1. HCV-HBV co-infection in Russian Federation Chumakov Institute of Poliomyelitis and Viral Encephalitis, Moscow Karen Kyuregyan VIII Annual Conference of New Visby Network on Hepatitis C February 13-16, 2011 Vilnius

2. Data on incidence of hepatitis B and C in Russian Federation based on official registration Results of laboratory study of patients from two regions with different HBV and HCV prevalence: Moscow region and Tyva Republic

3. Incidence of acute and chronic hepatitis B in Russian Federation (1999-2009)

4. Incidence of acute and chronic hepatitis C in Russian Federation (1999-2009)

5. Transmission routes of Hepatitis B and Hepatitis C in Russian Federation (1997 and 2008)

6. Distribution of chronic hepatitis B and chronic hepatitis C incidence in different age groups in Russian Federation (2008)

7. Similar trends in incidence for hepatitis B and hepatitis C; Common routes of transmission for HBV and HCV; Similar affected age groups; High prevalence of HBV-HCV co-infection could be expected; No official registration for mixed infections

8. Study groups Moscow: 244 patients with chronic hepatitis C Tyva 133 patients with chronic hepatitis: -38 patients with chronic hepatitis C -95 patients with chronic hepatitis B/D and cirrhosis

9. Incidence of chronic hepatitis B and chronic hepatitis C in Moscow region and in Tyva Republic (2006-2009)

10. HBV detection HBsAg: ELISA (“Diagnostic systems”, Russia) sensitivity - 0.01 ng/ml, K141E, Q129H, M133L, T126N, K 142S, P 142S, T143K, G145R HBV DNA: Nested PCR, S-gene primers sensitivity – about 100 copies/ml Batches < 15 samples Low copy K+ (150 copies/ml and 1500 copies/ml) 4 K- per batch

11. Moscow group 244 patients with chronic hepatitis C Tyva group 38 patients with chronic hepatitis C

12. Prevalence of HBV/HCV co-infection in Moscow group CHC, n=244 HBsAg + (HBV DNA -) N= 2 (0.82%) Anti-HBc + Anti-HBs+ HBsAg – N = 42 (17.2%) Anti-HBc + Anti-HBs - HBsAg – N = 96 (39.3%) Anti-HBc - Anti-HBs- HBsAg – N = 104 (42.6%) N = 138 (56.6%) Testing for occult HBV infection No cases of OBI detected

13. CHC, n=38 HBsAg + (HBV DNA -) N= 3 (7.9%) Anti-HBc + Anti-HBs+ HBsAg – N = 13 (34.2%) Anti-HBc + Anti-HBs - HBsAg – N = 13 (34.2%) Anti-HBc - Anti-HBs- HBsAg – N = 9 (23.7%) N = 26 (68.4%) Testing for occult HBV infection 2 cases of OBI Prevalence of HBV/HCV co-infection in Tyva group

14. Cases of occult HBV infection in CHC patients (Tyva) Sample ID HBV genotype SerotypeAa subst. in HBsAg HBV viral load 600Dayw1F8L Y134F Y 206C < 1000 copy/ml 1549A2adw2I25V< 1000 copy/ml

15. Immune staining with protein A – colloidal gold complex. x 300 000

16. Prevalence of HCV infection in patients with HBV/HDV HBsAg+/anti-HDV+ N=95 anti-HCV+ (HCV RNA-) N=8 (8.4%) After 1 year follow up 10/95 patients died Patients N=95 AgeM:FHDV RNA + N (%) HBV DNA+ N (%) Anti- HCV+ N (%) CH N (%) Cirrhosis A* N (%) Cirrhosis B-C* N (%) Survivors, n= 85 (89.5%) 37.6± 12.2 1:229 (34.1%) 23 (27.1%) 7 (8.2%)68 (80%) 4 (4.7%)13 (15.3%) Non- survivors, n=10 (10.5%) 46.5± 10.4 1.5:12 (20%)5 (50%)1 (10%)3 (30%)6 (60%)1 (10%) * - cirrhosis grade by Child-Pugh

17. Summary Prevalence of HBV/HCV co-infection in studied cohorts: 2 cases (0.82%) in Moscow region; however, 56.6% patients with HCV have markers of HBV exposure; 5 cases (13.2%) in hepatitis C patients + 8 cases (8.4%) in hepatitis B/D patients in Tyva Republic; Difference in HBV/HCV co-infection prevalence in 2 regions may be due to acquisition of HBV in different age.

18. Conclusion In such hyperendemic regions as Tyva Republic HBV testing should be recommended for all HCV positive patients

19. M.I.Mikhailov O.V.Isaeva L.Yu.Ilchenko N.I.Gromova I.A.Morozov T.V.Kozhanova I.V.Gordeychuk N.D.Oorzhak