170 HIV antibody positive subjects.Results:Patients mean age was 41±13 years,and 146(85.8%) were males.A total of 19(11.2%) HIV/AIDS subjects showed HBsAg positive, 87(51.2%) anti-HBs positive,7(4.1%) HBeAg positive,49(28.8%) anti-HBe positive,111(65.2%) anti-HBc positive.There are 45.3%HCV positive in this group,the triple infection rate of HIV,HBV and HCV was 5.3%. Conclusion:HCV infective rate is dramatically higher in the HIV/AIDS infectious patients than the HIV negative population,and the co-infection rate of HBV in HIV/AIDS is similar to the common.Part two:The Epidemic Analysis of Occult Hepatitis B Virus in HIV-Infected PatientsObjectives:The occult hepatitis B virus(HBV) is defined by the positive of HBV DNA in individuals with undetectable levels of HBV surface antigen(HBsAg).The objective of this study was to assess the prevalence and related factors of occult HBV in hiv-infected patients.Methods:The serum samples were from 105 HBsAg-negative patients with HIV patients hospitalized at Shanghai Public Health Clinical Center.Microparticle enzyme immunoassay(MEIA) was used to detect HBV serologic markers(HBsAg,anti—HBs,HBeAg,anti—HBe,anti—HBc),and enzyme linked immuneosorbent assay(ELISA) to HCV antibody.CD4+ cell count was examined by flow cytometry.Nested polymerase chain reaction(n PCR) was used to amplify surface protein region of HBV.Results:105 HIV/AIDS patients were 92 men (87.6%) and 13(12.4%) women,respectively.32(30.5%) patients were HBV DNA+,5 patients were negative for all HBV serologic markers,and 27 patients detected at least one of anti-HBc,anti-HBe and anti-HBs.14 patients(29.8%) with HBV DNA+ in 47 HIV patients coinfected with HCV,18 patients(31.0%) in 58 HIV-monoinfected patients,The mean CD4+ cell count was 145 cells/μl,26 patients(34.7%) in 75 patients with CD4+ cell＜200 cells/μl,6 patients(20%) in 30 patients with CD4+ cell＞200 cells/μl.No statistical significant association could be established between occult HBV infection and HBV serologic markers,coinfected HCV and CD4+ cell count.Analysis of S gene showed that 1 nucleotide sequence inserted "A" in nt527 and nt539,respectively,and induced the reading frame shift.9aminoacid sequences changed(C124S,I126T,I126V,T131I,L133I, K141N,P142L,S143T and S143P) in the HBV "a" determinant,and the rest of patients had no mutation in the HBV "a" determinant.Conclusions: Occult HBV occurred in a sizable proportion of HIV-infected patients. Immune Dysfunction and S gene variation may be the reason of occult HBV infection.Part three:Molecular epidemiology of HCV co-infection in 201 HIV patients in ShanghaiObjective:To investigate the molecular epidemic and subtypes of hepatitis C virus(HCV) co-infection in the human immunodeficiency virus patients in Shanghai.Methods:Enzyme linked immuneosorbent assay(ELISA) was used to detect HCV antibody and HCV RNA was extracted and amplified by nested PCR,then purified and directly sequenced in 201 HIV antibody positive subjects,who hospitalized in Shanghai Public Health Clinical Center affiliated to Fudan University. Results:Of 201 HIV infected patients,12.9%(26/201) were female,and 43.8%(88/201) were HCV antibody positive.The possibility of HIV infection transmission:Blood transfusion or blood products were 41.3%(83/201),sexual transmission were 27.4%(55/201),intravenous drug use were 3.0%(6/201),other(tooth extraction two cases,needle-stick injury and transplantation 1 case,respectively) were 2.0%(4/201),but 26.4%(53/201) were unknown.HCV transmission:Blood transfusion or blood products were 85.2%(75/88),sexually transmitted were 4.5%(4/88), intravenous drug use were 3.4%(3/88),unknown reasons were 6.2%(6/88). HCV genotype in 45 HIV/HCV co-infected patients were detected:1b(62.2%, 28/45),2a(22.2%,10/45),2a/2c(6.7%,3/45),1b+2a/2c(6.7%,3/45), 1b+2a(2.2%,1/45).Conclusions:HIV patients,who were infected with HCV major through the transfusion of Blood or blood products,co-infected HCV were higher than others,who should be routinely tested for anti-HCV. Major HCV Subtype is ib in HIV/HCV patients.There are double Subtypes of HCV in HIV/HCV patients.