of people with HIV/hepatitis C virus (HCV) co-infection in Asia are in need of HCV
therapy with a fifth of people having cirrhosis, investigators report in the Journal of Viral Hepatitis. The most
common HCV genotypes were genotypes 1 (59%) and 3 (26%). The majority of
people were taking antiretroviral therapy (ART) with good immunological and
“This is the first
regional study of comprehensive assessment of HCV infection and HCV-related
liver disease in HIV-HCV-coinfected patients in Asia,” write the authors. “The
proportion of patients in this cohort having liver disease is concerning, as
routine HCV treatment is usually not available or accessible for patients under
HIV care in South-East Asia.”
estimated 2.3 million individuals have HIV/HCV co-infection. Although
ART is being rolled out in resource-limited settings, access to HCV treatment –
both newer direct-acting antivirals (DAAs) and pegylated interferon-based therapies
– is rare. Consequently, people with HIV/HCV co-infection in resource-limited countries rarely undergo HCV disease assessment.
A non-invasive test, used instead of a biopsy, to measure the stiffness
or elasticity of the liver using an ultrasound probe.
An inherited gene which all individuals have. There are three genotypes of IL28B; these influence response to hepatitis C and its treatment. People with CC genotype are more likely to spontaneously clear acute infection or (during chronic infection) respond well to interferon-based treatment. The other two genotypes are known as CT and TT.
team of investigators therefore designed a cross-sectional study involving 480 adults with HIV infection with antibodies to HCV to assess prevalence of
chronic infection, genotype distribution and extent of liver disease. The individuals were recruited from HIV treatment centres in Bangkok (Thailand), Hanoi
(Vietnam), Jakarta (Indonesia) and Kuala Lumpur (Malaysia).
The majority of
people (89%) were male, median age was 38 years, 76% reported a history of
injecting drug use and 2% were still injecting heroin.
Most (94%) were
taking ART. Median CD4 cell count was 446 cells/mm3. Viral load
results were available for 221 people and 94% had viral suppression.
Hepatitis B virus (HBV) screening results were available for 229 people, with
4% carrying this infection.
Overall, 85% of
people had a positive HCV RNA result confirming chronic HCV infection.
results were available for 380 individuals with chronic infection. Genotype 1
(59%) predominated with genotype 3 (26%) the next most common, followed by
genotype 6 (11%). Very few cases of genotypes 2, 4 and 5 were identified.
Screening for the
IL28B gene was performed on 222 people. The CC and TT alleles were identified
in 85% and 15% of individuals, whereas the TT and TG genotypes were present in 90%
All 380 people tested
for genotype were assessed for liver fibrosis using FibroScan. Results showed that 38% had no/mild fibrosis (F0-1), 22%
had moderate fibrosis (F2), 20% had severe fibrosis (F3) and 21% had cirrhosis
Therefore, 62% of
people had liver disease warranting therapy.
with more advanced liver disease were older age (p < 0.01), detectable HIV viral
load (p = 0.05), increasing BMI over 25 (p = 0.01) and CT allele (p < 0.01).
“In our cohort,
most patients with HCV Ab [antibodies] had chronic infection, and 62% of those
chronically infected had previously undiagnosed liver disease,” conclude the
authors. “This finding and the HCV GT [genotype] distribution diversity
observed emphasize that creating access to DAA-based HCV therapy is urgent and
needs to incorporate pan-genotypic regimens with good efficacy for GT3,
including in patients with liver cirrhosis.”