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

464 Abstracts ThPeC7510-ThPeC7514

XIV International AIDS Conference

ThPeC751 0 HIV and hepatitis C virus co-infection in the UFO
cohort of young injection drug users in San
Francisco
K. Page-Shafer, P. Lum, J. Hahn, J. Evans, E. Stein, P. Davidson, P. Bourgois,
A. Moss. University of California, San Francisco, CA, United States
Background: High rates of viral hepatitis infections have persisted among injection drug users (IDU) despite intensive interventions. We examine rates and risk
factors for HIV and hepatitis C virus (HCV) co-infection in an HCV negative cohort
of young IDU in San Francisco.
Methods: Young (<30 yrs) IDUs were recruited into a cohort study by street outreach workers in San Francisco, from Jan, 2000 to Dec, 2001. At baseline and
follow-up participants were interviewed and tested for anti-HCV, hepatitis B virus
(HBV) and HIV.
Results: 840 young IDU were screened, 316 (38%) recruited, and 209 (66%)
were followed. At baseline, 3.95% were HIV positive (+), 21.3% HBV+, 38.1%
anti-HCV+; 22 (3%) were HIV/HCV co-infected. Prevalent HIV/HCV co-infection
was independently associated with age (per year increase) (OR=1.2, 95% CI,
1.06-1.4), no high school (HS) vs. > HS (OR=1 1.0, 95% CI, 2.5-48.3), and history
of sex work vs. no history (OR=6.0, 95% CI, 2.1-17.2). Of 209 anti-HCV negative
young IDU, 5 (2%) were HIV+. Seroconversion rates for HCV were 28 per 100
person years of observation (pyo); 40/100 pyo among females and 22/100 pyo
among males (P=0.06). Only 1 HIV seroconversion was observed (0.6/100 pyo)
in the cohort. The 5 HIV+ cohort members were distinguished from HIV negatives
by the following characteristics: 100% are MSM compared 40% of HIV-negatives.
HIV+'s were more likely to report: a recent STD (33% vs 3%, p=0.02); a history
of sex work (50% vs. 25%, p=0.02), and consistent condom use (67% vs. 23%,
p=0.13); and less likely to report borrowing needles (17% vs. 66%, p=0.03).
Conclusions: HIV/HCV co-infection is not highly prevalent among young IDU in
San Francisco, despite a high incidence and prevalence of HCV. HIV infection is
concentrated in a high-risk sub-population of MSM who have increased sexual
risk. Early and targeted prevention for HIV and HCV needs to focus on reducing
sexual and parenteral risk, respectively.
Presenting author: Kimberly Page-Shafer, 74 New Montgomery, Ste 600, San
Francisco, CA, United States, Tel.: [phone], Fax: [phone], Email: [email protected]
ThPeC7511 1Morbidity and mortality by hepatitis C virus (HCV)
infection and HCV genotype in a cohort of HIV
positive hemophilics in Madrid; 1979 to 2000
M. Quintana', A. Barrasa2, J. Del Amo3, I. Ferreros4, S. Perez-Hoyos4,
A. Villar1, V. Jimenez1, J. Gago 1, F. Hernandez1. 1Hospital La Paz, C/Sinesio
Delgado no 6, Madrid, 28029, Spain; 2Centro Nacional de Epidemiologia,
Madrid, Spain; 3Plan Nacional sobre Sida, Madrid, Spain; 4Escuela Valenciana
de Estudios para la Salud, Valencia, Spain
Background: To study morbidity and mortality by HCV infection and to describe
the distribution of HCV genotypes in a cohort of 370 HIV positive haemophilics
Methods: All HIV positive patients seen from 1979 to 2000 in a tertiary referral hospital for the treatment of haemophilia in Madrid were included. Information on demographic, clinical, immunological and treatment characteristics, HCV
co-infection and HCV genotype was recorded. Diagnoses of HCV infection were
established through a positive HCV antibody test and a positive PCR. HCV genotypes were performed by INNO-LIPA technique.
Results: Median date of first HIV positive test was 1985; median date of diagnosis of HCV infection was 1994. Of 370 haemophilics, 282 (76%) were co-infected
with HCV and 79 had HCV genotypes performed. 28 (35%) had genotype la, 26
(33%) type 1 b, 3 (4%) type 2b, 9 (11%) type 3, 9 (11%) had both types l1a and
1 b, 2 (3%) had both types l1a and 4, 1 (1%) had both types 2a and 2c and 1 (1%)
had 3 different types of genotype 2a and l1b and 2c. Over half (54%) were diagnosed with HCV infection between 1992-96 and 26% after 1996. Among patients
co-infected with HCV, 19 (5%) persons developed cirrhosis. 18 (7.5%) persons
died of cirrhosis, 10 (8%) before 92, 3 (3%) between 92-96 and 5 (13%) after 96.
There were 13 (5%) pre-AIDS deaths (3 due to unknown causes) of which 10
were due to cirrhosis, 4 of them occurring after 1996.
Conclusions: There is considerable heterogeneity of HCV genotypes in HIVHCV co-infected haemophilics in Spain as a consequence of the utilisation of
imported plasma factors. HCV infection is a leading cause of death among HIV
positive haemophilics, which is increasing as a result of the prolonged life expectancy secondary to potent antiretroviral treatment. The impact of HCV genotype on HIV progression and on response to treatment of HCV infection in this
cohort needs to be evaluated.
Presenting author: Alicia Barrasa, C/ Sinesio Delgado n 6, Madrid, 28029,
Spain, Tel.: [phone], Fax: [phone], E-mail: [email protected]

ThPeC7512I A pilot program for treating hepatitis C in
HIV/hepatitis C virus coinfected individuals with
comorbid psychiatric illness and/or addiction
L.E. Taylor, B. Schwartzapfel, C. MacLeod, E.R. Feller, J.D. Rich, K.T Tashima.
The Miriam Hospital/Brown University, Providence RI, United States
Issues: HIV/Hepatitis C virus (HCV) coinfected patients are at increased risk for
HCV disease progression. Interferon, the mainstay of therapy, has been asso
ciated with depression, suicide and addiction relapse. In the U.S. because most
people acquire HCV through injection drug use, prevalence of addiction and mental illness among this population is high, limiting HCV treatment. Yet unless we are
able to treat coinfected patients with these comorbidities, those most affected by
HCV will go untreated. We developed an intervention to support coinfected patients with psychiatric and/or substance disorders through HCV treatment.
Description: 38 patients (34% female, mean age 45, 95% history addiction, 84%
mental illness) were evaluated. Of 23 patients biopsied, 4 were stage 1; 5 stage 2;
8 stage 3; 6 cirrhotic. Three developed decompensated liver disease during evaluation. After months in which no patients started pegylated interferon/ribavirin
given concerns about psychiatric effects, we devised a pilot intervention to safely
treat to those needing life-saving medication. Individualized care plans involving HIV specialists, hepatologist, nurse and psychiatrist were created. Frequent
home contact with an outreach worker and collaboration between members of the
multidiciplinary team enhanced adherence and allowed for rapid assessment and
response to side effects. Thus far our first 2 patients have had virologic response
with no serious adverse effects.
Lessons learned: It is feasible, safe and effective to treat HIV+ patients with
mental illness and/or addiction for HCV with individualized intensive psychosocial
and medical support.
Recommendations: Withholding HCV treatment from coinfected patients for reasons of addiction, psychiatric history or psychosocial instability place those most
in need of treatment at risk for disease progression. Guidelines for HCV treatment
should include consideration of coinfected patients on a case-by-case basis.
Presenting author: Lynn E. Taylor, The Miriam Hospital, 164 Summit Ave, Providence RI 02906, United States, Tel.: [phone], Fax: [phone],
E-mail: [email protected]
ThPeC7513 Addiction and mental illness are barriers to
Hepatitis C treatment among HIV/Hepatitis C virus
coinfected individuals
L.E. Taylor, K.T. Tashima, E. Alt, E.R. Feller, T. Costello, T.P. Flanigan. Brown
University miriam hospital, 164 summit ave., providence, ri, 02906, United States
Issues: HIV/Hepatitis C virus (HCV) coinfected patients are at increased risk for
HCV disease progression. Treatment for these individuals is limited. We investigated why 46 of 51 coinfected patients were not enrolled in an HCV treatment
trial.
Description: Patients evaluated in a coinfection clinic were screened for eligibility
to participate in an HCV therapy study. Reasons for not enrolling were recorded
and analyzed. Twelve patients (26%) were excluded due to psychiatric illness,
9 (20%) for active drug use, 3 (6.5%) for previous interferon/ribavirin and 12
(26%) declined the study. Twenty-seven(58%) were excluded for other medical
reasons including hematological abnormalities; thyroid, cardiac or pulmonary disease; normal ALT.
Lessons learned: These results are important for coinfected patients seeking
treatment. In the U.S. the main route of HCV acquisition is injection drug use.
Yet those using drugs are excluded from studies. The number of active drug
users indicates the need to reconsider whether this group should be excluded
and whether patients should be evaluated on an individual basis. Interferon has
been associated with depression and suicide, limiting treatment for those with
mental illness. The prevalence of psychiatric disorders suggests the need for development of a multidisciplinary treatment and support program. For 4 of the 10
patients with normal ALT levels, this was their only exclusion criterion. Normal
ALT levels do not always correlate with lack of pathological findings. Patient were
excluded for hematologic reasons. Use of GCSF and/or erythropoietin may allow
patients to be treated. Many chose not to participate due to the rigorous treatment
regime and time commitment, highlighting that treatment is difficult to tolerate.
Recommendation: There is an urgent need to determine effective treatment for
coinfected patients with psychiatric illness and addiction comorbidities, and for
improved, more inclusive HCV treatment.
Presenting author: lynn taylor, miriam hospital, 164 summit ave., providence,
ri, 2906, United States, Tel.: [phone], Fax: [phone], E-mail: Itaylor
@lifespan.org
ThPeC7514 The dynamics of the HIV and HCV epidemics
among Injecting Drug Users (IDU) living in South of
Brazil and attending Syringe Exchange Programs
(SEP): an analysis of two cross-sectional studies
W.T. Caiaffa1, FA. Proietti1, A.B. Carneiro-Proietti2, D. Doneda3, D. Gandolfi3,
A.C.M. Reis1, S.A. Mingoti1, T.H.E. AJUDE-Brasil Project4. 1Federal University
of Minas Gerais, Rua Monte Alegre 797 apto 302, 30240-230 Belo Horizonte,
Minas Gerais, Brazil; 2Hemominas Foundation, Belo Horizonte, Brazil; 3Ministry
of Health, Braslia, Brazil; 4Brazilian AIDS/STD Program & UFMG, Belo
Horizonte, Brazil

Background: Special attention has been devoted to the Southern part of Brazil,
where the HIV epidemic has concentrated in IDU, their partners and concepts,
provoking a shift in the epidemic pattern. This study aimed to investigate evidences of an increased HIV and HCV infections in South of Brazil on IDU.
Methods: The AjUDE I and II were two cross-sectional studies carried out in
Brazil in 1998 and 2000. IDU attending SEP were interviewed.
HIV and HCV serology using spot blood and paper filter were tested by ELISA.