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

468 Abstracts ThPeC7528-ThPeC7532

XIV International AIDS Conference

Presenting author: Yves Benhamou, GH Pitie-Salpetriere, 47-83 Parc Boulevard, Paris, 75013, France, Tel.: [phone], Fax: [phone], E-mail:
[email protected]
ThPeC7528I Safety and efficacy of long-term adefovir dipivoxil
(ADV) for lamivudine-resistant (Lam-R) HBV in HIV
infected patients
Y Benhamou1, M. Bochet1, V. Thibault', V. Calvez', M.H. Fievet1, M. Sullivan2,
C. Brosgart2, H. Namini2, T. Poynard1, C. Katlama'. 1GH Pitie-Salpetriere, GH
Pitie-Salpetriere, 47-83 Parc Boulevard, Paris, 75013, France; 2Gilead Sciences,
Foster City, France
Background: LAM-R has been associated with progressive liver disease. The
incidence of LAM-R increases with increasing duration of treatment: after four
years, approximately 90% of HIV/HBV co-infected patients are LAM-R.
Objective: To evaluate the long-term safety and efficacy of ADV 10mg qd for the
treatment of LAM-R HBV in HIV/HBV co-infection.
Methods: Thirty-five patients with HIV RNA <2.6 loglo copies/mL and confirmed
YMDD mutations were enrolled in this ongoing study. ADV 10mg was added to
concurrent LAM (in background anti-HIV therapy).
Results: Thirty-four males/1 female with median LAM exposure of 21.3~10
months were enrolled. Four patients discontinued for reasons unrelated to ADV.
Median time on ADV was 72 (68-72) weeks. Fourteen patients had paired biopsies (pre-treatment and year 1): median METAVIR scores decreased from A2
(range 0-3) and F3 (0-4) pretreatment to Al (0-2) (p=0.02) and F2 (0-3) at
one year. At W72, mean (~SE) ALT changed from baseline (102.4~11.56 IU/L)
by -48.20~14.39 IU/L (p<0.001). Mean serum HBV DNA (Roche PCR, logio
copies/mL) steadily declined from baseline (8.64~0.08) by -4.80 ~1.15 at W72
(p<0.0001): 9/31 (29%) patients were PCR negative (<3 logio copies/mL). No resistance or HBV DNA rebound has been seen to date. Of the 33 HBeAg+ patients
at baseline, 3 (9%) seroconverted by W72. No significant changes in laboratory
parameters were observed. ADV was generally well tolerated.
Conclusion: Seventy-two weeks of ADV 10mg daily is well tolerated, results in
significant histological improvement, continued decline of serum HBV DNA and
ALT, and HBeAg seroconversion in HIV/HBV co-infected patients.
Presenting author: Yves Benhamou, GH Pitie-Salpetriere, 47-83 Parc Boulevard, Paris, 75013, France, Tel.: [phone], Fax: [phone], E-mail:
[email protected]
ThPeC7529 Geographical variation of Hepatitis B infection
among HIV infected South Africans
M.C. DohertyV1, R. Phili2, A. Mafokhola2, E. Vardas2. 1Massachusetts General
Hospital, Cambridge, MA, United States; 2Perinatal HIV Research Unit Chris
Hani Baragwanath Hospital, Johannesburg, South Africa
Background: Hepatitis is endemic in South Africa with HBsAg carrier rates of
10-25% in adults depending on geographic location. We studied factors associated with infectious and past hepatitis B infection in a sample of HIV positive and
negative persons.
Methods: 241 adults (1/3 HIV negative, 1/3 HIV infected, 1/3 with AIDS) were
studied in Soweto and Durban, South Africa from 2000 to 2001. Immunological
markers of HIV, HBsAg, HBeAg, HBcAb, HCV, CD4 count and viral load (VL)
were measured using standard assays. Logistic regression was used to identify
correlates associated with infectious and past hepatitis infection while adjusting
for cofounders.
Results: Of 241 persons enrolled, 51% lived in Soweto, 49% lived in Durban,
mean age=30, mean CD4 count=291, median VL=90,600 copies. 16 (6.6%) were
positive for HBsAg, 6 (2.4%) were also positive for HBeAg representing highly infectious carriers of hepatitis B. 44 (18.3%) were positive for HBcAb representing
natural past infection. There were no overlaps between HBsAg and HBcAb and
no HCV infections. Correlates independently associated with infectious HBV carriage included living in Durban (Adjusted OR [AOR] =3.8; 01:1.2-12.3) and HIV+
(AOR=5.2; 01:1.1-23.6). Independent correlates of past HBV infection included
living in Soweto (AOR=25 C1:7.2-83.3), and CD4 >200 (AOR=1.3 C1:1.1-1.5) controlling for HIV infection. Age, gender and viral load did not explain differences in
Hepatitis B markers by location.
Conclusions: This study revealed significant geographic variability in markers
of hepatitis infection, with Durban in KwaZulu-Natal province with higher carrier
rates. This province has the highest HIV rates and our sample might represent
newer HIV and HBV infections. HBV carriage may increase the risk of HIV acquisition; more studies over time on HBV and HIV interactions in South Africa are
warranted.
Presenting author: Meg Doherty, 2 Greenough Avenue, Apt #1, Cambridge, MA
02139, United States, Tel.: [phone], E-mail: [email protected]

ThPeC7530 High HBV prevalence and low HIV prevalence in
rural Gabon
M. Makuwa1, S. Souquiere1, I. Bedjabagal, T. Niangui1, F. Simon2, P. Roques'.
1 C/RMF, Virologie, CHU, Rouen, France; 2CHU, Rouen, France
Background: Previous studies carried out in Gabon showed a relatively low HIV
prevalence (0.3-2%) in contrast to a high frequency of HBV infection (>8%). In or
der to assess the specificity and geographical distribution of HBV and HIV strains
a transversal study was conducted in the eastern provinces of Gabon.
Methods: 313 subjects (mean age=38 years, M/F=1.03) living in 5 villages close
to the equator line were tested for the presence of HIV and HBV markers (HbsAg,
HbcAb, HbsAb). A fragment of HBV gene env (700bp) was amplified Sequences
were aligned with those previously published using Clustal W.(1.7) and phylogenetic analysis was performed with PAUP.4.
Results: The overall HIV prevalence in this area of rural Gabon was 0.7%. The
overall HbcAb prevalence in the villages was 76.7%; 9.6% of subjects tested were
HbsAg+; only 10% of the population had been immunized against HBV infection.
All HBV strains sequenced except two belonged to HBV subtype A, which was
common for all villages. Two HBV strains from patients originating from the same
village were closely related to HBV-C and HBV-E subtypes, respectively.
Conclusion: These results confirmed the very high prevalence in this area despite a vaccination initiative conducted in the end of 1980s. The discrepancy between HBV and HIV prevalences remains to be explain
Presenting author: Frangois Simon, VIROLOGIE, CHU, ROUEN, 76031,
France, Tel.: [phone], Fax: [phone], E-mail: francois.simon
@chu-rouen.fr
ThPeC7531 Tolerability of Pegylated Interferon and Ribavirin in
the HIV/HCV co-infected population
S. Hopkins, F. Lyons, E. Brannigan, F Mulcahy, C. Bergin. St. Jamess Hospital
Dept. of Genitourinary Medicine & Infectious Diseases, GUIDE Clinic, St.
James's Hospital, James's St, Dublin 8, Ireland
Background: With the advent of highly active antiretroviral therapy, the prognosis
of HIV+ patients has altered. End stage liver disease is an increasing cause of
morbidity and mortality in those patients co-infected with HCV.
Methods: All co-infected patients are followed at a designated treatment clinic. All
patients are eligible if they are virologically suppressed with a CD4 count > 200
x 106/ml, or do not currently need HAART as per current international guidelines
and fulfil treatment criteria for HCV.
Results: 16 patients (M:F;12:4) have commenced therapy 87.5% contracted HIV
and HCV through IDU. 8 patients are currently on Methadone maintenance therapy. Mean age is 37.9 yrs(R 28-49). 10 patients are on HAART with viral loads
<50cpm and mean CD4 536 x 106/mI. 6 patients are not on HAART with mean
VL 21888 and mean CD4 536x 106/mI. 10 are genotype 3 and 6 are genotype
1. Mean biopsy score is 3.7/6. Side effects to date are flu like symptoms (100%),
diarrhoea (8%), headache (64%), itch/ dry skin (32%) and alopecia (8%). The
mean weight loss was 4.5kg (range 2 - 10kg) over the first four weeks. Haematological side effects have occurred in all patients though only 3 patients required
dose modification (thrombocytopaenia, severe haemolytic anaemia). The mean
Hb at baseline was 14.6g/dl and fell to mean 11 g/dl at four weeks; mean ANC fell
from 2.67 x 109/I to 1.8 x 109/I. One patient suffered from a severe haemolytic
anaemia with a drop in Hb from 14.3 x 106/dl to 7.8 x 106/I. One patient was discontinued secondary to severe depression at week 10. 11 patients are >12 wks
on therapy At wk 12, 5 are HCV RNA - (all geno 3); 6 are HCV RNA + (3 geno 1;
3 geno 3)
Conclusion: Any patient with a Hb < 10g/dl is given erythropoietin (4000iu sc
weekly). Early response rates are low in this co-infected population primarily due
to advanced HIV disease and prolonged HCV infection.
Presenting author: Susan Hopkins, Dept. of Genitourinary Medicine & Infectious
Diseases, GUIDE Clinic, St. James's Hospital, James's St, Dublin 8, Ireland, Tel.:
[phone], Fax: [phone], E-mail: [email protected]
ThPeC7532 Reactivation of hepatitis B virus in patients with
HIV infection and seropositivity for hepatitis B core
antibody
J.R. Kostman K. Wolff, R. Maniglia, A. Norris, M. Duffalo. Presbyterian Medical
Center, Presbyterian Medical Center, Division of Infectious Diseases, 39th and
Market Streets, Philadelphia, Pa. 19104, United States
Background: Reactivation of hepatitis B (HBV) with clinical hepatitis has been reported as a complication of potent antiretroviral therapy in patients with previous
antibodies to hepatitis B surface antibody. We describe two cases of reactivation
hepatitis B in individuals with
HIV-HBV co-infection and previous antibodies only to hepatitis B core antibody.
Methods: We reviewed the clinical records of two patients with acute hepatitis
B for previous hepatitis serologies, other causes of liver disease, timing of and
response to antiretroviral therapy, and clinical outcomes.
Results: Patient 1, a 35 year old man, had a CD4 cell count of 3 and HIV
RNA of 1,400,000 copies at time of HIV diagnosis. His hepatitis serologies revealed evidence of antibody to HBV core antibody only, with negative hepatitis A
and C antibodies. 1 year after beginning HAART with d4T, ddl, nevirapine, and
indinavir, his CD4 cell count had risen to 618 and HIV RNA was < 50 copies. 22

months after beginning therapy, he developed clinical hepatitis with ALT of 1817,
HbsAg and HbeAg positive, and hepatitis A core IgM positive. HBV DNA was
> 6000 pg/ml. Clinical hepatitis persisted for several months with persistent HbsAg. Patient 2, a 43 year old man, had a CD4 cell count of 14 and HIV RNA of
141,000 at diagnosis; hepatitis B serologies revealed only positivity to core antibody. 4 months after beginning HAART with d4T, ddl, and lopinavir/ritonavir CD4
count was 41 and HIV RNA was < 50; however,he developed progressive liver