Epidemiology of HCV and HIV/HCV Infection in Guangzhou, China. Title. Charles Wang, M.D.

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1 Epidemiology of HCV and HIV/HCV Infection in Guangzhou, China Title Charles Wang, M.D.

2 Background Hepatitis C infects 170 million worldwide & 3 million Chinese HIV infects 33.3 million worldwide & 740,000 Chinese HIV/HCV co-infection is very common due to share transmission routes especially in at risk populations such as intravenous drug users (IDUs)

3 Background China s population is at risk for HIV/HCV coinfection Unsterile Injections Former Plasma Blood Donors IDU China s population is 1.6 million (largest in world) Unsafe Medical Injections -? Risky Sex MSM + HIV -?

4 Studies focused on HIV/HCV co-infection in China are needed

5 Objectives Compare epidemiology of HIV/HCV coinfected subjects with HCV mono-infected subjects Demographic data Clinical data HCV genotype data

6 Methods

7 Study Design Type: Retrospective Time: Geography: Guangzhou, China Southern China Facility: Outpatient Hepatitis Clinic Guangzhou Eight s People s Hospital Subjects: HCV infected outpatients who were candidates for IFN based therapy Inclusion Criteria: Adults > 18 years, HCV IgG or IgM, HCV RNA, HIV ELISA / Western Blot Exclusion Criteria: Contraindications to IFN based HCV therapy: decompensated liver cirrhosis (by ultrasound), severe cytopenias, renal/heart failure, pregnancy, AIDS

8 Data Abstraction & Genotyping Age Sex Ethnicity Education Level Marital Status Employment Status Home residence permit location (hukou) Date of blood sample Route of HCV Transmission recorded in hospital chart Labs - same year as blood sample AST ALT Platelets

9 Fibrosis Scores APRI FiB4

10 Results

11 Table 1 :

12 1 HIV/HCV co-infected patients had higher rates of HCV genotype 3a, 6a, and lower rates of 1b.

13 2 HIV/HCV co-infected patients were more likely to acquire infection from IVDU

14 3 HIV/HCV co-infected patients had evidence of worse fibrosis scores

15 Discussion

16 HCV Epidemiology in China

17 HCV Genotype Epidemiology in Southern Asia

18 Multiple studies of IDUs in Asia have found high rates of 6a

19 We found in HIV/HCV co-infected patients genotype 6a is more common than in HCV mono-infected patients. This differs from past Chinese studies of HIV/HCV coinfected and HCV mono-infected patients.

20 Differences in HCV genotypes between HIV/HCV co-infected and HCV monoinfected may be due to differences in HCV risk factors

21 Our results suggest an IVDU based transmission of HIV and HCV genotype 6a

22 6a is increasing in Guangdong Chen YD % Guangdong (hospital patients, blood donors, IVDU) Lu Ling % Guangdong (blood donors) Fu Y % Guangdong (blood donors)

23 Expansion of 6a in HIV/HCV coinfected suggest ongoing IDU related transmission potential despite decreasing IDU-associated HIV in China

24 Chinese with HIV/HCV co-infected have compromised liver function when compared to HCV mono-infected Results: 1) HIV/HCV co-infected had higher mean fibrosis scores and more scores significant for fibrosis 2) HIV/HCV co-infected were less likely to have APRI [OR, 0.39; 95% CI, ; P = 0.002] and FiB4 [OR, 0.51; 95% CI, ; P = 0.036] scores with no significant fibrosis. Generalizability: Studies on APRI and FiB4 scores shown ability to predict liver fibrosis and death in HIV/HCV cohorts Suggests: HIV infection accelerated HCV related liver fibrosis is occurring in our population

25 Higher rates of liver fibrosis underscores the need for HCV treatment in HIV/HCV co-infected from China Who urgently needs treatment? Could not rule out fibrosis in % of HIV/HCV coinfected Why is treatment not given? 1) Detection of disease 2) Access to Treatment Costs, Infrastructure

26 Study Limitations Sampling Bias Fibrosis Score Limited data on: Transmission risk factors Fibrosis risk factors (length of infection, other hepatotoxicities)

27 Conclusions

28 Summary HIV/HCV co-infected have higher rates of HCV genotype 6a. HIV/HCV co-infected were more likely to acquire infection from IVDU. This suggests a potential for ongoing IDU based HIV and HCV genotype 6a transmission. HIV/HCV co-infected had evidence of worse liver fibrosis, underscoring the need for HCV treatment in this population.

29 Acknowledgements Dr. Cai Wei Ping Guangzhou Eight s People Hospital Dr. Joseph D. Tucker UNC Dr. Stanley Lemon UNC NIH Fogarty Fellows Program Funding: P.R. China 2012ZX , and NIH R24 TW007988, 5P30AI

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