title: High Proportion of HIV-HCV Coinfected Patients with Advanced Liver Fibrosis Requiring Hepatitis C Treatment in Haiphong, Northern Vietnam (ANRS 12262).
abstract: 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.
  
  
  
  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).
  
  
  
  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).
  
  
  
  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.
authors.affiliation: University of Medicine Pham Ngoc Thach, Ho Chi Minh City, Vietnam.|INSERM U1058 "Pathogenesis and Control of Chronic Infections", Montpellier, France.
authors.forename: Tam
authors.initials: T
authors.lastname: Nguyen Truong
authors.affiliation: INSERM U1058 "Pathogenesis and Control of Chronic Infections", Montpellier, France.|Department of Infectious and Tropical Diseases, Caremeau University Hospital, Nîmes, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Laureillard
authors.affiliation: Department of Infectious and Tropical Diseases, Saint-Antoine Hospital, AP-HP, Paris, France.|Sorbonne Universités, UPMC Université Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France.
authors.forename: Karine
authors.initials: K
authors.lastname: Lacombe
authors.affiliation: Department of Public Health, University of Medicine and Pharmacy, Hai Phong, Vietnam.
authors.forename: Huong
authors.initials: H
authors.lastname: Duong Thi
authors.affiliation: Department of Infectious and Tropical Diseases, Viet Tiep Hospital, Hai Phong, Vietnam.
authors.forename: Phuc
authors.initials: P
authors.lastname: Pham Thi Hanh
authors.affiliation: Pasteur Institute, Ho Chi Minh City, Vietnam.
authors.forename: Lien
authors.initials: L
authors.lastname: Truong Thi Xuan
authors.affiliation: Department of virology, Viet Tiep hospital, Haiphong, Vietnam.
authors.forename: Nga
authors.initials: N
authors.lastname: Chu Thi
authors.affiliation: Department of virology, Viet Tiep hospital, Haiphong, Vietnam.
authors.forename: Anh
authors.initials: A
authors.lastname: Luong Que
authors.affiliation: Department of Infectious and Tropical Diseases, Viet Tiep Hospital, Hai Phong, Vietnam.
authors.forename: Vinh
authors.initials: V
authors.lastname: Vu Hai
authors.affiliation: INSERM U1058 "Pathogenesis and Control of Chronic Infections", Montpellier, France.|Department of epidemiology, University Hospital, Montpellier, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Nagot
authors.affiliation: INSERM U1058 "Pathogenesis and Control of Chronic Infections", Montpellier, France.|Department of bacteriology and virology, University Hospital, Montpellier, France.
authors.forename: Edouard
authors.initials: E
authors.lastname: Tuaillon
authors.affiliation: Department of clinical immunology, Henri Mondor Hospital, AP-HP, Créteil, France.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Dominguez
authors.affiliation: Department of Hepatology, St Mary's Hospital, Imperial College, London, United Kingdom.
authors.forename: Maud
authors.initials: M
authors.lastname: Lemoine
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D060085:Coinfection / Q000188:drug therapy / Q000453:epidemiology* / Q000821:virology; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology / Q000821:virology; D006526:Hepatitis C / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology / Q000821:virology; D006801:Humans; D008103:Liver Cirrhosis / Q000453:epidemiology / Q000209:etiology* / Q000821:virology; D008297:Male; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014744:Vietnam / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents; D000998:Antiviral Agents