Viral Hepatitis among HIV+ Patients in Northern Vietnam

BACKGROUND: Liver disease due to hepatitis B (HBV) and hepatitis C (HCV) is becoming the largest cause of death in HIV+ individuals worldwide. Compared with its neighbors, Vietnam has been identified as a country where coinfection with viral hepatitis among HIV+ persons is especially high, concentrated in people who inject drugs (PWID). The goal of this project was to identify the prevalence of and extent of clinical services offered for HCV and HBV among HIV+ patients at four medical facilities in northern Vietnam. METHODS: We conducted a retrospective chart review among HIV+ patients beginning ART between 2012 and 2015 at Bach Mai Hospital and the National Hospital for Tropical Diseases (NHTD) in Hanoi, and the Pho Yen and Thai Nguyen City Health Centers in Thai Nguyen Province. Collected data included demographics, history of injection drug use, and testing and treatment status for HBV and HCV. A missing test result counted as a negative result for calculation of prevalence. RESULTS: 979 patient charts were examined (Bach Mai, n = 522; NHTD, n = 200; Pho Yen, n = 91; Thai Nguyen, n = 166). Across all four sites, prevalence of HCV coinfection ranged from 26% to 36%, HBV coinfection ranged from 5% to 7%, and HBV/HCV coinfection ranged from 2% to 8%. At Bach Mai and NHTD, PWID were ~50% of the HCV coinfected group and nearly 60% of the HCV/HBV dually coinfected group. As first line treatment for HBV was the same as ART, all patients with HBV were already being treated for it. HCV treatment was limited, with Bach Mai Hospital being the only site that had evidence of treatment. At Bach Mai, 3% of HIV patients coinfected with HCV only and 2% of HIV patients with both HCV/HBV received treatment for their HCV. Pegylated interferon+ribavirin was the only regimen used. CONCLUSION: Compared with the general Vietnamese population, HCV was more prevalent among our sample of HIV+ individuals. As missing results were counted as negatives, it is likely that the true prevalence rates of both HCV and HBV are higher than reported. The lack of treatment for HCV among coinfected HIV+ individuals was concerning, particularly given the morbidity of HCV coinfection, and is an area for future intervention. Given the large percentage of HCV coinfected patients that were PWID, future efforts for the prevention and treatment of HCV should be focused in this community. DISCLOSURES: All authors: No reported disclosures.