Epidemiology of hepatitis B, hepatitis C, and syphilis co-infections in HIV-1 patients: a retrospective cross-sectional study of prevalence and viral load correlates.

Abstract

Background: Co-infections with hepatitis B (HBV), hepatitis C (HCV) and syphilis complicate the clinical management of people living with HIV by influencing disease progression, treatment response, and transmission risk. Despite the growing HIV burden in Türkiye, data on the impact of these coinfections remain limited.

Objectives: To determine the prevalence of HBV, HCV, and syphilis coinfections in adults with HIV-1 and to examine their associations with demographics and HIV-1 viral load.

Design: Retrospective cross-sectional study.

Setting: Single center, tertiary care hospital in Türkiye.

Patients and methods: Adults diagnosed with HIV-1 between March 2019 and June 2024 at Ankara Bilkent City Hospital were included. Demographic information, HIV viral load measurements, and serological and molecular test results for HBV, HCV, and syphilis were retrieved from the institutional laboratory database. Coinfection status was assessed relative to age, gender, and HIV viral load.

Main outcome measures: Prevalence and distribution of HBV, HCV, and syphilis coinfections and their associations with demographic variables and HIV viral load.

Sample size: 724 patients.

Results: The study population was predominantly male (86%), with a median age of 40 years. Syphilis was the most common coinfection (25.6%), followed by HBV at 4.1% and HCV at 1.8%. Syphilis was significantly more prevalent among men (P=.001), and HBV coinfection was associated with older age (P=.005). No significant associations were observed between HIV viral load and any co-infection. Notably, a substantial proportion of patients, especially those newly diagnosed after 2019, had high HIV RNA levels, suggesting delayed diagnosis and treatment initiation. Triple coinfections were rare but remain clinically relevant.

Conclusions: The high prevalence of syphilis and delayed HIV diagnoses highlight the urgent need for improved screening protocols, timely initiation of antiretroviral therapy, and broader implementation of HBV vaccination programs. An integrated multisectoral approach is critical to address the overlapping clinical and public health burdens posed by these co-infections. Healthcare strategies must consider the impact of COVID-19-related service disruptions, which likely contributed to delays in diagnosis and treatment.

Limitations: Lack of data on patients' behavioral risk factors and no follow-up on treatment outcomes for syphilis.