Injecting drug use worsens the quality of life in HIV-HCV co-infected patients in Vietnam.

In Vietnam, in 2024, the HIV prevalence was estimated at 0.4% accounting for approximatively 270,000 adult people living with HIV (PLHIV). PLHIV may also face hepatitis C virus (HCV) co-infection, although co-infection disproportionally affects people who inject drugs (PWID). It has been shown that usually, PLHIV have lower health-related quality of life (HRQoL) than HIV-negative individuals. This study, focusing on HIV-HCV co-infected individuals on antiretroviral therapy (ART), offers the opportunity to investigate their HRQoL and compare PWID to non-PWID. The MOVIDA Hep 2 project, a prospective cohort study, enrolled HIV-HCV co-infected patients on ART in Vietnam. At enrolment, the HRQoL in the cohort was assessed using the EQ-5D-5L standardized scale. Low self-rated HRQoL was defined as providing a score below the 25th percentile. Factors associated with this outcome were identified using mixed-effects logistic regression models. A total of 343 HIV-HCV co-infected participants were enrolled in the study, of whom 249 (72.6%) were PWID. Participants were on ART for 116 months in median. Overall, 62 (18.1%) participants reported pain/discomfort and 42 (12.2%) reported anxiety/depression, the proportions did not differ by PWID status (p=0.85 and p=0.07, respectively; Fisher exact test). However, when self-rating their HRQoL, PWID gave a significantly lower score (p<0.001). Factors associated with low self-rated HRQoL were PWID status, ethnicity and alcohol consumption as well as reporting pain/discomfort and anxiety/depression. Interestingly, PWID self-rated their HRQoL at a lower level than non-PWID despite similar long the duration of ART (around 10 years in median) in both groups. Our results suggest that PWID face more physical and psychological distress. The extent of such problems is difficult to ascertain, but screening patients to identify those who need more specific support or attention would be beneficial. Offering integrated mental health screening and care could also benefit these patients, but then the question of integrating mental health care in the national health insurance must also be questioned or addressed.