Zhongnan Hospital of Wuhan University, Wuhan, China.
Center for AIDS Research, Wuhan University, Wuhan, China.
JMIR Public Health Surveill. 2024 Feb 27;10:e46750. doi: 10.2196/46750.
The burden of hepatitis B virus (HBV), hepatitis C virus (HCV), and syphilis coinfections remains disproportionately high among people living with HIV/AIDS. Hubei province is located in central China, where there are distinct regional characteristics of the distribution of people living with HIV/AIDS acquired via diverse transmission routes and the AIDS epidemic itself.
We aimed to estimate the magnitude of HBV, HCV, or syphilis coinfections among people living with HIV/AIDS with blood-borne transmission, which includes former paid blood donors, contaminated blood recipients, and intravenous drug users, as well as among people with sex-borne HIV transmission (including heterosexual people and men who have sex with men) and people with mother-to-child HIV transmission.
From January 2010 to December 2020, people living with HIV/AIDS were tested for hepatitis B surface antigen (HBsAg), HCV antibodies, and syphilis-specific antibodies. The positive patients were further tested for HBV markers, HBV DNA, and HCV RNA, and received a rapid plasma reagin circle card test. All people living with HIV/AIDS were first divided into transmission groups (blood, sex, and mother-to-child); then, people with blood-borne HIV transmission were divided into former paid blood donors, contaminated blood recipients, and intravenous drug users, while people with sex-borne HIV transmission were divided into heterosexual people and men who have sex with men.
Among 6623 people living with HIV/AIDS, rates of chronic HCV infection were 80.3% (590/735) in former paid blood donors, 73.3% (247/337) in intravenous drug users, 57.1% (444/777) in contaminated blood recipients, 19.4% (21/108) in people with mother-to-child HIV transmission, 8.1% (240/2975) in heterosexual people, and 1.2% (21/1691) in men who have sex with men. Chronic HBV infection rates were similar among all people with blood-borne HIV transmission. However, compared to heterosexual people, the chronic HBV infection rate was greater in men who have sex with men (213/1691, 12.6% vs 308/2975, 10.4%; χ=5.469; P=.02), although HBV exposure was less common (827/1691, 48.9% vs 1662/2975, 55.9%; χ=20.982; P<.001). Interestingly, the combination of HBsAg and hepatitis B e antigen (HBeAg) was found in 11 patients with sex-borne HIV transmission, but in 0 people with blood-borne HIV transmission (11/196, 5.6% vs 0/521, 0%; χ=29.695, P<.001). In people with sex-borne HIV transmission, the proportions of patients with a syphilis titer ≥1:16 and neurosyphilis were 8.6% (105/1227) and 7.8% (37/473), respectively, whereas these values were 0 in people with blood-borne HIV transmission.
In people living with HIV/AIDS, HCV transmission intensity was significantly associated with specific exposure modes of blood or sexual contact. The rate of chronic HBV infection among men who have sex with men was higher than in any other population. Attention should be paid to the high prevalence of neurosyphilis in people living with HIV/AIDS who contract HIV by sexual intercourse.
乙型肝炎病毒（HBV）、丙型肝炎病毒（HCV）和梅毒合并感染在艾滋病毒/艾滋病患者中负担过重。湖北省位于中国中部，其艾滋病毒/艾滋病患者的分布具有明显的地域特征，包括通过不同传播途径获得的艾滋病毒感染者和艾滋病患者，以及性传播（包括异性恋者和男男性接触者）和母婴传播的艾滋病毒感染者。
我们旨在评估血液传播途径（包括既往有偿献血者、受污染血液接受者和静脉吸毒者）以及性传播途径（包括异性恋者和男男性接触者）和母婴传播途径的艾滋病毒感染者中 HBV、HCV 或梅毒合并感染的程度。
从 2010 年 1 月至 2020 年 12 月，对艾滋病毒感染者进行乙型肝炎表面抗原（HBsAg）、丙型肝炎抗体和梅毒特异性抗体检测。阳性患者进一步检测 HBV 标志物、HBV DNA 和 HCV RNA，并接受快速血浆反应素环状卡片试验。所有艾滋病毒感染者首先分为传播组（血液、性和母婴）；然后，血液传播的艾滋病毒感染者分为既往有偿献血者、受污染血液接受者和静脉吸毒者，而性传播的艾滋病毒感染者分为异性恋者和男男性接触者。
在 6623 名艾滋病毒感染者中，既往有偿献血者的慢性 HCV 感染率为 80.3%（590/735），静脉吸毒者为 73.3%（247/337），受污染血液接受者为 57.1%（444/777），母婴传播的艾滋病毒感染者为 19.4%（21/108），异性恋者为 8.1%（240/2975），男男性接触者为 1.2%（21/1691）。所有血液传播的艾滋病毒感染者的慢性 HBV 感染率相似。然而，与异性恋者相比，男男性接触者的慢性 HBV 感染率更高（213/1691，12.6%比 308/2975，10.4%；χ=5.469；P=.02），尽管 HBV 暴露的情况较少（827/1691，48.9%比 1662/2975，55.9%；χ=20.982；P<.001）。有趣的是，在性传播的艾滋病毒感染者中发现了 11 例 HBsAg 和乙型肝炎 e 抗原（HBeAg）联合阳性患者，但在血液传播的艾滋病毒感染者中未发现（11/196，5.6%比 0/521，0%；χ=29.695，P<.001）。在性传播的艾滋病毒感染者中，梅毒滴度≥1:16 和神经梅毒的比例分别为 8.6%（105/1227）和 7.8%（37/473），而血液传播的艾滋病毒感染者中则为 0。
在艾滋病毒感染者中，HCV 传播强度与血液或性接触的特定暴露模式显著相关。男男性接触者慢性 HBV 感染率高于其他人群。应注意性传播途径感染 HIV 的艾滋病毒感染者中神经梅毒的高患病率。
