HCV-HBV co-infection in Russian Federation

Chumakov Institute of Poliomyelitis and Viral Encephalitis, Moscow

Karen Kyuregyan

VIII Annual Conference of New Visby Network on Hepatitis C

February 13-16, 2011

Vilnius

• Data on incidence of hepatitis B and C in Russian Federation based on official registration

• Results of laboratory study of patients from two regions with different HBV and HCV prevalence: Moscow region and Tyva Republic

Incidence of acute and chronic hepatitis B in Russian Federation

(1999-2009)

43,842,5

35,3

19,3

1310,4

13,9

75,3

42,7

9

14,216 15

1315,5

8,6

14,1 14 14,2 14,4

0

5

10

15

20

25

30

35

40

45

50

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

years

inci

den

ce,

case

s p

er 1

00,0

00

Acute hepatitis B

Chronic hepatitis B

Incidence of acute and chronic hepatitis C in Russian Federation

(1999-2009)

20,922,2

16,7

7,15,2 4,8 4,5 4,1 3,6 2,8 2,2

12,9

21,1

29,530,7

33,1 3431,8

35,837,1

39,140,9

0

5

10

15

20

25

30

35

40

45

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

years

inci

den

ce,

case

s p

er 1

00,0

00

Acute hepatitis C

Chronic hepatitis C

Transmission routes of Hepatitis B and Hepatitis C in Russian Federation

(1997 and 2008)

40,2

12,7

28,7

18,4

38,6

38,8

18,4

4,2

0%

20%

40%

60%

80%

100%

1997 2008

HBV transmission

Not determined Household contacts and sexual transmission

Drug abuse Nosocomial transmission

37,7

9,4

43,3

9,6

45,2

25,9

24,8

4,1

0%

20%

40%

60%

80%

100%

1997 2008

years

HCV transmission

Not determined Household contacts and sexual transmission

Drug abuse Nosocomial transmission

Distribution of chronic hepatitis B and chronic hepatitis C incidence in different age groups in Russian Federation (2008)

3%

27%

21%

15%

19%

14%

19%

43%

23%

8%4%2%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

CHB CHC

>60

50-59

40-49

30-39

20-29

15-19

0-14

• Similar trends in incidence for hepatitis B and hepatitis C;

• Common routes of transmission for HBV and HCV;

• Similar affected age groups;

• High prevalence of HBV-HCV co-infection could be expected;

• No official registration for mixed infections

Study groups

Moscow:

• 244 patients with chronic hepatitis C

Tyva

• 133 patients with chronic hepatitis:

- 38 patients with chronic hepatitis C

- 95 patients with chronic hepatitis B/D and cirrhosis

Incidence of chronic hepatitis B and chronic hepatitis C in Moscow region and

in Tyva Republic (2006-2009)

Incidence of CHB and CHC in Moscow region

31,9229,39

36,02

41,65

6,77 6,74 7,939,74

0

5

10

15

20

25

30

35

40

45

2006 2007 2008 2009

years

inci

denc

e, c

ases

per

100

,000

Chronic hepatitis C

Chronic hepatitis B

Incidence of CHB and CHC in Tyva Republic

5,84 6,8

9,34

18,54

23,3722,01

20,61

32,61

0

5

10

15

20

25

30

35

2006 2007 2008 2009

years

inci

denc

e, c

ases

per

100

,000

Chronic hepatitis B

Chronic hepatitis C

HBV detection• HBsAg: ELISA (“Diagnostic systems”, Russia) sensitivity - 0.01 ng/ml, K141E, Q129H, M133L, T126N, K 142S, P 142S, T143K, G145R • HBV DNA:Nested PCR, S-gene primerssensitivity – about 100 copies/mlBatches < 15 samplesLow copy K+ (150 copies/ml and 1500 copies/ml)4 K- per batch

Moscow group

• 244 patients with chronic hepatitis C

HCV genotype distribution, %

46,7

7,4

45,9

1b 2a 3a

Tyva group

• 38 patients with chronic hepatitis C

HCV genotype distribution, %

65,82,6

31,6

1b 1a 3a

Prevalence of HBV/HCV co-infection in Moscow group

CHC, n=244

HBsAg + (HBV DNA -)

N= 2 (0.82%)

Anti-HBc +

Anti-HBs+

HBsAg –

N = 42 (17.2%)

Anti-HBc +

Anti-HBs -

HBsAg –

N = 96 (39.3%)

Anti-HBc -

Anti-HBs-

HBsAg –

N = 104 (42.6%)

N = 138 (56.6%)

Testing for occult HBV infection

No cases of OBI detected

CHC, n=38

HBsAg + (HBV DNA -)

N= 3 (7.9%)

Anti-HBc +

Anti-HBs+

HBsAg –

N = 13 (34.2%)

Anti-HBc +

Anti-HBs -

HBsAg –

N = 13 (34.2%)

Anti-HBc -

Anti-HBs-

HBsAg –

N = 9 (23.7%)

N = 26 (68.4%)

Testing for occult HBV infection

2 cases of OBI

Prevalence of HBV/HCV co-infection in Tyva group

Cases of occult HBV infection in CHC patients (Tyva)

Sample ID

HBV genotype

Serotype Aa subst. in HBsAg

HBV viral load

600 D ayw1 F8L

Y134F

Y 206C

< 1000 copy/ml

1549 A2 adw2 I25V < 1000 copy/ml

Immune staining with protein A – colloidal gold complex. x 300 000

Prevalence of HCV infection in patients with HBV/HDV

HBsAg+/anti-HDV+

N=95

anti-HCV+ (HCV RNA-)

N=8 (8.4%)

After 1 year follow up 10/95 patients died

Patients

N=95

Age M:F HDV RNA +

N (%)

HBV DNA+

N (%)

Anti-HCV+

N (%)

CH

N (%)

Cirrhosis A*

N (%)

Cirrhosis B-C*

N (%)

Survivors, n= 85 (89.5%)

37.6±

12.2

1:2 29 (34.1%)

23 (27.1%)

7 (8.2%) 68 (80%)

4 (4.7%) 13 (15.3%)

Non-survivors, n=10 (10.5%)

46.5±

10.4

1.5:1 2 (20%) 5 (50%) 1 (10%) 3 (30%) 6 (60%) 1 (10%)

* - cirrhosis grade by Child-Pugh

SummaryPrevalence of HBV/HCV co-infection in studied cohorts:• 2 cases (0.82%) in Moscow region; however, 56.6% patients with HCV have markers of HBV exposure;

• 5 cases (13.2%) in hepatitis C patients + 8 cases (8.4%) in hepatitis B/D patients in Tyva Republic; • Difference in HBV/HCV co-infection prevalence in 2 regions may be due to acquisition of HBV in different age.

Conclusion

• In such hyperendemic regions as Tyva Republic HBV testing should be recommended for all HCV positive patients

M.I.MikhailovO.V.IsaevaL.Yu.IlchenkoN.I.GromovaI.A.MorozovT.V.KozhanovaI.V.Gordeychuk N.D.Oorzhak