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Background: The knowledge of hepatitis C virus (HCV) burden in Cambodia is essential for evidence informed policy development and for the mobilization of resources, including improving access to HCV cure with direct acting antivirals. The objectives of this study were to assess the prevalence and genetic diversity of HCV and to identify associated risk factors with hepatitis C mono-infection or with HCV/HIV co-infection.
Methods: Between March and April 2016, we conducted a cross-sectional survey on HCV in four geographical areas in Cambodia: Phnom Penh, Battambang, Siem Reap and Preah Sihanouk province. Subjects were randomly selected among HIV-uninfected pregnant women attending public antenatal care clinics and among HIV-infected subjects who were followed-up in the national HIV program. HCV Ab testing was done with the HCV Bio-Rad enzyme-linked immunosorbent assay (ELISA). All HCV Ab-positive subjects were tested for HCV RNA viral load (VL) with the Omunis PUMA HCV kit. HCV genotyping was performed in the NS5B region.
Results: A total of 935 participants were enrolled, including 510 (54.6%) pregnant women and 425 (45.4%) HIV-infected individuals, with median age of 27 years (IQR, 24-31) and 42 years (IQR, 37-49), respectively. Overall, HCV Ab prevalence was 3.6% (34/935) and significantly higher in HIV-infected individuals, compared to pregnant women (6.8% vs 0.9%) (p< 0.001). Of the 34 anti-HCV-positive individuals, 24 (70.6%) showed detectable HCV RNA VL results, leading to an overall prevalence of active HCV infection of 2.6%. Active HCV infection rate was higher in HIV-infected subjects than in pregnant women (23/425, 5.4% vs 1/510, 0.2%) (p< 0.001). HCV RNA median was 6.29 log10 IU/mL (range, 2.47-7.08). Predominant HCV genotypes were 1b (55%), 6 (40%), and 2 (5%). In multivariate analysis after adjustment on HIV status and provinces, HCV infection was significantly associated with older age (OR:4.54, 95%CI: 1.62-12.72, p=0.004), having a family member positive for HCV (OR:3.49, 95%CI: 1.47-8.25, p=0.004), reporting a history of testing for hepatitis infection (OR:2.53, 95%CI: 1.14-5.58, p=0.021), and having received intravenous medication in the last past 5 years
(OR:8.26, 95%CI: 1.10-61.99, p=0.040).
Conclusions: In Cambodia, active HCV infection is common among HIV-infected subjects, and is associated with history of intravenous medication.

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