The French national prospective cohort of patients co-infected with HIV and HCV (ANRS CO13 HEPAVIH): early findings, 2006-2010.
BACKGROUND
In France, it is estimated that 24% of HIV-infected patients are also infected with HCV. Longitudinal studies addressing clinical and public health questions related to HIV-HCV co-infection (HIV-HCV clinical progression and its determinants including genetic dimension, patients' experience with these two diseases and their treatments) are limited. The ANRS CO 13 HEPAVIH cohort was set up to explore these critical questions.To describe the cohort aims and organization, monitoring and data collection procedures, baseline characteristics, as well as follow-up findings to date.


METHODS
Inclusion criteria in the cohort were: age > 18 years, HIV-1 infection, chronic hepatitis C virus (HCV) infection or sustained response to HCV treatment. A standardized medical questionnaire collecting socio-demographic, clinical, biological, therapeutic, histological, ultrasound and endoscopic data is administered at enrollment, then every six months for cirrhotic patients or yearly for non-cirrhotic patients. Also, a self-administered questionnaire documenting socio-behavioral data and adherence to HIV and/or HCV treatments is administered at enrollment and yearly thereafter.


RESULTS
A total of 1,175 patients were included from January 2006 to December 2008. Their median age at enrollment was 45 years and 70.2% were male. The median CD4 cell count was 442 (IQR: 304-633) cells/μl and HIV RNA plasma viral load was undetectable in 68.8%. Most participants (71.6%) were on HAART. Among the 1,048 HIV-HCV chronically co-infected patients, HCV genotype 1 was predominant (56%) and cirrhosis was present in 25%. As of January, 2010, after a median follow-up of 16.7 months (IQR: 11.3-25.3), 13 new cases of decompensated cirrhosis, nine hepatocellular carcinomas and 20 HCV-related deaths were reported, resulting in a cumulative HCV-related severe event rate of 1.9/100 person-years (95% CI: 1.3-2.5). The rate of HCV-related severe events was higher in cirrhotic patients and those with a low CD4 cells count, but did not differ according to sex, age, alcohol consumption, CDC clinical stage or HCV status.


CONCLUSIONS
The ANRS CO 13 HEPAVIH is a nation-wide cohort using a large network of HIV treatment, infectious diseases and internal medicine clinics in France, and thus is highly representative of the French population living with these two viruses and in care.
INSERM, U897 and ISPED, Université Victor Segalen, Bordeaux, France. Marc-Arthur.Loko@isped.u-bordeaux2.fr
Marc-Arthur
MA
Loko
Dominique
D
Salmon
Patrizia
P
Carrieri
Maria
M
Winnock
Marion
M
Mora
Laurence
L
Merchadou
Stéphanie
S
Gillet
Elodie
E
Pambrun
Jean
J
Delaune
Marc-Antoine
MA
Valantin
Isabelle
I
Poizot-Martin
Didier
D
Neau
Philippe
P
Bonnard
Eric
E
Rosenthal
Karl
K
Barange
Philippe
P
Morlat
Karine
K
Lacombe
Anne
A
Gervais
François
F
Rouges
Alain Bicart
AB
See
Caroline
C
Lascoux-Combe
Daniel
D
Vittecoq
Cécile
C
Goujard
Claudine
C
Duvivier
Bruno
B
Spire
Jacques
J
Izopet
Philippe
P
Sogni
Lawrence
L
Serfaty
Yves
Y
Benhamou
Firouzé
F
Bani-Sadr
François
F
Dabis
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology; D018450:Disease Progression; D005260:Female; D005602:France / Q000453:epidemiology; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology; D015497:HIV-1 / Q000302:isolation & purification; D016174:Hepacivirus / Q000302:isolation & purification; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology; D006801:Humans; D008113:Liver Neoplasms / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood; D012307:Risk Factors; D011795:Surveys and Questionnaires; D019562:Viral Load
D019380:Anti-HIV Agents; D012367:RNA, Viral