Liver International ISSN 1478-3223
ORIGINAL ARTICLE
Burden of HIV and hepatitis C co-infection: the changing epidemiology of hepatitis C in HIV-infected patients in France Patrice Cacoub1,2,3,4, Francßois Dabis5, Dominique Costagliola6,7, Kayigan Almeida8,9, France Lert8,9, Lionel Piroth10 and Caroline Semaille11 1 Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Sorbonne Universites, UMR 7211, UPMC Univ Paris 06, Paris F-75005, France 2 INSERM, UMR_S 959, Paris F-75013, France 3 CNRS, FRE3632, Paris F-75005, France 4 Department of Internal Medicine and Clinical Immunology, AP-HP, Groupe Hospitalier Pitie-Salp^etriere, Paris F-75013, France 5 INSERM, U897, ISPED, Universit e Victor Segalen, Bordeaux, France 6 Institut Pierre Louis d’Epid emiologie et de Sant e Publique, Sorbonne Universites, UPMC Univ Paris 06, UMR_S 1136, Paris F-75013, France 7 Institut Pierre Louis d’Epid emiologie et de Sant e Publique, INSERM, UMR_S 1136, Paris F-75013, France 8 Centre de recherche en epid emiologie et sant e des populations, Inserm, U1018 Villejuif, France 9 Universit e de Versailles Saint-Quentin-en-Yvelines, UMRS 1018, Villejuif, France 10 Infectious Diseases Department, CHU, UMR 1347, University of Burgundy, Dijon, France 11 Agence nationale de s ecurit e du m edicament et des produits de sante, Saint-Denis F-93285, France
Keywords epidemiology – HIV – HCV Correspondence Pr Patrice Cacoub, MD, Department of Internal Medicine and Clinical Immunology, ^pital La Piti Ho e-Salp^ etri ere, 47-83, boulevard ^pital, 75651 Cedex 13, Paris, France de l’Ho Tel: + 33 (0) 1 42 17 80 27 Fax: + 33 (0) 1 42 17 80 33 e-mail: [email protected] Received 30 April 2014 Accepted 5 July 2014 DOI:10.1111/liv.12639 Liver Int. 2015; 35: 65–70
Abstract Background & Aims: To better evaluate the HIV–HCV co-infection burden in the context of new effective HCV treatment. Methods: We reviewed all the epidemiological data available on HCV-related disease in HIV-infected patients in France. Sources of data have been selected using the following criteria: (i) prospective cohorts or cross-sectional surveys; (ii) conducted at a national level; (iii) in the HIV-infected population; (iv) able to identify HCV co-infection and chronic active hepatitis C (HCV RNA positive); and (v) conducted during the period 2003–2012. Results: The overall prevalence of HIV–HCV co-infection has decreased from 22–24% to 16–18%. This prevalence decreased from 93% to 87% among injecting drug users while it increased from 4% to 6% among men who have sex with men. The characteristics of patients have changed: decrease in the proportion of patients with chronic active hepatitis C (HCV RNA positive) from 77% to 63% and in the genotypes 2 and 3 HCV infection; increase in the proportion of HCV genotype 1 (from 45–50% to 58%) and genotype 4 (from 15% to 22%). The proportion of patients treated with highly active antiretroviral therapy increased from 76% to 95%, with higher rates of undetectable HIV viral load (47% in 2004 vs. 85% in 2012). Conclusion: The decreasing prevalence and the change in patients profile in HIV–HCV co-infection underline the importance of continuing efforts to educate physicians and patients. This should increase the benefit of viral risk reduction policies and increase the access of co-infected patients to HCV treatment.
Owing to common routes of transmission (i.e. intravenous drug use and transfusion), about a third of patients infected with human immunodeficiency virus (HIV) in the United States and Europe are co-infected with hepatitis C virus (HCV). As the decline in HIVrelated mortality after the widespread use of highly active antiretroviral therapy (ART), liver disease caused by chronic HCV infection has become an important cause of mortality among co-infected patients (1–4). Liver disease complications represent the major nonAIDS-defining cause of death in HIV–HCV co-infected Liver International (2015) © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
patients (5–8). Most of the liver disease-related deaths have been attributed to HCV infection. In the absence of treatment for viral hepatitis, co-infected patients are at increased risk for developing cirrhosis, end-stage liver disease and hepatocarcinoma. In the early 1990s, large trials have demonstrated that HIV–HCV co-infected patients may achieve a sustained virological response with combined treatment of pegylated interferon plus ribavirin (at least in 27–44% of the cases), leading to histopathological improvement (9–12). The development of new direct antiviral agents should change soon
65
Cacoub et al.
HIV–HCV co-infection in France
the care of these patients, notably those infected by a HCV genotypes 1 and 4. In the early 1990s, because of the parenteral route of transmission of HCV and HIV, injecting drug users (IDUs) have been largely infected by both viruses through unsafe drug injection (shared contaminated needles and syringes or other injection equipment). In developed countries, as transmission through blood transfusion was brought under control in the late 1980s, IDU has become the main route of HCV transmission. During the same period, HIV contamination through IDU has declined dramatically in Western Europe thanks to harm reduction policies (sterile syringe provision and opioid substitution) (13). However, during the last decade, several outbreaks of acute hepatitis C have emerged among HIV-infected men who have sex with men (MSM) in Western Europe, Australia and North America in association with high-risk sexual practices (14). Better evaluate the HIV–HCV co-infection burden and better characterize patient profiles appear crucial in the context of the widespread use of new effective treatment against HCV infection. In this study, we reviewed all the epidemiological data available on HCV-related disease in HIV-infected patients in France. Methods
HCV RNA was >20% in a survey or a cohort, the prevalence of chronic active hepatitis C was not calculated for this source of data. InVS Co-infection survey, 2004
This one day national cross-sectional survey aimed to estimate the prevalence of HCV infection among HIVinfected adults in France, in 2004 (15). Data were collected among a random sample of hospital wards. Eligible individuals were those aged 18 years or more and HIV-infected (out- or in-patient) seeking care in one of the selected wards at the time of the survey. Overall, 1849 HIV-infected patients were included in 2004. Prospecth surveys, 2006 and 2009
The Prospecth studies are repeated 1-week cross-sectional surveys conducted in 2006 and 2009 (16, 17). Physicians involved in the management of HIV-infected patients from 50 hospital wards filled out a standardized questionnaire for all HIV–HCV co-infected patients (out- or in-patient). Physicians have included 416 and 419 HIV–HCV co-infected patients in the 2006 and 2009 surveys respectively. In the present analysis, data from Prospecth surveys were used to describe the characteristics of HIV–HCV patients and not to estimate HCV prevalence in HIV-infected population.
Sources of data
For this review, sources of data have been selected using the following criteria: (i) prospective cohorts or crosssectional surveys; (ii) conducted at a national level (France); (iii) in the HIV-infected population; (iv) able to identify HCV co-infection and chronic active hepatitis C and (v) conducted during the period 2003–2012. The methodology used for each of these cohorts or cross-sectional surveys has been previously detailed and published elsewhere (15–20). Data sources will be briefly described. All studies were approved by ethics committees. Most results on the prevalence of hepatitis C infection or on the prevalence of chronic active hepatitis C in the HIV-infected patients have never been published. Some analyses have been specifically done for this review. Study population, definition of outcomes
Eligible individuals were those aged 18 or more and with a positive HIV-1 antibody (Ab) test. HCV infection was defined as positive HCV Ab. Chronic active hepatitis C was defined as positive serum HCV RNA. For all sources of data, to calculate HCV infection prevalence and chronic active hepatitis C prevalence, individuals with unknown status regarding HCV status and those with unknown information regarding HCV RNA were excluded from the denominator. When the proportion of individuals with unknown information regarding
66
French hospital database (FHDH), ANRS CO4, 2010
The French Hospital Database on HIV (FHDH) is a hospital-based multicentre open cohort with inclusions ongoing since 1989 (18). This cohort includes data from 70 general or university hospitals. In 2010, a total number of 46 252 HIV-infected patients with a known HCV status have been included in the FHDH cohort. VESPA 1 and 2 studies, ANRS-EN12, 2011
The VESPA studies are large cross-sectional surveys, conducted in 2003 and 2011, aimed at studying the social situation and living conditions of people living with HIV (19). Data were collected among a random stratified sample of HIV-infected patients recruited in 81 hospital out-patient departments. Around 3000 HIVinfected patients were included in the Vespa2 survey. Data from the Vespa1 survey conducted in 2003 were only used for the calculation of the HCV prevalence among HIV-infected individuals. HEPAVIH, ANRS CO 13, 2012
The HEPAVIH cohort has included prospectively HIV– HCV co-infected patients seen in 17 hospital wards between January, 2006 and December, 2008 (20). Eligible individuals were diagnosed with a HIV-1 infection and chronic active hepatitis C (as confirmed by positive Liver International (2015) © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Cacoub et al.
HIV–HCV co-infection in France
HIV Ab and HCV RNA). HIV–HCV co-infected patients who cleared their HCV infection after treatment or those who were on HCV treatment at enrolment with undetectable HCV RNA were also enrolled in HepaVIH cohort, but were excluded from the present analysis.
the other hand, the FHDH and Vespa studies were not used to estimate the prevalence of chronic active hepatitis C among HIV-infected patients (the proportion of co-infected individuals with unknown information regarding HCV RNA was more than 40% in the FHDH cohort and the information on HCV RNA was not collected in the Vespa study).
Prevalence of HIV and HCV co-infection
On one hand, the HepaVIH cohort and Prospecth surveys were not used to estimate the prevalence of positive HCV Ab and chronic active hepatitis C among HIVinfected patients (because including only HIV–HCV coinfected patients). But they were used to describe the characteristics of HIV–HCV co-infected patients. On
Results
The number and characteristics of HIV–HCV coinfected patients included in the cross-sectional surveys (InVS 2004, Prospecth 2006/2009, Vespa2 2011) and the cohorts (FHDH 2010, HEPAVIH 2012) are presented in Table 1.
Table 1. Main characteristics of HIV and HCV infections in co-infected patients in France during the period 2004–2011 Source, year Number of patients Age (mean, years) Male (%) Geographical origin (%)* France Foreigners (%) HIV infection HIV transmission group (%) Injecting drug user† MSM‡ Heterosexual Transfusion or haemophiliac Others Undetermined ARV treatment, %¶ CD4 lymphocytes/ml < 350 ≥ 350 HIV viral load Undetectable (%) Detectable (%) HCV infection HCV seropositivity (%) HCV-RNA 800 000 copies/mL (%) Negative (%) HCV genotype (%) Genotype 1 Genotype 2 Genotype 3 Genotype 4 Genotype 5 Genotype 6
InVS, 2004
Prospecth, 2006
Prospecth, 2009
FHDH, 2010
Vespa2, 2011
HepaVIH, 09/2012
441 42.4 67.8
416 43.5 71
419 45.1 70
8,364 47.7 70.4
498 48.8 67.5
686 49.5 67.2
78.1 21.9
82 18
73 27
NA NA
85.5 14.5
78.7 21.3
71.9 3.9 14.3 5.3
77 6.8 9.4 3.8
55.8 21.5 12.4 5.5
61.6 12.3 18.1 4.8
66.6 14.2 6.4§ –
62.7 9.6 15 –
– 4.6 75.7
0 3.1 91
– 4.8 91
0.7 2.5 91.1
12.8 – 98
8 4.7 94.9
51.9 45.6
43.5 56.5
28.6 71.4
26.9 73.1
27.2 72.8
20.5 79.5
46.7 48.7
69.9 30.1
79 21
81.8 18.2
78.3 21.7
85.4 14.6
24.3
NA
NA
18.1
16.4
NA
NA NA 23
35 37. 3 27.7
27.2 36 36.8
NA NA NA
NA NA NA
27.8 44.5 27.8
NA NA NA NA NA NA
50 9 26 15 0 0
46 10 21 22 1 0
NA NA NA NA NA NA
NA NA NA NA NA NA
57.9 3.7 19.8 18 0.6 0
*Continent of birth. †Including IDU and men who have sex with men (MSM). ‡MSM = men who have sex with men; not IDU. §Heterosexual migrants. ¶ART = antiretroviral treatment. NA= not available.
Liver International (2015) © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
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HIV–HCV co-infection in France
Prevalence of hepatitis C infection in the HIV-infected population in France
The overall prevalence of HCV infection in HIVinfected patients has decreased during the last decade. In 2003/2004, the prevalence of HCV infection was 22% and 24% in the Vespa and InVS studies respectively (Fig. 1). In 2010/2011, the prevalence was 18% and 16% in the FHDH cohort and Vespa2 study respectively. Considering the different groups of transmission, the prevalence of HIV–HCV co-infection among IDUs decreased from 93% (95% CI = 89.0–95.3) in 2004 (InVS) to 87% in 2011 (Vespa2). The prevalence of HIV–HCV co-infection among MSM increased from 4% (95% CI = 2.0–4.7) in 2004 (InVS) to 6% in 2011 (Vespa2). Evolution of the main characteristics of HIV–HCV co-infected patients
Whatever the year of the survey, HIV–HCV co-infected patients were mainly males (about 70%) and mostly of French origin (73–82%) (Table 1). From 2004 to 2010, the mean age of patients progressively increased from 42 to 49 years. The distribution of viruses’ transmission groups has changed over time. In 2004 and 2006, the IDUs represented the great majority of all co-infected patients: 72% (InVS) and 77% (Prospecth), whereas the proportions of heterosexuals and MSM were lower (Fig. 2). Heterosexuals represented 14% in 2004 (InVS) and 9% in 2006 (Prospecth), and MSM 4% and 7% respectively. During the last decade, the proportion of IDUs has decreased from 72–78% (2004–2006) to 62–54% (2010– 2012). In parallel, the proportion of MSM has increased from
ORIGINAL ARTICLE
Burden of HIV and hepatitis C co-infection: the changing epidemiology of hepatitis C in HIV-infected patients in France Patrice Cacoub1,2,3,4, Francßois Dabis5, Dominique Costagliola6,7, Kayigan Almeida8,9, France Lert8,9, Lionel Piroth10 and Caroline Semaille11 1 Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Sorbonne Universites, UMR 7211, UPMC Univ Paris 06, Paris F-75005, France 2 INSERM, UMR_S 959, Paris F-75013, France 3 CNRS, FRE3632, Paris F-75005, France 4 Department of Internal Medicine and Clinical Immunology, AP-HP, Groupe Hospitalier Pitie-Salp^etriere, Paris F-75013, France 5 INSERM, U897, ISPED, Universit e Victor Segalen, Bordeaux, France 6 Institut Pierre Louis d’Epid emiologie et de Sant e Publique, Sorbonne Universites, UPMC Univ Paris 06, UMR_S 1136, Paris F-75013, France 7 Institut Pierre Louis d’Epid emiologie et de Sant e Publique, INSERM, UMR_S 1136, Paris F-75013, France 8 Centre de recherche en epid emiologie et sant e des populations, Inserm, U1018 Villejuif, France 9 Universit e de Versailles Saint-Quentin-en-Yvelines, UMRS 1018, Villejuif, France 10 Infectious Diseases Department, CHU, UMR 1347, University of Burgundy, Dijon, France 11 Agence nationale de s ecurit e du m edicament et des produits de sante, Saint-Denis F-93285, France
Keywords epidemiology – HIV – HCV Correspondence Pr Patrice Cacoub, MD, Department of Internal Medicine and Clinical Immunology, ^pital La Piti Ho e-Salp^ etri ere, 47-83, boulevard ^pital, 75651 Cedex 13, Paris, France de l’Ho Tel: + 33 (0) 1 42 17 80 27 Fax: + 33 (0) 1 42 17 80 33 e-mail: [email protected] Received 30 April 2014 Accepted 5 July 2014 DOI:10.1111/liv.12639 Liver Int. 2015; 35: 65–70
Abstract Background & Aims: To better evaluate the HIV–HCV co-infection burden in the context of new effective HCV treatment. Methods: We reviewed all the epidemiological data available on HCV-related disease in HIV-infected patients in France. Sources of data have been selected using the following criteria: (i) prospective cohorts or cross-sectional surveys; (ii) conducted at a national level; (iii) in the HIV-infected population; (iv) able to identify HCV co-infection and chronic active hepatitis C (HCV RNA positive); and (v) conducted during the period 2003–2012. Results: The overall prevalence of HIV–HCV co-infection has decreased from 22–24% to 16–18%. This prevalence decreased from 93% to 87% among injecting drug users while it increased from 4% to 6% among men who have sex with men. The characteristics of patients have changed: decrease in the proportion of patients with chronic active hepatitis C (HCV RNA positive) from 77% to 63% and in the genotypes 2 and 3 HCV infection; increase in the proportion of HCV genotype 1 (from 45–50% to 58%) and genotype 4 (from 15% to 22%). The proportion of patients treated with highly active antiretroviral therapy increased from 76% to 95%, with higher rates of undetectable HIV viral load (47% in 2004 vs. 85% in 2012). Conclusion: The decreasing prevalence and the change in patients profile in HIV–HCV co-infection underline the importance of continuing efforts to educate physicians and patients. This should increase the benefit of viral risk reduction policies and increase the access of co-infected patients to HCV treatment.
Owing to common routes of transmission (i.e. intravenous drug use and transfusion), about a third of patients infected with human immunodeficiency virus (HIV) in the United States and Europe are co-infected with hepatitis C virus (HCV). As the decline in HIVrelated mortality after the widespread use of highly active antiretroviral therapy (ART), liver disease caused by chronic HCV infection has become an important cause of mortality among co-infected patients (1–4). Liver disease complications represent the major nonAIDS-defining cause of death in HIV–HCV co-infected Liver International (2015) © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
patients (5–8). Most of the liver disease-related deaths have been attributed to HCV infection. In the absence of treatment for viral hepatitis, co-infected patients are at increased risk for developing cirrhosis, end-stage liver disease and hepatocarcinoma. In the early 1990s, large trials have demonstrated that HIV–HCV co-infected patients may achieve a sustained virological response with combined treatment of pegylated interferon plus ribavirin (at least in 27–44% of the cases), leading to histopathological improvement (9–12). The development of new direct antiviral agents should change soon
65
Cacoub et al.
HIV–HCV co-infection in France
the care of these patients, notably those infected by a HCV genotypes 1 and 4. In the early 1990s, because of the parenteral route of transmission of HCV and HIV, injecting drug users (IDUs) have been largely infected by both viruses through unsafe drug injection (shared contaminated needles and syringes or other injection equipment). In developed countries, as transmission through blood transfusion was brought under control in the late 1980s, IDU has become the main route of HCV transmission. During the same period, HIV contamination through IDU has declined dramatically in Western Europe thanks to harm reduction policies (sterile syringe provision and opioid substitution) (13). However, during the last decade, several outbreaks of acute hepatitis C have emerged among HIV-infected men who have sex with men (MSM) in Western Europe, Australia and North America in association with high-risk sexual practices (14). Better evaluate the HIV–HCV co-infection burden and better characterize patient profiles appear crucial in the context of the widespread use of new effective treatment against HCV infection. In this study, we reviewed all the epidemiological data available on HCV-related disease in HIV-infected patients in France. Methods
HCV RNA was >20% in a survey or a cohort, the prevalence of chronic active hepatitis C was not calculated for this source of data. InVS Co-infection survey, 2004
This one day national cross-sectional survey aimed to estimate the prevalence of HCV infection among HIVinfected adults in France, in 2004 (15). Data were collected among a random sample of hospital wards. Eligible individuals were those aged 18 years or more and HIV-infected (out- or in-patient) seeking care in one of the selected wards at the time of the survey. Overall, 1849 HIV-infected patients were included in 2004. Prospecth surveys, 2006 and 2009
The Prospecth studies are repeated 1-week cross-sectional surveys conducted in 2006 and 2009 (16, 17). Physicians involved in the management of HIV-infected patients from 50 hospital wards filled out a standardized questionnaire for all HIV–HCV co-infected patients (out- or in-patient). Physicians have included 416 and 419 HIV–HCV co-infected patients in the 2006 and 2009 surveys respectively. In the present analysis, data from Prospecth surveys were used to describe the characteristics of HIV–HCV patients and not to estimate HCV prevalence in HIV-infected population.
Sources of data
For this review, sources of data have been selected using the following criteria: (i) prospective cohorts or crosssectional surveys; (ii) conducted at a national level (France); (iii) in the HIV-infected population; (iv) able to identify HCV co-infection and chronic active hepatitis C and (v) conducted during the period 2003–2012. The methodology used for each of these cohorts or cross-sectional surveys has been previously detailed and published elsewhere (15–20). Data sources will be briefly described. All studies were approved by ethics committees. Most results on the prevalence of hepatitis C infection or on the prevalence of chronic active hepatitis C in the HIV-infected patients have never been published. Some analyses have been specifically done for this review. Study population, definition of outcomes
Eligible individuals were those aged 18 or more and with a positive HIV-1 antibody (Ab) test. HCV infection was defined as positive HCV Ab. Chronic active hepatitis C was defined as positive serum HCV RNA. For all sources of data, to calculate HCV infection prevalence and chronic active hepatitis C prevalence, individuals with unknown status regarding HCV status and those with unknown information regarding HCV RNA were excluded from the denominator. When the proportion of individuals with unknown information regarding
66
French hospital database (FHDH), ANRS CO4, 2010
The French Hospital Database on HIV (FHDH) is a hospital-based multicentre open cohort with inclusions ongoing since 1989 (18). This cohort includes data from 70 general or university hospitals. In 2010, a total number of 46 252 HIV-infected patients with a known HCV status have been included in the FHDH cohort. VESPA 1 and 2 studies, ANRS-EN12, 2011
The VESPA studies are large cross-sectional surveys, conducted in 2003 and 2011, aimed at studying the social situation and living conditions of people living with HIV (19). Data were collected among a random stratified sample of HIV-infected patients recruited in 81 hospital out-patient departments. Around 3000 HIVinfected patients were included in the Vespa2 survey. Data from the Vespa1 survey conducted in 2003 were only used for the calculation of the HCV prevalence among HIV-infected individuals. HEPAVIH, ANRS CO 13, 2012
The HEPAVIH cohort has included prospectively HIV– HCV co-infected patients seen in 17 hospital wards between January, 2006 and December, 2008 (20). Eligible individuals were diagnosed with a HIV-1 infection and chronic active hepatitis C (as confirmed by positive Liver International (2015) © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Cacoub et al.
HIV–HCV co-infection in France
HIV Ab and HCV RNA). HIV–HCV co-infected patients who cleared their HCV infection after treatment or those who were on HCV treatment at enrolment with undetectable HCV RNA were also enrolled in HepaVIH cohort, but were excluded from the present analysis.
the other hand, the FHDH and Vespa studies were not used to estimate the prevalence of chronic active hepatitis C among HIV-infected patients (the proportion of co-infected individuals with unknown information regarding HCV RNA was more than 40% in the FHDH cohort and the information on HCV RNA was not collected in the Vespa study).
Prevalence of HIV and HCV co-infection
On one hand, the HepaVIH cohort and Prospecth surveys were not used to estimate the prevalence of positive HCV Ab and chronic active hepatitis C among HIVinfected patients (because including only HIV–HCV coinfected patients). But they were used to describe the characteristics of HIV–HCV co-infected patients. On
Results
The number and characteristics of HIV–HCV coinfected patients included in the cross-sectional surveys (InVS 2004, Prospecth 2006/2009, Vespa2 2011) and the cohorts (FHDH 2010, HEPAVIH 2012) are presented in Table 1.
Table 1. Main characteristics of HIV and HCV infections in co-infected patients in France during the period 2004–2011 Source, year Number of patients Age (mean, years) Male (%) Geographical origin (%)* France Foreigners (%) HIV infection HIV transmission group (%) Injecting drug user† MSM‡ Heterosexual Transfusion or haemophiliac Others Undetermined ARV treatment, %¶ CD4 lymphocytes/ml < 350 ≥ 350 HIV viral load Undetectable (%) Detectable (%) HCV infection HCV seropositivity (%) HCV-RNA 800 000 copies/mL (%) Negative (%) HCV genotype (%) Genotype 1 Genotype 2 Genotype 3 Genotype 4 Genotype 5 Genotype 6
InVS, 2004
Prospecth, 2006
Prospecth, 2009
FHDH, 2010
Vespa2, 2011
HepaVIH, 09/2012
441 42.4 67.8
416 43.5 71
419 45.1 70
8,364 47.7 70.4
498 48.8 67.5
686 49.5 67.2
78.1 21.9
82 18
73 27
NA NA
85.5 14.5
78.7 21.3
71.9 3.9 14.3 5.3
77 6.8 9.4 3.8
55.8 21.5 12.4 5.5
61.6 12.3 18.1 4.8
66.6 14.2 6.4§ –
62.7 9.6 15 –
– 4.6 75.7
0 3.1 91
– 4.8 91
0.7 2.5 91.1
12.8 – 98
8 4.7 94.9
51.9 45.6
43.5 56.5
28.6 71.4
26.9 73.1
27.2 72.8
20.5 79.5
46.7 48.7
69.9 30.1
79 21
81.8 18.2
78.3 21.7
85.4 14.6
24.3
NA
NA
18.1
16.4
NA
NA NA 23
35 37. 3 27.7
27.2 36 36.8
NA NA NA
NA NA NA
27.8 44.5 27.8
NA NA NA NA NA NA
50 9 26 15 0 0
46 10 21 22 1 0
NA NA NA NA NA NA
NA NA NA NA NA NA
57.9 3.7 19.8 18 0.6 0
*Continent of birth. †Including IDU and men who have sex with men (MSM). ‡MSM = men who have sex with men; not IDU. §Heterosexual migrants. ¶ART = antiretroviral treatment. NA= not available.
Liver International (2015) © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
67
Cacoub et al.
HIV–HCV co-infection in France
Prevalence of hepatitis C infection in the HIV-infected population in France
The overall prevalence of HCV infection in HIVinfected patients has decreased during the last decade. In 2003/2004, the prevalence of HCV infection was 22% and 24% in the Vespa and InVS studies respectively (Fig. 1). In 2010/2011, the prevalence was 18% and 16% in the FHDH cohort and Vespa2 study respectively. Considering the different groups of transmission, the prevalence of HIV–HCV co-infection among IDUs decreased from 93% (95% CI = 89.0–95.3) in 2004 (InVS) to 87% in 2011 (Vespa2). The prevalence of HIV–HCV co-infection among MSM increased from 4% (95% CI = 2.0–4.7) in 2004 (InVS) to 6% in 2011 (Vespa2). Evolution of the main characteristics of HIV–HCV co-infected patients
Whatever the year of the survey, HIV–HCV co-infected patients were mainly males (about 70%) and mostly of French origin (73–82%) (Table 1). From 2004 to 2010, the mean age of patients progressively increased from 42 to 49 years. The distribution of viruses’ transmission groups has changed over time. In 2004 and 2006, the IDUs represented the great majority of all co-infected patients: 72% (InVS) and 77% (Prospecth), whereas the proportions of heterosexuals and MSM were lower (Fig. 2). Heterosexuals represented 14% in 2004 (InVS) and 9% in 2006 (Prospecth), and MSM 4% and 7% respectively. During the last decade, the proportion of IDUs has decreased from 72–78% (2004–2006) to 62–54% (2010– 2012). In parallel, the proportion of MSM has increased from
