De Weggheleire Anja, An Sokkab, De Baetselier Irith, Soeung Pisith, Keath Huy, So Veasna, Ros Sreyphors, Teav Syna, Smekens Bart, Buyze Jozefien, Florence Eric, van Griensven Johan, Thai Sopheak, Francque Sven, Lynen Lutgarde
Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Antwerp, Belgium.
Infectious Diseases, Sihanouk Hospital Center of Hope, Phnom Penh, Cambodia.
PLoS One. 2017 Aug 23;12(8):e0183530. doi: 10.1371/journal.pone.0183530. eCollection 2017.
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.
柬埔寨丙型肝炎的流行病学情况尚不为人所知。我们评估了金边市西哈努克希望医院中心艾滋病队列中丙型肝炎病毒（HCV）的流行情况及风险因素，以强化柬埔寨艾滋病感染者（PLWH）中合适的HCV检测策略的证据。2014年11月至2016年5月期间，所有同意参与研究且无HCV治疗史的成年PLWH，均按照美国疾病控制与预防中心（CDC）的算法接受HCV检测（HCV抗体II电化学发光免疫测定，随后进行COBAS® AmpliPrep/COBAS® TaqMan® HCV PCR检测以及INNO-LIA® HCV Score免疫印迹终末检测）。采用线性探针检测法Versant HCV genotype 2.0®进行基因分型。该研究共纳入3045例患者（43%为男性，中位年龄：42.5岁，高危人群占比<1%）。230例（7.6%；95%置信区间[CI] 6.6 - 8.5）检测出HCV抗体。进一步检测后，157例（5.2%；95% CI 4.4 - 6.0）确诊为HCV抗体阳性，106例（3.5%；95% CI 2.8 - 4.2）为活动性HCV感染。病毒血症患病率在50 - 55岁男性（7.3%）和>55岁女性（11.2%）中达到峰值。基因型1b（45%）和6型（41%）占主导地位。合并感染患者的天冬氨酸与血小板比值指数更高、血小板计数更低、乙肝表面抗原（HBsAg）阳性率更低且糖尿病更为常见。基于逻辑回归分析，输血史（调整比值比2.9；95% CI 1.
