HBV and HCV epidemiology and HIV and HCV molecular variability in the community of inmates in Italy

Project Title: Multicentric study on the epidemioloigcal and molecular chracteristics of HBV and HCV hepatitis viruses in the HIV-positive inmates in Italy.

Duration of the project : From December 2016 to June 2019

 

Main Topic:

Transmission of pathogens, such as HIV, HBV and HCV through blood and/or unprotected sexual intercourses is highly favored in a detention setting, due to overcrowding, scarce hygiene, promiscuity and absence of effective health policies.

Prevalence rates of blood-borne virus infections vary substantially among prison settings of different countries, reflecting the epidemiological characteristics of the geographic area, the risk category of people entering prisons and prevalence of foreign prisoners. Different prevalence values are reported for HIV and viral hepatitis antibody markers, varying from 0.04% to 17%, from 21.7% to 52% and from 4.9% to 80% for HIV, HBV and HCV, respectively, mostly depending on the prevalence of drug users and foreign people.

The high prevalence of HIV, HBV and HCV infections raises concerns for their spreading within the prison and the general population in Italy. However, efforts to contain spreading of these blood-borne pathogens in prisons are strongly limited by severe budget constraints that lead to crumbing and obsolete health facilities and by frequent inmate transfers between prisons that do not allow regular and constant clinical visits and maintenance of an effective correctional healthcare database.

In prisons, individuals may suffer from poorer health than the general population. Studies have shown that this situation is common in all high-income countries. This health disparity has been linked to various behavioral and socioeconomic factors, such as high rates of intravenous drug use, which lead to an increased risk of infectious diseases and mental illness, and increased alcohol misuse and smoking, which raise the risk of cardiovascular diseases and some tumors. Finally, since detainees are usually released after serving a term of imprisonment, upon which they interact with communities living outside of prisons, they present a complex and difficult challenge for public health, especially with regard to tackling communicable diseases such as HIV and HBV and HCV hepatitis.

 

Objective:

Therefore, objectives of the project are:

1. To evaluate presence of HBV and HCV infections in the population of HIV-positive inmates
2. To investigate the heterogeneity of HIV, HBV and HCV genetic forms circulating within the community of inmates in Italy.
3. To educate inmates to prevent blood-borne and sexual-transmitted diseases.

 

Type of study:

The project takes advantage of the collaboration of a network comprising several clinical centers in different cities distributed over the national territory, including Sardinia.

Plasma and blood cells are collected in each center. During sample collection the inmate is informed on the mechanisms of transmission of HIV, HBV and HCV, on the behaviors to prevent infection and on the available cures in case of infection.

At the National Center for HIV/AIDS research collected samples are be used for:

• Testing for the presence of HBV and HCV markers.
• Evaluating the presence of the HIV genetic forms by phylogenetic analysis of HIV sequences obtained either from plasma or cells
• Evaluating the presence of the HBV and HCV genetic forms in those individuals who resulted to be HBV- and/or HCV-infected, by phylogenetic analysis of sequences from these viruses obtained from plasma.
• Investigating for the presence of HIV and/or HBV and/or HCV variants that are resistant to therapy.

 

Expected results:

In the frame of a different project, we performed a first study on 69 inmates whose biological samples were collected in 7 detention centers of 7 cities in Italy and Sardinia. All detainees were informed on behaviors to prevent spreading of HIV, HBV and HCV and on available cures and the needed compliance to therapy. Twelve over 14 HIV-subtyped inmates were infected with HIV-1 subtype B strains. The two non-B strains belonged to subtype G and CRF02_AG, in an Italian and a Gambian patient, respectively. Variants carrying the K103N and Y181C resistance mutations to Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTI) were found in two out of 9 patients naïve for combined anti-retroviral therapy (cART) (22.2%). Most HIV positive patients (92.8%) showed evidence of past or present HBV and/or HCV infection. Prevalence of HBV and HCV was 81.2% for both viruses, whereas prevalence of HBV/HCV co-infection was 69.6%. A significantly higher presence of HCV infection was found in Italians (OR 11.0; interval 1.7-80.9) and in drug users (OR 27.8; interval 4.9–186.0). HCV subtypes were determined in 42 HCV or HBV/HCV co-infected individuals. HCV subtypes 1a, 3a, 4d and 1b were found in 42.9%, 40.5%, 14.3% and 2.4% of inmates, respectively. Low titers of HBV DNA in HBV DNA positive subjects precluded HBV subtyping.

In the frame of the current project, we collected samples from 66 inmates in other detention centers and other cities. Testing of samples is underway.

 

Responsible of the project: Maria Teresa Maggiorella (mariateresa.maggiorella@iss.it)

Department/Center: Centro Nazionale per la Ricerca su HIV/AIDS