28 LIST OF CANDIDATE’S SURVEYS ASSOCIATED WITH THESIS PUBLISHED 1. Nguyen Tien Hoa, Nguyen Tran Hien, Nguyen Thi Lan Anh, Le Anh Tuan (2010), Status of HIV, HBV, HCV infections and risk factors among injecting drug users and female sex workers in Hanoi, 2008, Journal of Preventive Medicine, Volume XIX, No 8 (116), pp. 50-56. 2. Nguyen Tien Hoa, Nguyen Van Luyen, Nguyen Thuy Linh, Bui Thi Lan Anh, Đo Huy Duong, Vu Thi Hong Duong, Nguyen Thanh Binh, Le Anh Tuan, Nguyen Tran Hien (2011), HIV, HBV, HCV prevalence and risk factors among injecting drug users and female sex workers in Hanoi, 2008-2010, Journal of Preventive Medicine, Volume XXI, No 7 (125), pp. 140-147. 1 MINISTRY OF EDUCATION- TRAINING - MINISRY OF PUBLIC HEALTH NATIONAL INSTITUTE OF HYGIENE AND EPIDEMIOLOGY NGUYEN TIEN HOA SITUATION OF HIV, HBV, HCV INFECTION AND ASSOCIATED FACTORS IN SOME HIGH RISK POPULATIONS IN HANOI, 2008-2010 Specialization: Epidemiology Code: 62.72.01.17 THESIS SUMMARY OF MEDICAL DOCTOR HANOI-2012 2 TRAINING INSTITUTION NATIONAL INSTITUTION OF HYGIENE AND EPIDEMIOLOGY Tutors: 1. Assoc. Prof. Nguyen Tran Hien 2. Prof. Le Anh Tuan Opponent scientist 1: Assoc. Prof. phD. Đoan Huy Hau Opponent scientist 2: Assoc. Prof. phD. Nguyen Duc Hien Opponent scientist 3: Assoc. Prof. phD. Nguyen Minh Son Thesis is protected at the assembly point of thesis at Level of Institute, meeting at the National Institute of Hygiene and Epidemiology, at last….now… dated… 2012 year. Thesis can find out at: 1. National library 2. Library of National Institute of Hygiene and Epidemiology 27 3. To enhance further researchs of the molecular epidemiology of blood borne viruses order to surveillance and determine molecular epidemiological characteristics of HIV, HBV, HCV infections in Vietnam. 4. It should be having measures to strengthen hepatitis B vaccination for high risk subjects. 26 For HBV/HCV co-infection among IDUs and FSWs, HCV-6 and HCV-1 genotypes ware similar. 3. Several influencing factors increase the transmission of HIV, HBV, HCV among IDUs, FSWs, HDPs and MTPs in Hanoi, 2008-2010: + Risks for HIV, HBV, HCV infection among IDUs and FSWs was drug injecting. The longer time of drug injecting, the higher rate of HIV, HCV infections; Risks for HIV, HBV, HCV infections among HDPs and MTPs, Duration of heamodialysis lasts many years and HDPs receives blood transfusion many times. + HIV, HCV infected IDUs was the highest in 30-39 age group. HIV infected FSWs was the highest in 20-29 age group and HCV infection was the highest in 30-39 age group. HBV infected HDPs was highest 30-39 age group. Number of HBV infected MTPs increases ages and the highest was over 50 age group. HCV infected HDPS and MTPs was upward tendency of ages but not statisticant difference. + HIV, HCV infected IDUs and FSWs were the highest rate among subjects have special conditions: divorce, seperation and widow. + Among IDUs and HDPs, who received HBV vaccination, the rate of HBV infection was lower than no HBV vaccination with statistical defference (p<0.05 and p<0.01). PETITIONS 1. To integrate HBV, HCV routine and sentinel surveillance with HIV surveillance for IDUs and FSWs associated with injecting drug to contribute making effective prevention and treatment for HIV, HBV, HCV infections. 2. To increase the quality of screening blood transfusion and blood products; to strengthen the preventive measures for blood-borne viruses cross- transmission in hemodilysis and blood transfusion units 3 BACKGROUND HIV, HBV, HCV are a important human communicable diseases viruse group and one of leading causes of diseases worldwide. These viruses have shared modes of transmission but the transmission efficiency of each virus differs from each other. Persons at high risk for HIV infections are also likely to be at high risk for other blood borne viruses, including HBV and HCV. Coinfection is modified the natural history of monoinfection. Further, coinfection with viral hepatitis may complicate the delivery impacting the selection of ART by increasing the risk of drug-related hepatoxicity and of specific agents. Owing to characteristics of disease transmission like that those agents has very high potentially transmission among special population groups which has behaviors or conditions increases transmission as injecting drug use, female sex worker, heamodialysis patients, multi-transfusion patients (at high risk groups). Those high risk groups has very important role among the epidemiology and public heath for the dangerous communicable diseases spreaded to the famillies and the general population. Based on those problems, we had searched thesis: “Situation of HIV, HBV, HCV infection and associated factors in some high risk populations in Hanoi, 2008-2010”. OBJECTIVES: 1. Determine the rate of HIV, HBV, HCV infection among Injecting drug users, female sex workers, heamodialysis patients and multi-tranfused patients in Hanoi, 2008-2010. 2. Determine genotypes of HIV, HBV, HCV among at high risk several subjects in Hanoi, 2008-2010. 3. Describe several risk factors increasring of HIV, HBV, HCV transmission among Injecting drug users, female sex workers, heamodialysis patients and multi-tranfused patients in Hanoi, 2008-2010. 4 NEW CONTRIBUTIONS OF THESIS - To determine prevalence of HIV, HBV, HCV among some at high risk groups (Injecting drug users, female sex workers, hemodialysis patients and multi- transmitted patients) in Hanoi, 2008-2010. - Provide several data of HIV, HCV genotypes has at high risk trasmission of injecting drug user and female sex workers. Recommendations about of occurring HIV-1 recombinant genotypes, find out the treatment those viruses will be more complicated in the near future. - To determine several relational factors may be increasing transmission of HIV, HBV, HCV among at high risk groups in Hanoi, 2008-2010. - To provide several recommendations may be apply in the most appropriatte surveillance and prevention of HIV, HBV, HCV in the near future Vietnam. - Survey results also have the value of the reference for science research, educated, trained work in the near future. Data of viruses coinfection may be contribute into the National Databank of AIDS programme for projects, National objective programmes find out and carried out. ARRANGEMENT Thesis have 142 pages and 6 appendix pages, include: Background 2 pages, overview 37 pages, method 24 pages, study results 34 pages, discussion 23 pages, conclusion 2 pages, petition 1 page, list of the article has relation with thesis published: 1 pages, difference document: 24 pages, appendix: 6 pages. Thesis use 223 differences documents (36 Vietnames documents và 187 foreign documents). Thesis have 34 tables, 16 figures. 25 CONCLUSIONS 1. The rate of HIV, HBV, HCV infection among IDUs, FSWs, HDPs and MTPs in Hanoi (2008-2010): 1.1. Among Injecting drug users: HCV prevalence was highest (60.0%, 57.3%, 69.3%) and had an increasing tendency (p<0.05). HIV prevalence was high (43.0%, 37.7%, 30.5%) but had an decreasing tendency (p<0.05) and HBV prevalence (16.5%, 15.1%, 12.5%) was decreasing. HIV/HCV co- infection was highest (86.0%, 92.0%, 100%), then HIV/HBV co-infection (15.1%, 6.7%, 16.4%) and HIV/HBV/HCV co-infection (10.5%, 6.7%, 16.4%). 1.2. Among Female sex workers: prevalence was highest (45.0%, 39.0%, 25.5%) but was decreasing (p<0.01) then HCV prevalence (24.6%, 27.0%, 21.5%) và HBV prevalence(14.5%, 9.0%, 9.5%). HIV/HCV co-infection was highest (32.2%, 32.1%, 52.9%) and had an increasing tendency (p<0.05) but HIV/HBV co-infection (12.2%, 9.0%, 7.8%) và HIV/HBV/HCV co-infection (3.3%, 3.8%, 2.2%) had an decreasing tendency. 1.3. Among Haemodialysis patients: HCV prevalence was highest (45.0%, 28.7%, 31.3%) and had an decreasing tendency, then HBV prevalence(12.0%, 11.3%, 10.7%). HBV/HCV co-infection was small. 1.4. Among Multi-transfused patients: HBV prevalence(7.0%, 6.7%, 5.4%) and HCV prevalence (13.0%, 5.3%, 3.3%) were the same and had an decreasing tendency . 2. HIV genotype of injecting drug users and female sex workers was CRF_AE01 and HCV genotype was HCV-6 (-6a, -6e) and HCV-1 (-1a, -1b). For HIV/HBV/HCV co-infection among IDUs, HCV genotype were mainly HCV-1a. 24 population in Vietnam. Our study, the rate of HBV infection among IDUs also is downward tendency but the difference in 3 years has not significantly statistic (p>0.05). Study result showed that, HBV transmission by drur injecting was lower HIV and HCV transmission or may be result of HB vaccination programme carried out very well for children before. Nowadays, it is little study about HB vaccination role for IDUs as well as other high risk subjects. Research of Vu Minh Quan in Bac Ninh (2009) showed that, HBV prevalence among IDUs was 11%. According to our study, the rate of HB vaccination among IDUs is 24.1%. The rate of HBV infection among HB vaccinated IDUs is significantly lower than among HB unvaccinated group (with p<0.05). For this reasons, B hepatitis vaccination for high risk people who HB unvaccination was the first measures among management for HB unvaccination people living with HIV in the industries coutries worldwide. + Several characteristics of HIV, HCV genotypes among injecting drug users and female sex workers: Study results about distribution HIV genotype and subtype showed that stability and predominant of CRF01_AE recombinant among IDUs and FSWs. Subjects, who has many risk behaviors will be more risk of infection with one or both HIV, HBV, HCV viruses and has tendency to make strictly shift of CRF01_AE recombinant among IDUs and FSWs. According to Tran Thanh Duong study (2005), who determined 4 genotypes (HCV-1, -2, -3, -6), with 12 subtypes in general population of Hanoi. Our study result, though sample number has limited, is similar. The majority of HCV subtype is 1a (50%) and then subtypes 1b, 6a and 6e. HCV-6e is new subtype no any author to talk about. HCV-6e subtype was identified among the injecting drug user, according to us, may be associated with complicated and high risk of the injecting drug user. They infected HCV by many transmittable modes, as shared needles and syringes, water of inject, absorbent cotton, unprotected sex with others,… 5 CHAPTER 1. OVERVIEW 1.1. Prevalence of HIV, HBV, HCV - Chronic hepatitis B is one of the most common causes of hepatocellular carcinoma (HCC) in the world. More than 400 million people are chronically infected with HBV globally. Thus, HBV infection is one of the most important infectious diseases worldwide. The majority of cases occuring in regions of Asia (predominant in East and Southest Asia) and Africa. It is estimated that 10 to 15 million people in Vietnam are living with HBV. - Approximately 180 million people world are infected with hepatitis C virus (HCV) and are at risk of developing serious hepatic complications such as cirrhosis, HCC or decompensation. Disease progression is more rapid in patients who are coinfected with HBV and HIV. - According to UNAIDS, about 40 million people are infected with HIV world and the majority of them live in Asia and Africa. Approximately 10% of them has concurrent chronic HBV and 4-5 million has chronic HCV. With the increased availability of antiretroviral therapy, the number of people surviving with HIV and presenting with HBV, HCV is increasing. 1.2. Molercular epidemiological characteristic - Analyses of the divergence of HBV genomic sequences has led to the identification of 10 HBV genotypes (A through J) and several subtypes. The geographic distribution of HBV genotypes has affected transmissed modes. The HBV genotypes have been documented to be strongly associated with disease progression and outcomes. Investigations of the molecular epidemiology of HBV genotypes have resulted in clinically significant advances over the past decade. It is recommended that a patient with chronic HBV infection should receive HBV genotyping. This measures will help practicing physicians tp identify those patients who are at increased risk of disease progression to end-stage liver disease and those who can benefit most from therapy. - 11 different HCV genotypes of HCV have been identified, but only genotypes 1, 2 and 3 are distributed worldwide, and about 60% of infections are due to 6 type 1a and 1b. The genotype of the virus plays a substantial role in determining the duration and type of treatment the patient receives; thus it is necessary to confirm the genotypes of a specific infection in order to plan an appropriate therapeutic strategy. - HIV is characterized by a high genetic variability. Nowadays, recombination is regarded as an integral part of the infectious cycle of this retrovirus, wich impacts on diagnosis and treatment of infections. Genetic variability have been correlated with the progression of the disease, development of a vaccine strategy against HIV infection. Phylogenetic analyses of HIV-1 strains have identifed three distinct groups: Major (M), outlier (O) and new (N) groups. More than 99% of the HIV-1 strains in this pandemic belong to group M and can be classified into nine subtypes (A, B, C, D, F, G, H, J and K) 16 circulating recombinant forms (CRFs) and at least 30 unique recombinant forms (URFs). Distribution of HIV-1 subtypes were not equal in different risk groups. 1.3. The status of HIV, HBV, HCV infection and several factors increased the transmission among some high risk groups 1.3.1. The Injecting drug users (IDUs): Injecting drug user is an important public health issue around the world: 16 millionpeople injected drugs in 2007 (range 11-21 million). IDUs has at high risk of blood-borne viral infections (include HIV, HBV, HCV). Injecting drug use plays a critical role in the trensmission of HIV in Vietnam. The predominant source of infections is unsafe drug injection. Hepatitis B and C viruses are even more effectively spread by this practive than is HIV. Up to half of injection drug uers infected with HIV are coinfected with HBV. In countries where HBV are highly endemic, the rate can be as high as 25%. In a study of 309 IDUs in Northern Vietnam, the prevalence of HBV infections was 80,9%. 1.3.2. Female sex workers (FSWs): FSWs associated drug use were high upward tendency and considered popular event in Vietnam. The high risk of FSWs were not only sexually focused but also injecting-related.According to previous survays show that HIV prevalence among the injecting FSWs is even higher than among male IDUs . 23 DISCUSSION + HIV prevalence among IDUs According to this survey result, the rate of HIV infection among IDUs was higher than result of Nguyen Anh Tuan survey in Hanoi in duration 2005-2006 but it was lower than this rate in Hai Phong (65.5%), Quang Ninh (58.7%) and equal to rate of HIV infection in Ho Chi Minh city (34.0%), Can Tho (36.6%), Bac Ninh (21.4%) at moment. However, this rate have downward tendency in the research duration (2008-2010). + HCV prevalence among IDUs: Chronic HCV prevalence was more popular than HIV, HBV prevalence among IDUs. Shared injecting equipment only one's also have risk of HCV infection. Result of our study showed that the rate of HCV infection during 2008-2010 (60.0%, 57.3%, 69.3%, respectively) was higher than the rate of HIV infection (43.0, 37.7%, 30.5%, respectively) among IDUs and this rate have significantly upward tendency from 60.0% (2008) to 69.3% (2010) with p<0.05. This result is equal with situation of HCV infection worldwide. Our study result also are equal with research of Vu Tuong Van in Bach Mai hospital. According to her result that the rate of HCV infection among IDUs, who examined in the hospital, was 64.25% positive people with HCV. However, our research result also was lower than result of Tran Thanh Duong (70.2%) carried out in Hanoi (2005) among IDUs. It is upward tendency of HCV infection among IDUs. + HBV prevalence among IDUs: Nowadays, HBV prevalence among IDUs have not assess in global level. In according to N.D. Manh study (2002), the rate of HCV infection among IDUs in Hanoi community was 21.19%. Our result showed that, the rate of HBV infection among IDUs in Hanoi during 2008-2010 is 16.5%, 15.1%, 12.5%, respectively. This rate is equal rate of HBV infection among in the general 22 95%CI 0.3 – 0.9 0.5-1.8 0.2 – 0.7 0.2-1.6 The rate of HBV infection among hepatitis B vaccinated IDUs (8.7%) significantly decreased in comparison with the rate of HBV infection HB unvaccinated IDUs (16.6%) with p<0.05. The prevalence of HBV among hepatitis B vaccination FSWs (10.4%) was not statisticantly difference among hepatitis B unvaccinated FSWs (10.9%) with p>0.05. The rate of HBV infection among hepatitis B vaccinated HDPs (6.0%) are lower significantly than the rate of HBV infection HB unvaccinated HDPs (16.6%) with p<0.01. The rate of HBV infection among hepatitis B vaccinated MTPs (3.9%) are lower than the rate of HBV infection HB unvaccinated HDPs (7.2%) but no significant difference with p>0.05. 7 1.3.3. Multi-transfused patients (MTPs): The risk of acquiring post-transfusion hepatitis B, C and HIV depends on factors like prevalence and donor testing strategies. In multiply transfused patients such as hemophiliacs are high risk for HCV infections 1.3.4. Haemodialysis patients (HDPs): Patients who participated in chronic haemodialysis are at increased risk for HCV. The prevalence of HCV in such patients reaches 15%, although it has declined in recent years. A number of risk factors have been identified for HCV infection among HDPs, including: blood transfusions, duration of heamodialysis, prevalence of HCV infection in the dialysis units and type of dialysis. CHAPTER 2. STUDY METHOD 2.1. Study sites 2.1.1. Study site: Hanoi city 2.1.2. Study time: from april to august per years, in 3 consecutive years from 2008 to 2010. 2.2. Study subjects: Injecting drug users (IDUs), female sex workers (FSWs), haemodialysis patients (HDPs), multi-transfused patients (MTPs). 2.3. Study Method 2.3.1. Study design and search strategy: Descriptive epidemiology, cross- sectional study in 3 consecutive years. 2.3.2. Sample size and study sample selection: 2.3.2.1. Sample size: Formula calculating the sample size design based on cross-sectional survey. Formula: n = 2 2 2 1 . e pq Z   8 Description: n: required sample size. p: the expected frequency value, expressed as decinal. q: 100-p, e: expected exact level. Z (1- /2) : confidence value based on  statisticant level, If: 1. Required sample size for IDUs and FSWs: p= 0.23 (the rate of HIV infected of IDUs and FSWs, according to sentinel surveillance results in Hanoi for 2 groups). e= 0.059,  = 0.05 for value Z (1-  /2 =1.96, with 95% confidence level. Required sample size: n= 200. Sample size selected in 3 years equal 600 samples per group (200 sample/group/year). Sample total: 1200 (600 sample/group) 2. Required sample size for HDPs and MTPs: p= 0.60 (the rate of HCV infected of HDPs and MTPs, according to survey results in Bach Mai hospital for 2 groups). e= 0.096,  = 0.05 for value Z (1-  /2 =1.96, with 95% confidence level. Required sample size: n= 100. Sample size selected in 3 years equal 400 samples per group (200 sample/group/year). Sample total: 800 (400 sample/group) + Genotype analysis was focused the study subject who was injecting drug users and female sex workers. They were the highest risk subjects of HIV, HBV, HCV infection in Vietnam to determine popular genotypes of IDUs and FSWs; to determine HBV and HCV genotypes difference between HIV infected group and no infection group. 2.3.2.2. Study sample strategy: “Take-all” sample method was used to select study subjects who was heamodialysis patients and multi-transfused patients. “Respontdent Driven Sampling” method was used for injecting drug users and female sex workers. 2.3.4. Sample selected procesures: Development and pre-testing of questionaires; Study staffs were trained. The voluntary participants was given a card with their study number (study ID). Code of study ID was regularly checked at each step to ensure that the numbered questionaire and biological sample matched 2.3.5.1. Serological tests: HBV, HCV and HIV infections were screend by ELISA, using Monolisa HBsAg Ultra, Monolisa anti-HCV Plus and Genscreen Ultra HIV Ag-Ab kits, respectively. The assay performance was controlled by running quality control sera (Virotrol I, Bio-rad) together with specimens. 2.3.5.2. For genotyping HBV, HCV and HIV was based on the polymerase gene, NS5B gene and Protease-Reverse transcriptase gene, respectively. Sequencing was carried out with BigDye terminator v3.1 on Genetic Analyzer 21 HIV infected FSWs were treatment more low than IDUs and difference between 2008-2010 were not significantly (p>0.05). 3.4.8. The relation between the rate of HBV, HCV and history of hepatitis among study objects Table 3.32 The relation between the rate of HBV, HCV and history of hepatitis History of hepatitis HBV infection HCV infection n % n % Yes 32 34.0 59 62.8 No 157 10.0 529 33.8 P < 0,01 < 0.01 OR 4.63 3.30 95%CI 2.9 – 7.3 2.1 – 5.1 - 34.0% HBV infected people have history of hepatitis diagnosed and 10.0% objects are unknowledge of their B hepatitis status. Those difference has significantly statistical evidence (p<0.01). - 62.8% HCV infected people have history of hepatitis diagnosed and 33.8% objects are unknowledge of their C hepatitis status. Those difference has significantly statistical evidence (p<0.01). 3.4.9. Hepatitis B vaccination of study objects Table 3.33 The relation between the rate of HBV infection and history of hepatitis B vaccination Vaccination IDUs FSWs HDPs MTPs n % n % n % n % Yes 12 8.7 15 10.4 11 6.0 4 3.9 No 72 16.6 46 10.9 31 16.6 20 7.2 p < 0.05 1.0 < 0.01 0.35 OR 0.48 0.95 0.32 0.52 20 MTPs 0 0.0 4 1.7 0 0.0 0.26 Differential rate of HIV infected FSWs has significantly difference in differential marital status with p<0.01. Table 3.28 The relation between the rate of HCV infection and marital status of study subjects Subjec ts Unmarried Married* Divorce, Separarion, widow p n % n % n % IDUs 187 57.2 138 66.7 47 73.4 < 0.05 FSWs 38 25.5 44 20.1 64 27.7 0.16 HDPs 20 28.2 106 35,2 9 32,1 0.52 MTPs 10 6.3 16 6.6 0 0.0 0.96 Among IDUs, HCV prevalence of married people (66.7%), people having special conditions: divorce, seperation, widow (73.4%) were significantly higher than of unmarried people (57.2%) with p<0.05. 3.4.7. Knowledge about the status of HIV infection of IDUs and FSWs Table 3.29. The rate of positive HIV infected IDUs and FSWs knew their HIV infected status Subject 2008 2009 2010 p n % n % n % IDUs 40 62.5 40 59.7 27 56.3 > 0.05 FSWs 31 42.5 32 46.4 8 19.5 < 0.05 Over half of HIV infected IDUs knowledged their infection status and those rate were not significantly difference between 2008-2010. Otherwise, HIV infected FSWs knowledged their infection status lower than IDUs and significantly downward tendency (p<0.05). Table 3.30 The rate of HIV cared IDUs, FSWs when they knowledged of their HIV infected status Subject 2008 2009 2010 p n % n % n % IDUs 34 85.0 28 70.0 12 52.2 < 0.05 FSWs 19 61.3 20 62.5 2 50.0 > 0.05 9 ABI 3130. The sequences were edited and contiguously assembled by software Seqman DNA Star Lasergene – Seqman. The sequence of HBV polymerase gene, HCV NS5B gene and HIV Protease-Reverse transcriptase gene are analyzed on-line by bioinformatic tools at websites, http://hbv.bioinf.mpi-inf.mpg.de/index.php, http://hcv.lanl.gov/content/index and http://hivdb.stanford.edu/, respectively to determine genotype. 2.3.6. Statistical analysis: Data was entered using the Winpath software computer program after which this data was transferred to the SPSS version 11.5 software program for analysis. Data analysis performed by use of Chi-square statistics and the Fisher Exact test. Variables with p values of 0.05 or less were considered statistically significalt. CHAPTER 3. RESULTS 3.1. Demographic characteristics 3.1.1. Age: Subjects <19 20-29 30-39 40-49 >50 Total n % n % n % n % n % IDUs 46 7.7 219 36.7 254 42.6 65 10.9 12 2.0 596 FSWs 31 5.3 244 41.6 240 41.0 67 11.4 4 0.7 586 HDPs 7 1.8 64 16.1 84 21.1 68 17.1 175 44.0 398 MTPs 63 15.8 117 29.3 70 17.5 55 13.8 94 23.6 399 Total 147 7.4 644 32.5 648 32.7 255 12.9 285 14.4 1979 - IDUs has mean-age that 30.7 with standard deviation (Sd) is 8.1 and 79.3% were in the 20-39 age group. - FSWs has mean-age that 30.7 with standard deviation is 7.4 and concentrated in the 20-39 age group (82.6%). - HDPs has mean-age that 45.7 with standard deviation is 15,03 but ≥ 50 (44.0%) age group is highest. - MTPs has mean-age that 35.5 with standard deviation is 15.45, but it distributed is rather equal in age groups of each other, the highest is 20-29 age group (29.3%) and at least in 40-49 age group (13.8%). 10 3.1.2. Marital status Subjects Unmarried Married Divorce, separation, widows Total n % n % n % IDUs 327 54.6 207 34.6 65 10.9 599 FSWs 149 24.8 219 36.5 232 38.7 600 HDPs 71 17.8 301 75.3 28 7.0 400 MTPs 158 39.5 241 60.3 1 0.3 400 Total 705 35.6 968 48.4 326 16.3 1999 - Majority of IDUs (54.6%) has unmarried. FSWs has 38.7% specilized conditions (seperation, divorce, widow). - Majority of HDPs and MTPs in this study has private family; 75.3% of HDPs and 60.3% of MTPs has married. However, MTPs has 39.5% of unmarried. 3.2. The rate of HIV, HBV, HCV infected and coinfected in Subjects 3.2.1. The rate of HIV infected subjects Table 3.5 The rate of HIV infected subjects Subjects 2008 2009 2010 n (+) % n (+) % n (+) % IDUs 200 86 43.0 199 75 37.7 200 61 30.5 FSWs 200 90 45.0 200 78 39.0 200 51 25.5 HDPs 100 1 1.0 150 0 0.0 150 0 0.0 MTPs 100 0 0.0 150 0 0.0 150 4 2.7 - The rate of HIV infected IDUs has to show downward tendency in 2008-2010 period with p<0.05. - The rate of HIV infected FSWs has to show downward tendency in 2008- 2010 period with p<0.01. 3.2.2. The rate of HBV infected subjects Table 3.6 The rate of HBV infected subjects Subjects 2008 2009 2010 n (+) % n (+) % n (+) % IDUs 200 33 16.5 199 30 15.1 200 25 12.5 FSWs 200 29 14.5 200 18 9.0 200 19 9.5 HDPs 100 12 12.0 150 17 11.3 150 16 10.7 19 FSWs 9 29.0 106 43.4 95 39.6 9 29.0 106 43.4 <0.01 HDPs 0 0.0 1 1.6 0 0.0 0 0.0 1 1.6 0.26 MTPs 0 0.0 0 0.0 2 2.9 0 0.0 0 0.0 0.33 Table 3.24 The relations between the rate of HBV infection and age groups of study subjects Study Subjects Age groups p ≤ 19 20 - 29 30 - 39 40 - 49 ≥ 50 n % n % n % n % n % IDUs 7 14.9 21 9.6 47 18.5 11 16.9 2 16.7 0.10 FSWs 1 2.9 27 11.1 26 10.8 10 14.9 1 25.0 0.38 HDPs 0 0.0 8 12.5 17 20.2 8 11.8 12 6.9 <0.05 MTPs 3 4.8 3 2.6 1 1.4 6 10.9 12 12.8 <0.01 Table 3.25 The relations between the rate of HCV infection and age groups of study subjects Subjects Age group p ≤ 19 20 - 29 30 - 39 40 - 49 ≥ 50 n % n % n % n % n % IDUs 5 10.9 122 56.0 192 75.6 45 69.2 7 58.3 <0.01 FSWs 3 9.7 60 24.7 75 31.3 6 9.0 0 0.0 <0.01 HDPs 2 22.2 19 29.7 25 29.8 30 44.1 59 33.7 0.30 MTPs 4 6.3 8 6.8 1 1.4 6 10.9 7 7.4 0.30 3.4.6. Relations between marital status and the rate of HIV, HBV, HCV infection: Table 3.26 The relation between the rate of HIV infection and marital status of study subjects Sub. Unmarried Married* Divorce, Separarion, widow p n % n % n % IDUs 112 34.3 78 37.7 32 49.2 0.07 FSWs 35 23.5 76 34.7 108 46.6 < 0.01 HDPs 1 1.4 0 0.0 0 0.0 0.10 [...]... 8.33 95%CI 1.1 - 3.0 1.6 - 13.8 4.2 - 16.6 The rate of HIV, HBV, HCV infected FSWs associated with drug injecting (44.8%) was higher significantly FSWs unassociated with drug injecting Table 3.17 The relation between duration of drug injecting and rate of HIV, HBV HCV infection among FSWs Duration of HIV infection HBV infection HCV infection drug injecting n % n % n % < 2 years 7 41.2 2 11.8 6 35.3 2-5... between duration of drug injecting and HIV, HBV, HCV prevalence among IDUs Duration of HIV infection HBV infection HCV infection drug injecting n % n % n % 15 < 2 years 12 16.9 5 7.0 26 36.6 2-5 years 20 30.8 10 15.4 42 64.6 > 5 years 171 50.3 55 16.2 281 82.9 p < 0.01 0.14 < 0.01 HIV, HCV prevalence of IDUs increased significantly in duration of drug injecting (p . between duration of drug injecting and the rate of HIV, HBV, HCV coinfection of IDUs Duration of drug injecting HIV/HBV co -infection HIV /HCV co -infection HBV /HCV co -infection n % n. HBV, HCV infection and associated factors in some high risk populations in Hanoi, 2008-2010 . OBJECTIVES: 1. Determine the rate of HIV, HBV, HCV infection among Injecting drug users, female. influencing factors increase the transmission of HIV, HBV, HCV among IDUs, FSWs, HDPs and MTPs in Hanoi, 2008-2010: + Risks for HIV, HBV, HCV infection among IDUs and FSWs was drug injecting.