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

28
LIST OF CANDIDATE’S SURVEYS ASSOCIATED
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
2
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.

26
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.



4

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-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:

n =
2
2
2
1
.
e
pq
Z



8
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
n % n %
Yes 32 34.0 59 62.8
No 157 10.0 529 33.8
P < 0,01 < 0.01
OR 4.63 3.30
95%CI 2.9 – 7.3 2.1 – 5.1
- 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
Vaccination IDUs FSWs HDPs MTPs
n % n % n % n %
Yes 12 8.7 15 10.4 11 6.0 4 3.9
No 72 16.6 46 10.9 31 16.6 20 7.2
p < 0.05 1.0 < 0.01 0.35
OR 0.48 0.95 0.32 0.52

20
MTPs 0 0.0 4 1.7 0 0.0 0.26
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
n % n % n %
IDUs 187 57.2 138 66.7 47 73.4 < 0.05
FSWs 38 25.5 44 20.1 64 27.7 0.16
HDPs 20 28.2 106 35,2 9 32,1 0.52
MTPs 10 6.3 16 6.6 0 0.0 0.96
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
Subject 2008 2009 2010 p
n % n % n %
IDUs 40 62.5 40 59.7 27 56.3 > 0.05
FSWs 31 42.5 32 46.4 8 19.5 < 0.05
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
Subject 2008 2009 2010 p
n % n % n %
IDUs 34 85.0 28 70.0 12 52.2 < 0.05
FSWs 19 61.3 20 62.5 2 50.0 > 0.05
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,

and 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
n % n % n % n % n %
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%).


10

3.1.2. Marital status
Subjects Unmarried Married Divorce, separation, widows Total

n % n % n %
IDUs 327 54.6 207 34.6 65 10.9 599
FSWs 149 24.8 219 36.5 232 38.7 600
HDPs 71 17.8 301 75.3 28 7.0 400
MTPs 158 39.5 241 60.3 1 0.3 400
Total 705 35.6 968 48.4 326 16.3 1999
- 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
Subjects 2008 2009 2010
n (+) % n (+) % n (+) %
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
HDPs
100 1 1.0 150 0 0.0 150 0 0.0
MTPs
100 0 0.0 150 0 0.0 150 4 2.7
- 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
Subjects 2008 2009 2010

n (+) % n (+) % n (+) %
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
Age groups
p
≤ 19 20 - 29 30 - 39 40 - 49 ≥ 50
n % n % n % n % n %
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
Subjects Age group
p

≤ 19 20 - 29 30 - 39 40 - 49 ≥ 50
n % n % n % n % n %
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
n % n % n %
IDUs 112 34.3 78 37.7 32 49.2 0.07
FSWs 35 23.5 76 34.7 108 46.6 < 0.01
HDPs 1 1.4 0 0.0 0 0.0 0.10

18




Table 3.21 Relations between condom use and HIV, HBV, HCV prevalence
Condom use
*

HIV infect. HBV infect. HCV infect.
n % n % n %
Non-consistent 270 24.0 110 12.9 402 35.8
Consistent 115 48.3 30 13.8 109 45.8
p < 0.01 0.8 < 0.01

OR 0.34 0.8 0.66
95% CI 0.3 – 0.5 0.6-1.4 0.5 – 0.9
* proportion of consistent condom use in the past 12 months
3.4.4. Duration of heamodialysis and HBV, HCV infection:
Bảng 3.22 The relations between duration of heamodialysis and HBV,
HCV infection
Duration of
heamodialysis
HBV
infection
HCV
infection
HBV/HCV
co-infection
n % n % n %
< 2 years 32 13.5 50 21.1 8 3.4
2-5 years 10 7.2 65 46.8 3 2.2
> 5 years 3 13.6 20 90.9 3 13.6
p 0.17 < 0.01 < 0.05

3.4.5. Relations between the rate of HIV infection and age groups of study
subjects:
Table 3.23 The relation between the rate of HIV infection
and age groups of study subjects
Study
Subjects
Age groups
p
≤ 19 20 - 29 30 - 39 40 - 49 ≥ 50
n % n % n % n % n %

IDUs 4 8.7 80 36.5 119 46.9 4 8.7 80 36.5 <0.01

11
MTPs
100 7 7.0 150 10 6.7 149 8 5.4
The rate of HBV infected subjects has downward tendency but no
difference in 2008-2010 period.
3.2.3. The rate of HCV infected subjects
Table 3.7 The rate of HCV infected subjects
Subjects 2008 2009 2010
n (+) % n (+) % n (+) %
IDUs
200 120 60.0 199 114 57.3 199 138 69.3
FSWs
199 49 24.6 200 54 27.0 200 43 21.5
HDPs
100 45 45.0 150 43 28.7 150 47 31.3
MTPs
100 13 13.0 150 8 5.3 150 5 3.3
- The rate of HCV infected IDUs has upward tendency.
- The rate of HCV infected FSWs is high but no significant difference in 2008-
2010 period (p>0.05).
- There are a difference of 3 years duration (2008-2010) about the rate of HCV
infected HDPs. They has downward tendency. Compared 2008-2009 and 2009-
2010 was a difference statistically significant (p<0.01 and p< 0.05).
- The rate of HCV infected MTPs ( 13.0% (2008); 5.3% (2009); 3.3% (2010)
was lower than other subjects and also has downward tendency in 2008-2010
duration having statistically significant vith p<0.05.
3.2.4. The rate of HIV, HBV, HCV coninfected subjects
3.2.4.1. The rate of HIV, HBV, HCV coinfected IDUs:

Table 3.8 The rate of HIV, HBV, HCV coinfected IDUs
Coinfection 2008 2009 2010
n (+) % n (+) % n (+) %
HBV/HIV 86 13 15.1 75 5 6.7 61 10 16.4
HCV/HIV 86 74 86.0 75 69 92.0 61 61 100
HBV/HCV/HIV 86 9 10.5 75 5 6.7 61 10 16.4
- The rate of HIV/HCV coinfected IDUs was upward tendency from 2008
(86.0%) to 2010 (100%) having statisticanlly significant with p<0.05.

12
- The rate of HBV/HCV coinfected IDUs living with HIV were rather
high (10.5% (2008); 6.7% (2009); 16.4% (2010)). Those rate were equal with
the rate of HIV/HBV coinfected IDUs (15.1%; 6.7% and 16.4%, respectively).

3.2.4.2. . The rate of HIV, HBV, HCV coinfected FSWs:
Bảng 3.9 The rate of HIV, HBV, HCV coinfected FSWs

Coinfection 2008 2009 2010
n (+) % n (+) % n (+) %
HBV/HIV 90 11 12.2 78 7 9.0 51 4 7.8
HCV/HIV 90 29 32.2 78 25 32.1 51 27 52.9
HBV/HCV/HIV 90 3 3.3 78 3 3.8 51 1 2.0

- The rate of HIV/HCV coinfected FSWs were rather high and has upward
tendency. Comparison between 2008-2010 and 2009-2010 has statistical
significalt difference with p<0.05.
- The rate of HIV/HBV coifected FSWs from 2008 to 2010 were 12.2%,
9.0%, 7.8%, respectively. The rate of HIV/HBV/HCV coinfected FSWs from
2008 to 2010 were 3.3%, 3.8%, 2.0%, respectively. Those rate were a
difference in the 2008-2010 period but those were not statistically significant

difference (p>0.05). Those rates were not equal the rate of HIV/HCV
coinfected FSWs from 2008 to 2010.

3.2.4.3. The rate of HBV/HCV coinfection among HDPs and MTPs:
The rate of HBV/HCV coinfected HDPs from 2008 to 2010 were 4.0%, 4.0%,
2.67%, respectively. The rate of HBV/HCV coinfected MTPs from 2008 to
2010 were 1.0%, 0.0%, 0.0%, respectively. Those rate were low and in HDPs
higher than MTPs. Difference of those rate within 2008-2010 were not
statistically significant (p>0.05).





17
n % n % n %
IDUs 118 69.4 121 68.8 103 56.3 < 0.05
FSWs 190 95.5 178 90.8 189 95.5 > 0.05
Number of IDUs shared needles was rather high but has significantly
downward tendency (p<0.05). But on the Contrary, shared needles of FSWs
was very high and has not significantly difference in the survey duration.
3.4.3. Sexual relations and condom use of IDUs and FSWs
Table 3.19 Percentage of subjects who had sex with over a partner in the
12 months prior survey
Subjects 2008 2009 2010 p
n % N % n %
IDUs 95 51.1 89 48.6 91 46.4 > 0.05
FSWs 194 99.5 176 92.6 187 97.9 < 0.05
HDPs 0 0.0 0 0.0 0 0.0
MTPs 2 3.4 0 0.0 8 38.1 < 0.05

The results clearly shows that IDUs who had highly sex with over a
parthner in the 12 months prior sur vey per years (2008-2010) and has
decreased tendency but difference has not significant statistical (p>0.05).
Table 3.20 Rate of condom use with partner in the past 12 months among
survey subjects
Subjects

2008 2009 2010 p
n % n % n %
IDUs 118 69.4 121 68.8 103 56.3 < 0.05
FSWs 190 95.5 178 90.8 189 95.5 > 0.05
HDPs 9 19.1 13 17.8 19 30.2 > 0.05
MTPs 12 30.8 14 21.9 2 8.0 > 0.05
- The rate of condom use among IDUs was rather high but it is significantly
downward tendency (p<0.05)
- The level of condom use among FSWs is high but it was not significantly
difference between 2008-2010 (p>0.05).
- The level of condom use was low among both HDPs and MTPs.


16
95%CI 0.9-1.8 0.9-2.5 3.2 - 7.3
According to the result of table 3.15, the rate of HIV, HBV infected
FSW assocciated with drug use was higher than among FSWs without drug
use. However, Those difference was not significantly. Only the rate of HCV
infection among FSWs associated drug use was significantly higher than
among FSWs without drug use (p<0.01).
Table 3.16 The relation between drug injecting and HIV, HBV, HCV
infection among FSWs
Drug

Injecting
HIV infection HBV infection HCV infection
n % n % n %
Yes 69 44.8 28 18.2 88 57.1
No 28 31.8 4 4.5 12 13.8
P < 0.05 < 0.01 < 0.01
OR 1.73 4.67 8.33
95%CI 1.1 - 3.0 1.6 - 13.8 4.2 - 16.6
The rate of HIV, HBV, HCV infected FSWs associated with drug
injecting (44.8%) was higher significantly FSWs unassociated with drug
injecting.
Table 3.17 The relation between duration of drug injecting and rate of
HIV, HBV HCV infection among FSWs
Duration of
drug injecting
HIV infection HBV infection HCV infection
n % n % n %
< 2 years 7 41.2 2 11.8 6 35.3
2-5 years 12 38.7 5 16.1 16 51.6
> 5 years 48 46.6 20 19.4 64 62.1
p

0.71 0.72 0.09
HIV, HBV, HCV prevalence among FSWs has upward tendency based
on duration of drug injecting. However, those difference was not significantly
statistical
3.4.2. Shared needles of IDUs and FSWs:
Table 3.18 Percentage of IDUs and FSWs reporting needle sharing in the a
month prior survey
Subject 2008 2009 2010 p

13




3.3. Genotyping genotypes and subtype of HIV, HBV, HCV in IDUs and
FSWs
3.3.1. Genotype of HIV, HBV, HCV in the IDUs:
Table 3.11 Prevalence of genotypes of HIV, HBV, HCV in IDUs
No.

Coding Serologic test's result HIV
genotype
HCV
genotype
HIV

HBV

HCV

1 10M00213 pos pos pos
KXĐ
1b
2 10M00240 pos pos pos KXĐ
1a
3 10M00249 pos pos pos
CRF01_AE 1a
4 10M00292 pos pos pos KPT

6a
5 10M00327 pos pos pos
CRF01_AE 1b
6 10M00332 pos pos pos KPT
1a
7 10M00346 pos pos pos KPT
1a
8 10M00384 pos pos pos KXĐ
1a
9 10M00390 pos pos pos KXĐ KXĐ
10 10M00392 pos pos pos KPT
1b
11 10M00235
neg
pos pos KPT
12 10M00237
neg
pos pos KXĐ
13 10M00269
neg
pos pos
6a
14 10M00318
neg
pos pos
1a
15 10M00338
neg
pos pos
6e

16 10M00368
neg
pos pos
1a
17 10M00386
neg
pos pos
6e
+ Determine genotypes of coinfection cases with both 3 viruses (HIV, HBV,
HCV) showed that:
- Among HIV genotypes: 2/10 cases determined that CRF01_AE recombinants.
8/10 cases were not determined subtypes because of viral load was at low level.
- Among HCV genotypes: The majority was HCV-1 subtypes (80%), include:
1a (5/8), 1b (3/8). 6a subtype (1/8) and 1/8 not determined subtype.
- Among HBV genotype: HBV genotype analysis was not carried out because
of those samples ware viral load at low level.

14
+ Analysis 7 coinfection cases with HBV and HCV but no HIV infcetion
showed that only 2 subtypes HCV: HCV-1 and HCV-6, including: 1a (2/7), 6e
(2/7), 6a (1/7) and 2 cases was not analysised because viral load was at low
level.
3.3.1. Genotype of HIV, HBV, HCV in the FSWs:
Table 3.12 Prevalence of genotypes of HIV, HBV, HCV in FSWs

No.

Coding
Serologic test's result HIV
genotype

HCV
genotype
HIV HBV HCV
1
10M00058 pos pos pos
CRF01_AE
KPT
2

10M00005
neg
pos pos
6a
3
10M00121
neg
pos pos
1a
4
10M00126
neg
pos pos KXĐ
5

10M00006

pos
neg neg
KPT

6

10M00007

pos
neg neg
KPT

7 10M00032
pos
neg neg
KPT

8 10M00038
pos
neg neg
KPT

9

10M00094

pos
neg neg
KPT

10 10M00096
pos
neg neg
KXĐ

11 10M00101
pos
neg neg
KPT

12 10M00127
pos
neg neg CRF01_AE

13

10M00139

pos
neg neg CRF01_AE

14 10M00186
pos
neg neg
KXĐ

+ Analysis genotypes of FSWs:
- HIV genotype: HIV subtypes were determined that CRF01_AE subtype
- HCV genotype: only 2 subtypes: HCV-1a and HCV-6a
- HBV genotype: Survey sample has viral load at low level, which can not
determine genotypes.
3.4. Several influencing factors on trasmission of HIV, HBV, HCV among
survey objects
3.4.1. Duration of drug injecting of IDUs and FSWs:

3.4.1.1. Duration of drug injecting of IDUs:
Table 3.13 The relation between duration of drug injecting and HIV, HBV,
HCV prevalence among IDUs
Duration of
drug injecting
HIV infection HBV infection HCV infection
n % n % n %

15
< 2 years 12 16.9 5 7.0 26 36.6
2-5 years 20 30.8 10 15.4 42 64.6
> 5 years 171 50.3 55 16.2 281 82.9
p

< 0.01 0.14 < 0.01
HIV, HCV prevalence of IDUs increased significantly in duration of drug
injecting. (p<0.01).
The rate of HBV infection was also upward tendency in duration of drug
injecting. However, those difference was not enough statistical evidence
significantly.
Table 3.14 The relations between duration of drug injecting and the rate of
HIV, HBV, HCV coinfection of IDUs
Duration of
drug
injecting
HIV/HBV
co-infection
HIV/HCV
co-infection
HBV/HCV

co-infection
n % n % n %
< 2 years
2 2.8 10 14.1 1 1.4
2-5 years
3 4.6 18 27.7 7 10.8
> 5 years
22 6.5 162 47.6 44 12.9
p
0.44 < 0.01 < 0.05
- The rate HIV/HCV, HBV/HCV co-infection was significantly upward
tendency in duration of drug injecting.
- The rate of HIV/HBV co-infection also was increased in duration of drug
injecting. The highest rate of infection among subject has duration of drug
injecting over 5 years. However, this difference was not enough statistical
evidence.
3.4.1.2.Dug use behavior of FSWs:
Table 3.15 The relation between drug using and HIV, HBV, HCV infection
among FSWs
Drug
using
HIV infection HBV infection HCV infection
n % n n %
Yes 98 40,0 33 13.5 101 41.4
No 121 34.2 33 9.3 45 12.7
P 0.15 0.11 < 0.01
OR 1.28 1.51 4.85