Revista de SIDA e investigación clínica

High Frequency of Advanced Hepatic Disease among HIV/HCV Co-Infected Patients in Cambodia: The HEPACAM Study

Abstract

Nathalie Lerolle, Setha Limsreng, Isabelle Fournier-Nicolle, Sowath Ly, Janin Nouhin, Bertrand Guillard, Sreymom Ken, Anne Dulioust, Pichit Khuon, Jean-Francois Delfraissy, Vara Ouk and Olivier Segeral

Background: Little is known about HIV/Hepatitis C Virus (HCV) co-infection in resource-limited countries, although chronic HCV infection is one of the most relevant comorbidities in HIV population. The aim of this study was to determine the severity of liver disease in a cohort of HIV/HCV co-infected patients followed in Calmette Hospital, Phnom Penh, Cambodia, and to analyse the impact of HCV infection on antiretroviral therapy efficacy and hepatotoxicity.

Methods: HIV patients with positive HCV antibodies were enrolled in this cross-sectional study. HIV monoinfected patients formed the control group. Transverse evaluation of co-infected patients was performed collecting clinical, biological, virological and ultrasonographic data. HIV course, response to antiretroviral therapy and frequency of hepatocytolysis were compared in both groups.

Results: Among 50 HIV patients known with HCV antibodies, 31 (62%) had positive plasma HCV RNA and were included (58% men, median age 44 years). HCV genotype 1 was the most prevalent (68%), followed by genotype 6 (25%). Twelve patients (39%) met clinical, biological and/or ultrasonographic criteria for cirrhosis. FibroTest stage was 3-4 in 16 patients (52%). HIV/HCV co-infected patients demonstrated similar immune restoration and virological response to antiretroviral therapy as the 160 HIV mono-infected patients. Co-infected patients were more likely to have alanine aminotransferase elevation at baseline and to develop grade 2 or 3 hepatocytolysis in the two years after antiretroviral therapy initiation, specifically when nevirapine was used during the first six months of treatment.

Conclusions: HIV/HCV co-infected patients are at increased risk for acquiring severe hepatic fibrosis. HCV coinfection does not affect response to ART. Efavirenz should be preferred to nevirapine in co-infected patients due to hepatotoxicity. Further research is required to target access to appropriate management of HIV/HCV co-infections in resource-limited countries.