High hepatitis C virus infection among female sex workers in Viet Nam: strong correlation with HIV and injection drug use
DOI:
https://doi.org/10.5365/wpsar.2019.10.1.002Abstract
Objective: The World Health Organization’s guidelines on viral hepatitis testing and treatment recommend prioritizing high prevalence groups. Hepatitis C virus (HCV) infection disproportionately affects people who inject drugs and men who have sex with men, but data on female sex workers (FSW) are limited. The study aimed to determine active HCV infection and risk factors associated with HCV exposure among Vietnamese FSW.
Methods: We surveyed 1886 women aged >= 18 years from Haiphong, Hanoi and Ho Chi Minh City who had sold sex in the last month. We tested for HCV antibody and HCV core antigen as markers for exposure to HCV and active infection, respectively.
Results: Across these provinces, high prevalence of HCV exposure (8.8–30.4%) and active infection (3.6–22.1%) were observed. Significant associations with HCV exposure were HIV infection (aOR = 23.7; 95% CI: 14.8–37.9), injection drug use (aOR = 23.3; 95% CI: 13.1–41.4), history of compulsory detention (aOR = 2.5; 95% CI: 1.4–4.2) and having more than 10 sex clients in the last month (aOR = 1.9; 95% CI: 1.2–3.2). Among FSW who reported never injecting drugs, HIV infection (aOR = 24.2; 95% CI: 14.8–39.4), a history of non-injection drug use (aOR = 3.3, CI: 1.8–5.7), compulsory detention (aOR = 2.2; 95% CI: 1.2–4.0) and having over 10 sex clients in the last month (aOR = 2.2, 95% CI: 1.3–3.7) were independently associated with HCV exposure.
Discussion: FSW have elevated HCV risks through sex- and drug-related pathways. These findings highlight the need to offer FSW-targeted HCV interventions and ensure their access to HIV prevention and treatment.
References
Global Hepatitis Report 2017. 2017, World Health Organization: Geneva.
Hajarizadeh, B., J. Grebely, and G.J. Dore, Epidemiology and natural history of HCV infection. Nature Reviews Gastroenterology & Hepatology, 2013. 10(9): p. 553-562.
Alter, M.J., Epidemiology of hepatitis C virus infection. World Journal of Gastroenterology, 2007. 13(17): p. 2436.
Degenhardt, L., et al., Estimating the burden of disease attributable to injecting drug use as a risk factor for HIV, hepatitis C, and hepatitis B: findings from the Global Burden of Disease Study 2013. Lancet Infect Dis, 2016. 16(12): p. 1385-1398.
World Health Organization, WHO guidelines on hepatitis B and C testing. 2017, World Health Organization: Geneva, Switzerland.
General Department of Preventive Medicine, M.o.H., Center for Disease Analysis, and World Health Organization, Estimates and Projection of Disease Burden and Investment Case for Hepatitis B and C in Viet Nam. 2017, Ministry of Health: Hanoi.
Duong, H.T., et al., Risk Behaviors for HIV and HCV Infection Among People Who Inject Drugs in Hai Phong, Viet Nam, 2014. AIDS Behav, 2017.
Nadol, P., et al., Findings from integrated behavioral and biologic survey among males who inject drugs (MWID) - Vietnam, 2009-2010: evidence of the need for an integrated response to HIV, hepatitis B virus, and hepatitis C virus. PLoS One, 2015. 10(2): p. e0118304.
Nadol, P., et al., High hepatitis C virus (HCV) prevalence among men who have sex with men (MSM) in Vietnam and associated risk factors: 2010 Vietnam Integrated Behavioural and Biologic Cross-Sectional Survey. Sex Transm Infect, 2016.
StataCorp, Stata Statistical Software: Release 14. 2014, StataCorp LP: College Station, TX.
Sandesh, K., et al., Prevalence of Hepatitis B and C in the normal population and high risk groups in north Kerala. Trop Gastroenterol, 2006. 27(2): p. 80-3.
Wu, J.C., et al., Prevalence, infectivity, and risk factor analysis of hepatitis C virus infection in prostitutes. J Med Virol, 1993. 39(4): p. 312-7.
Goldenberg, S.M., et al., Dual sexual and drug-related predictors of hepatitis C incidence among sex workers in a Canadian setting: gaps and opportunities for scale-up of hepatitis C virus prevention, treatment, and care. International Journal of Infectious Diseases, 2017. 55: p. 31-37.
Iversen, J., et al., HIV, HCV, and Health-Related Harms Among Women Who Inject Drugs: Implications for Prevention and Treatment. J Acquir Immune Defic Syndr, 2015. 69 Suppl 2: p. S176-81.
Zhang, G.Q., S.D. Chen, and J.H. Lian, [Seroepidemiological study of HBV and HCV infection in sexually promiscuous groups]. Zhonghua Liu Xing Bing Xue Za Zhi, 1995. 16(4): p. 213-6.
Maher, L., et al., Amphetamine-type stimulant use and HIV/STI risk behaviour among young female sex workers in Phnom Penh, Cambodia. International Journal of Drug Policy 2011. 22: p. 203-209.
Ward, H. and M. Ronn, Contribution of sexually transmitted infections to the sexual transmission of HIV. Curr Opin HIV AIDS, 2010. 5(4): p. 305-10.
World Health Organization, et al., Implementing Comprehensive HIV/STI Programmes With Sex Workers: Practical Approaches From Collaborative Interventions. 2013, World Health Organization: Geneva.
Grebely, J., et al., The effects of female sex, viral genotype, and IL28B genotype on spontaneous clearance of acute hepatitis C virus infection. Hepatology, 2014. 59(1): p. 109-20.
Sulkowski, M.S., Management of hepatic complications in HIV-infected persons. J Infect Dis, 2008. 197 Suppl 3: p. S279-93.
Hipgrave, D.B., et al., Hepatitis B infection in rural Vietnam and the implications for a national program of infant immunization. Am J Trop Med Hyg, 2003. 69(3): p. 288-94.
Nguyen, V.T., M.L. McLaws, and G.J. Dore, Highly endemic hepatitis B infection in rural Vietnam. J Gastroenterol Hepatol, 2007. 22(12): p. 2093-100.
Truong, B.X., et al., Genotype and variations in core promoter and pre-core regions are related to progression of disease in HBV-infected patients from Northern Vietnam. Int J Mol Med, 2007. 19(2): p. 293-9.
Parekh, S., et al., Genome replication, virion secretion, and e antigen expression of naturally occurring hepatitis B virus core promoter mutants. J Virol, 2003. 77(12): p. 6601-12.
Lin, C.L. and J.H. Kao, Risk stratification for hepatitis B virus related hepatocellular carcinoma. J Gastroenterol Hepatol, 2013. 28(1): p. 10-7.
Pinkham, S. and K. Malinowska-Sempruch, Women, Harm Reduction and HIV. Reproductive Health Matters, 2008. 16(31): p. 168-181.
Sievert, W., et al., A systematic review of hepatitis C virus epidemiology in Asia, Australia and Egypt. Liver Int, 2011. 31 Suppl 2: p. 61-80.
Freiman, J.M., et al., Hepatitis C Core Antigen Testing for Diagnosis of Hepatitis C Virus Infection: A Systematic Review and Meta-analysis. Ann Intern Med, 2016. 165(5): p. 345-55.
Dunford, L., et al., Hepatitis C virus in Vietnam: high prevalence of infection in dialysis and multi-transfused patients involving diverse and novel virus variants. PLoS One, 2012. 7(8): p. e41266.
Hong, N.T., et al., Utilization of HIV voluntary counseling and testing in Vietnam: an evaluation of 5 years of routine program data for national response. AIDS Educ Prev, 2011. 23(3 Suppl): p. 30-48.
