A cross-sectional study of hepatitis C among people living with HIV in Cambodia: Prevalence, risk factors, and potential for targeted screening

Anja De Weggheleire, Sokkab An, Irith De Baetselier, Pisith Soeung, Huy Keath, Veasna So, Sreyphors Ros, Syna Teav, Bart Smekens, Jozefien Buyze, Eric Florence, Johan van Griensven, Sopheak Thai, Sven Francque, Lutgarde Lynen, Anja De Weggheleire, Sokkab An, Irith De Baetselier, Pisith Soeung, Huy Keath, Veasna So, Sreyphors Ros, Syna Teav, Bart Smekens, Jozefien Buyze, Eric Florence, Johan van Griensven, Sopheak Thai, Sven Francque, Lutgarde Lynen

Abstract

The epidemiology of hepatitis C in Cambodia is not well-known. We evaluated the prevalence of hepatitis C virus (HCV) and risk factors in the HIV cohort of Sihanouk Hospital Center of Hope in Phnom Penh to strengthen the evidence for suitable HCV testing strategies among people living with HIV (PLWH) in Cambodia. All consenting adult PLWH without a history of HCV treatment were tested for HCV between November 2014 and May 2016 according to the CDC algorithm (HCV antibody II electro-chemiluminescence immunoassay, followed by COBAS® AmpliPrep/COBAS® TaqMan® HCV PCR and INNO-LIA® HCV Score immunoblot end-testing). Genotyping was performed using the line probe assay Versant HCV genotype 2.0®. The study enrolled a total of 3045 patients (43% males, median age: 42.5 years, <1% high-risk). HCV antibodies were detected in 230 (7.6%; 95% confidence interval [CI] 6.6-8.5). Upon further testing, HCV antibodies were confirmed in 157 (5.2%; 95% CI 4.4-6.0) and active HCV in 106 (3.5%; 95% CI 2.8-4.2). Viremic prevalence peaked among men aged 50-55 years (7.3%) and women aged >55 years (11.2%). Genotype 1b (45%) and 6 (41%) were predominant. Coinfected patients had a higher aspartate-to-platelet ratio index, lower platelets, a lower HBsAg positivity rate and more frequent diabetes. Based on logistic regression, blood transfusion antecedents (adjusted odds ratio 2.9; 95% CI 1.7-4.9), unsafe medical injections (2.0; 1.3-3.2), and partner (3.4; 1.5-7.6) or household member (2.4; 1.3-3.2) with liver disease were independently associated with HCV in women. However, having a tattoo/scarification (1.9; 1.1-3.4) and household member (3.1; 1.3-7.3) with liver disease were associated with HCV in men. Thus, our study found intermediate endemicity of active hepatitis C in a large Cambodian HIV cohort and provides initial arguments for targeted HCV screening (>50 years, partner/household member with liver disease, diabetes, increased aspartate-to-platelet ratio index) as efficient way forward.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. HCV testing algorithm, tests used,…
Fig 1. HCV testing algorithm, tests used, and prevalence measures.
Fig 2. Flowchart of study enrollment and…
Fig 2. Flowchart of study enrollment and hepatitis C diagnostic results.
Fig 3. Age- and gender-specific prevalence of…
Fig 3. Age- and gender-specific prevalence of HCV and HBV.
ECLIA = electro-chemiluminescence immunoassay. Confirmed HCV exposure = positive for HCV antibodies with ECLIA and positive for HCV-RNA or HCV INNO-LIA immunoblot.

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