High Frequency of Advanced Hepatic Disease among HIV/HCV Co-Infected Patients in Cambodia: The HEPACAM Study
Nathalie Lerolle1,5*, Setha Limsreng2,3, Isabelle Fournier-Nicolle4,5, Sowath Ly5, Janin Nouhin6, Bertrand Guillard7, Sreymom Ken6, Anne Dulioust1,2, Pichit Khuon2,3, Jean-François Delfraissy1,2,4, Vara Ouk2,3 and Olivier Segeral1,2
1Assistance Publique - Hôpitaux de Paris (AP-HP), Département de Médecine Interne et Maladies Infectieuses, Centre Hospitalier Universitaire de Bicêtre, 78 rue du Général Leclerc, 94 276 Le Kremlin-Bicêtre, France
- *Corresponding Author:
- Nathalie Lerolle
Assistance Publique - Hôpitaux de Paris (AP-HP)
Département de Médecine Interne et Maladies Infectieuses
Centre Hospitalier Universitaire de Bicêtre
78 rue du Général Leclerc
94 276 Le Kremlin-Bicêtre, France
E-mail: [email protected]
Received Date: June 15, 2012; Accepted Date: July 05, 2012; Published Date: July 08, 2012
Citation: Lerolle N, Limsreng S, Fournier-Nicolle I, Ly S, Nouhin J, et al. (2012) High Frequency of Advanced Hepatic Disease among HIV/HCV Co-Infected Patients in Cambodia: The HEPACAM Study (ANRS 12267). J AIDS Clinic Res 3:161. doi:10.4172/2155-6113.1000161
Copyright: © 2012 Lerolle N, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Background: Little is known about HIV/Hepatitis C Virus (HCV) co-infection in resource-limited countries, although chronic HCV infection is one of the most relevant comorbidities in HIV population. The aim of this study was to determine the severity of liver disease in a cohort of HIV/HCV co-infected patients followed in Calmette Hospital, Phnom Penh, Cambodia, and to analyse the impact of HCV infection on antiretroviral therapy efficacy and hepatotoxicity.
Methods: HIV patients with positive HCV antibodies were enrolled in this cross-sectional study. HIV monoinfected patients formed the control group. Transverse evaluation of co-infected patients was performed collecting clinical, biological, virological and ultrasonographic data. HIV course, response to antiretroviral therapy and frequency of hepatocytolysis were compared in both groups.
Results: Among 50 HIV patients known with HCV antibodies, 31 (62%) had positive plasma HCV RNA and were included (58% men, median age 44 years). HCV genotype 1 was the most prevalent (68%), followed by genotype 6 (25%). Twelve patients (39%) met clinical, biological and/or ultrasonographic criteria for cirrhosis. FibroTest stage was 3-4 in 16 patients (52%). HIV/HCV co-infected patients demonstrated similar immune restoration and virological response to antiretroviral therapy as the 160 HIV mono-infected patients. Co-infected patients were more likely to have alanine aminotransferase elevation at baseline and to develop grade 2 or 3 hepatocytolysis in the two years after antiretroviral therapy initiation, specifically when nevirapine was used during the first six months of treatment.
Conclusions: HIV/HCV co-infected patients are at increased risk for acquiring severe hepatic fibrosis. HCV coinfection does not affect response to ART. Efavirenz should be preferred to nevirapine in co-infected patients due to hepatotoxicity. Further research is required to target access to appropriate management of HIV/HCV co-infections in resource-limited countries.