High Proportion of HIV-HCV Coinfected Patients with Advanced Liver Fibrosis Requiring Hepatitis C Treatment in Haiphong, Northern Vietnam (ANRS 12262)

Tam Nguyen Truong (1) , Didier Laureillard (2, 1) , Karine Lacombe (3, 4) , Huong Duong Thi (5) , Phuc Pham Thi Hanh (6) , Lien Truong Thi Xuan (7) , Nga Chu Thi (8) , Anh Luong Que (8) , Vinh Vu Hai (6) , Nicolas Nagot (1) , Edouard Tuaillon (1) , Stéphanie Dominguez (9) , Maud Lemoine (10)

1 Pathogénèse et contrôle des infections chroniques (PCCI)
2 CHU Nîmes - Hôpital Universitaire Carémeau [Nîmes]
3 iPLESP - Institut Pierre Louis d'Epidémiologie et de Santé Publique
4 CHU Saint-Antoine [AP-HP]
5 Dpt of Public Health [Hai Phong]
6 Dpt of Infectious and Tropical Diseases [Hai Phong]
7 Institut Pasteur d'Ho Chi Minh Ville
8 Dpt of virology [Hai Phong]
9 Service d'immunologie clinique [Créteil]
10 Dpt of Hepatology [London]

Rationale and Aims Screening and treatment for chronic hepatitis C are very limited in Vietnam and clinical data on HCV-related liver disease in HIV-coinfected people are almost inexistent. This study aimed to assess the severity of liver fibrosis and its risk factors in HIV-HCV coinfected patients in Haiphong, Northern Vietnam. Methods A cross-sectional study was conducted at a HIV outpatient clinic. Consecutive HIV treated adults with positive HCV serology completed a standardised epidemiological questionnaire and had a comprehensive liver assessment including hepatic elastography (Fibroscan®, Echosens). Results From February to March 2014, 104 HIV-HCV coinfected patients receiving antiretroviral therapy (ART) were prospectively enrolled (99 males, median age: 35.8 (32.7–39.6) years, median CD4 count: 504 (361–624) /mm3. Of them, 93 (89.4%) had detectable HCV RNA (median 6.19 (4.95–6.83 Log10 IU/mL). Patients were mainly infected with genotypes 1a/1b (69%) and genotypes 6a/6e (26%). Forty-three patients (41.3%) had fibrosis ≥F2 including 24 patients (23.1%) with extensive fibrosis (F3) and/or cirrhosis (F4). In univariate analysis, excessive alcohol consumption, estimated time duration from HCV infection, nevirapine and lopinavir-based ARV regimen and CD4 nadir were associated factors of extensive fibrosis/cirrhosis. Alcohol abuse was the only independent factor of extensive fibrosis in multivariate analysis. Using Fibroscan® as a gold standard, the high thresholds of AST-to-platelet ratio index (APRI) and fibrosis-4 score (FIB-4) had very good performances for the diagnosis of extensive fibrosis/cirrhosis (Se: 90 and 100%, Sp:84 and 81%, AUROCs = 0.93, 95%CI: 0.86–0.99 and 0.96 (0.92–0.99), respectively). Conclusion In this study, nearly 25% of HIV-HCV coinfected patients successfully treated with ART have extensive fibrosis or cirrhosis, and therefore require urgently HCV treatment.

Domaines: Maladies infectieuses

Tam Nguyen Truong, Didier Laureillard, Karine Lacombe, Huong Duong Thi, Phuc Pham Thi Hanh, et al.. High Proportion of HIV-HCV Coinfected Patients with Advanced Liver Fibrosis Requiring Hepatitis C Treatment in Haiphong, Northern Vietnam (ANRS 12262). PLoS ONE, 2016, 11 (5), pp.e0153744. ⟨10.1371/journal.pone.0153744⟩. ⟨hal-01317436⟩