Prevalence of hepatitis B and C viruses in HIV-positive patients in China: a cross-sectional study

Introduction: Liver disease related to hepatitis B (HBV) and hepatitis C (HCV) may temper the success of antiretroviral therapy (ART) in China. Limited data exist on their prevalence in HIV-positive Chinese. A multi-centre, cross-sectional study was carried out to determine the prevalence and disease characteristics of HBV and HCV co-infection in HIV-positive patients across 12 provinces. Methods: HIV-positive ART-naive patients were recruited from two parent cohorts established during November 2008-January 2010 and August 2012-September 2014. Hepatitis B surface antigen (HBsAg), hepatitis B e antigen and HCV antibody (anti-HCV) status were retrieved from parent databases at the visit prior to ART initiation. HBV-DNA was then determined in HBsAg + patients. HCV-RNA was quantified in anti-HCV + patients. Aspartate aminotransferase-to-platelet ratio index (APRI) and the fibrosis-4 (FIB4) were calculated. Chi-square test, Kruskal-Wallis test and logistic regression were used for statistical analysis, as appropriate. Results: Of 1944 HIV-positive patients, 186 (9.5%) were HIV-HBV co-infected and 161 (8.3%) were HIV HCV co-infected. The highest HIV-HBV prevalence (14.5%) was in Eastern China while the highest HIV-HCV prevalence was in the Central region (28.2%). HIV-HBV patients had lower median CD4 + T cell count (205 cells/mu L) than either HIV monoinfected (242 cells/mu L, P = 0.01) or HIV-HCV patients (274 cells/mu L, P = 0.001). Moderate-to-significant liver disease was present in >65% of the HIV-HCV, similar to 35% of the HIV-HBV and similar to 20% of the HIV monoinfected patients. Independent associations with moderate-to- significant liver disease based on APRI included HBV (Odds ratio, OR 2.37, P < 0.001), HCV (OR 9.64, P < 0.001), CD4 count <= 200 cells/mL (OR 2.55, P < 0.001) and age >= 30 years (OR 1.80, P = 0.001). Conclusions: HBV and HCV prevalence is high in HIV-positive Chinese and differs by geographic region. HBV and HCV co-infection and HIV monoinfection are risks for moderate-to-significant liver disease. Only HIV-HBV is associated with greater HIV-related immunosuppression. Incorporating screening and management of hepatitis virus infections into Chinese HIV programmes is needed.