Determination of HCV Prevalence in a HIV Patient Cohort in Phnom Penh, Cambodia
Determination of HCV Prevalence in a HIV Patient Cohort in Phnom Penh, Cambodia
Hepatitis C (HCV) is an important global public health problem, disproportionately affecting
 HIV positive populations. Asia and Africa account for most of the co-infection burden, but
 access to HCV screening and treatment is still very limited. It is expected though, with the
 recent therapeutic advances and increasing global advocacy efforts, that HCV treatment should
 become a feasible option in the near future.

 Sihanouk Hospital Center of HOPE (Phnom Penh, Cambodia) is catering for one of the largest
 HIV cohorts of the country, followed in an ambulatory settings. In this cohort, the
 prevalence of HCV co-infection will be determined, as well as HCV genotype diversity and the
 severity of liver disease. The researcher will also explore the performance of simple blood
 tests/panels as predictors of significant fibrosis and/or cirrhosis.

 Patients will attend two study-visits. All adult patients of the HIV patient cohort of SHCH
 will be proposed HCV testing during their next HIV follow-up consultation, following the
 latest algorithm of the Centre for Disease Control (CDC) (May 2013). Anamnesis and clinical
 examination will focus, additionally to routine practice, on presence of general and HCV
 liver-disease related features. Laboratory analyses will include basic HIV tests (CD4), and
 tests for liver function such as Hepatitis B surface antigen (HbsAg) .

 During the following routine HIV follow-up consultation, the results of HCV testing will be
 explained to the patient. If the patient is HCV negative, his/her study participation ends
 here. If currently infected with HCV, the clinician will repeat the HCV liver-disease
 (extra-hepatic & hepatic) related anamnesis and clinical examination, and prescribe
 additional blood tests for the non-invasive liver fibrosis/cirrhosis blood panel tests, liver
 and kidney function. Patients will moreover be asked to undergo a liver ultrasound and liver
 stiffness measurements.
Hepatitis C (HCV) is an important global public health problem, disproportionally affecting
 HIV positive populations. Asia and Africa account for most of the co-infection burden, but
 access to HCV screening and treatment is still very limited. The high cost and complexity of
 current diagnostic and treatment algorithms are major bottlenecks and the linked lack of
 accurate HCV prevalence estimates and treatment-need data do not allow for robust treatment
 advocacy and program planning. Cambodia is not an exception.

 It is expected though, with the recent therapeutic advances and increasing global advocacy
 efforts, that HCV treatment should become a feasible option in the near future. Sihanouk
 Hospital Center of HOPE (Phnom Penh, Cambodia) is catering for one of the largest HIV cohorts
 of the country, and it is planning to engage in HCV treatment from 2014 2015 onwards, with a
 double objective of direct patient benefit and catalyst role at national level, as in the
 past when starting its antiretroviral (ARV) program.

 Within this specific setting, the researchers plan to determine the prevalence of HCV
 co-infection, HCV genotype diversity and severity of liver disease in this HIV patient
 cohort, followed in an ambulatory setting. The researchers will also explore the performance
 of simple blood tests/panels as predictors of significant fibrosis and/or cirrhosis .

 The current HCV diagnostic procedures (and tools), as applied in this study, are too
 expensive and resource-demanding to allow for scalability in resource limited settings. Thus,
 the researchers plan to set up during this study a biobank with samples of a clinically well
 described HIV patient population. These samples should allow constituting a well-balanced
 panel for evaluation of future 'more scalable' HCV diagnostic tools.

 Patients will attend two study-visits. All adult patients of the HIV cohort will be proposed
 HCV testing during their next regular HIV follow-up consultation. HCV testing will follow the
 latest algorithm of the Centre for Disease Control (CDC) (May 2013). During this same
 consultation, anamnesis and clinical examination will focus, additionally to routine practice
 ,on presence of general and HCV liver-disease related features. Laboratory analyses will also
 include basic HIV (CD4), and tests for liver function such as Hepatitis B surface antigen
 (HbsAg).

 During the following routine HIV follow-up consultation (2-3 months later), the results of
 HCV testing will be explained to the patient. If the patient is HCV negative, his/her study
 participation ends here. If currently infected with Hepatitis C, the clinician will repeat
 the HCV liver-disease (extra-hepatic & hepatic) related anamnesis and clinical examination
 and prescribe additional blood tests for the non-invasive liver fibrosis/cirrhosis blood
 panel tests, liver and kidney function. Patients will moreover be asked to undergo a liver
 ultrasound and liver stiffness measurements.

 The biobank will be set up with left over biological samples (whole blood plasma and serum)
 and comprehensive clinical information of all patients who give additional consent for this
 scope. Both biological samples and clinical information will be coded, to ensure
 confidentiality.
Inclusion Criteria:

 -  Adult (> or = 18 years old)

 -  Documented HIV positive

 -  In regular HIV care follow-up (min. 2 consultations in the last six months prior to
 the study)

 -  Willing and able to provide written informed consent

 Exclusion Criteria:

 • HIV patients with currently taking Hepatitis C treatment or with a history of prior
 hepatitis C treatment