Brief Article Open Access
Copyright ©2010 Baishideng. All rights reserved.
World J Hepatol. Jan 27, 2010; 2(1): 42-48
Published online Jan 27, 2010. doi: 10.4254/wjh.v2.i1.42
Seroprevalence of HCV and its co-infection with HBV and HIV among liver disease patients of South Tamil Nadu
Ganesh Kumar Anbazhagan, Sridharan Krishnamoorthy, Thirunalasundari Thiyagarajan 620024, Tamil Nadu, India
Ganesh Kumar Anbazhagan, National Facility for Marine Cyanobacteria, Bharathidasan University, Tiruchirappalli 620024, Tamil Nadu, India
Sridharan Krishnamoorthy, Department of Gastroenterology, KAP Viswanatham Government Medical College and Annal Gandhi Memorial Government Hospital, Tiruchirappalli 620024, Tamil Nadu, India
Thirunalasundari Thiyagarajan, Department of Biotechnology, Bharathidasan University, Tiruchirappalli 620024, Tamil Nadu, India
Author contributions: Anbazhagan GK carried out the research; Krishnamoorthy S gave the samples, helped in identifying the patients and contributed to the clinical work; Thiyagarajan T had the idea and guided the work.
Correspondence to: Thirunalasundari Thiyagarajan, Professor, Department of Biotechnology, Bharathidasan University, Tiruchirappalli 620024, Tamil Nadu, India.
Telephone: +91-0431-2407086
Received: August 18, 2009
Revised: January 14, 2010
Accepted: January 21, 2010
Published online: January 27, 2010


AIM: To determine the seroprevalence of hepatitis C virus (HCV) and its co-infection with hepatitis B virus (HBV), hepatitis delta agent (HDV) and human immunodeficiency virus (HIV) among liver disease patients of south Tamil Nadu.

METHODS: A total of 1012 samples comprising 512 clinically diagnosed cases of liver disease patients and 500 apparently healthy age and sex matched individuals were screened for Hepatitis C virus (anti HCV and HCV RNA), Hepatitis B virus (HBsAg), Hepatitis delta agent (anti HDV) and Human immuno virus (antibodies to HIV-1 and HIV-2) using commercially available enzyme linked immunosorbent assay kits. HCV RNA was detected by RT-PCR. Liver function tests like ALT, AST, GGT, ALP, bilirubin and albumin were also studied.

RESULTS: The seroprevalence of HCV was found to be 5.6% among liver disease patients by ELISA. 27/512, 49/512 and 12/512 patients were positive for HIV, HBV & HDV respectively. Co-infection of HCV & HBV was found in 8 patients, with 6 for HCV & HIV and 4 for HCV, HBV & HIV co-infections. Sex-wise analysis showed that HIV, HCV & HBV and HCV & HIV co-infection was high among females whereas for HBV it was high in males. The mean ALT and AST in HCV positive cases were 42.1 ± 8.3 and 49 ± 10.1. In people co-infected with HCV & HBV or HCV & HIV or HCV, HBV & HIV the mean ALT of 58.0 ± 03.16, 56.78 ± 4.401 and 64.37 ± 4.01 respectively.

CONCLUSION: We strongly recommend routine test of the blood for HCV in addition to HBV and HIV. We also recommend individualized counseling to identify those at risk and testing for those who want it. Improved surveillance and periodic epidemiological studies will have to be undertaken to monitor and prevent these blood-borne viruses.

Key Words: Hepatitis C virus, Hepatitis B virus, Human immunodeficiency virus, Co-infection, Liver function test


Hepatitis C virus (HCV) infection is the most common chronic blood borne infection in the world[1]. HCV belongs to the family flaviviridae and the genus hepacivirus. It often causes lifelong persistent infection[2]. The prevalence of HCV infection worldwide has been estimated to be about 3% with 170 million people affected by HCV[3]. Meanwhile two billion people have been infected with hepatitis B virus (HBV). Of these, 360 million have chronic infection and 600 000 die each year due to HBV infection and related liver diseases[4]. HBV and HCV infections account for a substantial proportion of liver diseases worldwide. The majority of those with chronic HBV and/or HCV infection will develop complications i.e. 15%-40% may develop cirrhosis, liver failure and or hepatocellular carcinoma[5]. The exact number of patients infected with both HCV and HBV world wide is unknown[6]. It has been estimated that over the next 20 years, the proportion of HBV/HCV infected patients with cirrhosis will increase from 16% to 32% and that other complications will also increase dramatically including hepatic decompensation (increasing by 106%), HCC (increasing by 81%) and liver related deaths (increasing by 180%)[7]. In addition, prevalence of human immunodeficiency virus (HIV) is increasing everyday and it has become a disaster for humankind in certain areas. HIV accounted for 38.6 million infections world wide by the end of 2005[8]. These three viruses (HCV, HBV and HIV) have similar routes of transmission, namely through blood and blood products. Sharing of needles to inject drugs and sexual activity enables the co-infection of these viruses and thereby makes co-infection or super infection a common event[9]. End stage liver disease is currently a major concern among HIV positive individuals due to co-infection with hepatotropic viruses[10,11]. HIV infected patients with multiple hepatitis virus infections have a higher rate of liver related morbidity and mortality than patients with HIV infection alone or with a single hepatitis virus infection. The degree of immunodepression is an important factor in liver disease progression[12]. Current estimations indicate that approximately 1.8% to 2.5% of Indian population is presently infected by HCV[13]. The prevalence as well as the significance of HCV infection varies considerably from country to country, probably because of cultural factors and social habits that influence HCV transmission. A community based Indian study on HCV indicated a seroprevalence of 0.87% and that the rate reportedly increased from children < 10 years to 1.85% among subjects > 60 years of age[14]. Knowledge and awareness of HCV infection have been obtained from seroprevalence studies carried out in blood donors and hemodialysis patients from large cities[15-17]. Reports on the prevalence of HCV infection in the Indian subcontinent is scarce. Hence, this study was conducted to investigate the seroprevalence of HCV and its co-infection with HBV and HIV in liver disease patients in South Tamil Nadu.

Study samples

The study was performed in 512 clinically diagnosed cases of liver disease patients and 500 apparently healthy age and sex matched controls. All the liver diseases and control samples were diagnosed and given by the Gastroenterologist based on signs, symptoms and examination. Blood samples were collected from them, serum was separated and stored at -20°C until use. Among the liver disease patients clinical conditions including acute liver disease, chronic liver disease and cirrhosis were also diagnosed by the Gastroenterologist.


The blood samples were screened for markers of various hepatitis viruses and HIV by using third generation ELISA kits. Hepatitis B surface antigen (HBsAg) was screened by Hepalisa, supplied by M/s. J. Mitra and Co Pvt. Ltd, India; Hepatitis B envelop antigen (HBeAg) and antibody to envelop antigen (anti-HBe) using ELISA kits supplied by M/s. Biorad laboratories, USA; Antibodies to HCV, HDV and HIV were screened by using Microlisa kits supplied by M/s. J. Mitra and Co Pvt. Ltd, India. All reactive analyses were repeated twice.


Liver function tests studied were alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma glutamyl transpeptidase (GGT), serum alkaline phosphatase (SAP), bilirubin and albumin. The results were correlated with serological findings. The upper limits of normal for various tests were ALT 0-65 IU/L, AST 5-40 IU/L, GGT 0-61 IU/L, SAP 20-140 KA, Bilirubin Total 0.3 to 1.9 mg%, Direct bilirubin: 0 to 0.3 mg%, Indirect bilirubin 0.1-1.0 mg% and Albumin 35-50 gms%.

Molecular diagnosis of HCV

For the detection of the HCV genome, RNA was extracted from the samples and was subjected to reverse transcriptase polymerase chain reaction (RT-PCR). This was carried out for the constant HCV 5’ untranslated region (5’ UTR).

Statistical analysis

Statistical package for social sciences (SPSS, version 17.0) software was used for analyzing the data. Statistical tests used to find the significance were χ2 for association of attributes and t-test for difference in the mean for independent samples.


Among the 512 liver disease patients investigated, 281 were male and 231 were female. Overall 29 (5.6%) were positive for HCV. This positivity was either for anti HCV by ELISA, for HCV RNA by RT-PCR or for both. Results based on other viral infection revealed 27 (5.2%) for HIV, 49 (9.5%) for HBsAg, and 12 (23%) for HDV (Table 1). Table 2 shows the incidence of blood borne viral infection and co-infection among liver disease patients. Co-infection of HCV & HBV was found in 8 patients, with 6 for HCV & HIV and 4 for HCV, HBV & HIV co-infections. In addition, clinical conditions of all viral infections and co-infections were significantly (P < 0.01) associated with liver disease (Table 3). Table 4 gives the age-wise distribution of patients with different kinds of viral infections. The total viral positivity was insignificant in various age groups (P > 0.05). Among the viral positive cases, HBV was most prevalent followed by other viral infections and co-infections whilst the rest were insignificant (P < 0.05) (Tables 5 and 6). The results of liver function tests in HCV infected and co-infected patients are presented in Table 7. All the parameters tested were found to increase significantly (P < 0.05) when compared to controls. Data collected based on risk factor for HCV seroconversion reveals, 47.6% of the patients had blood transfusion, 6 had surgical intervention (14.2%), 5 were intravenous drug users(11.9%) and 11 (26%) had unknown causes. Blood transfusion (65%) was observed as the predominant risk factors in the co-infected patients.

Table 1 Incidence of blood borne viral infection (HCV, HBV, HDV and HIV) among liver disease patients n(%).
CategoryTotal number testedGender
HCV, HBV, HDV and HIV positive
Liver disease51228123129 (5.6)49 (9.5)12 (2.3)27 (5.2)
Control500250250-7 (1.4)--
Table 2 Incidence of blood borne viral infection and co-infection among liver disease patients.
CategoryClinical conditionGender
Virus positiveVirus negativeTotalVirus positiveVirus negativeTotal
Liver diseaseAcute liver disease225577123850127
Chronic liver disease453479265177156
ControlWithout any signs or symptoms42462503247250500
Table 3 Clinical condition vs blood-borne viral infection.
Clinical conditionDifferent viral infection positive
Total virus negativeTotal number tested
HCVHBVHIVHDVHCV and HBVHCV and HIVHBV and HIVHCV, HBV and HIVTotal virus positive
Acute liver disease-19104--2-3592127
Chronic liver disease except cirrhosis131117866647185156
Table 4 Different viral infection vs age groups.
Viral infectionAge group in years
11-2021-3031-4041-5051-6061 and above
HCV and HBV1211218
HCV and HIV1121-16
HBV and HIV1142-19
HCV, HBV and HIV1-11-14
All virus positive113530362012144
All virus negative428382945116369
Table 5 Different viral infection vs sex.
Viral infectionGender
P value
HCV positive18110.423
HCV negative263220
HBV positive4180
HBV negative240223
HIV positive14130.745
HIV negative267218
HDV positive840.406
HDV negative273227
HCV and HBV positive530.663
HCV and HBV negative276228
HCV and HIV positive330.809
HCV and HIV negative278228
HBV and HIV positive630.474
HBV and HIV negative275228
HCV, HBV and HIV positive220.844
HCV, HBV and HIV negative279229
Table 6 Clinical condition vs different viral infection vs sex.
SexClinical conditionDifferent viral infection positive
Total positiveTotal negative
MaleAcute liver disease-1453----2255
Chronic liver disease except cirrhosis899543524534
FemaleAcute liver disease-451--2-1238
Chronic liver disease except cirrhosis528323122651
P value0.21100.8530.2560.48410.3231--
Table 7 Liver function test in HCV infected and co-infected patients (mean ± SD, n = 29).
CategoryLiver function test
Bilirubin (mg%)
SAP (KA units)ALT (IU/L)AST (IU/L)GGT (IU/L)Albumin (gms%)
Control0.5340 ± 0.2190.210 ± 0.0550.386 ± 0.01573.227 ± 21.62237.76 ± 9.3524.77 ± 07.6569.70 ± 11.032.78 ± 0.219
HCV positive patients3.461 ± 0.8740.643 ± 0.17360.936 ± 0.016144.630 ± 12.97642.1 ± 8.349.00 ± 10.198.446 ± 09.573.87 ± 0.24
P value0000.0050000
HCV and HBV coinfected patients3.70 ± 0.961.59 ± 0.061.641 ± 0.052140.887 ± 10.92258.0 ± 03.1640.412 ± 02.00899.362 ± 06.1503.14 ± 0.66
P value00000000
HCV and HIV coinfected patients2.920 ± 1.0321.975 ± 0.9411.997 ± 0.078134.53 ± 10.65156.78 ± 4.40139.65 ± 2.2497.60 ± 5.943.12 ± 0.97
P value00.0010.00100.0010.00100
HCV, HBV and HIV coinfected patients3.295 ± 1.4243.202 ± 0.4880.265 ± 0.052141 ± 17.30164.37 ± 4.0142.87 ± 2.8499.95 ± 03.0393.14 ± 0.02
P value0.0090000.0050.0060.0030.004

HIV, HBV and HCV are the three most common chronic blood borne viral infections documented worldwide[18]. Epidemiological studies of blood-borne viral disease such as HCV, HBV and HIV are important for revealing the risk groups and risk factors for these infections. Screening these groups of viruses helps us to solve difficulties in collecting information among healthy populations[19].

India has the second highest number of people living with HIV infection[20]. Co-infection of hepatotropic viruses with HIV infection reportedly leads to massive impairment of cell mediated responses and enhances the kinetics of hepatotropic viral replication[21-24]. The prevalence of HCV in this study is 8.2% in liver disease patients. A study conducted by Chowdhury et al[25] (2003) from eastern India showed a prevalence of 0.87%, which is ten times less than that observed in the present study. That study predominantly comprised blood-transfusion-acquired HCV infections rather than other modes of transmission. Age-wise analysis in the present study found HCV to be high among individuals belonging to the 41-50 years (28.5%) age group. HCV infections usually progress slowly to terminal liver disease[26]. It is, therefore, possible to recognize the impact that the disease may have in the future based on the knowledge of its previous incidence. It is also feasible to estimate the burden of late complications associated directly with the presence of chronic liver disease[27].

It was observed that males were more susceptible to HCV than female among the study population. This concurs with a previous report that male subjects were at a higher risk of developing HBV infection than females[28-29].

Out of the 512 liver disease patients tested 49 (9.5%) were positive for HBsAg. Similar results were obtained in an earlier study conducted on chronic liver disease in India[30]. A multicenter study in Italy showed that the subjects with dual HBV and HCV infection were more likely to be older than 42 years[31]. Similar results (1.5%) were found in the current study.

Sud et al[28] (2001) have reported 33.8% prevalence of HBV co-infection in HIV positive patients. Although the effect of HBV infection on HIV is uncertain, HIV appears to have marked influence on the natural history of HBV infection. Although HIV shares a common route of infection with HBV and HCV, its sexual transmission is known to be relatively efficient whereas the sexual transmission of HCV appears to be significantly less efficient than for HIV. Although detailed reports have documented HCV, HBV and HIV co-infection worldwide, only a few reports have been published regarding co-infection in India. Kumar et al[32] (2003) reported a 2.9% co-infection of HBV and HIV in patients with liver diseases. The increased viral replication of HBV in AIDS patients indicates that HIV significantly affects the HBV life cycle and the host ability to clear HBV infection. If this is true, more HBV infection and more chronic carriers would be expected as the AIDS epidemic expands in this part of the country. Such a profile would have worrying public health implications[33]. The frequency of HCV & HIV co-infection in this study (1.9%) is much lower than that reported previously among HCV & HIV co-infections in India[29,34-38] and higher than from the general Indian population[39]. In the HIV & HCV co-infected patients, the HCV RNA positivity was found to be higher. These observations were in agreement with previous reports of increased hepatotropic viral replication in immunocompromised subjects[40,41]. Moderate or severe chronic hepatitis or cirrhosis was more frequent in patients with HBV and HCV co-infections than in patients infected with HBV or with HCValone. Generally, HCV superinfection can cause a much more severe liver disease in patients with chronic HBV infection. This lends support to the notion that HBV superinfection may also aggravate the disease severity and increase the risk of fulminant hepatitis. In both HIV positive and negative cohorts, the presence of HBV & HCV, HBV & HDV or triple hepatitis infection was strongly associated with intravenous drug use (IDU). Overall, from 0.4% to more than 50% of HIV patients may carry more than one hepatitis virus[42-47]. The reported co-infection rates of HBV and HCV in HIV patients worldwide have varied, depending on the geographic regions, risk groups and the type of exposure involved[48,49]. Tankhiwale et al[50] (2003) reported 5.6% seroprevalence of HCV and 25.8% HBV in HIV infected patients. These co-infection rates were much higher than that of our findings. Four individuals co-infected with HCV, HBV & HIV had neither surgical intervention, blood transfusion or intravenous drug use, suggesting that sexual intercourse could have been the route of infection.


Hepatitis C virus (HCV) infection creates a significant burden on health care systems. HCV infection has probably been endemic in many populations for centuries. Despite a declining incidence of new infections, the burden of disease in terms of mortality is expected to increase over the next decade. The complexity and uncertainty related to the geographic distribution of HCV infection and chronic HCV, determination of the associated risk factors and evaluation of cofactors that accelerate its progression, underscore the difficulties in global prevention and control of HCV. Thus, this study set out to determine the seroprevalence of HCV and its co-infection with other blood borne hepatitis group of viruses and human immunodeficiency virus.

Research frontiers

As HCV is a silent killer virus, diagnosis, treatment and prevention are very important. Hence the results of this study will, if further explored, benefit the public, health care workers, voluntary blood donors and liver disease patients.

Innovations and breakthroughs

Most earlier workers have studied the seroprevalence of HCV either by enzyme linked immunosorbent assay (Antigen or Antibody) specific for the virus or by RT-PCR (viral genome) alone. In this study the seroprevalence of HCV was evaluated by both the methods. This should help to both modify treatment and prevent infection.


The identification of a high prevalence of HCV in this study indicates the significance of screening HBV, HCV and HDV in addition to HIV, among liver disease patients. Hence we strongly recommend routine testing for health care workers, voluntary blood donors and others to include HBV, HCV, HDV and HIV. We also recommend individualized counseling to identify those at risk as well as testing for those who request it. Improved surveillance and periodic epidemiologic studies will have to be undertaken to monitor and prevent the spread of virulent and interferon-resistant strains. Given the current incidence and prevalence data cited above, HCV infection and its co-infection is expected to remain a problem. Further research in the virology, epidemiology, treatment and prevention of blood-borne viral infection is essential if better outcomes to be achieved.

Peer review

The present manuscript deals with an interesting epidemiologic data, and the topic is also interesting.


Peer reviewer: Eva Herrmann, Professor, Department of Internal Medicine, Biomathematics Saarland University, Faculty of Medicine, Kirrberger Str., 66421 Homburg/Saar, Germany

S- Editor Zhang HN L- Editor Hughes D E- Editor Liu N

1.  Gasiorowicz M, Hurie M, Russell A, Hoxie N, Vergeront J. Epidemiologic trends in infection, mortality, and transplants related to hepatitis C in Wisconsin. WMJ. 2006;105:34-39.  [PubMed]  [DOI]  [Cited in This Article: ]
2.  Alter HJ, Seeff LB. Recovery, persistence, and sequelae in hepatitis C virus infection: a perspective on long-term outcome. Semin Liver Dis. 2000;20:17-35.  [PubMed]  [DOI]  [Cited in This Article: ]
3.  Sy T, Jamal MM. Epidemiology of hepatitis C virus (HCV) infection. Int J Med Sci. 2006;3:41-46.  [PubMed]  [DOI]  [Cited in This Article: ]
4.  Shepard CW, Simard EP, Finelli L, Fiore AE, Bell BP. Hepatitis B virus infection: epidemiology and vaccination. Epidemiol Rev. 2006;28:112-125.  [PubMed]  [DOI]  [Cited in This Article: ]
5.  Lok AS, McMahon BJ. Chronic hepatitis B. Hepatology. 2007;45:507-539.  [PubMed]  [DOI]  [Cited in This Article: ]
6.  Liu Z, Hou J. Hepatitis B virus (HBV) and hepatitis C virus (HCV) dual infection. Int J Med Sci. 2006;3:57-62.  [PubMed]  [DOI]  [Cited in This Article: ]
7.  Davis GL, Albright JE, Cook SF, Rosenberg DM. Projecting future complications of chronic hepatitis C in the United States. Liver Transpl. 2003;9:331-338.  [PubMed]  [DOI]  [Cited in This Article: ]
8.   Available from: http:// en/ HIV_data/2006GlobalReport/default.asp. Accessed on 2007-10-06.  [PubMed]  [DOI]  [Cited in This Article: ]
9.  Chung RT. Hepatitis C and B viruses: the new opportunists in HIV infection. Top HIV Med. 2006;14:78-83.  [PubMed]  [DOI]  [Cited in This Article: ]
10.  Alter MJ. Epidemiology of viral hepatitis and HIV co-infection. J Hepatol. 2006;44:S6-S9.  [PubMed]  [DOI]  [Cited in This Article: ]
11.  Monica F, Lirussi F, Pregun I, Vasile F, Fabris L, Okolicsanyi L. Hepatitis C virus infection in a resident elderly population: a 10-year follow-up study. Dig Liver Dis. 2006;38:336-340.  [PubMed]  [DOI]  [Cited in This Article: ]
12.  Gaeta GB, Precone DF, Cozzi-Lepri A, Cicconi P, D’Arminio Monforte A. Multiple viral infections. J Hepatol. 2006;44:S108-S113.  [PubMed]  [DOI]  [Cited in This Article: ]
13.  Chandra M, Khaja MN, Farees N, Poduri CD, Hussain MM, Aejaz Habeeb M, Habibullah CM. Prevalence, risk factors and genotype distribution of HCV and HBV infection in the tribal population: a community based study in south India. Trop Gastroenterol. 2003;24:193-195.  [PubMed]  [DOI]  [Cited in This Article: ]
14.  Chowdhury A, Santra A, Chaudhuri S, Dhali GK, Chaudhuri S, Maity SG, Naik TN, Bhattacharya SK, Mazumder DN. Hepatitis C virus infection in the general population: a community-based study in West Bengal, India. Hepatology. 2003;37:802-809.  [PubMed]  [DOI]  [Cited in This Article: ]
15.  Rivera-López MR, Zavala-Méndez C, Arenas-Esqueda A. [Prevalence for seropositivity for HIV, hepatitis B and hepatitis C in blood donors]. Gac Med Mex. 2004;140:657-660.  [PubMed]  [DOI]  [Cited in This Article: ]
16.  Carreto-Vélez MA, Carrada-Bravo T, Martínez-Magdaleno A. [Seroprevalence of HBV, HCV, and HIV among blood donors in Irapuato, Mexico]. Salud Publica Mex. 2003;45 Supp 5:S690-S693.  [PubMed]  [DOI]  [Cited in This Article: ]
17.  Silva LK, Silva MB, Rodart IF, Lopes GB, Costa FQ, Melo ME, Gusmão E, Reis MG. Prevalence of hepatitis C virus (HCV) infection and HCV genotypes of hemodialysis patients in Salvador, Northeastern Brazil. Braz J Med Biol Res. 2006;39:595-602.  [PubMed]  [DOI]  [Cited in This Article: ]
18.  Soriano V, Barreiro P, Nuñez M. Management of chronic hepatitis B and C in HIV-coinfected patients. J Antimicrob Chemother. 2006;57:815-818.  [PubMed]  [DOI]  [Cited in This Article: ]
19.  Gunduz T, Mumcuoglu I, Güray M. Evaluation of hepatitis B surface antigen, anti-hepatitis C virus and anti-human immunodeficiency virus antibodies and syphilis seropositivity in blood donors: six years' seropositivity. Int J Clin Pharmacol Res. 2005;25:155-158.  [PubMed]  [DOI]  [Cited in This Article: ]
20.  National AIDS Control Organization (NACO). HIV/AIDS epidemiological Surveillance & Estimation report for the year 2005.  Available from: http://  [PubMed]  [DOI]  [Cited in This Article: ]
21.  Yachimski P, Chung RT. Update on Hepatitis B and C Coinfection in HIV. Curr Infect Dis Rep. 2005;7:299-308.  [PubMed]  [DOI]  [Cited in This Article: ]
22.  Schooley RT. HIV and hepatitis C virus coinfection: bad bedfellows. Top HIV Med. 2005;13:112-116.  [PubMed]  [DOI]  [Cited in This Article: ]
23.  Koch S, Göbels K, Oette M, Heintges T, Erhardt A, Häussinger D. [HIV-HBV-coinfection--diagnosis and therapy]. Dtsch Med Wochenschr. 2006;131:1873-1877.  [PubMed]  [DOI]  [Cited in This Article: ]
24.  Murphy MJ. Managing HIV/HBV coinfection can challenge some clinicians. HIV Clin. 2003;15:6-9.  [PubMed]  [DOI]  [Cited in This Article: ]
25.  Chowdhury A, Santra A, Chaudhuri S, Dhali GK, Chaudhuri S, Maity SG, Naik TN, Bhattacharya SK, Mazumder DN. Hepatitis C virus infection in the general population: a community-based study in West Bengal, India. Hepatology. 2003;37:802-809.  [PubMed]  [DOI]  [Cited in This Article: ]
26.  Chen SL, Morgan TR. The natural history of hepatitis C virus (HCV) infection. Int J Med Sci. 2006;3:47-52.  [PubMed]  [DOI]  [Cited in This Article: ]
27.  Armstrong GL, Wasley A, Simard EP, McQuillan GM, Kuhnert WL, Alter MJ. The prevalence of hepatitis C virus infection in the United States, 1999 through 2002. Ann Intern Med. 2006;144:705-714.  [PubMed]  [DOI]  [Cited in This Article: ]
28.  Sud A, Singh J, Dhiman RK, Wanchu A, Singh S, Chawla Y. Hepatitis B virus co-infection in HIV infected patients. Trop Gastroenterol. 2001;22:90-92.  [PubMed]  [DOI]  [Cited in This Article: ]
29.  Padmapriyadarsini C, Chandrabose J, Victor L, Hanna LE, Arunkumar N, Swaminathan S. Hepatitis B or hepatitis C co-infection in individuals infected with human immunodeficiency virus and effect of anti-tuberculosis drugs on liver function. J Postgrad Med. 2006;52:92-96.  [PubMed]  [DOI]  [Cited in This Article: ]
30.  Arora DR, Sehgal R, Gupta N, Yadav A, Mishra N, Siwach SB. Prevalence of parenterally transmitted hepatitis viruses in clinically diagnosed cases of hepatitis. Indian J Med Microbiol. 2005;23:44-47.  [PubMed]  [DOI]  [Cited in This Article: ]
31.  Gaeta GB, Stornaiuolo G, Precone DF, Lobello S, Chiaramonte M, Stroffolini T, Colucci G, Rizzetto M. Epidemiological and clinical burden of chronic hepatitis B virus/hepatitis C virus infection. A multicenter Italian study. J Hepatol. 2003;39:1036-1041.  [PubMed]  [DOI]  [Cited in This Article: ]
32.  Kumar A, Shukla I, Malik A. Co-infection with hepatitis B and human immunodeficiency viruses in patients of liver disease. Indian J Med Microbiol. 2003;21:141-142.  [PubMed]  [DOI]  [Cited in This Article: ]
33.  Shire NJ, Sherman KE. Management of HBV/HIV-coinfected Patients. Semin Liver Dis. 2005;25 Suppl 1:48-57.  [PubMed]  [DOI]  [Cited in This Article: ]
34.  Kumarasamy N, Solomon S, Flanigan TP, Hemalatha R, Thyagarajan SP, Mayer KH. Natural history of human immunodeficiency virus disease in southern India. Clin Infect Dis. 2003;36:79-85.  [PubMed]  [DOI]  [Cited in This Article: ]
35.  Bhattacharya S, Badrinath S, Hamide A, Sujatha S. Co-infection with hepatitis C virus and human immunodeficiency virus among patients with sexually transmitted diseases in Pondicherry, South India. Indian J Pathol Microbiol. 2003;46:495-497.  [PubMed]  [DOI]  [Cited in This Article: ]
36.  Hussain T, Kulshreshtha KK, Sinha S, Yadav VS, Katoch VM. HIV, HBV, HCV, and syphilis co-infections among patients attending the STD clinics of district hospitals in Northern India. Int J Infect Dis. 2006;10:358-363.  [PubMed]  [DOI]  [Cited in This Article: ]
37.  Gupta S, Singh S. Hepatitis B and C virus co-infections in human immunodeficiency virus positive North Indian patients. World J Gastroenterol. 2006;12:6879-6883.  [PubMed]  [DOI]  [Cited in This Article: ]
38.  Poudel KC, Jimba M, Okumura J, Wakai S. Emerging co-infection of HIV and hepatitis B virus in far western Nepal. Trop Doct. 2006;36:186-187.  [PubMed]  [DOI]  [Cited in This Article: ]
39.  Chandra M, Khaja MN, Farees N, Poduri CD, Hussain MM, Aejaz Habeeb M, Habibullah CM. Prevalence, risk factors and genotype distribution of HCV and HBV infection in the tribal population: a community based study in south India. Trop Gastroenterol. 2003;24:193-195.  [PubMed]  [DOI]  [Cited in This Article: ]
40.  Lascar RM, Gilson RJ, Lopes AR, Bertoletti A, Maini MK. Reconstitution of hepatitis B virus (HBV)-specific T cell responses with treatment of human immunodeficiency virus/HBV coinfection. J Infect Dis. 2003;188:1815-1819.  [PubMed]  [DOI]  [Cited in This Article: ]
41.  O'Leary JG, Chung RT. Management of hepatitis C virus coinfection in HIV-infected persons. AIDS Read. 2006;16:313-316, 318-320.  [PubMed]  [DOI]  [Cited in This Article: ]
42.  Greub G, Ledergerber B, Battegay M, Grob P, Perrin L, Furrer H, Burgisser P, Erb P, Boggian K, Piffaretti JC. Clinical progression, survival, and immune recovery during antiretroviral therapy in patients with HIV-1 and hepatitis C virus coinfection: the Swiss HIV Cohort Study. Lancet. 2000;356:1800-1805.  [PubMed]  [DOI]  [Cited in This Article: ]
43.  Sulkowski MS, Moore RD, Mehta SH, Chaisson RE, Thomas DL. Hepatitis C and progression of HIV disease. JAMA. 2002;288:199-206.  [PubMed]  [DOI]  [Cited in This Article: ]
44.  Lincoln D, Petoumenos K, Dore GJ. HIV/HBV and HIV/HCV coinfection, and outcomes following highly active antiretroviral therapy. HIV Med. 2003;4:241-249.  [PubMed]  [DOI]  [Cited in This Article: ]
45.  Anderson KB, Guest JL, Rimland D. Hepatitis C virus coinfection increases mortality in HIV-infected patients in the highly active antiretroviral therapy era: data from the HIV Atlanta VA Cohort Study. Clin Infect Dis. 2004;39:1507-1513.  [PubMed]  [DOI]  [Cited in This Article: ]
46.  Law WP, Duncombe CJ, Mahanontharit A, Boyd MA, Ruxrungtham K, Lange JM, Phanuphak P, Cooper DA, Dore GJ. Impact of viral hepatitis co-infection on response to antiretroviral therapy and HIV disease progression in the HIV-NAT cohort. AIDS. 2004;18:1169-1177.  [PubMed]  [DOI]  [Cited in This Article: ]
47.  Rockstroh J, Konopnicki D, Soriano V, Krik O, Antunes F, Knysz B, Tural C, Wit SD, Mocroft A, Lundgren J; Hepatitis B and hepatitis C in the EuroSIDA Cohort: Prevalence and Effect on Mortality, AIDS Progression and Response to HAART. Eleventh conference on retroviruses and opportunistic infections 2004; abs 799. .  [PubMed]  [DOI]  [Cited in This Article: ]
48.  Rockstroh JK. Management of hepatitis B and C in HIV co-infected patients. J Acquir Immune Defic Syndr. 2003;34 Suppl 1:S59-S65.  [PubMed]  [DOI]  [Cited in This Article: ]
49.  Tien PC. Management and treatment of hepatitis C virus infection in HIV-infected adults: recommendations from the Veterans Affairs Hepatitis C Resource Center Program and National Hepatitis C Program Office. Am J Gastroenterol. 2005;100:2338-2354.  [PubMed]  [DOI]  [Cited in This Article: ]
50.  Tankhiwale SS, Khadase RK, Jalgoankar SV. Seroprevalence of anti-HCV and hepatitis B surface antigen in HIV infected patients. Ind J Med Microbial. 2003;21:268-270.  [PubMed]  [DOI]  [Cited in This Article: ]