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

466 Abstracts ThPeC7519-ThPeC7523

XIV International AIDS Conference

Conclusion: The managed care and the treatment of HIV+/HCV+ patients seem
less efficient than for patients with HCV infection alone.
Presenting author: Gilles Pialoux, ROTHSCHILD HOSPITAL, 33 boulevard de
Picpus 75012 Paris, France, Tel.: [phone], Fax: [phone],
E-mail: [email protected]
ThPeC7519I HCV infection is associated with lower levels of
serum LDL cholesterol and total cholesterol in
HIV-positive individuals
PM. Polgreen1, S.L. Fultz2, A. Justice3, D.J. Diekema1, L. Rabeneck4,
S. Weissman5, J.T Stapleton1. 1Veterans Affairs Medical Center and University
of Iowa, Iowa City, IA, United States; 2 Veterans Affairs Medical Center and
University of Pittsburgh, Pittsburgh, PA, United States; 3 Veterans Affairs Medical
Center and University of Pittsgburgh, Pittsburgh, PA, United States; IVeterans
Affairs Medical Center and Baylor College of Medicine, Houston, TX, United
States; 5Hospital of St. Raphael, New Haven, CT United States
Background: Hypercholesterolemia is increasingly common among HIV infected
people, especially in the era of HAART Hepatitis C virus (HCV) has been shown
to utilize the low density lipoprotein (LDL) receptor for cell binding and entry, associates with LDL and very low density lipoprotein in serum, and is cleared by
LDL apheresis. The effect of HCV infection on serum lipid levels in HIV-positive
individuals is unknown.
Methods: Serum lipid levels from HIV-HCV co-infected individuals were compared with levels in HIV-infected participants without HCV antibody in the Veterans Aging Cohort 3 Site Study (VACS3). Associations of total cholesterol, LDL
cholesterol and HDL cholesterol and HCV infection were determined using multivariate linear regression analysis including relevant covariates (PI, NRTI, and
NNRTI use, "statin", niacin, and fibrate use, age, gender, race, ALT, AST, glucose,
HIV viral load, CD4+ count, HIV transmission category, current ethanol use, past
ethanol use and the presence of binge drinking).
Results: Multivariate linear regression revealed that HCV infection was independently associated with lower LDL cholesterol (p<0.001; n=409) and total cholesterol levels (p<0.001; n=606). Protease inhibitor use was associated with higher
LDL and total cholesterol (p<0.001 for both). Neither HCV infection nor PI use
was significantly associated with HDL cholesterol level (n=408). There was no
association between cholesterol levels and the use of lipid-lowering medications,
age, gender, HIV transmission category, HIV RNA levels, ALT or AST levels.
Conclusions: HCV co-infection was associated with lower LDL and total cholesterol levels in HIV-infected people. Further characterization of this association and
its relationship to HIV therapy and underlying hepatic disease is underway.
Presenting author: Jack Stapleton, University of Iowa, Dept. of Internal
Medicine, SW 34 GH, Iowa City, IA, United States, E-mail: jack-stapleton@uiowa.
edu
ThPeC7520 Orthotopic liver transplantation (OIt) in Hiv-1
infected patients: Evaluation of a protocol to select
appropriate candidates (1999-2001)
J. Murillas, J.M. Miro, A. Rimola, L. Grande, A. Moreno, N. De Benito, J. Blanch,
M. Monras, J.M. Gatell. Hospital Clinic-IDIBAPS, Barcelona, Spain
Objectives: to evaluate the capacity of an OLT protocol to select appropriate
candidates for OLT in Spanish HIV-1-infected patients.
Methods: The OLT protocol for HIV-1- infected patients was designed in 1999 for
the Transplant Organization of Catalonia (OCATT). Liver criteria: HIV-1 infected
patients with end stage liver disease (ESLD) with any complication were evaluated for OLT. HIV-1 infection criteria: long term non-progressors (LTNP) or no
previous C events (but pulmonary tuberculosis), CD4 cell count >200 cells/ tL
and undetectable HIV-1 RNA plasma viral load (PVL, <200 copies/ml) on antiretroviral therapy (ART). Drug abuse criteria: no heroin or cocaine abuse in the
last two years and no alcohol consumption in the last 6 months. The protocol was
modified in June 2001: patients with >100 CD4 cells/lL were admitted if they
had a percentage higher than 20%, and undetectable PVL with ART was only
necessary at the time of OLT.
Results: 33 HIV-1-infected patients with ESLD were evaluated in the last 3 years.
28 patients were not considerated candidates for OLT due to: previous C events
in 20 cases, CD4 cell count <200 cel/il in 13 cases and/or to have a Child-Pugh A
class in 8 cases. 5 patients with ESLD met the inclusion criteria were included in
the general OLT waiting list of our institution. 4 were males, median age 36 years
(28-41), all were formers iv drug abusers. The etiology was HCV in all of them,
one coinfected with HBV. The median CD4 cell count was 440 cel/ il (105-799)
and PVL was undetectable in 4 cases, the fifth was a LTNP with CD4 cell count
>500 cells/lL and PVL of 7,110 copies/ml without ART. Four out of five have
died while were in the OLT waiting list. The median time in the waiting list was 3
months (1-6).
Conclusion: Only 15% of HIV-1 infected patients with ESLD were candidates for

OLT in this protocol. These patients had a high mortality ratio while were in the
OLT waiting list and this should be taken into account in this protocol.
Presenting author: Javier Murillas, Hospital Clinic, Villaroel, 170, Barcelona,
Spain, Tel.: [phone], E-mail: [email protected]

ThPeC7521I No increase in mortality among patients with
HIV-HCV coinfection: a retrospective study
G. Fibbia, S. Miccolis, D. Tomasoni, G. Gattuso, A. Scalzini. Infectious Diseases
Division, Mantova, Italy
Background: In the last years the mortality in HIV-1 positive patients with the
advent of HAART has observed a dramatic decline. Some authors report an increase in mortality and morbidity rates related to cirrhosis and its complications
in HIV-HCV coinfected patients. Other authors described no difference in mortality HCV-related cirrhosis in HIV positive patients before and after the HAART
introduction.
Methods: At our institution the rate of HCV infection in HIV-1 positive patients is
of 55% with the majority of subjects belonging to IVDU category We evaluated
retospectively the incidence of mortality in our HIV-1 population of patients due
to HIV/AIDS and to HCV related cirrhosis in two different period (1994-1996 and
1997-2001).
Results: Since 1994 to 1996 (3 years of observation) the mortality in HIV positive
patients was overall of 81 subjects; of these 72 (88,9%) for AIDS and 9 (11,1%)
for HCV-related cirrhosis. In the period after the beginning of HAART (1997-2001;
5 years) the mortality was of 45 patients of whom 30 (66,7%) for AIDS and 15
(33,3%) for cirrhosis. The incidence of mortality in 1994-1996 years was of 24
cases/year for AIDS and 3 cases/year for HCV related cirrhosis; since 1997 to
2001 the mortality was of 6 cases/year and 3 cases/year respectively for AIDS
and cirrhosis. The mean decline for AIDS mortality was of 75% for year.
Conclusions: In our retrospective study there was been a significant decline in
mortality due to HIV infection after the introduction af HAART. The absolute mortality due to HCV in the two period of observation was unchanged. The higher
mortality rates in 1997-2001 than in 1994-1996 is only related to the decline in
HIV mortality rate.
Presenting author: Giancarlo Fibbia, Infectious Diseases Division, 46100, Viale
Albertoni 1, 46100 Mantova, Italy, Tel.: [phone], Fax: [phone], Email: [email protected]
ThPeC7522 Decline in prevalence of HBV and HIV serologic
markers and co-infection among voluntary testers.
Madrid, 1988-2000
C. Rodriguez 1, J. del Romero', P. Clavo1, J. Ballesteros', A. Lillol,
A. Sanabria1, J. Castilla2. 1 Centro Sanitario Sandoval, Servicio Regional de
Salud, Sandoval, 7., 28010, Madrid, Spain; 2Centro Nacional de Epidemiologia
(ISCIII) y Secretaria del Plan Nacional sobre Sida, Madrid, Spain
Background: We analysed prevalence of HBV and HIV serologic markers, and
co-infection among persons attended in a clinic in Madrid, and evaluated the impact of hepatitis B vaccination.
Methods: 22,855 patients attended for the first time in a STD/HIV clinic of Madrid
between 1988 an 2000 were included. Information concerning parenteral and sexual risk exposures, and previous vaccination for hepatitis B was recorded. Serological determinations of HIV and HBV markers were carried out.
Results: The annual number of patients varied between 1492 and 2483. The proportion of first visit patients who had got vaccinated was lower than 0.1% in 1988
and in 2000 reached 22% among injected drug users (IDU), 22% among men
who had sex with men (MSM), 2% among female sex workers, and 16% among
other heterosexuals. Prevalence of anti-HBc+ markers among IDU remained high,
reaching 70% in 1988 and 66% in 2000; among female sex workers it descended
from 24% to 9%, among MSM from 43% to 23% and among other heterosexuals from 19% to 9%. Similarly, HIV prevalence among IDU stayed high, reaching
48% in 1988 and 48% in 2000, whereas among female sex workers it diminished
from 2.4% to 0.6% and among MSM from 25% to 8%. Among non IDU heterosexual persons, HIV prevalence did not show a definite tendency, with 2.8% in
1988 and 2.2% in 2000. HIV/ HBV (HBs-Ag+) co-infection lessened among IDU,
passing from 6.2% in 1988 to 3.4% in 2000, and among MSM it decreased from
2.5% to 0.70/%. Not one of the 3714 female sex workers and only 10 of the 8274
heterosexual non-IDU patients presented co-infection.
Conclusions: Prevalence of HIV and HBV markers and of co-infection have diminished significantly among MSM and female sex workers. This seems to suggest that the decrease of markers to both viruses is mainly due to a reduction in
risk behaviours. Among IDU, both markers and co-infection have remained high.
The impact of HBV vaccination in the populations we studied still remains limited.
Presenting author: Carmen Rodriguez, Sandoval, 7., 28010, Madrid, Spain, Tel.:
[phone], Fax: [phone], E-mail: [email protected]
ThPeC7523 Prevention of Hepatitis-B infection needs public
health attention
S. Agrawal1, A. Gupta2. 1Swasthya Kalyan Blood Bank, Jaipur, India; 2Raj State
Blood Transfusion Council, Jaipur, India

Background: Hepatitis-B infection is more common than HIV and HCV Infection
in blood donors. Human are the only reservoir for Hepatitis-B virus. Virus is highly
infectious. The rate of infection varies from 0.01 to 30 % from one country to another. In India the prevalence of Hepatitis-B is 3 to 15 %. This is also confirmed
from the data of blood banks. The infection of Hepatitis-B also transmits by the
same routes as HIV. It is true that vaccine is available for this disease but this
disease has not taken as Public Health Importance as HIV.