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

84 Abstracts WePeB6022-WePeB6025

XIV International AIDS Conference

results retested and if found reactive consider sero +ve as per protocol at a tertiary referal centre in Calcutta.
Results are shown in the table.
Conclusions: Baselines HCV prevalence is alarming. HIV sero+vity is low in
blood donors representative of healthy, general pop'n and consistant with ANCHIV sentinel surveillance 0.3% in Calcutta/West Bengal (5 rounds 98-01) as
against 0.7% estimated by UNAIDS. Effective intervention to prevent transfusion
transmitted diseases urgently needed. Compulsory HCV screening in HIV +ves
requiring ARV drugs whose use is increasing in India with drastic price reduction
(3 ARV drugs-1 US$/day - 3 TC, d4T,Nevirapine.
Presenting author: Subir Kumar Dey, P-41/1 Natabar Pal Road, State - West
Bengal, City-Howrah, Zip-711105, India, Tel.: [phone], Fax: +91(33)
554 5741, 843 0749, E-mail: [email protected]
WePeB6022 Evaluation and treatment of HIV+ veterans
coinfected with hepatitis C
S.L. Fultz1, A. Butt2, S. Weissman3, L. Rabeneck4, A.C. Justice1. ICenter for
Health Equity Research and Promotion, VA Pittsburgh Healthcare System and
University of Pittsburgh, VA Pittsburgh Healthcare System, University Drive C -
11 East (130-U), Pittsburgh, PA 15240, United States; 2Division of Infectious
Diseases, VA Pittsburgh Healthcare System and University of Pittsburgh,
Pittsburgh, United States; 3Hospital of Saint Raphael, New Haven, United
States; 4 VA Center of Excellence and Baylor College of Medicine, Houston,
United States
Background: The Department of Veterans Affairs (VA) has recommended that
all veterans (regardless of HIV status) with risk factors for hepatitis C be tested,
and treated when appropriate. Although many veterans have been tested few are
being treated. This may be especially true among HIV positive patients. The purpose of this study was to quantify the evaluation and treatment of HIV positive
patients coinfected with hepatitis C.
Methods: Using provider- and patient-reported information, along with medical
records for patients in the Veterans Aging 3 Site Cohort Study (VACS 3), we identified the presence of recommended indications for treatment along with accepted
contraindications. Information on hepatitis C antibody testing, liver biopsies and
prescriptions for interferon and ribavirin were also obtained to determine which
patients were tested and treated for hepatitis C. Multivariate logistic regression
was used to identify factors predictive of being tested for hepatitis C.
Results: Of the 881 patients, 700 (80%) were tested for hepatitis C antibodies,
and 300 (43%) of those tested positive. Of the 300 patients with hepatitis C, 64
(21%) were eligible for treatment. Of these, 11 (17%) underwent liver biopsy and
2 (3%) received prescriptions for interferon. No patients received dual therapy.
Logistic regression revealed that the major factors predictive of being tested for
hepatitis C were history of intravenous drug use, abnormal liver enzymes and the
testing patterns of individual providers.
Number % of Total % Prior Row
881 100 100 HIV positive patient
700 79.5 79.5 "& tested for hepatitis C
300 34.0 42.9 "& positive for hepatitis C
205 23.2 68.3... & indication for treatment
64 7.3 31.2. & no contraindication for treatment
11 1.2 17.2. " " " & underwent liver biopsy
2 0.23 18.2 """"" & received prescription for interferon
Conclusions: While the majority of HIV infected veterans was tested for hepatitis
C, only a minority of those coinfected with hepatitis C and known to have indications for and no contraindications against treatment, received treatment. While
some of this attrition may be due to patient refusal, the testing behavior of individual providers is very important.
Presenting author: Shawn Fultz, VA Pittsburgh Healthcare System, University
Drive C - 11 East (130-U), Pittsburgh, PA 15240, United States, Tel.: [phone]
6000, Fax: [phone], E-mail: [email protected]
WePeB6023 Liver biopsy in HIV/HCV-Coinfected patients
G. Klausen1, J. Kolbergt, F. Niedobitek2, J. Goelz1, A. Moll, D. Schleehauf1,
D. Prziwara1, C. Cordes1. t Praxiszentrum Kaiserdamm, Praxiszent rum
Kaiserdamm, Kaiserdamm 24, D- 14057 Berlin, Germany; 2institute for
Pathology, Berlin, Germany
Background: In times of HAART, HIV/HCV-coinfected patients are more likely to
suffer and to die of hepatic complications than from AIDS. We routinely carry out
liver biopsies in our coinf.pats. in order to identify cases with high risk of progression of liver fibrosis and to treat them appropriately. The aim of this evaluation is,
to test the adequacy of this procedure.
Methods: The results of 40 liver biopsies of HIV/HCV-coinf. pats. are analysed

retrospectively and compared to a matched group of 43 HCV-monoinf. pats. There
are only small differences between the two groups in average age (39,8 resp.
40,2 years) and gender (40% resp. 37% female). Liver fibrosis is classified in
METAVIR stages from FO (no fibrosis) to F4 (cirrhosis) and for each group the
average METAVIR-Score is calculated.
Results: The average METAVIR-score is higher in the coinf. group than in the
monoinf.group (2.08 vs. 1.84). In the coinf. group the following results were found:

Age >40 years: average METAVIR-Score 2.56, age <40: 1.75; male sex: 2.08,
female: 2.13; transmission by IVDU: 1.97, other ways of transm.: 2.44; elev. ALT:
2.36, normal ALT: 1.41; CD4<500: 2.2, CD4>500: 1.8; pats. on ART: 2.13, without ART: 2.18; on ART with PI: 2.33, on ART without PI: 1.82. Statistical analysis
of all data shows no significant differences (p>0,05) between groups.
Conclusions: Liver fibrosis is more severe in HIV/HCV-coinf. pats. than in HCVmonoinf. In HIV/HCV-coinf. pats., liver fibrosis is more severe in those pats., who
are older, who did not get their infections by IVDU, who have elev. ALT and who
have <500 CD4-cells. Among pats. with ART, the ones with PI-containing ART
show more severe fibrosis than with PI-free ART. However, all these findings are
not statistically significant and do not give reliable evidence concerning the individual extent of liver fibrosis. Liver biopsy is the only reliable method for examining
the severity of the progression of chronic Hep. C in HIV/HCV-coinf. patients.
Presenting author: Gerd Klausen, Praxiszentrum Kaiserdamm, Kaiserdamm 24,
D-14057 Berlin, Germany, Tel.: [phone], Fax: [phone], E-mail:
[email protected]
WePeB6024I The role of hepatitis infection and nevirapine on
liver abnormalities among HIV patients
V.M. Nasiff, M. Beltran, R. Gil, N. Sanga. Hospital San Isidro, Laprida 212, San
Isidro (1642), Pcia Buenos Aires, Argentina
Background: Coinfection with hepatitis virus (B or C or both) and TARV including Nevirapine are well known to cause liver abnormalities in HIV subjects. The
present study was carried out in order to determine whether those variables are
relevant among patients currently under treatment at San Isidro Hospital.
Methods: We conducted a retrospective cross sectional study using data from
229 clinical records corresponding to HIV patients (CDC Stages A: 33%, B:32%,
C:35%) atending at our Service from July to December 2001. Analysis was done
considering 3 cathegories of patients: no enzymes abnormalities, mild elevations (double or triple) and those with very high liver enzymes (above triple).
Percentages were calculated and absolute results were globaly compared using
Chi Square Test (and Yates).
Results: Patients with no enzymes abnormalities (n: 133= 58%): Hepatitis Coinfection: 11,27%, TARV including NVP: 24,8%, Both Variables: 4,5%. Patients
With Mild Enzymes Elevations (n:66= 27,51%): Hepatitis Coinfection: 50,79%,
TARV including NVP: 12,6%, Both: 22,2%. Patients With Important Enzymes Elevations (n:8= 3,45%): Hepatitis Coinfection: 50%, TARV including NVP: 1,25%,
Both: 37,5%. Differences among the groups were found to be highly significant
(p<0,005) for Hepatitis Seropositivity and both components, not for NVP considered alone.
It seems remarkable that abnormalities in liver enzymes (twice or more reference
normal level) were found in 31% and it was associated with HCV coinfection in
75% of those patients. In this group, 13,20% were found to present high HIV viral
load (> 50.000 copies) and 33,96% had CD4 cout less than 200/mm3.
Conclusion: Hepatitis Coinfection seems to be a mayor cause for liver function
impairment among HIV patients in our media though other factors (alge, alcohol
abuse, other drugs) shuould be investigated.
Presenting author: Vilma Maria Nasiff, Laprida 212, San Isidro (1642), Pcia
Buenos Aires, Argentina, Tel.: [phone], Fax: [phone], E-mail:
[email protected]
WePeB6025I Pegylated Interferon-alpha and Ribavirin Therapy
for Hepatitis C in HIV-coinfected patients: 24
weeks results
J.K. Rockstrohl, C. Schulz', S. Mauss2, G. Klausen3, E. Voigt1, J. G61z3.
SUniversity of Bonn, Dept of Medicine I, Bonn, Germany; 2Private Practice,
Disseldorf, Germany; 3Praxiszentrum Kaiserdamm, Berlin, Germany
Objective: To evaluate efficacy, tolerance and safety of pegylated interferon-a
2b (PEG-IFN) plus ribavirin (RBV) combination therapy for hepatitis C in HIVcoinfected patients.
Methods: 30 HIV/HCV-coinfected patients (median age 40.6 years (range 29;
59), 20 male and 10 female) were treated with PEG-IFN 1,5 mg/kg body weight
+ RBV 400 mg bid. Quantitative HCV-RNA, liver transaminases, CD4-cell count
and HIV-RNA were determined at baseline, week 4, 12, 24 and 48. All adverse
events were documented throughout the study period. The study is still ongoing
but results from week 24 are available.
Results: Median baseline values were: HIV-RNA 7,354 copies/ml (range < 50;
24,100), CD4-cell count (abs) 510/kI (range 70; 1,007), CD4-cell count (rel) 27%
(range 15; 70) and alanine aminotransferase (ALT) 51 U/I (range 11; 160). Median
HCV-RNA was 1,834,310 copies/ml (range 9,300; 15,663,237). 22 (73%) patients
had a HCV-genotype 1 infection. After 6 months of therapy, virological response
(defined as HCV-RNA < 500 IU/mi (= limit of detection)) was observed in 17 of
30 (57%) individuals. 14 patients (46,7%) did not continue therapy up to or after 6
months. Reasons for treatment withdrawal were: virological non-response (30%),

severe PEG-INF or ribavirin related side effects (13%), and active drug abuse
(3,3%). Median CD4-count (abs) at month 6 remained stable with 359 (144; 601)
cells/p l and 26 (17; 44)%, respectively. HIV-RNA at month 6 was comparable to
baseline with 9449 (< 50; 54,000) copies/ml. Further follow-up of the patients is
ongoing.
Conclusions: After 24 weeks of PEG-IFN + ribavirin treatment more than 50%
of the patients showed early virological response (HCV-RNA < limit of detection