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Hepatitis Highlights from Intl AIDS Conference Barcelona
Reported by Jules Levin
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CD4 count predicts Hep A & Hep B Vaccine responses
Yoon attempted to determine the efficacy of vaccination for these viruses in HIV infected patients and to determine what factors may predict failure to respond serologically. All patients are screened for HAV, HBV and HCV at their initial clinic visit. Patient's are offered HAV and/or HBV vaccination if HAV ab negative, HBV sAB negative, HBV cAB negative and HBV sAg negative regardless of their HCV status. Recombinant Hepatitis B vaccine (Engerix-Ba) is administered intramuscularly as 20 mcg at three intervals over a six month period. Hepatitis A vaccine (Havrixa) is administered intramuscularly as 1440 EL.U at two separate intervals within 6-12 months of each other.
126 patients who received HAV vaccination and 96 patients who received HBV vaccination from October 1997- June 2001were included in our analysis. Rates of HAV vaccine failure for patients with CD4 count >500, 200-500 and <200 were 13.89%, 32.81% and 69.23% respectively. Rates of HBV vaccine failure for patients with CD4 count >500, 200-500 and <200 were 36.67%, 44.9% and 86.67% respectively. Smoking history, BMI, and risk for HIV infection were analyzed. The authors concluded the response rates for Hepatitis A and B vaccination appear to be quite poor in patients with CD4 count <200. We recommend that vaccination in such patients be delayed until the CD4 count rises above 200.
[MoPeB3156] P.T. Smith New York Presbyterian Hospital, New York, United States
Response Rates Reported in HCV/HIV Coinfected IVDU Patients: efficacy and tolerance of therapy with IFN/RBV and Pegintron/RBV
Authors suggest case management of coinfected patients should stress an early HCV-therapy before the necessary antiretroviral therapy.
In this study 47 patients were enrolled (197 coinfected patients in clinic consider). 22 (47%) pts. were treated with IFN-alpha-2b/RBV, 25 (53%) received a pegIFN-alpha-2b/RBV -treatment. IFN-alpha-2b (5 MU daily/ 3 month, 5 MU TIW following months) and ribavirin (1000-1200 mg daily). PegIFN-alpha-2b - PegIntron- (1.5 mcg/kg once a week) and ribavirin (800 mg daily). Treatment duration was 24 weeks for genotype 2and 3 and 48 weeks for Genotype 1 and 4.
51% male, 49% female with a mean age of 35 years. 62% where in methadone-maintenance, 38% were abstinent. 53% take antiretroviral therapy. 93% were HCV- therapy naive, 7% failed to respond to a previous course of IFN - monotherapy. HCV-RNA-PCR was < 2 Mio copies/mL in 42% and > 2 Mio copies/mL in 58%. Median HIV-RNA-PCR was 6,648 copies/mL (range <50 - 46, 000), median CD4 count 586 cells/mm3 (range 181-1 864), median ALT was 47 IU (range 11-138). Median score of fibrosis was 2.6 (METAVIR scoring system): Distribution of genotypes: 1 50% (n 21), 2 (n 1), 3 (n 17), 4 (n 3), more than one genotype (n 5).
Outcome of IFN-alpha-/RBV-regimes (ITT-analysis): 23% sustained response, 21% early reponse, 29% were nonresponders, 27% discontinuated therapy. Outcome of pegIFN-alpha/RBV-regimes: 20% sustained response, 36% early response, 12% were nonresponders, 32% discontinuated therapy. But since genotype 2/3 received only 24 weeks therapy perhaps that is too short & longer therapy term would improve responses.
Authors concluded ITT-analysis shows lower rates of sustained response in coinfected IVDUs than in nonaddicted and non-co-infected populations. The mean reason is the very high break-off-rate due to side effects due to psychiatric comorbidity and drug interactions particular with concommitant HAART.
[MoPeB3258] J. Goelz Berlin, Germany
Deaths Due to Liver Disease & Hepatitis in SF Increasing in the era of highly active antiretroviral therapy (HAART): 1994-1998
This study analyzed the causes of death among persons with AIDS in San Francisco who died before and after 1996. From 1994-1998, 5234 deaths occurred in persons with AIDS. The mortality rate for underlying causes of death due to HIV/AIDS declined significantly after 1995 (P<0.001), while the mortality rate for non-HIV/AIDS-related causes remained stable. The proportion of deaths associated with septicemia, non-AIDS-defining malignancy, chronic liver disease, viral hepatitis, overdose, obstructive lung disease, coronary artery disease, and pancreatitis increased significantly (p<0.05). While the numbers were small, there was a trend toward increasing deaths due to pancreatitis after 1996.With increasing AIDS survival, prevention of chronic diseases, assessment of long-term toxicity from HAART, and surveillance for additional causes of mortality will become increasingly important.
[MoPeC3334] D.H. Osmond University of California San Francisco, Center for AIDS Prevention Studies, San Francisco
HIV-1 and hepatitis C virus infections among recent injecting drug users in Spain
Injecting drug use is the main category of HIV transmission in Catalonia (Spain). This study examines the prevalence of HIV and HCV in individuals becoming IDUs. A cross-sectional study in IDUs recruited in 2 hospital detoxification units in metropolitan Barcelona (Hospitalet de Llobregat and Badalona). P
227 patients (80% M, 20% W) were included. Age at starting IDU was 24.5 years (median) (IQR 21-28). Fifty percent of them started IDU in 1996. The duration of IDU before admission was 1.5 years and prevalence of HIV and HCV was 12.3% (28/227) and 66% (150/227) respectively. Serologic profile: 11% (26/227) were HIV+/HCV+, 1% (2/227) HIV+/HCV -, 55% (124/227) HIV-/HCV+ and 33% (75/227) HIV-/HCV-. Prevalence of HCV among HIV+ was 93% and 62% in the HIV seronegative individuals (p<0.05). HIV infection was found in 11% of male IDUs vs.23% in females (p<0.05). HIV prevalence is relatively high among young and recent-onset IDUs. The high rates of HCV and HIV infections among female IDUs emphasizes the need to target parenteral and sexual risk reduction interventions early.
[MoPeC3380] F. Bolao Hospital de Bellvitge, c/pomaret 21, 08017, Barcelona, Spain
36% Rate of HCV in Young IVDUs in 5 Urban Cities
This CDC study looks at prevalence of hepatitis and HIV of HIV among 18-30 year old IVDUs. IDUs were recruited in Baltimore, Chicago, Los Angeles, New York City, and New Orleans (N=2,198). Participants underwent HIV, HBV and HCV antibody testing and interviewer-administered surveys at baseline and up to two 6-month follow-up visits. Participants were 63% male; 53% white, 20% Black, 19% Hispanic, and 8% other; median age was 23 years and median injecting duration was 3 years (range = <1-20 year). Prevalence at baseline of study was 4.7% for HIV, 22.2% for HBV, and 36.2% for HCV. Having sex with IVDUs and number of sex partners were associated with having diseases. Trading sex for money or drugs and sharing needles was associated with having HCV. smoking, trading sex for drugs or money, and splitting drugs with a needle for HCV. The authors concluded that interventions for young IVDUs must address sexual as well as injection risk behaviors.
[MoPeC3403] R.S. Garfein Centers for Disease Control and Prevention, Centers for Disease Control and Prevention
41% HCV+, 51% HBV+, 17% HIV+ among drug-involved female sex workers in Miami, Florida: risk reduction programs needed
The Centers for Disease Control has designated rates of HIV and AIDS in Miami to be at state-of-emergency levels, particularly among women, yet epidemiologic data on HIV and hepatitis infection among female sex workers in this area are scarce. A study was funded by the U.S. National Institute on Drug Abuse to assess the prevalence of HIV, HBV and HCV in this population, and to describe the extent of sexual and drug risk behaviors among street-based female sex workers.
The people studied are recruited from the streets of Miami by active sex workers trained in outreach techniques. Following informed consent, clients complete a baseline interview regarding risk behaviors, are urine tested for drug use, and participate in HIV and hepatitis prevention education. Pre-test counseling and blood testing for HIV and hepatitis are then conducted. Test results, post-test counseling, and additional prevention education are provided two weeks later. To date, 300 clients have been enrolled into the study. The sample has a median age of 40 years, is 49% African-American, 43% white-Anglo and 8% Latina. 81.1% used alcohol in the past 30 days, 56.8% used marijuana, 91.9% used crack-cocaine, and 13.5% used heroin. 35.1% of the clients reported a history of injection drug use. The clients had been sex workers for a mean of 18.1 years, with an average of 29.6 sexual partners in the past month. More than half reported being violently victimized in the past year. Of those whose test results have been received, 17% tested HIV positive, 51% were HBV positive, and 41% were HCV positive. This study documents the need for HIV and hepatitis risk reduction programs for female sex workers, as well as the need for violence prevention.
[MoPeC3498] H.L. Surratt, J.A. Inciardi University of Delaware, Coral Gables, Florida, 33134, United States
Study Suggests that Coinfected patients responding better to HAART may increase HCV genetic diversity and cause less response to HCV therapy
This study explored the effect HIV & HAART may have on HCV progression and why HIV may accelerate HCV progression. Three patient groups of HIV/HCV co-infected patients were identified: those who initiated HAART (H); those on HAART with an HIV VL < 50/ml for > 1 yr (S); and HIV drug naive who remained off HIV therapy (C). 17 patients (7 H, 6 S and 4 C) were included for study. HIV and HCV VL were significantly reduced and increased respectively in H (those who started HAART) compared to S and C. Despite increases in CD4 and CD8 counts in H, these numbers and CD4/CD8 ratio remained greater in S. The relative change over time in clone #, entropy, diversity and Ka/Ks favored the S group. The mean values for these variables over time were significantly higher in the S group compared to H and C. HCV genotype did not appear to affect the above changes.
The authors concluded that HCV quasi-species complexity and diversity appears greater in those on stable HAART and who have higher CD4/CD8 counts. Higher T cell counts are probably reflective of increased immunologic pressure leading to virologic escape and evolving increased diversity. HAART can impact HCV diversity in co-infected patients.
[WePeB6039] M. Holodniy Palo Alto Health Care System, aids research center
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