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      Prevalence of hepatitis C among HIV-1, HIV-2 and dually reactive patients: A multi-country cross-sectional survey in West Africa

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          Abstract

          Little is known on the impact of HIV-2 infection on HCV viral replication. The aim of the study was to compare HCV prevalence and viral replication based on HIV types in West Africa.

          A cross-sectional survey was conducted within the IeDEA HIV-2 West Africa cohort from March to December 2012. All HIVinfected adult patients who attended participating HIV clinics during the study period were included. Blood samples were collected and re-tested for HIV type discrimination, HCV serology and viral load.

          A total of 767 patients were enrolled: 186 HIV-1, 431 HIV-2 and 150 HIV-1&2 dually reactive. At time of sampling, 531 (69.2%) were on ART and median CD4+ cell count was 472/mm 3. Thirty (3.9%, 95% CI 2.7-5.5) patients were anti-HCV positive (4.3% in HIV-1, 4.0% in HIV-1&2 dually reactive and 3.7% in HIV-2; p=0.91). Detectable HCV RNA was identified in 21 (70.0%) patients (100% in HIV-1 and HIV- 1&2 dually reactive vs. 43.8% in HIV-2; p=0.003).

          Systematic screening should be promoted and performed in this population, since HCV is now potentially curable in sub- Saharan Africa.

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          Sofosbuvir for hepatitis C genotype 2 or 3 in patients without treatment options.

          Ira M Jacobson, Stuart Gordon, Kris V Kowdley … (2013)
          Patients chronically infected with hepatitis C virus (HCV) genotype 2 or 3 for whom treatment with peginterferon is not an option, or who have not had a response to prior interferon treatment, currently have no approved treatment options. In phase 2 trials, regimens including the oral nucleotide polymerase inhibitor sofosbuvir have shown efficacy in patients with HCV genotype 2 or 3 infection. We conducted two randomized, phase 3 studies involving patients with chronic HCV genotype 2 or 3 infection. In one trial, patients for whom treatment with peginterferon was not an option received oral sofosbuvir and ribavirin (207 patients) or matching placebo (71) for 12 weeks. In a second trial, patients who had not had a response to prior interferon therapy received sofosbuvir and ribavirin for 12 weeks (103 patients) or 16 weeks (98). The primary end point was a sustained virologic response at 12 weeks after therapy. Among patients for whom treatment with peginterferon was not an option, the rate of a sustained virologic response was 78% (95% confidence interval [CI], 72 to 83) with sofosbuvir and ribavirin, as compared with 0% with placebo (P<0.001). Among previously treated patients, the rate of response was 50% with 12 weeks of treatment, as compared with 73% with 16 weeks of treatment (difference, -23 percentage points; 95% CI, -35 to -11; P<0.001). In both studies, response rates were lower among patients with genotype 3 infection than among those with genotype 2 infection and, among patients with genotype 3 infection, lower among those with cirrhosis than among those without cirrhosis. The most common adverse events were headache, fatigue, nausea, and insomnia; the overall rate of discontinuation of sofosbuvir was low (1 to 2%). In patients with HCV genotype 2 or 3 infection for whom treatment with peginterferon and ribavirin was not an option, 12 or 16 weeks of treatment with sofosbuvir and ribavirin was effective. Efficacy was increased among patients with HCV genotype 2 infection and those without cirrhosis. In previously treated patients with genotype 3 infection, 16 weeks of therapy was significantly more effective than 12 weeks. (Funded by Gilead Sciences; POSITRON and FUSION ClinicalTrials.gov numbers, NCT01542788 and NCT01604850, respectively.).
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            Hepatitis C seroprevalence and HIV co-infection in sub-Saharan Africa: a systematic review and meta-analysis.

            V Bhargavi Rao, Nur Johari, Philipp du Cros … (2015)
            An estimated 150 million people worldwide are infected with hepatitis C virus (HCV). HIV co-infection accelerates the progression of HCV and represents a major public health challenge. We aimed to determine the epidemiology of HCV and the prevalence of HIV co-infection in sub-Saharan Africa.
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              The influence of human immunodeficiency virus coinfection on chronic hepatitis C in injection drug users: a long-term retrospective cohort study.

              N Boyer, P Rufat, S Matheron … (2001)
              In this study we analyzed the influence of human immunodeficiency virus (HIV) infection on the course of chronic hepatitis C through multivariate analysis including age, alcohol consumption, immune status, and hepatitis C virus (HCV)-related virologic factors. Eighty HIV-positive and 80 HIV-negative injection drug users included between 1980 and 1995 were matched according to age, gender, and duration of HCV infection and followed-up during 52 months. The progression to cirrhosis was the primary outcome measure. The impact of HIV on HCV-RNA load, histologic activity index, response to interferon therapy, and liver-related death was also considered. In HIV-positive patients, chronic hepatitis C was characterized by higher serum HCV-RNA levels (P =.012), higher total Knodell score (P =.011), and poorer sustained response to interferon therapy (P =.009). High serum HCV-RNA level was associated with low CD4-lymphocyte count (P =.001). Necroinflamatory score was higher in HIV-positive patients (P =.023) independently of the CD4-lymphocyte count, whereas increased fibrosis was related to decreased CD4-lymphocyte count (P =.011). The progression to cirrhosis was accelerated in HIV-positive patients with low CD4 cell count (RR = 4.06, P =.024) and in interferon-untreated patients (RR = 4.76, P =.001), independently of age at HCV infection (P =.001). Cirrhosis caused death in 5 HIV-positive patients. The risk of death related to cirrhosis was increased in heavy drinkers (RR = 10.8, P =.001) and in HIV-positive patients with CD4 cell count less than 200/mm(3) (RR = 11.9, P =.007). In this retrospective cohort study, HIV coinfection worsened the outcome of chronic hepatitis C, increasing both serum HCV-RNA level and liver damage and decreasing sustained response to interferon therapy. Age and alcohol were cofactors associated with cirrhosis and mortality. Interferon therapy had a protective effect against HCV-related cirrhosis no matter what the patient's HIV status was.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Public Health Afr
                Journal ID (publisher-id): JPHIA
                Title: Journal of Public Health in Africa
                Publisher: PAGEPress Publications, Pavia, Italy
                ISSN (Print): 2038-9922
                ISSN (Electronic): 2038-9930
                Publication date (Electronic): 10 October 2018
                Publication date Collection: 01 October 2018
                Volume: 9
                Issue: 2
                Electronic Location Identifier: 871
                Affiliations
                [1 ]Université de Lomé, Département de Santé Publique , Lomé-Togo
                [2 ]ISPED, Université de Bordeaux & Centre INSERM U1219 - Bordeaux Population Health , Bordeaux, France
                [3 ]Programme PACCI, site de recherche ANRS, Abidjan, Côte d’Ivoire
                [4 ]Département de Dermatologie et d’Infectiologie, UFR des Sciences Médicales, Université Félix Houphouët Boigny , Abidjan, Côte d’Ivoire
                [5 ]Université Polytechnique de Bobo, Institut Supérieur des Sciences de la Santé , Bobo-Dioulasso, Burkina Faso
                [6 ]Hôpital de Jour de Bobo , Service des Maladies Infectieuses (CHU Souro Sanou), Bobo-Dioulasso, Burkina Faso
                [7 ]Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Treichville , Abidjan, Côte d’Ivoire
                Author notes
                Université de Lomé, Faculté des Sciences de la Santé, Département de Santé Publique, Lomé, Togo. +228.99.68.67.35. didier.ekouevi@ 123456gmail.com

                Contributions: DKE, PAC and BT conceived the study, participated in its design and coordination, performed the statistical analyses and wrote the first draft of the manuscript. AJ, AP, FD and SPE participated in the design of the study and helped to draft the manuscript. FD is the Primary Investigator of the IeDEA West Africa (WADA) cohort. All authors read and approved the final manuscript.

                Conflict of interest: the authors declare no conflict of interest.

                Article
                DOI: 10.4081/jphia.2018.871
                PMC ID: 6325423
                SO-VID: bc1b9a34-4bd7-4459-89cd-813174d2f9de
                Copyright © ©Copyright D.K. Ekouevi et al., 2018
                License:

                This work is licensed under a Creative Commons Attribution NonCommercial 4.0 License (CC BY-NC 4.0).

                History
                Date received : 12 February 2018
                Date accepted : 05 July 2018
                Page count
                Figures: 0, Tables: 2, Equations: 0, References: 32, Pages: 5
                Funding
                Funding: the WADA Collaboration is partly funded by the National Cancer Institute (NCI), the Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD), and the National Institute of Allergy and Infectious Diseases (NIAID) of the US National Institutes of Health (NIH), as part of the International Epidemiologic Databases to Evaluate AIDS (IeDEA) under Award # U01AI069919. The ANRS (France REcherche Nord &sudSida-hivHépatites) supported part of the laboratory work performed within this study.
                Categories
                Subject: Article

                Keywords: hiv-2,hcv,hbv,west africa
                Data availability:
                Keywords: hiv-2, hcv, hbv, west africa

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