Abstract Book Vol. 2 [International Conference on AIDS (14th: 2002: Barcelona, Spain)]

XIV International AIDS Conference

Abstracts ThPeC7489-ThPeC7492 459

for anal/rectal cancer via yearly anal pap smears in HIV infected men and women
has been suggested, but the best methodology, follow-up procedures and utility
in general practice has not been established.
Description: We have been using anal pap smears for screening for 3 years in a
not-for-profit, community based HIV clinic in Rochester, New York,. Smears were
collected on Dacron swabs and submitteud to a group of three pathologists for
interpretation. 458 men received 719 PAP smears of which 102 (14%) were abnormal. 71 (9.8%) squamous atypia, 30 (4.2%) mild to moderate dysplasia, and
2 (0.3%) carcinoma in situ (CIS). 162 women received 122 anal pap smears of
which 7 were abnormal, six (4.9%) squamous atypia and 1 (0.8%) CIS. Of the 80
patients with abnormal smears for whom follow-up was available, 18 had lesions
which were treated by colorectal surgeons, 18 had repeat PAP smears that were
unchanged, 14 had repeat PAP smears which reverted to normal and 30 either
were not repeated or did not keep follow-up appointments.
Lessons learned: Overall 14% of patients had abnormal anal PAP smears over
the 3 years and 3% had lesions that required treatment. Women received fewer
anal PAP smears than did men because many used outside gynecologists who
did not do them.
Recommendations: Anal PAP smears are effective screening for anal/rectal cancer in HIV + men and women. Patients must be encouraged to keep follow-up
appointments and a tracking system for results is important.
Presenting author: Steven Fine, Community Health Network, 758 South Avenue, Rochester, New York 14620, United States, Tel.: +[phone], Fax:
+[phone], E-mail: [email protected]
ThPeC7489 Epidemiology of HIV and hepatitis C coinfection
among injecting drug users
A. Sanvisens1, S. Perez-Hoyos2, R. Catala1, D. Fuster1, J. Del Amo3,
I. Hernandez-Aguado4, R. Muga1. 1Hospital Universitari Germans Trias i Pujol,
Badalona, Spain; 2EVES, c/canyet s/n, 08916, Badalona, Barcelona, Spain;
3Plan Nacional del Sida, Madrid, Spain; 4 Universitat Miguel Hernandez,
Alicante, Spain
Background: Although co-infection with HIV and hepatitis C virus (HCV) is common, there are few long-term studies on mortality from liver disease in coinfected
injecting drug users (IDUs).
Objective: To examine the liver-related mortality among persons at risk for HIV
and HCV infection.
Patients and methods:cohort study of IDUs from Valencia, Alicante and CastelIon (Spain)recruited in 3 comunity-based centers for voluntary counseling and
testing between Jan.1990 and Dec.1996. Sociodemographic, drug use characteristics and EIA for HCV and HIV were obtained at study entry. Primary causes
of mortality were ascertained from national death registries and classified into 3
categories: liver disease, Aids and all other diagnoses
Results: Median age at study entry was 27 years and the median follow-up time
from study entry to death, last time seen, or February 28, 2000 was 5.9 years
(IQR 7.4-4.5). Of 3.247 IDUs (77.5% M, 22.5% W), 2.759 were HCV + (85%),
including 1.324 HIV + (48%), and 1.435 HIV negative. There were 19.229 total
person-years (PYs) of follow-up time and 475 deaths resulting in an alll-cause
mortality rate (MR) of 2.5/100 PYs (4/100 PYs in HCV+/VIH+ and 1.3/100 PYs in
HCV+/VIH-, RR=3.7, 95% C1=2.4-5.7). Of the 475 deaths, 238 were attributable
to AIDS (50.1%), 22 (4.6%) were attributable to liver disease with an overall
liver-related MR of 0.1 PYs and 215 (45.3%) to all other causes. Three liverrelated deaths ocurred in the HCV+/HIV seronegative group (MR 0.03/100PYs)
and the remaining 19 amongst the HCV+/HIV seropositive IDU (MR 0.2/100 PYs)
(RR=8.0, 95% CI=(2.36-26.96) p<0.001). MRs across calendar periods: AIDSrelated MRs prior and after 1997 were 0.9/100 PYs and 0.5/100 PYs respectively
(RR 0.6, 95% CI=0.44-0.
75). Conclusions:The extremely high levels of HCV infection among IDUs and the
underlying HIV epidemic in Spain may lead to a large health burden of end-stage
liver disease among (ex-) IDUs over the coming years.
Presenting author: Arantza Sanvisens, c/canyet s/n, 8916, Badalona,
Barcelona, Spain, Tel.: [phone], Fax: [phone], E-mail: rmuga
@ aids2002.com
ThPeC7490 Effect of Antiretroviral therapy on liver-related
mortality in HIV/HCV coinfected patients
N. Qurishi1, C. Kreuzberg1, L. Hess2, B. Kupfer3, G. Luechters1, E. Voigt1,
W. Effenberger2, J. Rockstroh1, T. Sauerbruch1, U. Spengler1. 'Department of
Internal Medicine, Med. Klinik und Poliklinik I, Station Wunderlich,
Sigmund-Freud-Str. 25, 53105 Bonn, Germany; 2Institut of Experimental
Haematology and Transfusion Medicine, Bonn, Germany; 3Institute of Virology
and Microbiology Bonn, Germany
Background: Hepatitis C virus (HCV) infection takes a more progessive course in
patients with concomitant HIV infection. Antiretroviral therapy has remarkably im
proved the prognosis of HIV but does not affect HCV replication. Thus, it remains
unclear, whether HIV/HCV co-infected patients have a survival benefit.
Design: We retrospectively analysed survival in 285 HCV/HIV co-infected patients, which had been followed since 1990. Total deaths and liver-related deaths
were analysed by Kaplan-Meier statistics stratified with respect to highly active
antiviral therapy (HAART) for the period I (1996-2000), and therapy with nucleoside analogues for the period II (1990-1995).

Results: In period I, overall 25 deaths and 10 liver-related deaths were observed.
However, only two liver-related deaths were observed in the 94 patients who had
received HAART (p<0.05). Kaplan-Meier analysis confirmed a total survival benefit of HAART also for HIV/HCV co-infected patients (mean survival: 1749 versus
1585 days; p=0.041). Furthermore, liver-related survival was significantly better
in HAART-treated patients than in patients without HAART (mean survival: 1816
versus 1701 days; p=0.045) In period II we also found significantly better total survival (2790 versus 1504 days; p<0.0001) and liver-related survival (2969 versus
2050; p<0.0001) in the 148 patients on nucleoside analogues. However, probably
due to emerging viral resistance this benefit was not maintained through period I.
Conclusion: Our survival analysis suggests that antiretroviral therapy significantly reduces total mortality also in HIV/HCV coinfected patients, probably related to better preservation of immune functions. Therefore, antiretroviral therapy
should not be withheld from HIV positive patients with concomitant hepatitis C.
Presenting author: Nazifa Qurishi, Med. Klinik und Poliklinik I, Station Wunderlich, Sigmund-Freud-Str. 25, 53105 Bonn, Germany, Tel.: [phone], Fax:
[phone], E-mail: [email protected]
ThPeC7491 Lack of transmission of HCV in a cohort of
heterosexual serodiscordant couples
S. Garcia1, J. Del Romero', B. Marincovich2, C. Rodriguez', P Clavo',
J. Ballesteros', V. Hernando', J. Castilla3. ' Centro Sanitario Sandoval, Servicio
Regional de Salud, Sandoval, 7, 28010 Madrid, Spain; 2Beca MUTIS, Agencia
Espanola de Cooperacion Internacional, Madrid, Spain; 3Centro Nacional de
Epidemiologia (ISCIII) y Secretaria del Plan Nacional sobre Sida, Madrid, Spain
Background: The aim of the present study is to analyse HCV transmission in a
cohort of heterosexual couples that are discordant both for HIV and for HCV.
Methods: Between 1991 and 2000, in a STD/HIV clinic, we followed a dynamic
cohort of 165 persons -147 women and 18 men- whose mean age was 29.7+4 years, who were not initially infected neither by HIV nor by HCV, but whose
steady heterosexual partner presented antibodies to both viruses (index case),
and in all cases showed previous injected drug use. Every six months, clinical,
epidemiological and risk behaviour information was collected, and antibodies to
both viruses were determined. Risk exposures other than sexual intercourse with
co-infected partner were excluded.
Results: A total of 471 person-years of follow-up and more than 36,000 vaginal or anal intercourses were taken into account. During follow-up 68 persons
(41%) had vaginal (66) and/or anal (7) intercourse without condom with their infected partner. 68% (n=113) had unprotected orogenital exposures. Furthermore,
among the 40 persons who used condom in all contacts, 8 declared breaking of
condom during intercourse. 22 women became pregnant, of which two were index cases. During follow-up a total of over 5200 vaginal and anal coitus without
condom with the infected partner was estimated, as well as more than 22,000 unprotected orogenital contacts, and 90 episodes of condom breaking during anal
or vaginal penetration. Seroconversion to HIV occurred for one woman, but there
was no seroconversion to HCV (95% confidence interval, 0-7 per 10,000 coitus
without condom). The incidence rate for HIV was 2 per 1000 person-years, and
1.9 per 10,000 coitus without condom (95% CI, 0.1-12.4 per 10,000).
Conclusions: We did not observe any case of heterosexual transmission of HCV
from HIV co-infected patients. These results are consistent with other studies that
describe a low or null transmissibility of HCV in stable heterosexual relations.
Presenting author: Jorge Del Romero, Sandoval, 7, 28010 Madrid, Spain, Tel.:
[phone], Fax: [phone], E-mail: [email protected]
ThPeC7492 Sustained response to combination therapy with
interferona2b (IFN) and ribavirin (RBV) for chronic
hepatitis C in HIV-infected patients
I. Santos, M.C. Barrasa, J. Sanz, N. Ruiz-Gimenez, M.T. Fernandez-Dorado.
Servicio de Medicina Interna, Hospital Universitario de la Princesa, Servicio de
Medicina Interna, Hospital Universitario de la Princesa, Diego de Leon, 62,
28006-Madrid, Spain
Background: to evaluate the efficacy and safety of therapy with IFN and RBV for
the treatment of chronic hepatitis (CH) C in HIV-infected patients.
Methods: open prospective trial between Dec-99 and Jul-01 in 26 patients coinfected with hepatitis C virus (HCV) and HIV, diagnosed of CH by means of a
biopsy. We performed CD4 cells count, HIV viral load, hematology, biochemistry
at baseline and weeks 8, 16, 24, 48 y 72. HCV viral load was performed at baseline and weeks 16, 24, 48 y 72. Patients were treated with IFN 3 MU 3 times a
week and RBV 1-1,2 g daily for 6 months (genotype 2-3) or 12 months (genotype 1-4). 23 patients were on HAART. Primary endpoint was a sustained viral
response, defined by the lack of HCV RNA in serum 6 months after the end of
treatment. Results are described as intention to treat.
Results: males 22, females 4. Mean age 36,5 yo. Mean CD4 cells count:
632x10<6>/L (r:180-1186). Mean serum HIV RNA (log): 2,76 (r: 2,6-3,7). HCV

genotype: la-1b, 13; 2b, 1; 3a, 10; 4, 2. Median baseline ALT and AST: 118 and
78 IU/ml. Adverse events: flu-like syndrome in 22, insomnia in 10, weight loss in
9. 3 patients withdrew the therapy due to flu-like syndrome. 1 patient commited
suicide in week 18. RBV was withdrew in 1 patient due to severe anemia and the
dose of RBV was diminished in 4 patients in week 2 due to anemia. There was
no impact on the level of HIV RNA. All patients showed absolute decrease in CD4
cells count. 6 months after the end of the treatment, 7 patients (27%) exhibited