Parallel and overlapping HIV and bloodborne hepatitis epidemics in Africa.

A world overview of HIV and hepatitis B and C virus (HBV and HCV) infections shows strong parallels in the distribution of generalized epidemics. However, several recent papers have argued that HCV prevalence in countries and cohorts in sub-Saharan Africa is too low to allow parenteral transmission to account for an important proportion of HIV infections. This conclusion is unwarranted. The transmission efficiencies of HCV and HIV through needlestick accidents are similar, while some parenteral exposures - such as intramuscular injections - may be more efficient in transmitting HIV than HCV. Much of the data used to show current low HCV prevalence in Africa comes from blood samples collected in 1986-95. For South Africa, the picture of low and stable HCV prevalence in the 1990s is based on selected evidence and ignores multiple studies reporting 3-5.4% prevalence in the black population. From a literature search, we found 62 cohorts in Africa with information on HCV and HIV prevalence. Across these cohorts, there is a trend for HCV prevalence to increase with HIV, though much of the variance is unexplained. For 25 cohorts with sufficient data, the median relative risk for HCV infection for persons with HIV is 1.52.