PLoS ONE (Jan 2016)

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

  • Tam Nguyen Truong,
  • Didier Laureillard,
  • Karine Lacombe,
  • Huong Duong Thi,
  • Phuc Pham Thi Hanh,
  • Lien Truong Thi Xuan,
  • Nga Chu Thi,
  • Anh Luong Que,
  • Vinh Vu Hai,
  • Nicolas Nagot,
  • Edouard Tuaillon,
  • Stéphanie Dominguez,
  • Maud Lemoine

DOI
https://doi.org/10.1371/journal.pone.0153744
Journal volume & issue
Vol. 11, no. 5
p. e0153744

Abstract

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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.