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HIV/HCV Co-Infection: Untreated Epidemic in Urban Miami
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Reported by Jules Levin
CROI 2012 Seattle WA
Khaled Deeb1,2, Paula Dilanchian1, Kanwal Razzaq1, Carolyn Senk1, Michael Kolber1, Dushyantha Jayaweera1
1University of Miami, Miller School of Medicine, Department of Infectious Diseases, Miami, FL, United States
2Barry University, Miami Shores, FL, United States
CONCLUSIONS
- It is interesting that only about half of the total HIV populations were tested for HCV.
- Only half of those co-infected were referred for hepatitis C co infection clinic.
- 69% were men and 69% were older than 50 years. 60% were African Americans, 29% Hispanic and 11% were White.
- There is a great need to educate the providers on HCV treatment and improve care to this most vulnerable inner city population.
- Genotype I was 89% with 1A being 69%. There was a gender difference in absolute CD4 cell count with men having a higher count.
"38% of patients with positive serology did not have a follow up viral loads"
"Across the three major races (whites, blacks, and Hispanics), we found that genotypes 1 & 4 were most common among the Black race while genotype 1 is equally found among Hispanics and whites although these differences were not significant. Genotypes 2 and 3 were least common among Blacks whereas genotype 4 is almost non-excitant among Whites"
"Distribution of HCV Genotype shows that 480 (68%) patients had genotype done out of total 705 co-infected HIV/HCV population. Almost 90% of patients carried Hepatitis C genotype 1 and very little (<1%) were of genotype 4. The most prevalent genotype was 1a (61%)"
"Almost 70% were male and 67% were older than 50 years. Blacks comprised 60% of the population and 29% were Hispanics where the whites were among the minority of the co-infection population"
"Data shows strong correlations between HIV and HCV viral loads(from Jules: probably reflects ethnicity). Genotypes 1a and 1b are most difficult to manage and presents a clinical risk as indicated by the high baseline of both viruses. Qualification of hepatitis C RNA levels based on Genotypes HCV Genotype 1 carried higher baseline levels of HCV-RNA than genotypes 2, 3, 4"
TABLE 1
A pair-wise comparison between co-infected HIV/HCV patients (n=1073) based on HCV viral RNA loads at baseline. Patients with detectable viral load (HCV RNA Positive of >50 copies/mL) seeking HARRT regimen are generally older with wider age range than those with undetectable viral load. Furthermore, patients with undetectable HCV RNA viral loads generally have lower HIV RNA viral loads and higher CD4+ T-cell count and percentage.
FIGURE 4
Distribution of patients based on demographics. Males are almost twice the size of female. Almost 70% were male and 67% were older than 50 years. Blacks comprised 60% of the population and 29% were Hispanics where the whites were among the minority of the co-infection population.
FIGURE 5
Comparisons of HCV and HIV viral loads to HCV Genotypes. Data shows strong correlations between HIV and HCV viral loads. Genotypes 1a and 1b are most difficult to manage and presents a clinical risk as indicated by the high baseline of both viruses. Qualification of hepatitis C RNA levels based on Genotypes HCV Genotype 1 carried higher baseline levels of HCV-RNA than genotypes 2, 3, 4.
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