This workshop took place in Vientiane from 29 February to 2 March 2012. It was introduced by the Deputy Minister of Health of Laos Associated Professor Bounkong Syhavong, Mr Nicolas Steenkeste (Fondation Mérieux, Asia) and Mr Bernard Vanthomme (Agence Universitaire de la Francophonie in Laos). This workshop brought together, for the first time, health professionals from different Provinces of Laos involved in diagnostics and clinic and therapeutic follow up of patients infected with viral hepatitis. During three days of seminars, speakers covered news concerning hepatitis viruses, in particular on chronic viral infection and their treatment uptake, on the direction of Dr Phimpha Paboriboune (CICML) and of Professor Paul Dény.
In Laos, as in many other South East Asian countries, viral hepatitis B and C represent a major public health problem, more so in terms of screening than patient management. Furthermore, medical knowledge amongst staff is still limited.
Vaccination against hepatitis B has been integrated in the Laotian national programme since 2001 while the problem of co-infection of HIV and HBV or HCV are unexplored. The viral load of around 2000 patients infected with HIV is followed at the CICML. These 1890 people represent 88,5% of HIV infected patients in the country; conversely, only 1,5% of them are declared as being coinfected with HBV and very few with HCV. A possible hypothesis is that there is no systematic screening of hepatitis infections within the HIV positive population.
At a diagnostic level, the majority of regional hospital laboratories look for the AgHBs serum (qualitative approach) and the anti-HCV antibody. However, other virological markers evaluating the evolution of Hepatitis B (AgHBe and Ac anti-HBe), the study of the HCV genotype and the quantification of viral loads (HBV and HCV), are done in Thailand, creating a major expenditure for patients to which the cost of treatment must be added. Even if certain patients have access to imported compounds (Lamivudine, Adéfovir, Ténofovir et Peg-IFN alfa-2a), the therapeutic follow up from specialized doctors is limited. Since January 2010, the CICML has put in place an HBV and HCV viral load quantification technique to evaluate the effectiveness of treatment although clinicians also require continued training in patient management and their therapeutic follow up.
Priority research themes were identified for public health in Laos, in particular thanks to the drive that brought the implementation of HIV viral load at the CICML. More unifying research projects between Laos, Vietnam, Cambodia and Thailand, to create a real South East Asian consortium, were brought to attention, and themes identified, mainly hepato-cellular-carcinoma and preventive vaccination.
Under the impetus of the deputy minister, the wish to repeat this type of event was put forward to more significantly share esteemed knowledge and practices for managing hepatitis in Laos by allowing a true quality control of treatment practices through close cooperation with local bodies and health authorities.