Paper # 693|
Prevalence of HCV Infection among HIV-1-infected Pregnant Women in Malawi: The BAN Study
Charles Chasela1,2 and the BAN Study Team
1UNC Project, Lilongwe, Malawi and 2Univ Coll Dublin, Ireland
Introduction: Co-infection with hepatitis C virus
(HCV) and human immunodeficiency virus type I (HIV-1) is a significant international
public health problem. Given the potential for chronic HCV-associated
morbidity, we evaluated the prevalence of HCV infection among HIV-infected
pregnant women enrolled in the Breastfeeding, Antiretroviral, and Nutrition
(BAN) Study in Lilongwe, Malawi (www.thebanstudy.org).
Methods: Serum collected from 2043 HIV-infected
pregnant women was screened for HCV using a chemiluminescent immunoassay (CIA)
for anti-HCV IgG (Vitros ECi, Ortho CD, Rochester, NY). All specimens with a
signal-to-cut-off (S/CO) ratio of 1.0 and above were considered anti-HCV CIA reactive.
All anti-HCV reactive specimens were subject to confirmatory testing with a recombinant
immunoblot assay (RIBA HCV 3.0, Novartis V&D, Emeryville, CA) and HCV RNA
test. Proportions and confidence intervals, using binomial exact approximations,
Results: Of 2043 women tested, 113 (5.5%) were anti-HCV
reactive; 14/113 (12.4%, 95%CI, 6.9 to 19.9%) had a CIA S/CO ratio above 8.0.
Of the 113 anti-HCV reactive, 108 were tested with RIBA. Only 2 of the 108 (1.9%,
95%CI 0.2 to 6.5%) were positive, consistent with confirmed past or current HCV
infection; 26 (24.1%, 95%CI 16.3 to 33.3%) were indeterminate, and 80 (74%,
95%CI 64.8 to 82.0%) were negative. All 113 specimens tested were HCV RNA negative.
The mean (SD) age of study participants was 25.8 (5.1) years, and women had a median
CD4 count (IQR) of 420 (300 to 573) cells/mm3, alanine
aminotransferase (ALT) of 13 (10 to 15) mg/dL, and albumin of 2.8 (2.5 to 3.0)
Conclusions: Although this population of
HIV-infected pregnant women in Malawi demonstrates a high frequency of anti-HCV
reactivity when screened (5.5%), the prevalence of confirmed past or current
HCV infection is very low (<0.1%). The high HCV reactivity is most likely a
false positive result in this low prevalence population.