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

460 Abstracts ThPeC7493-ThPeC7496

XIV International AIDS Conference

undetectable HCV RNA (their genotype was: 1, l1a; 5, 3a; 1, 4). Median levels of
ALT and AST of all patients decreased at the end of treatment to 37 and 34.
Conclusions: our results show that combination therapy is effective in 50% of
cases of genotype 3 by achieving sustained viral response, but only in 1 of 13
with genotype 1. There were no interferences in surrogate markers of HIV infection and in most of the cases adverese events were of no importance.
Presenting author: Ignacio Santos, Servicio de Medicina Interna, Hospital
Universitario de la Princesa, Diego de Leon, 62, 28006-Madrid, Spain, Tel.:
[phone], Fax: [phone], E-mail: isantosg @hotmail.com
ThPeC7493I Risk factors associated to hepatitis C infection
among patients with HIV infection
M.C.J. Mendes-Correa1, A.A.B. Barone2. 1AIDS Outpatient Clinic, University of
Sao Paulo, Praca Vicentina de Carvalho n.84, 05447-050, Sao Paulo, Sao
Paulo, Brazil; 2School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
Background: Hepatitis C virus (HCV) and HIV share the same routes of transmission, which explains the high frequency of combined infections by these
viruses. Objective-A case-control study was carried out in order to assess the
risk factors associated to HCV in HIV co-infected patients.
Methods: From January 1999 through July 2001, 235 patients (146 male, 89 female),attending the AIDS Outpatient Clinic were enrolled.118 patients tested positive for HCV (Elisa and PCR) were included as cases. 117 patients tested negative for HCV (Elisa) were included as controls. Information was collected through a
questionnaire, comprising questions involving identification, demographic characteristics, risk factors(use of intravenous illicit drugs (IDU),blood transfusion, sexual
behavior, sexual contact with HIV or HCV seropositive partners, use of inhaled
drugs, body piercing, tattooing and other risk factors).Demographic and socioeconomic characteristics were similar in cases and controls. The adjusted Odds
Ratios for HCV infection and risk factors were estimated by multivariate logistic
regression.
Results: The independent risk factors were: IDU (OR=25.46; 95% CI, 4.91 -131.88), use of inhaled illicit drugs (OR= 3.56; 95% CI, 1.22-10.44), history of
a IDU sexual partner (OR= 3.46; 95% CI, 1.24-9.65), history of a sexual partner
who had received transfusion (OR= 4.79; 95% CI, 0.95-24.19) (P < 0.05), history
of a sexual partner with past history of chronic hepatic disease (OR= 5.45; 95%
CI, 1.33-22.32), anal intercourse (OR= 3.93; 95% CI, 1.27-12.13)and age above
30(OR= 4.65; 95% CI, 1.31-16.43).
Conclusions: In co-infected patients, HCV transmission is associated to:1 -Intravenous and/or inhaled illicit drugs; 2-Risk factors for transmission of HCV
in sexual partners;3-Anal intercourse
Presenting author: Cassia Mendes-Correa, Praca Vicentina de Carvalho n.84,
05447-050, Sao Paulo, Sao Paulo, Brazil, Tel.: [phone], Fax: +55 11
38199242, E-mail: [email protected]
ThPeC7494 The association of genital ulcerative disease with
HIV and HCV in southern India
M.A. Marx', K.G. Murugavel2, S. Sivaram', A.K. Sri Krishnan2, S. Solomon2,
D.L. Thomas3, D.D. Celentanol. 'Johns Hopkins School of Public Health, 117
South Collington Ave, Baltimore, MD, 21231, United States; 2YRG-CARE,
Chennai, India; 3Johns Hopkins School of Medicine, Baltimore, United States
Objectives: To determine the association of genital ulcerative disease and HIV
and HCV in slum communities of Chennai, India.
Methods: Almost two thousand adults aged 18-40 living in 30 slum communities
were randomly selected and invited to attend health camps. They answered survey questions about sexual and parenteral risk behaviors, and provided blood,
urine and vaginal swabs for biological testing. Samples were tested for HIV, HCV,
HSV-2 and other STDs in the Chennai study laboratory.
Results: Of those selected, 85% (N=1656) agreed to participate, and 83%
(N=1631) provided biological samples for testing. Men who have sex with men
(MSM, N=44) and male injection drug users (IDU, N=6) were at high risk of HIV
(MSM: OR= 8.55, 95% CI: 1.52, 48.00; IDU: OR=59.83, 5.08, 705.48) and HCV
(MSM: OR= 4.32, 1.18, 15.95; IDU: OR= 54.05, 11.70, 249.68). Excluding MSM
and IDU, and controlling for frequent alcohol use and number of lifetime sex partners, men reporting having had genital ulcers were almost three times as likely
to have HCV (AOR= 2.86, 0.80, 10.22) as those denying genital ulcers. HSV2-positive men were seven times as likely to be HIV-positive (AOR= 7.44, 0.97,
57.06) and over four times as likely to be HCV positive (AOR= 4.53, 1.28, 16.01)
as HSV-negative counterparts. HSV-2 was not associated with HIV or HCV in
women. However, controlling for number of lifetime sex partners, women reporting genital ulcers were over three times as likely to be HCV-positive (AOR= 3.54,
0.99, 12.68) compared with those denying genital ulcers.
Conclusions: These data suggest that although sexual transmission of HCV is
thought to be rare, genital ulcerative disease may increase the risk for HCV.

Presenting author: Melissa Marx, 117 South Collington Ave, Baltimore, MD,
21231, United States Territory, Tel.: [phone], Fax: [phone], E-mail:
[email protected]

ThPeC7495 Clinical profile of HIV positive patients with end
stage liver disease attending an outpatient AIDS
Clinical Unit at a University Hospital
D. Fuster1, C. Tural2, H. Guardiola3, J. Tor3, J. Romeu 1, G. Sirera, R. Muga4
A. Ballesteros4, R. Planas6, C. Rey-Joly7, B. Clotet4. IHIV Unit!/Servei de
Medicina Interna, Hospital Gemans Trias i Pujol, Badalona (Barcelona), Spain;
2AIDS Unit!/Servei de Medicina Interna. Hospital Germans Trias i PujoL,
Badalona (Barcelona), Spain; 3AIDS Unit Servei de M. Interna, Hospital
Germans Trias i Pujol, Ctra. Canyet s/n, 08916 Badalona (Barcelona), Spain;
4AIDS Unit! Servei de M. Interna, Hospital Germans Trias i Pujol, Ctra. Canyet
s/n, 08916 Badalona (Barcelona), Spain; 5AIDS Unit Servei de M. Interna,
Hospital Germans Trias i Pujol, Ctra. Canyet s/n, 08916 Badalona (Barcelona),
Spain; 6Servei de Gastroenterologia, Hospital Germans Trias i Pujol, Ctra.
Canyet s/n, 08916 Badalona (Barcelona), Spain; 7AIDS Unit Servei de M.
Interna, Hospital Germans Trias i Pujol, Ctra. Canyet s/n, 08916 Badalona
(Barcelona), Spain
Background: Since the widespread use of HAART, end stage liver disease
(ESLD) is an emerging cause of morbidity and mortality among HIV + patients
(p).
Material and methods: Cross sectional study to describe the prevalence and
characteristics of ESLD in a cohort of HIV + p attending the outpatient AIDS Unit
at the Hospital Universitari Germans Trias i Pujol, during the year 2001.
Results: Thirty- nine p [25 men with a median age of 39 years (range: 30-66)]
with ESLD were identified during the study period. Thirty- seven p were coinfected
with HCV, 8 were also HBsAg + and 1 was coinfected with HDV. Alcohol abuse
was documented in 7 p. The main risk behaviour for HIV acquisition was injecting
drug use (37p/ 39). Eight p had a prior AIDS event. The median CD4+ count was
256 (range: 28-1494). The diagnosis of ESLD was stated with clinical data in 24/
39 p, and with liver biopsy in 15/39. The median Child- Pugh score was 6 (range:
5- 13). Thirty-one p were HAART experienced [median time 48.5 months (3- 67)],
which had to be discontinued in 10 p due to hepatotoxicity. The most frequent
ESLD complication was ascites (18/ 39 p), 5 had presented variceal bleeding,
4 hepatic encephalopathy and 1 spontaneous bacterial peritonitis. Seven p died
due ESLD during the study period, all of them had had a prior ESLD complication,
with a median time of 10 months (range: 1-23) between the first complication and
death. Twelve of the 2000 p attending this outpatient AIDS Unit died during the
year 2001
Conclusions: ESLD is the first cause of death among HIV + p in this study period. The low CD4+ count, the high rate of HAART discontinuation and also the
short time between the first ESLD complication and death are cornerstones in the
clinical management of this population.
Presenting author: Daniel Fuster, AIDS Unit/ Servei de Medicina Interna, Hospital Germans Trias i Pujol, Ctra. Cnyet s/n, 08916 Badalona (Barcelona), Spain,
Tel.: [phone], Fax: [phone], E-mail: [email protected]
ThPeC7496 Multi-center, randomized, open-label study of the
safety and efficacy of Interferon (IFN) alfa-2b plus
Ribavirin (RBV) for the treatment of Hepatitis C
virus (HCV) in HIV-infected persons
M.S. Sulkowskil, F. Felizarta2, J. Slim3, D.T. Dieterich4, R.F. Hudnall5. 'Johns
Hopkins, johns hopkins school of medicine, 1830 monument street, ste. 319,
baltimore, md 21287-003, United States; 2None, Bakersfield, CA, United States;
3None, Newark, NJ, United States; 4NYU, New York, NY, United States;
5Hepatitis Resource Network, Tacoma, WA, United States
Background: HCV is an opportunistic disease due to accelerated liver disease
progression in HIV-infected patients. Few studies have examined the use of
IFN/RBV in HIV-infected pts.
Methods: Open-label, randomized, multicenter trial comparing IFN a2b 3mlU
QD/RBV 800g/d to IFN a2b 3mlU TIW/RBV 800g/d for 48 wks. Inclusion: HIV+,
HCV RNA+, compensated liver disease, and stable antiretroviral therapy (ART >
4wks). Exclusion: active OI, active substance abuse, severe psychiatric disease,
and CD4<100 /mm3. Liver biopsy was recommended. Efficacy outcome: negative serum HCV RNA level (RT-PCR) at 12wks of therapy (early viral response,
EVR) and 24wks after discontinuation (sustained viral response, SVR). Safety
outcomes: AEs, discontinuation, and changes in CD4 count/HIV RNA levels.
Results: 180(QD-90/TIW-90) pts were randomized. Baseline characteristics
(QD/TIW): mean age, 44/44 yrs; Male, 78/74%; Caucasian, 58/44%; IDU,
59/64%; HCV genotype 1, 78/80%; mean HCV RNA level, 5.9/6.0 log/mL; ART
use, 89/82%, mean CD4, 551/533 per mm3, mean HIV RNA, 1531/3698 c/mL.
161 (QD-79/TIW-82) pts received at least one dose of medication; 37 pts (23%;
QD-18/TIW-19) stopped before wk 12. At wk 12, intention-to-treat EVR: QD, 20/79
pts (25.3%) and TIW, 8/82 pts (9.8%) (P=. 01); on-treatment EVR: QD, 20/61 pts
(32.8%) and TIW, 8/63 (12.7%) (P=.01). AEs lead to discontinuation in 20 (10/10)
of 37 pts who stopped before wk 12; most were due to psychiatric (10) or lab
abnormalities (6). 1 of 16 pts who received DDI-based ART developed pancreatitis/lactic acidosis. No increase in HIV RNA was observed in pts who received

D4T or ZDV and RBV.
Conclusions: IFN/RBV QD was significantly more effective than standard TIW at
treatment wkl2, which suggests a higher SVR will be achieved with this regimen
and supports the use of pegylated IFNs. However, the high rate (23%) of discontinuation highlights the impact of treatment side effects and need to develop
strategies to maintain adherence.