HCV co-infection and markers of liver injury and fibrosis among HIV-positive childbearing women in Ukraine: results from a cohort studyReport as inadecuate




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BMC Infectious Diseases

, 16:755

HIV and co-infections

Abstract

BackgroundUkraine’s injecting drug use-driven HIV epidemic is among the most severe in Europe with high burden of HCV co-infection. HIV-HCV co-infected individuals are at elevated risk of HCV-related morbidity, but little is known about burden of liver disease and associated factors in the HIV-positive population in Ukraine, particularly among women.

MethodsCharacteristics of 2050 HIV-positive women enrolled into the Ukrainian Study of HIV-infected Childbearing Women were described by HCV serostatus. Aspartate transaminase AST to platelet ratio APRI and FIB-4 scores were calculated and exact logistic regression models fitted to investigate factors associated with significant fibrosis APRI >1.5 among 762 women with an APRI score available.

ResultsOf 2050 HIV-positive women median age 27.7 years, IQR 24.6-31.3, 33% were HCV co-infected 79% of those with a history of injecting drug use vs 23% without and 17% HBsAg positive. A quarter were on antiretroviral therapy at postnatal cohort enrolment. 1% of the HIV-HCV co-infected group had ever received treatment for HCV. Overall, 24% had an alanine aminotransferase level >41 U-L and 34% an elevated AST 53% and 61% among HIV-HCV co-infected. Prevalence of significant fibrosis was 4.5%; 2.5% among 445 HIV mono-infected and 12.3% among 171 HIV-HCV co-infected women. 1.2% had a FIB-4 score >3.25 indicating advanced fibrosis. HCV RNA testing in a sub-group of 56 HIV-HCV co-infected women indicated a likely spontaneous clearance rate of 18% and predominance of HCV genotype 1, with one-third having genotype 3 infection. Factors associated with significant fibrosis were HCV co-infection AOR 2.53 95%CI 1.03-6.23, history of injecting drug use AOR 3.51 95%CI 1.39-8.89, WHO stage 3-4 HIV disease AOR 3.47 95%CI 1.51-7.99 vs stage 1-2 HIV disease and not being on combination antiretroviral therapy AOR 3.08 95%CI 1.23-7.74, adjusted additionally for HBV co-infection, smoking and age.

ConclusionsMost HIV-HCV co-infected women had elevated liver enzymes and 12% had significant fibrosis according to APRI. Risk factors for liver fibrosis in this young HIV-positive population include poorly controlled HIV and high burden of HCV. Results highlight the importance of addressing modifiable risk factors and rolling out HCV treatment to improve the health outcomes of this group.

KeywordsHIV Hepatitis C Women Liver fibrosis Ukraine APRI FIB-4 Combination antiretroviral therapy Eastern Europe AbbreviationscARTcombination antiretroviral therapy

ALTAlanine aminotransferase

APRIAST to platelet ratio

ASTAspartate transaminase

DAIDSDivision of AIDS

ECSEuropean Collaborative Study

GTGenotype

HBsAgHepatitis B surface antigen

HCVHepatitis C virus

IDUInjecting drug use

IQRInterquartile range

PMTCTPrevention of mother-to-child transmission

ULNUpper limit of normal

WHOWorld Health Organisation

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Author: Heather Bailey - Nataliya Nizova - Violeta Martsynovska - Alla Volokha - Ruslan Malyuta - Mario Cortina-Borja - Claire Thor

Source: https://link.springer.com/







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