Laborator y st ud y Hepatitis C virus infection in HIV-1 positive individuals ji-om Slovenia 
K E Y 
WORDS 
HIV, HCV, co-
infection, 
Slovenia, 
AIDS 
Hepatitis C virus infection inlllV--1 
positive individuab;from Slnvenia 
K. Seme, M. Poljak, I. J. Marin, J. Tomažič and L. Vidmar 
SU MMARY 
The incidence of infection by hepatitis C virus (HCV) is increased among HIV infected individuals, reflect-
ing shared epidemiological risks. The aim of our study was to determine the prevalence of HCV infection 
among 136 HIV-1-positive individuals from Slovenia. The overall prevalence of HCV infection in HIV-
positive individuals was 16.9%, which is among the lowest prevalence found in similar studies from 
other European countries. The prevalence of HIV and HCV co-infection was the highest in hemophiliacs 
and intravenous drug users. A significant difference in HCV infection prevalence between blood and 
sexual exposure risk groups was found (76% vs. 1.9% respectively, p<0.01 ). 
Introduction 
The co-infection by hepatitis C virus (HCV) and 
human immunodeficiency virus (HIV) is quite common, 
mainly due to some shared transmission routes. Previ-
ous studies placed the prevalence of HCV infection 
among HIV-positive individuals between 3-98% w ith 
the large variation primarily attributable to the popula-
tion studied (1). Thus, the prevalence of HCV infection 
in those who acquired HIV infection by sexual trans-
mission varies from 4-18%, and rises to nearly 100% in 
some hemophiliacs series (1 , 2). The objective of our 
study was to determine the prevalence of HCV infec-
tion among HIV-1-positive individuals from Slovenia. 
Materials and methods 
136 HIV-1-positive individuals (102 men, 34 women) 
from Slovenia were included in the study. They repre-
sented 80.9% of 168 HIV infected individuals who have 
been detected in Slovenia up to December 31, 2000 (91 
AIDS cases, 77 anti-HIV positive individuals) . They were 
distributed according to risk factors for HIV infection 
as follows: 69 (50.7%) homosexualicy/ bisexuality, 32 
(23.5%) heterosexual high-risk behavior, 13 (9.6%) he-
mophilia, 11 (8.1%) intravenous drug use, 5 (3.7%) un-
known, 4 (2 .9%) vertical transmission, 1 (0.7%) human 
bite by an AIDS patient and 1 (0.7%) a combination of 
homosexuality and intravenous drug use. 
Acta Dermatoven APA Vol 11, 2002, No 2 ------------------ 41 
epatitis C virus infection in HIV-1 positive individuals from Slovenia 
In ali patients included in the study, anti-HCV status 
was determined using the Ortho HCV 3.0 ELISA Test 
System (Ortho Diagnostic Systems, Neckargemiind, 
Germany). Reactive sera were supplementary tested by 
Inno-Lia HCV III Update Test (Innogenetics , Ghent, 
Belgium). The presence of HCV RNA was determined 
using second-generation Roche COBAS Amplicor HCV 
assay (Roche Molecular Systems, Nutley, USA). 
Results 
23 (16 men, 7 women) out of 136 HIV-positive indi-
viduals (16.9%) were anti-HCV positive. 18 anti-HCV 
positive patients (78.3%) w ere also viremic. HCV RNA 
was not detected in any of HCV-seronegative/ HIV-in-
fected individual from Slovenia. 
Antibodies to HCV were detected in 92.3% (12/ 13) 
hemophiliacs, 63.6% (7 / 11) intravenous drug users 
(IVDUs), 6.25% (2/ 32) of those who acquired HIV in-
fection by heterosexual high-risk behavior, in one 
woman with unknown risk factor for HIV infection and 
in a homosexual IVDU. 
Discussion 
The overall prevalence of HCV infection in HIV-
positive individuals from Slovenia w as 16.9%, which is 
among the lowest prevalence found in similar studies 
from other countries (2-7). The low overall prevalence 
of HCV and HIV co-infection in our country can be ex-
plained by the fact that almost 75% of ali subjects in-
cluded in the study acquired HIV infection by sexual 
transmission. The risk of HCV transmission is namely 
REFEH. ENCES 
Laborator y st ud y 
far smaller for patients who acquire HIV infection 
through the sexual route than for those who acquire it 
through the parenteral route (1, 2, 6, 7). This was also 
clearly established in our study, where a significant dif-
ference in HCV infection prevalence between blood and 
sexual exposure risk groups was found (76% vs. 1.9% 
respectively, p<0.01). The prevalence ofHCV infection 
in our group of HIV-positive individuals was the high-
est in hemophiliacs and IVDU. Ali but one Slovenian 
HIV infected hemophiliacs (92.3%) were also HCV in-
fected, which is similar to the percentage reported from 
other countries (2-7). In contrast only63.7% of our HIV-
1-positive IVDUs were HCV infected. When compar-
ing these results with those obtained in other countries, 
where 58-92% HIV-positive IVDUs are HCV infected (2-
7), it is obvious that the prevalence of HCV infection in 
Slovenian HIV-positive IVDUs is among the low est 
found to date. This low prevalence of HCV infection 
among Slovenian HIV-positive IVDUs is not surprising, 
since the prevalence of ali parenterally transmissible 
viruses (HIV, HTLV, HBV, HCV and HGV) is lower or 
among the lowest in comparison with IVDUs from other 
European countries (8, 9) . 
Conclusions 
The overall prevalence of HCV infection in HIV-
positive individuals from Slovenia was 16.9%, which is 
among the lowest prevalence found in similar studies 
from other European countries. The prevalence of HIV 
and HCV co-infection was the highest in hemophiliacs 
and IVDU. A significant difference in HCV infection 
prevalence between blood and sexual exposure risk 
groups was found (76% vs. 1.9% respectively, p<0.01). 
l. Rodriguez-Rosado R, Garcia-Samaniego J, So1iano V. Hepatitis C, an emerging problem in HN-iri-
fected patients. AIDS Rev 1999; 1: 22-8. 
42 
2. QuarantaJF, Delaney SR, Alleman S, et al. Prevalence of antibody to hepatitis C virus (HCV) in HN-1-
infected patients (Nice SEROCO cohort) . J Med Virol 1994; 42: 29-32. 
3. Mendel I, Clotteau L, Lambert S, et al. Hepatitis C virus infection in an HN-positive population in 
Normandy: Antibodies, HCV RNA and genotype prevalence. J Med Virol 1995; 47: 231-6. 
4. Weinstock DM, Merrick S, Malak SA, et al. Hepatitis C in an urban population infected with human 
immunodeficiency virus. AIDS 1999; 13: 2593-5. 
5. OckengaJ, Tillmann HL, Trautwein C, et al. Hepatitis Band C in HN-infected patients.J Hepatol 1997; 
27: 18-24. 
Acta Dermatoven APA Vol 11, 2002, No 2 
L a b o r a tor y s t ud y 
AUTHORS' 
ADDRESSES 
Hepatitis C virus infection in H!V-1 positive individuals from Slovenia 
6. Feinboim H, Gonzalez J, Fassio E, et al. Prevalence of hepatitis viruses in an anti-human immunodefi-
ciency virus-positive population from Argentina. A multicentre study. J Vira! Hep 1999; 6: 53-7. 
7. Greub G, Ledergerber B, Battegay M, et al. Clinical progression, survival, and immune recovery during 
antiretroviral therapy in patients with HlV-1 and hepatitis C virus coinfection: The Swiss HlV cohort study. 
Lancet 2000; 356: 1800-5. 
8. Trišler Z, Seme K, Poljak M, et al. Prevalence of hepatitis C and G virus infections among intravenous 
drug users in Slovenia and Croatia. ScandJ Infect Dis 1999; 31: 33-5. 
9. Poljak M, Bednarik], Rednak K, et al. Seroprevalence of human T cell leukaemia/lymphoma virus type 
1 (HTLV-1) in pregnant women, patients attending venereological outpatients services and intravenous 
drug users from Slovenia. Folia Biologica (Praha) 1998; 44: 23-5. 
Katja Seme MD, PhD, Institute oj Microbiology and Immunology, 
Medica! Faculty, Zaloška 4, 1105 Ljubljana, Slovenia . 
Mario Poljak MD, PhD, Institute oj Microbiology and Immunology, 
Medica! Faculty, Zaloška 4, 1105 Ljubljana, Slovenia 
Irena J. Marin MSc, Institute oj Microbiology and Immunology, Medical 
Faculty, Zaloška 4, 1105 Ljubljana, Slovenia 
Janez Tomažič MD, PhD, Department oj Injectious Diseases, Clinical 
Center, Japljeva 2, 1000 Ljubljana, Slovenia 
Ludvik Vidmar MD, PhD, Department oj Injectious Diseases, Glinica! 
Center, Japljeva 2, 1000 Ljubljana, Slovenia 
Acta Dermatoven APA Vol 11, 2002, No 2 ------------------ 43