title: HCV co-infection and markers of liver injury and fibrosis among HIV-positive childbearing women in Ukraine: results from a cohort study.
abstract: BACKGROUND
  Ukraine's injecting drug use-driven HIV epidemic is among the most severe in Europe with high burden of HCV co-infection. HIV/HCV co-infected individuals are at elevated risk of HCV-related morbidity, but little is known about burden of liver disease and associated factors in the HIV-positive population in Ukraine, particularly among women.
  
  
  METHODS
  Characteristics of 2050 HIV-positive women enrolled into the Ukrainian Study of HIV-infected Childbearing Women were described by HCV serostatus. Aspartate transaminase (AST) to platelet ratio (APRI) and FIB-4 scores were calculated and exact logistic regression models fitted to investigate factors associated with significant fibrosis (APRI >1.5) among 762 women with an APRI score available.
  
  
  RESULTS
  Of 2050 HIV-positive women (median age 27.7 years, IQR 24.6-31.3), 33% were HCV co-infected (79% of those with a history of injecting drug use vs 23% without) and 17% HBsAg positive. A quarter were on antiretroviral therapy at postnatal cohort enrolment. 1% of the HIV/HCV co-infected group had ever received treatment for HCV. Overall, 24% had an alanine aminotransferase level >41 U/L and 34% an elevated AST (53% and 61% among HIV/HCV co-infected). Prevalence of significant fibrosis was 4.5%; 2.5% among 445 HIV mono-infected and 12.3% among 171 HIV/HCV co-infected women. 1.2% had a FIB-4 score >3.25 indicating advanced fibrosis. HCV RNA testing in a sub-group of 56 HIV/HCV co-infected women indicated a likely spontaneous clearance rate of 18% and predominance of HCV genotype 1, with one-third having genotype 3 infection. Factors associated with significant fibrosis were HCV co-infection (AOR 2.53 95%CI 1.03-6.23), history of injecting drug use (AOR 3.51 95%CI 1.39-8.89), WHO stage 3-4 HIV disease (AOR 3.47 95%CI 1.51-7.99 vs stage 1-2 HIV disease) and not being on combination antiretroviral therapy (AOR 3.08 95%CI 1.23-7.74), adjusted additionally for HBV co-infection, smoking and age.
  
  
  CONCLUSIONS
  Most HIV/HCV co-infected women had elevated liver enzymes and 12% had significant fibrosis according to APRI. Risk factors for liver fibrosis in this young HIV-positive population include poorly controlled HIV and high burden of HCV. Results highlight the importance of addressing modifiable risk factors and rolling out HCV treatment to improve the health outcomes of this group.
authors.affiliation: Population, Policy and Practice Programme, UCL Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK. heather.bailey@ucl.ac.uk.
authors.forename: Heather
authors.initials: H
authors.lastname: Bailey
authors.affiliation: The Public Health Center of the Ministry of Health of Ukraine, Kyiv, Ukraine.
authors.forename: Nataliya
authors.initials: N
authors.lastname: Nizova
authors.affiliation: The Public Health Center of the Ministry of Health of Ukraine, Kyiv, Ukraine.|Institute of Epidemiology and Infectious Diseases of NAMS, Kiev, Ukraine.
authors.forename: Violeta
authors.initials: V
authors.lastname: Martsynovska
authors.affiliation: Shupyk National Medical Academy of Postgraduate Education, Kiev, Ukraine.
authors.forename: Alla
authors.initials: A
authors.lastname: Volokha
authors.affiliation: Perinatal Prevention of AIDS Initiative, Odessa, Ukraine.
authors.forename: Ruslan
authors.initials: R
authors.lastname: Malyuta
authors.affiliation: Population, Policy and Practice Programme, UCL Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK.
authors.forename: Mario
authors.initials: M
authors.lastname: Cortina-Borja
authors.affiliation: Population, Policy and Practice Programme, UCL Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK.
authors.forename: Claire
authors.initials: C
authors.lastname: Thorne
mesh_terms: D000328:Adult; D000367:Age Factors; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001219:Aspartate Aminotransferases / Q000032:analysis; D015415:Biomarkers / Q000032:analysis*; D001792:Blood Platelets / Q000166:cytology / Q000378:metabolism; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology*; D015331:Cohort Studies; D060085:Coinfection / Q000453:epidemiology; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D016174:Hepacivirus / Q000235:genetics / Q000302:isolation & purification; D006526:Hepatitis C / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D008103:Liver Cirrhosis / Q000209:etiology*; D016015:Logistic Models; D016017:Odds Ratio; D015995:Prevalence; D012307:Risk Factors; D012907:Smoking; D014455:Ukraine / Q000453:epidemiology; D019562:Viral Load; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents; D000998:Antiviral Agents; D015415:Biomarkers; D001219:Aspartate Aminotransferases
keywords: APRI; Combination antiretroviral therapy; Eastern Europe; FIB-4; HIV; Hepatitis C; Liver fibrosis; Ukraine; Women