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Background:  Over 4 million people are infected with HIV in India. Hepatitis B surface Antigen (HBSAg) prevalence in India is 3 to 5%, hepatitis C (HCV) prevalence is 1 to 2%. Hepatitis B (HBV), HCV, HIV co-infection prevalence is unknown. Risk for HIV transmission is mainly heterosexual sex. HCV and HBV transmission through medical injection has been documented in resource poor settings. We evaluated HCV and HBV prevalence and risk factors among HIV positive and negative men and women in India.

Methods:  YRG CARE is a non-profit HIV referral center in Chennai, India providing care for over 5,000 people.  Five hundred consecutive attendees who were over 18 enrolled after informed consent.  Participants received demographic and risk questionnaires, history, physical exam and counseling. Blood for HIV antibodies with micro-ELISA kits (Vironostika, Organon), Western Blot assay (Biorad), Hepatitis B surface antigen (HbsAg), antibody to HCV with third generation ELISA (Murex Diagnostics) and RIBA were obtained. Data analyses was performed with SPSS v10.0 (Chicago, USA). Univariate analyses with chi-squared test or Fisher exact test for small-expected cell sizes determined potential correlate variables. Multivariate logistic regression was performed on statistically significant risk factors.

Results:  Among participants (median age 31, 66% male) seroprevalences were HIV 73%, HBV 5%, HCV 5%, HIV/HBV 4%, HIV/HCV 3%, and HCV/HBV 0%. 25 of 27 HCV ELISA positive results were confirmed with HCV RIBA. 95% of all participants received medical injections. 100% of 25 subjects who received more than100 injections were HIV infected. None were HCV positive; 5% were HBSAg positive. HIV positivity on multivariate analysis correlated with receipt of eleven or more medical injections in the last ten years, history  of STD, TB, trucking, having paid money for sex. (p <0.05)  In univariate analysis HIV (not HCV or HBV) seropositivity was also associated with head shaving for religious purposes (p = 0.004) and use of street  barbers (p = 0.001) . HCV seropositivity was associated with receipt of blood transfusion (p = 0.001). HIV and HBSAg were not.

Conclusions:  Our study demonstrates low HIV /HCV/HBV co-infection rates in Chennai. Screening for HBV and HCV in HIV infected patients may be reserved for patients in whom there is significant clinical suspicion. Unsterile medical injections and nontraditional exposure to blood-borne diseases may be associated with HIV transmission.

Keywords: Hepatitis C; Hepatitis B; Co-Infection Seroprevalance