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Prevalence of HIV, Hepatitis B and C Infections and an Assessment of HCV-Genotypes and Two IL28B SNPs Among People Who Inject Drugs in Three Regions of Nepal

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Prevalence of HIV, Hepatitis B and C Infections and an Assessment of HCV-Genotypes and Two IL28B SNPs Among People Who Inject Drugs in Three Regions of Nepal

Hans-Tilmann Kinkel et al. PLoS One.

Abstract

As part of a comprehensive health care programme for people who use drugs in Nepal, HIV and viral hepatitis B and C status--including risk factors, HCV-genotypes and co-infections--as well as two IL28B Single-nucleotide polymorphisms (SNPs) were assessed for a random sample of 401 people who inject drugs in three regions of Nepal: mid-western Terrai (Nepalgunj), the eastern region (Dharan, Biratnagar) and the central region (Kathmandu, Lalitpur and Chitwan). Individuals were included who showed at least a minimum of health care seeking behaviour. This latter criterion was defined by being registered with any organisation offering health services. The average age of the participants was 30.5 yrs, and the average length of intravenous drug use was 8.5 yrs. The prevalence rates of HBsAg, anti-HIV antibodies and HCV-RNA were 3.5%, 13.8% and 41.9%, respectively. Spontaneous HCV clearance was evident in 16% of all of those who tested positive for anti-HCV antibodies. Independent risk factors for HCV-RNA positivity were age, gender, geographical region, duration of injecting drug use, history of imprisonment and HIV co-infection. In the age group ≤24 yrs, the rate of spontaneous HCV clearance was 43.5%. Overall, 59.8% of HCV infections were caused by HCV genotype 3 and 40.2% by HCV genotype 1. No other HCV genotypes were identified in this study. The IL28B SNP rs12979860 and rs8099917 were identified in 122 patients, and 75.4% of all participants had both favourable genotypes rs12979860 C/C and rs8099917 T/T.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. HCV-RNA positivity stratified by age.
Rate of HCV-infection is associated with age (χ2-p<0.001, error bars show 95% CI).
Fig 2
Fig 2. Rate of spontaneous clearance stratified by age and HIV status.
Rate of spontaneous clearance of HCV is associated with age (spontaneous clearance associated with age: χ2-p<0.001) and HIV status (spontaneous clearance associated with HIV-status in “all” patients: two-sided Fischer’s Exact p = 0.03, error bars show 95% CI).
Fig 3
Fig 3. Percentage of HCV genotype-frequencies.
Fig 4
Fig 4. Phylogenetic tree of the 5 UTR region of HCV.
The tree is generated by the neighbour-joining method in MEGA 6. The symbol indicates the reference sequences. The first character of the code indicates the origin of the sample (K: Kathmandu, L: Lalitpur, (Central Region), B: Biratnagar (Eastern Region), and N: Nepalgunj (Western Region).
Fig 5
Fig 5. Rate of spontaneous clearance stratified by HBsAg-status.
Spontaneous HCV clearance among people living with HBsAg is significantly higher versus people who are negative for HBsAg. (Two-sided Fisher exact p<0.001, error bars show 95% CI).
Fig 6
Fig 6. Percentage of frequencies of HIV and HCV mono- and co-infection.
At 3.3%, HIV mono-infection is a comparatively rare constellation whereas HIV/HCV co-infection is found in 18.1% of all participants (n = 397).

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Grant support

This work was supported by Nepali-German Project “HIV prevention for the high–risk group of injecting drug users” and commissioned by the German Federal Ministry of Economic Cooperation and Development (BMZ). The analysis, results and recommendations in this paper represent the opinion of the authors and are not necessarily representative of the position of the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH (www.giz.de; www.mohp.gov.np). No individuals employed or contracted by the funders (other than the named authors) played any role in: study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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