HCV Viral Load And Subtypes Among HCV Mono-infected And HIV/HCV Co-infected Patients

1. HCV Viral Load among HCV mono-infected and HIV/HCV Co-infected PatientsObjective The study aims to explore the impact of HIV infection and antiretroviral therapy(ART) on HCV viral load among HCV-infected patients.Methods A cross-sectional study was designed to include HCV mono-infected patients and HIV/HCV co-infected patients from Shanxi Province and Yunnan Province using a cluster sampling method. Questionnaires collecting social-demographic and epidemiological information and related behavioral characteristics about participants were answered. Laboratory tests were performed and information of ART were collected from routine management. HCV RNA viral load in blood of all participants were assessed. Data entry was finished by using Epidata software and analyses were performed using SPSS 16.0 software.Results A total of 170 HCV antibody positive participants were enrolled from Longchuan County, Yunnan Province in 2009.25 participants were HCV mono infected, while 145 were co-infected with HIV. Most of them were male (91.8%). The average age was 37.3±7.4 years old.54.7% were Jingpo,18.2% were Dai, two of the ethnic minority groups in china, whereas 17.1% were Han.77.6% of the participants accepted education for less than 6 years. The main route of HIV infection was injection drug use(82.1%).68 participants(46.9%) were taking ART.A total of 188 HCV antibody positive participants were also enrolled from Yuncheng City in 2004 and from Wenxi County in 2006.20 participants were mono infected, while 168 were co-infected with HIV. Among them 59.6% were male. The participants had an average age of 45.7±7.8 years old. All of them were Han.70.2% of the participants had education for less than 6 years. Most of HIV-infected patients(95.8%) were infected through blood donation.116(69%) were taking ART.120 out of 170 participants from Longchuan have detectable serum HCV RNA loads. The detection rate was 64.0% for HIV negative subjects and 71.7% for HIV positive ones.121 out of 188 participants from Shanxi have detectable serum HCV RNA loads. The detection rate was 70.0% for HIV negative participants and 63.7% for HIV positive subjects. To approximate a normal distribution, quantitative HCV RNA levels were log transformed. Analysis of t test was performed to examine the differenced between log*HCV RNA levels. The HIV positive participants have a higher log*HCV RNA level than HIV negative ones. However, taking ART did not have an obvious influence on HCV viral loads among HIV infected participants. The results were consistent in both study sites.A further analysis about HCV RNA suppression and its related factors showed that HIV infected or not did not have impact on HCV RNA suppression rate (χ2=0.613, P=0.434) while among HIV infected participants, people who were receiving ART had a lower suppression rate(17.6%) than those were not(37.7%) (χ2=7.133, P=0.008). After adjusting for Logistic regression model showed that people of Dai have a lower suppression than Han (OR=0.18,95%CI:0.04-0.72). Participants had education for more than 9 years have a lower suppression rate than the illiterates (OR=0.25, 95%CI:0.07-0.96). Among HIV infected subjects, those who were not taking ART had a higher rate than people being treated (OR=3.10,95%CI:1.34-7.16).67 participants(35.6%) from Shanxi have their serum HCV RNA suppressed while no characteristics were found to have impact on the viral suppression.Conclusions HIV infection and antiretroviral therapy have impact on serum HCV RNA load among HCV infected patients. The two study sites had a same conclusion that HIV/HCV co-infected people had higher viral loads than HCV mono-infected ones. ART decreased HCV RNA suppression rate. Also, ethnic groups and education level have influence on suppression rates. Some related factors showed regional differences. Dynamic surveillance and research should be enhanced on the diseased progression and viral replication levels of HIV/HCV co-infected patients. 2. HCV Subtypes among HCV mono-infected and HIV/HCV Co-infected PatientsObjective To determine the HCV genotype among HCV mono-infected and HIV/HCV co-infected patients from Longchuan County, Yunnan Province.Methods 120 HCV mono-infected and HIV/HCV co-infected participants who had detectable serum viral load were included from Longchuan County, Yunnan Province. Complimentary DNA(cDNA) was synthesized and two rounds of PCR amplifications were done (first round PCR and Nested PCR) based on the 5'-UTR, C/El and NS5B regions. Genotyping was carried out and phylogenetic trees were constructed to determine the genotype.Results PCR amplification succeeded for all the 116(96.7%) samples based on 5'-UTR region while for 107(89.2%) samples base on C/E1 and NS5B region, respectively.103 samples were amplified successfully by both C/E1 and NS5B regions, and their genotype given by phylogenetic trees were the same.The results of genotyping were analyzed by constructing phylogenetic trees. Genotyping based on C/E1 region and NS5B provided results for 111(92.5%) samples. 37(33.3%) belonged to 3b,32(28.8%) were 6u,24(21.6%) were 6n,11(9.9%) were 3a, 5(4.5%) were 1a and 2(1.8%) were 6v. For HIV/HCV co-iunfected patients,34(34.7%) were 3b,28(28.6%) were 6u,21(21.4%) were 6n,9(9.2%) were 3a,5(5.1%) were 1a and 1(1.0%) were 6v. For HCV mono-infected patients,4(30.8%) were 6u,3(23.1%) were 6n,3(23.1%) were 3b,2(15.4%) were 3a,1(7.7%) were 6v. HIV/HCV co-infected patients have similar distribution of HCV genotypes with HCV mono-infected ones.The highly conserved 5'-UTR region showed limited ability in distinguishing genotypes reliably.Conclusions For HCV infected patients who mainly got infected through injection drug use from Longchuan, the genotypes of the successfully amplified samples were 3b,6u and 6n.3a, la and 6v were also found in the study population. The similar distribution of genotype for both HIV/HCV co-infected and HCV mono-infected patients suggested a similar transmission route for virus and drug. This distribution showed an obvious difference from main land, China where 1b and 2a were much more prevalent. The distribution of HCV genotype is similar with that of South-east Asian countries such as Thailand and Myanmar. The epidemic of HCV was influenced by South-east Asian region. Phylogenetic trees from the NS5B region and C/El region reliably distinguish subtypes while 5'-UTR region contains insufficient variation in determining HCV classifications.