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While many studies from other countries1,2 document hepatitis B virus (HBV) and hepatitis C virus (HCV) infection rates in STD clinic patients, very few data are available from India. In the present report, we have analysed the rate of HBV and HCV infections in STD patients by using serological and molecular methods of diagnosis.
The study subjects were symptomatic STD patients (n = 143), who attended the STD clinic, Government General Hospital, Chennai, between September 1998 and August 2000, randomly included for a study on STDs after obtaining informed consent. Blood samples were evaluated for hepatitis and HIV markers by ELISA kits; HBsAg, HBeAg/anti-HBe (Biorad laboratories, USA), anti-HCV (Murex Diagnostics, UK), anti-HIV 1 and 2 (Xyton Diagnostics, India). Anti-HIV positivity was confirmed by another EIA kit (Sanofi Pasteur, France). Detection of HBV DNA and HCV RNA was performed by polymerase chain reaction (PCR)3 and RT-PCR4 methods.
The serological and molecular marker profile for HBV and HCV is shown in table 1. HBsAg was positive in 37 (25.9%) patients, while HBV DNA was detected in 25 (67.6%) of them. HBV DNA was detected in 23 of 28 HBeAg positives and two of nine anti-HBe positive cases. The overall HBV positivity rate was significantly higher in females than in males (33.7% v 15.9%; p<0.05). Anti-HCV was positive in six (4.2%) patients and five of them showed HCV-RNA positivity. RT-PCR additionally detected HCV-RNA in two anti-HCV negative patients. The overall HCV prevalence was 5.6%. Anti-HIV positivity was seen in 24 (16.8%) patients. Men had a significantly higher HIV positivity rate compared to women (27% (17/63) v 8.8% (7/80); p<0.05). HIV co-infection was observed in five (13.5%) of the HBV infected patients and in two (25%) of the HCV positive patients in whom HCV RNA alone was positive.
There was a low prevalence of injection drug use (7.7%), history of blood transfusion (5.6 %), and homosexual contact (2.9%) and these risk factors showed no correlation with HBV and HCV positivity. Having multiple sexual partners was a risk factor significantly associated with HBV and HCV positivity in men. Men who had multiple sexual partners (n = 35) had 14.3% HCV positivity and 17.1% HBsAg positivity, while in those who did not report multiple sexual contact, 3.8% had HBsAg positivity and none had HCV positivity.
The results of the present study suggest that STD clinic patients may be considered as a targeted high risk group for routine screening for HBV and HCV to control the high infection rates. HIV co-infection in HBV/HCV infected patients is a matter of concern to evolve better clinical management strategies. Our data emphasise the need for molecular diagnosis to prevent underdiagnosis of HCV infection in STD/HIV patients. The HBV positivity rate (26%) observed in the present series of STD patients is high compared to previous Indian reports.5,6 HBV vaccination in STD patients may be a much needed intervention to strengthen STD control programmes in India. Further large studies are required to assess the magnitude of HBV and HCV infections, role of sexual transmission, and associated risk factors in the STD population.