HIV/AIDS • CID 2008:46 (1 June) • 1761
H I V / A I D SM A J O R A R T I C L E
Extremely High Prevalence and Genetic Diversity
of Hepatitis C Virus Infection among HIV-Infected
Injection Drug Users in Taiwan
Jyh-You Liu,1,4Hsi-Hsun Lin,1Yung-Ching Liu,2,6Susan Shin-Jung Lee,2Ya-Lei Chen,3Chien-Ching Hung,5
Wen-Chien Ko,7Chun-Kai Huang,1Chung-Hsu Lai,1Yao-Shen Chen,2Yi-Li Shih,1Hsing-Chun Chung,1
Shiou-Haur Liang,1and Jiun-Nong Lin1
1Department of Medicine, E-Da Hospital/I-Shou University,2Department of Medicine, Kaohsiung Veterans General Hospital, and
Biotechnology, National Kaohsiung Normal University, Kaohsiung;
University College of Medicine, National Taiwan University Hospital, and
National Cheng Kung University Hospital, Tainan, Taiwan, Republic of China
4School of Medicine and
6National Yang-Ming University, Taipei; and
5Department of Internal Medicine, National Taiwan
7Department of Medicine,
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 IDUswasconductedfrom1993through
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 annualprevalence
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 ahigh prevalenceofHCVinfectionamongHIV-infectedIDUsinTaiwan,
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.
An outbreak of human immunodeficiency virus (HIV) type 1 infection among injection drug
Coinfection with HIV and hepatitis C virus (HCV) is
a rapidly emerging global public health problem. In-
jection drug users (IDUs) have a particularly high risk
of acquiring HIV-HCV coinfection. HIV-HCV coin-
fection hastens HCV-related liver disease, causing an
increased rate of progression to cirrhosis, decompen-
Received 30 September 2007; accepted 15 January 2008; electronically
published 23 April 2008.
Reprints or correspondence: Dr. Hsi-Hsun Lin, Dept. of Infectious Diseases, E-
Da Hospital/I-Shou University, 1 E-Da Rd., Yan-Chau Shiang, Kaohsiung County,
824, Taiwan, Republic of China (email@example.com).
Clinical Infectious Diseases2008;46:1761–8
? 2008 by the Infectious Diseases Society of America. All rights reserved.
sated liver disease, hepatocellular carcinoma, and death
[1, 2]. With the advent of HAART, there has been a
marked decrease in the incidence of opportunistic in-
fections among HIV-infected individuals,withliverdis-
ease caused by HCV infection becoming the leading
cause of death among persons with HIV infection
worldwide [3, 4].
In 2004, an extensive outbreak of HIV infection oc-
curred among IDUs inTaiwan,andsincethen,injection
drug use has become the most frequent risk factor for
incident HIV infection in Taiwan. A risk factor analysis
of reported cases revealed that the proportion of IDUs
infected with HIV increased from 1.7% (13 of 772 IDUs
were infected with HIV) in 2002 to 8.1% (70 of 862)
in 2003, to 41.3% (628 of 1520) in 2004, to 72.4%
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1768 • CID 2008:46 (1 June) • HIV/AIDS
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