Extremely High Prevalence and Genetic Diversity of Hepatitis C Virus Infection among HIV‐Infected Injection Drug Users in Taiwan

Department of Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan, Republic of China.
Clinical Infectious Diseases (Impact Factor: 8.89). 07/2008; 46(11):1761-8. DOI: 10.1086/587992
Source: PubMed


An outbreak of human immunodeficiency virus (HIV) type 1 infection among injection drug users (IDUs) occurred in Taiwan, and thereafter, injection drug use became the most frequent risk factor for HIV infection in Taiwan. We sought to study the prevalence of and genotypes causing hepatitis C virus (HCV) infection among HIV-infected IDUs in Taiwan.
A multicenter, longitudinal cohort study of 990 HIV-infected IDUs was conducted from 1993 through 2006. Blood samples were collected and analyzed for the presence of antibody to HCV and to determine the genotype of HCV.
The overall prevalence of HCV infection among HIV-infected IDUs was 96.6%. The annual prevalence increased from 65.5% before 2002 to 98.6% in 2006. The main circulating HCV genotypes were 1a (accounting for 29.2% of samples), 6a (23.5%), and 3a (20.2%), whereas 1b, the most predominant genotype circulating in the general population in Taiwan, accounted for only 13.2% of samples. Genotypes 2b (accounting for 6.6% of samples), 6k (2.9%), 2a (1.6%), 6g (1.6%), and 3b (1.2%) were present in only a few IDUs. Multivariate logistic regression analysis revealed that duration of injection drug use and a travel history to China or Southeast Asia were significantly associated with infection due to HCV genotypes 1a, 3, and 6.
Our study demonstrated a high prevalence of HCV infection among HIV-infected IDUs in Taiwan, with a predominance of infection due to genotypes 1a, 6a, and 3a, as a result of the impact of IDUs' behavior and their drug trafficking route. Our study revealed that HCV infection in IDUs originated from a geographically large transmission network that was mainly distinct from that associated with other HCV-infected individuals; this transmission network has also been documented in association with HIV infection in IDUs.

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    • "Second, the status of human immunodeficiency virus (HIV) was unavailable. Co-infection of HIV and HCV is an emerging public problem worldwide, particularly in injection drug users [38]. However, we believe that rare HIV cases (0.01%) in ESRD population in Taiwan diminished the impact of HIV status in our study result. "
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    ABSTRACT: Background Chronic kidney disease (CKD) and hepatitis C virus (HCV) infection are closely linked and both increase patient mortality. The association of HCV and risk of developing end-stage renal disease (ESRD) has not been analyzed with competing risk model. Method We enrolled a prospective cohort of 4,185 patients (mean age, 62 years; 41% female) registered in the CKD integrated care program at two affiliated hospitals of Kaohsiung Medical University in Taiwan between November 11, 2002 and May 31, 2009. With competing risk model, we analyzed the association of HCV infection, defined by seropositive of anti-HCV antibody, and hepatitis B virus (HBV) infection, defined by seropositive of HBV surface antigen, with the risk of entering ESRD. Results The prevalence of HCV infection was 7.6% and it increased with the CKD stages (trend test, P<0.001), while the prevalence of HBV infection was 7.4% and no specific trend among CKD stages (tend test, P = 0.1). During the 9,101 person-year follow-up period, there were 446 death and 1,205 patients entering ESRD. After adjusting death as the competing risk, the estimated 5-year cumulative incidence rate of ESRD among patients with and without HCV infection were 52.6% and 38.4%, respectively (modified log-rank, P<0.001). Multivariable analysis showed that HCV infection, but not HBV infection, had higher risk of developing ESRD compared with cases without infection (HCV, HR: 1.32, 95% CI: 1.07–1.62; HBV, HR: 1.10, 95% CI: 0.89–1.35). Subgroup analyses showed consistent results. Conclusions With death-adjusted competing risk analysis, HCV infection is associated with an increased risk of developing ESRD in CKD cohort.
    PLoS ONE 06/2014; 9(6):e100790. DOI:10.1371/journal.pone.0100790 · 3.23 Impact Factor
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    • "In China, at least three genotypes (1, 3 and 6) and 11 subtypes (1a, 1b, 2a, 2b, 3a, 3b, 6a, 6n, 6u, 6v and 6e) were observed among IDUs [17]. However, the distribution of HCV genotypes and subtypes among IDUs differed between regions [6], [9]–[12], [16], [18]. Many studies have shown that the distribution of HCV was similar to that found along the drug-trafficking routes [6], [11], [17], [19] In the present study, we investigated the prevalence of HCV genotypes and subtypes in 100 IDUs from Yunnan Province and confirmed the circulation of three HCV genotypes (genotype 1, 3 and 6) and eight HCV subtypes (subtype 1a, 1b, 3a, 3b, 6a, 6n, 6u and 6v) (Tables 1). "
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    ABSTRACT: Recently, high proportions (15.6%-98.7%) of intravenous drug users (IDUs) in China were found to be positive for hepatitis C virus (HCV). Yunnan Province is located in southwestern China and borders one of the world's most important opium-producing regions, thus it is an important drug trafficking route to other regions of China. Here, we assessed 100 HCV-positive plasma samples from IDUs who were enrolled through the Kunming Center for Disease Control and Prevention in 2012. HCV C/E1 fragments were PCR-amplified and sequenced. We identified eight HCV subtypes (1a, 1b, 3a, 3b, 6a, 6n, 6u and 6v), of which genotype 6 was most predominant (frequency, 47%) followed by genotypes 3 (41%) and 1 (12%). HCV subtypes 6n (30%) and 3b (29%) were most common and were identified in 59% of the IDUs. We compared HCV genotypes among IDUs in Yunnan Province with those from other regions and found that the distribution patterns of HCV genotypes in Yunnan Province were similar to those in southern China, but different from those in eastern China. However, the distribution patterns of HCV subtypes varied among Yunnan Province and southern China, despite the shared similar genotypes. A comparison of the current data with those previously reported showed that the frequency of HCV genotype 6 increased from 25% to 47% within 5 years, especially subtypes 6a (5% to 15%) and 6n (11.2% to 30%). In contrast, the frequencies of subtypes 3b and 1b decreased by almost 50% within 5 years. Our results provided further information to support the assertion that drug trafficking routes influence HCV transmission patterns among IDUs in Yunnan Province. The frequency of HCV genotypes and subtypes changed rapidly among IDUs in Yunnan Province and subtypes 6a and 6n may have originated in Vietnam and Myanmar, respectively.
    PLoS ONE 12/2013; 8(12):e82598. DOI:10.1371/journal.pone.0082598 · 3.23 Impact Factor
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    • "From the samples from individuals coinfected with HIV and HCV, eight were PCR positive for both regions, and sequences could be obtained from seven samples. The results showed the existence of HCV genotypes 1a (3 samples), 1b (2 samples) and 3a (2 samples), which are all genotypes previously found among coinfected subjects, but in different geographical locations [17,19,34-37]. Two strains cluster closely together (genetic distance < 1%) in subtype 1b in both trees, and they are derived from two individuals who were a heterosexual couple at the time of sampling, strongly implying transmission from one individual to the other, but it cannot be certain whether infection was through sexual practises or household transmission. "
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    ABSTRACT: ABSTRACT: Initial data on the molecular epidemiology of HCV infection in Cyprus showed a highly polyphyletic infection and multiple points of introduction into the general population. The continuation and expansion of this investigation is presented here including high risk groups. The samples include additional subjects from the general population, a group of inmates and HIV/HCV coinfected individuals, whose strains were amplified by RT-PCR and sequenced in partial Core-E1 and NS5B regions. The results confirm the broad genotype distribution and polyphyletic infection on the island, and no new subtypes were found. Monophyletic clusters between strains of the prisoners and the injecting drug users imply sharing of infected equipment, and highlight the risk of widespread transmission in these cohorts, although no spill-over to the general population was observed. The results of this study underline the impact of population movements and high-risk population groups on the changing molecular epidemiology of HCV, with strains moving to Europe from Asia, Africa and Eastern Europe by means of immigration and modern transmission routes.
    BMC Research Notes 10/2011; 4(1):468. DOI:10.1186/1756-0500-4-468
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