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

462 Abstracts ThPeC7502-ThPeC7505

XIV International AIDS Conference

Conclusion: HCV infection is highly prevalent among HIV patients Mostly they
were infected with HCV-lb.
Presenting author: Waqar Al Kubaisy, Hay Babil Mahalla 929 Zukak 7 No 46,
Baghdad, Iraq, Tel.: [phone], Fax: [phone], E-mail: [email protected]
ThPeC7502 The effect of HIV-HCV coinfection in a cohort of
HIV-serconverters before and after the introduction
of HAART
M. Dorrucci', C. Valdarchi', F. Castelli2, M. Zaccarelli3, P. Pezzottil, G. Rezza'.
1Istituto Superiore di Sanita, Viale Regina 299 - 00161 Rome Italy, Italy; 2Clinica
Malattie Infettive Universita, Brescia, Italy; 31stituto Nazionale Malattie Infettive L.
Spallanzanh Rome, Italy
Backround: The introduction of HAART and the consequent increase in survival
among HIV-infected persons has exacerbated the problem of co-infection with
hepatitis C virus (HCV). However, the effect of co-infection on HIV-disease progression remains unclear. The objective of this study was to evaluate this effect,
comparing co-infected persons to those infected with HIV only
Methods: We conducted a prospective incidence cohort study (part of the Italian
Seroconversion Study). Time zero of analysis was the estimated date of HIVseroconversion (midpoint in time between the last negative and the first positive
HIV test). Multivariate Cox models were used to evaluate the effect of co-infection
on HIV-disease progression, using AIDS as the end-point. Analyses were repeated with time zero set at the date of HCV testing.
Results: We followed 558 HIV-seroconverters for a median time of 8 years; 343
(61%) were males and 215 (39%) females. The most common HIV transmission category was intravenous drug use (IDUs) (59% of seroconverters). The
median age was 27 years. A total of 349 (62%) persons were co-infected, and
IDUs were more likely to be co-infected than non-IDUs (92% vs. 20%; p<0.001).
The age-adjusted relative hazard (RH) of progressing to AIDS was 1.07 (95%Cl:
0.70-1.62) for the co-infected persons vs. those with HIV infection only. When
considering only IDUs, the RH of progressing to AIDS was 0.85 for co-infected
persons (95%CI: 0.40-1.83). Before the introduction of HAART (June 1996), the
RH of AIDS was 0.72 (95%CI: 0.47-1.13) for co-infected persons vs. those with
HIV infection only; after the introduction of HAART, it was 1.63 (95% Cl: 0.81 -3.27).
Conclusions: Co-infection does not appear to significantly increase the risk of
HIV-disease progression. However, the population-effect of HAART seems to be
smaller among co-infected persons, which could be related to the hepato-toxic
effects of HAART.
Presenting author: Maria Dorrucci, Viale Regina 299 - 00161 Rome Italy, Italy,
Tel.: [phone], Fax: [phone], E-mail: maria.dorrucci @ iss.it
ThPeC7503 Effect of Maternal HIV Co-infection on Vertical
Transmission of Hepatitis C Virus (HCV): A
Meta-analysis
B.L. Pappalardo. Blood Centers of the Pacific, B/lood Centers of the Pacific, 270
Masonic Ave., San Francisco, CA, 94118, United States
Background: Maternal co-infection with HIV has been implicated as a potentially
important co-factor for enhanced vertical transmission of HCV. However, in the
studies published to date, small sample sizes and lack of a consistent diagnostic
definition of pediatric infection have limited accurate evaluation of HCV vertical
transmission from mothers with and without concomitant HIV infection.
Methods: Meta-analysis of published and unpublished studies of HCV vertical
transmission from HCV-infected mothers with and without HIV co-infection. Standardized diagnostic criteria were utilized to minimize methodological heterogeneity between studies. Odds ratios (OR) and 95% confidence intervals (Cl) for individual studies were calculated with maternal HIV serostatus as the exposure
measure and HCV vertical transmission as the outcome measure. Overall summary estimates were calculated using a random effects model that estimated a
weighted average of OR from individual studies.
Results: In total, 1010 infants from 9 studies were included in an analysis of
HCV-infected mothers (defined by anti-HCV+ antibody assays). The overall risk
of HCV vertical transmission was 3.48 (95% Cl: 2.04-5.95; p=0.00001) for infants
born to anti-HCV+/HIV+ co-infected mothers compared with infants born to antiHCV+/HIV- mothers. In a subanalysis of 430 infants born to viremic (HCV RNA+)
mothers, the overall risk of HCV vertical transmission was 2.22 (95% Cl: 0.98 -5.03; p=0.06) for infants born to HCV viremic/HIV+ co-infected mothers compared
with infants born to HCV viremic/HIV- mothers.
Conclusions: The risk of HCV vertical transmission appears to be due primarily
to the presence of detectable maternal HCV RNA which may be higher in mothers
with immunosuppression secondary to HIV co-infection.
Presenting author: Brandee Pappalardo, Blood Centers of the Pacific, 270 Ma
sonic Ave., San Francisco,CA, 94118, United States, Tel.: [phone], Fax:
[phone], E-mail: bpappalardo @ bloodcenters.org

ThPeC7504 Absence of Hepatitis C Virus (HCV) infection
amoung HIV-infected U.S. military members
N.F. Crum', S.K. Brodine2, M. Grillo', M.R. Wallace'. 'NavalMedical/Center,
San Diego, naval medical center, infectious diseases, 34800 bob wilson drive,
san diego ca 92134, United States; 2San Diego State Univ, San Diego, United
States
Background: An estimated 170 million people worldwide are seropositive for
HCV including 3 million in the U.S. Approximately 30% of HIV-infected persons
living in the U.S. are coinfected with HCV. HCV is an opportunistic infection due
to its rapid progression and severe complications in HIV-infected persons. We assessed the risk of HCV-HIV coinfection in a cohort of recent HIV seroconverters.
Methods: One hundred eighty-six U.S. military members who were recent
HIV seroconverters during 1994-2001 participated. Questionnaire data including
demographics and potential risk factors, and hepatitis C serologies by enzyme
immunoassay were collected.
Results: Over an eight-year period, only 1 of 186 (0.5%) was positive for HCVHIV coinfection. Most were male (98%) with a median age of 28 years (range
19-44)and 98% were born in the U.S. All participants denied intravenous drug
use on a confidential survey; 12% reported body piercing, 12% tattoo 2% blood
transfusion, and 3% needlestick injury The HCV positive patient was born in the
U.S., denied parental exposures except for a blood transfusion in 1996.
Conclusions: U.S. military members with HIV seroconversion since 1994 have
an extremely low rate of HCV coinfection compared to other
HIV-infected populations. Only 0.5% of the group had HCV whereas the
U.S. average is 30% among HIV-infected persons. HCV is primarily transmitted
via parental routes including drug use (intravenous and intranasal), unscreened
blood products, and rarely by sexual activity
The low seroprevalence in our study group is due to the 'no drug use' policy in the
U.S. military, whereby members undergo periodic, random drug screenings. The
route of transmission in the single HCV-positive patient is unknown; he denied
drug use. This data suggests that aggressive anti-drug measures are extremely
effective in preventing hepatitis C coinfection in HIV-infected persons.
Presenting author: nancy crum, naval medical center, infectious diseases,
34800 bob wilson drive, san diego ca 92134, United States, Tel.: [phone],
Fax: [phone], E-mail: [email protected]
ThPeC7505 Hepatitis C virus co-infection in PLWHA from
Santos, Brazil: prevalence and associated risk
factors
P.E. Braga', A. Etzel2, M.R.A. Cardoso', A.C. Segurado3. 1Department of
Epidemiology, School of Public Health, University of Sao Paulo, Sao Paulo,
Brazil; 2Santos AIDS Reference Center, Santos, Brazil; 3Department of
Infectious Diseases, School of Medicine, University of Sao Paulo, Av. Dr Eneas
de Carva/ho Aguiar 470, Sao Paulo, Brazil
Background: Hepatitis C virus (HCV) co-infection is frequent in people living with
HIV/AIDS (PLWHA), due to their modes of transmission, what may contribute significantly for higher morbidity and mortality
Methods: To clarify the modes of acquisition of these viruses in Santos, Brazil, we
conducted a seroprevalence study of HCV infection in 495 HIV-infected patients,
assisted at an HIV/AIDS reference center in Santos, from February 1997 to January 1998, as well as the investigation of association between HCV seropositivity
and exposure to sexually and blood-transmitted agents. Patients were considered HCV-seropositive if they exhibited seroreactivity in two enzymeimmunoassays (Boehringer-Mannheim and Roche).
Results: HCV seroprevalence was 36.2% (CI95% 31.9-40.4). HCV infection was
more frequent (85.7% C195% 78.2-91.3) in IVDUs than among non drug users
(20.9% C195% 16.8-25.1, p<0.001). Using a multiple logistic regression model
adjusted for sex, age and education, we investigated factors possibly associated
to HCV infection, separately for IVDUs and non IVDUs. Among IVDUs, HCV coinfection was associated with needle sharing (OR=4.2 CI95% 0.9-19.0, p=0.06),
HBV (anti-HBc) (OR=4.4; CI95% 1.3-14.6, p=0.01) and HTLV-I/ll seropositivities
(OR=6.4 CI95% 1.0-38.8, p=0.02), but not with number of lifetime sexual partners, previous STD, intercourse with sex workers or HHV-8 seropositivity. Among
non IVDUs, HCV co-infection was associated with sexual partnership with IVDU
(OR=2.1 CI95% 1.0-4.3, p=0.07), anti-HBc seropositivity (OR=1.7; CI95% 1.0 -2.9, p=0.05) and negatively associated with HHV-8 infection (OR=0.3 CI95% 0.1 -0.8, p=0.01). In this group HCV seropositivity was not associated with HTLV-I/II
infection and sexual practices including receptive anal intercourse, oral sex or sex
with sex workers.
Conclusions: Exposure to blood can be regarded as an important risk factor for
the acquisition of HCV co-infection among PLWHA in Santos, Brazil.
Presenting author: Aluisio Segurado, Av. Dr. Eneas de Carvalho Aguiar 470,
Sao Paulo, Brazil, Tel.: [phone], Fax: [phone], E-mail: segurado
@usp.br