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

86 Abstracts WePeB6030-WePeB6034

XIV International AIDS Conference

WePeB60301 Insulin resistance (IR) and prevalence of diabetes
mellitus (DM) in antiretroviral (ARV) nafve patients
coinfected with hepatitis C (HCV) and HIV-1
compared to patients with HIV-1 infection alone
For The Terry Beirn Community Programs for
Clinical Research on AIDS
F. Visnegarwala', L. Chen2, S. Raghavan 3, E. Tedaldi4. IBaylor College of
Medicine, Houston, United States; 2University of Minnesota, Minneapolis, United
States; 3Columbia University, New York, United States; 4 Temple University, #424,
Thomas Street Clinic, 2015, Thomas Street, Houston, TEXAS, United States
Background: Disorders of glucose metabolism are reported with HIV& HAART
Increased prevalence of type II DM is reported with HCV in non-HIV population.
We compared IR & prevalence of DM in ARV naive pts with HIV & HIV/HCV coinfection.
Methods: Demographics, fasting metabolic panel, hepatitis B & C serology,
ALT/AST were obtained from baseline (BL) data pts enrolled in CPCRA Metabolic
Study (061). HCV infection was defined as HCV+ antibody. IR was determined by
HOMA model, DM was defined per ADA criteria.
Results: Among 415 pts enrolled, 87 (20%) were HIV/HCV coinfected. There
was no difference between HIV/HCV & HIV grps in BL wt, BMI, CD4, VL, gender or triglycerides, but the HIV/HCV grp was older (43 v 37 yrs, p<0.001), had
more AA/Latino (83 v 70%, p=0.02), IDU (54 v 3%, p=0.001), had higher AST
(62 v 38 U/L, p<0.001) & ALT (55 v 43 U/L, p=0.03) & lower cholesterol (153
v 164 mg/dL, p=0.04). The prevalence of DM was higher in the HIV/HCV grp
(9 v 3%, p=0.004) although HOMA IR was not different (2.2 v 2.1, p =0.89). In
univariate analysis, the odds having DM for HCV/HIV grp vs the HIV grp was
3.2 (CI:1.2-8.4, p=0.02), for pts with IDU: 3.4 (1.2-9.5, p=0.02), age/ 10-yr increment: 1.78 (1.2-2.7; p=0.01), for 1-unit BMI increment was 1.08 (1.0-1.2, p=0.05).
Even when adjusted for age, gender, race, BMI, waist to hip ratio in a multivariate
model the association between HCV and diabetes remained borderline significant
(OR=2.48, CI: 0.91-6.76, p=0.08). Similar association between HCV and IR was
not found.
Conclusions: In a cohort of ARV nafve pts, the prevalence of DM is higher among
HCV coinfected pts as compared to non-coinfected cohort. However, no association with insulin resistance was observed.
Presenting author: Fehmida Visnegarwala, #424, Thomas Street Clinic, 2015,
Thomas Street, Houston, TEXAS, United States, Tel.: [phone], Fax:
[phone], E-mail: fehmidav@ bcm.tmc.edu
WePeB6031I Serum biochemical markers of liver fibrosis in
human immunodeficiency virus and hepatitis c
virus-coinfected patients
Y. Benhamou, R.P. Myers, F. Imbert-Bismut, M.A. Vallantin, S. Dominguez,
V. Thibault, F. Bricaire, T. Poynard, C. Katlama. Hdpital Pitid-Salp6triere, Hopital
Pitid-Salp6tribre, Service d'Hdpatologie, 27 boulevard de I'H6pital 75013 Paris,
France
Background: Liver biopsy is the gold standard for assessing fibrosis in patients
with chronic hepatitis C virus (HCV) infection, but this procedure is invasive and
prone to complications. The objective was to determine the operating characteristics of a non-invasive index of biochemical markers in patients with HIV/HCV
coinfection.
Methods: Patients: 130 HIV/HCV-coinfected patients with a liver biopsy and
serum tested for markers of liver fibrosis between August 1995 and November
2000.
Measurements:
An index incorporating age, gender, a2-macroglobulin, apolipoprotein A1, haptoglobin, total bilirubin, and g-glutamyl-transpeptidase derived using multivariate
logistic regression was compared with liver histology. HIV-specific indices incorporating this 5-marker index, and CD4 count and HIV load were also constructed
using multivariate logistic regression. The primary outcome was the diagnosis of
significant fibrosis (F2 to F4 fibrosis by the Metavir system). The diagnostic values of the indices were compared using receiver operating characteristic (ROC)
curves.
Results: By multivariate analysis, the most informative markers for the prediction of F2 to F4 fibrosis were a2-macroglobulin (P<0.0001), gender (P=0.02),
g-glutamyl-transpeptidase (P=0.053), and apolipoprotein Al (P=0.061). For this
outcome, the area under the ROC curve of the 5-marker index was 0.856 ~ 0.035,
not significantly different from those of the HIV-specific indices. On a scale from
zero to 1.00, the 5-marker index had a positive predictive value of 83% for scores
> 0.60, and a negative predictive value of 93% for scores of <0.20. These thresholds could reduce the necessity of liver biopsy by 55% (72/130 patients) whilst
maintaining an accuracy of 89% (64/72 patients).
Conclusion: An index including five biochemical markers accurately predicts significant fibrosis in patients with HIV/HCV coinfection and may substantially reduce
the necessity of liver biopsy.

Presenting author: Yves Benhamou, Hopital Piti6-Salpdtribre, Service
d'Hepatologie, 27 boulevard de l'H6pital 75013 Paris, France, Tel.: +33 1
42101041, Fax: [phone], E-mail: [email protected]

WePeB6032I The seroprevalenc of Viral Hepatitis in HIV infected
persons attending a clinic in the Southwestern
United States
J. Post1, C. Williams1, E. Post1, D. Hobohm2. 1McDowellHCC, 1144 E
McDowell Rd., Ste. 300, Phoenix, Arizona, United States; 2Maricopa Medical
Center, Phoenix, AZ United States
Background: HIV infection (HIV) is associated with Viral Hepatitis, which increases morbidity, mortality and utilization of medical care resources. McDowell
HCC provides primary care for over 1000 HIV infected persons in central Arizona
USA. An assessment of the hepatitis co-morbidity was needed for planning future
needs.
Methods: All patients were assessed for serostatus to Hepatitis A, B and C and
viral activity of Hepatitis B and C. Demographics including gender, ethnicity, race,
age and risk factors were collected.
Results: 887 persons tested ranging in age from 16 to 80 years. 80% males, 25%
Hispanic, 755 Non-Hispanic, 15% black, 80% white. Risk factors were 44% MSM,
34% heterosexual, and 16% injection drug use. 56% Hepatitis A (HAV) seropositive. 8% Hepatitis B (HBV) antigen positive with HBV DNA detected in 30%. 20%
Hepatitis C (HCV) seropositive with HCV RNA detected in 65%. 10 of 35 HCV
antibody negative persons had HCV RNA detected. HCV Genotypes: 70% were
type 1, 12% were indeterminate. Of active hepatitis cases 7% had HAV and HBV
activity. The data have been stratified by gender, race, ethnicity and risk factors.
Conclusions: This survey provides a picture of HIV/Viral Hepatitis co-infection
providing a basis for planning preventative and treatment services. Based on this
sample eligibility for vaccination to HAV and HBV would be 44% and 59% respectively. Treatment for HBV and/or HCV could be considered for 1% andl3%
respectively of the clinic population.
Presenting author: John Post, 1144 E. McDowell Rd., Ste. 300, Phoenix, Arizona, United States, Tel.: [phone], Fax: [phone], E-mail: [email protected]
WePeB6033 Rates of testing for Hepatitis C virus in
HIV-infected injecting drug users receiving
medical care
M.R. Pfeiffer, J. Sackoff, M.A. Bernard, E. Bryan, S. Raj-Singh. New York City
Department of Health, HI V/AIDS Surveillance Program, 346 broadway, cn-44,
new york, ny 10013, United States
Background: In New York City (NYC), 50% to 90% of injecting drug users (IDU)
are infected with Hepatitis C Virus (HCV), and the Centers for Disease Control
and Prevention (CDC) recommends that all IDUs be tested. This analysis describes the rates of HCV testing and associated factors in a population of Human
Immunodeficiency Virus (HIV) infected IDUs in care.
Methods: This analysis draws on patients recruited from two HIV clinics in NYC
for the Adult Spectrum of HIV Disease project, a longitudinal chart review study of
HIV-infected persons in care. Inclusion criteria were a first clinic visit in February
1999 or after and a history of IDU. Patients tested for HCV were compared to
those not tested on gender, race, age, HCV positivity, time since first HIV positive
test and length of follow-up. HCV testing and positivity among clinic patients who
are men who have sex with men (MSM) were examined for comparison.
Results: The 96 IDUs were predominantly male (71%) and Black (56%) or Hispanic (42%), with a median age of 44. They were followed for a median of 11
months. Overall, 93% (89/96) were tested for HCV, 90% (80/89) within six months
of the first clinic visit. The HCV positivity rate was 71% (63/89). Patients not tested
were significantly younger (37 vs. 44, p = 0.05) and were followed for less time
(6 months vs. 11 months, p = 0.04). Forty-three percent (3/7) of untested patients had only one clinic visit. HCV testing rates did not differ significantly by
gender, race or time since first positive HIV test. Among MSM, 95% (35/37) were
tested for HCV, 77% (27/35) within six months. The HCV positivity rate was 29%
(10/35).
Conclusions: In this sample of HIV-infected IDUs receiving HIV care, 93% were
tested for HCV and 71% were positive. A similar percentage of MSM were tested,
although the prevalence of HCV was significantly lower. Continued vigilance is
needed to ensure appropriate care of co-infected patients.
Presenting author: melissa pfeiffer, 346 broadway, cn-44, new york, ny 10013,
United States, Tel.: [phone], Fax: [phone], E-mail: [email protected]
WePeB6034 Earlier occurrence and increased severity of
Hepatocellular carcinoma in HIV coinfected
patients
M. Airoldi1, M. Puoti1, R. Bruno2, P Costa3, I. El Hamad 1, C. Filice2,
F. Castelli1, F Donato4, A. Scalzini 3, G. Filice 2, G.R Carosi1. 1Clinica Malattie
Infettive, Clinica Malattie Infettive, Pie Spedali Civii 1, 125123 Brescia, Italy;

2Malattie Infettive Universit di Pavia, Pavia, Italy; 3Divisione Malattie Infettive,
Mantova, Italy; 4Cattedra d'giene Universitb di Brescia, Brescia, Italy
Background: Cirrhosis due to hepatitis viruses infections and alcohol abuse is
the main risk factors for hepatocellular carcinoma (HCC). These factors are very
frequent in HIV seropositives In addition liver cells displasia, HCC and an accelerated and higher incidence of HCC during experimental cancerogenesis have
been observed in Tat transgenic mice. The aims of this study are to assess char