Two-thirds of people with HIV/HCV co-infection in Southeast Asia in need of HCV therapy

Almost two-thirds 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 virological outcomes.

“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.”

Worldwide, an 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.

An international team of investigators therefore designed a cross-sectional study involving 480 HIV-positive adults 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.

HCV genotype 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% and 10%.

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 (F4).

Therefore, 62% of people had liver disease warranting therapy.

Factors associated 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.”