situation of hiv, hbv, hcv infection and associated factors in some high risk populations in hanoi, 2008-2010

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

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

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

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

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-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:

2 2

e

pq



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

- 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

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

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

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

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

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%)

3.1.2 Marital status

Subjects Unmarried Married Divorce, separation, widows Total

- 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

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

- 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

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

p

≤ 19 20 - 29 30 - 39 40 - 49 ≥ 50

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

p

≤ 19 20 - 29 30 - 39 40 - 49 ≥ 50

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