Hepatitis C seroprevalence among people living with HIV/AIDS and pregnant women in four provinces in Cambodia: an integrated bio-behavioral survey

Abstract

Background Understanding the extent of viral hepatitis burden in specific subgroups, such as pregnant women and people living with HIV/AIDS (PLWHA), and their geographic distribution is essential for evidence-informed policy and mobilizing resources for targeted treatment and prevention efforts. However, in Cambodia, the epidemiology of hepatitis C remains uncertain. We estimated the hepatitis C virus (HCV) burden and transmission risk factors among PLWHA and pregnant women attending antenatal care (ANC) in Cambodia. Methods Between March and April 2016, we conducted a cross-sectional survey in four diverse geographical areas: the capital city of Phnom Penh and three provinces. We collected information on demographic characteristics and risk behaviors and performed HCV antibody (Anti-HCV) testing among pregnant women attending public ANC clinics and among those receiving HIV care at the hospitals. We computed the prevalence of HCV among the two population subsets and performed logistic regression analyses to identify risk factors associated with HCV antibody positivity. Results Of 935 participants enrolled, 510 (54.6%) were pregnant women and 425 (45.4%) were PLWHA. Anti-HCV prevalence was significantly higher in PLWHA than in pregnant women (29/425, 6.8% vs 5/510, 0.9%, P < 0.001). Of the geographic regions, Preah Sihanouk province (Southwest) had the highest anti-HCV prevalence among PLWHA (12.0%, P = 0.031). There was no significant geographic difference in anti-HCV prevalence among pregnant women. In multivariable analyses (data subset to PLWHA), HCV infection was significantly associated with having a family member positive for HCV (OR = 7.6 [95% CI: 1.01–57.84], P = 0.048) and a history of intravenous medication injection in the last 5 years (OR = 7.1 [95% CI: 2.79–18.10], P < 0.001). Conclusions HCV infection is relatively common among Cambodian PLWHA, likely related to intravenous medication injection and intra-familial viral transmission. Systematic HCV testing and care among PLWHA (and possibly their family members) might be necessary. Setting up a surveillance system for HCV might also be beneficial for some geographical regions and populations.

Medical injection and infusion practices among HIV-seronegative people and people living with HIV: a behavioural survey of 10 HIV testing and opportunistic infections/antiretroviral therapy sites in Cambodia

“…Several other factors such as limited education, tendency of prescribers to recommend and participant’s personal preference of injection and the study population could be responsible for higher rates being reported in our study compared with others. However, these seemed consistent with a recently published paper which found high hepatitis C prevalence among Cambodian population that is likely due to medical injections 16. High prevalence of medical injection (ranging from 30% to 68%) had also been reported across studies conducted in South Asia 17.…”

“…Our work is one of the few studies which examined injection practices among PLWH over the past decade. Another study was conducted in 2016 (a year prior to when our study had started) 16. Regardless, additional studies are necessary in order to confirm the findings from our work and understand the true underlying injection practices among PLWH.…”

“…However, these seemed consistent with a recently published paper which found high hepatitis C prevalence among Cambodian population that is likely due to medical injections. 16 High prevalence of medical injection (ranging from 30% to 68%) had also been reported across studies conducted in South Asia. 17 Results from a Kenyan survey published in 2016 suggested a positive association between HIV and those who reported having received injection in the last 12 months, 18 although it should be noted that the Kenyan study only reported injections from care providers and not traditional healers or other types of providers.…”

“…Finally, to examine the relationship between unsafe medical injection practices and HIV status, we performed logistic regression, adjusting for sex, age, education, occupation, residence location, injection preference and other risk factors. Confounding variables were based on prior knowledge and literature review on similar work previously conducted 12 15 16. All analyses were done in STATA V.14.…”

Trends in hepatitis C virus coinfection and its cascade of care among adults living with HIV in Asia between 2010 and 2020

“…In the Asia-Pacific region, the prevalence of HCV co-infection among adult PLHIV ranges from 2.9% to 80% depending on the characteristics of the study population [4][5][6][7][8][9][10][11][12]. Injecting drug use is consistently associated with an increased risk of HCV coinfection, [10,[13][14][15][16] and men who have sex with men (MSM) and sex workers living with HIV are also at increased risk [17,18].…”