A research team led by Dr. Krishna Poudel, associate professor of community health education in the UMass Amherst School of Public Health and Health Sciences, is reporting high coinfection rates of hepatitis C virus (HCV) among HIV-positive individuals residing in the Kathmandu Valley, Nepal. The researchers found a high prevalence of HCV exists among both individuals who are receiving antiretroviral therapy and those who are not, suggesting that screening for HCV among HIV-positive people would be useful, in particular, for those with lifetime injection drug use and soon after their initial HIV diagnosis.

[Photo: Dr. Krishna Poudel]

Working with a cohort of 319 HIV-positive individuals recruited by Dr. Poudel in the wider context of a baseline survey of a prospective positive living with HIV (POLH) study, the researchers administered a cross-sectional survey and screened participants’ serum samples for HCV antibodies. Dr. Poudel and colleagues found that 43.3 percent of individuals tested positive for HCV, greatly exceeding rates reported in countries such as India (2.4-3.5 percent) and Brazil (36.2 percent). Among participants not receiving antiretroviral therapy, the coinfection rate reported 58.1 percent compared to 37.8 percent among those receiving antiretroviral therapy. Among participants with lifetime injection drug use, the prevalence of HCV coinfection was a staggering 96.2 percent.

“Coinfection of HCV and HIV is a growing public health concern,” states Dr. Poudel. “While antiretroviral therapy has dramatically increased the lifespan, as well as, the quality of life for HIV-positive people both in developed and in resource-limited countries, HCV-induced liver disease has emerged as a major cause of morbidity and mortality among the coinfected.”

Of the 33.4 million people globally who have been diagnosed HIV-positive, an estimated 20% are coinfected with HCV.

Patient management for coinfected individuals has proven challenging. Coinfected patients are more likely to develop liver enzyme abnormalities and liver toxicity when treated with antiretroviral therapy. The successful treatment of HCV has been associated with a regression of liver fibrosis and with a reduced risk of antiretroviral therapy-related liver toxicity.

“HIV-positive people are encouraged to get screened for HCV,” says Dr. Poudel, “and those with positive results should consider receiving HCV treatment.” Knowing that patients are coinfected informs practitioners to provide specific education on HCV transmission and treatment, factors influencing liver disease progression, risk reduction strategies, and risk of reinfection.

“Screening for HCV among HIV-positive people, particularly those with lifetime injection drug use and soon after their HIV diagnosis, would be useful for the timely identification of HCV coinfection as well as education and possibly treatment,” concludes Dr. Poudel and colleagues.

Researchers from Claremont Graduate University in Claremont, California; the Graduate School of Medicine at the University of Tokyo; the National Center for Global Health and Medicine in Tokyo, Japan; the University of the Ryukyus in Okinawa, Japan; and Waseda University in Tokyo, Japan, contributed to the study. The findings appear in the current issue (May/June) of the Journal of the International Association of Providers of AIDS Care (JIAPAC).