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Session 110 Poster Abstracts
Epidemiology and Natural History of HIV/HCV Co-Infection
Tuesday, 1:30 - 3:30 pm
Poster Hall


799
Hepatitis B and Hepatitis C in the EuroSIDA Cohort: Prevalence and Effect on Mortality, AIDS Progression and Response to HAART
J Rockstroh*1, D Konopnicki2, V Soriano3, O Kirk4, F Antunes5, B Knysz6, C Tural7, S De Wit2, A Mocroft8, J Lundgren4, and EuroSIDA study group
1Univ. of Bonn, Germany; 2St. Pierre Univ., Brussels, Belgium; 3Inst. de Salud Carlos III, Madrid, Spain; 4Hvidovre Univ. Hosp., Hvidovre, Denmark; 5Faculty of Med., Lisbon, Portugal; 6Wroclaw Univ., Poland; 7Germans Trias I Pujol, Barcelona, Spain; and 8Royal Free Univ., London, UK

Background: The course of hepatitis B and C is accelerated in HIV-co-infection. On the contrary the impact of concomitant hepatitis on HIV still remains controversial.

Methods: We assessed HbsAg/HCV prevalence, survival, clinical progression, HIV suppression and CD4-cell recovery under HAART according to HbsAg/HCV status in the EuroSIDA-cohort.

Results: HBV serology was available for 5,883 patients and  HCV for 4957 patients at recruitment into EuroSIDA. The prevalence was 9% (n=530) for HbsAg+ and 34% (n=1685) for HCV . The highest HCV-prevalence was found in Eastern and Southern Europe with 47.7% and 44.9 % whereas the highest HbsAg prevalence was found in Argentina (17.8%) and Northern Europe (9.7%). No increased risk for clinical progression (AIDS/death) was found in HCV+ vs HCV- patients after adjustment for CD4 count, age, prior AIDS diagnosis, HAART, recruitment date, hepatitis B status, gender, ethnic origin and risk group (incidence rate ratio (IRR) 0.92; 95 % CI 0.79 to 1.07; p  = 0.27). In multivariate analysis there was an increased risk of liver-related deaths in HCV-pos. patients (IRR 3.18, 95 % CI 1.23-6.18, p = 0.014) but not of global mortality (p  = 0.4). Progression to AIDS was higher in HBV+ vs HBV- patients (13.1 vs 4.1/100 person years) in an univariate model but this was not true after adjustment for the same factors. In multivariate analysis global and liver-related mortalities were significantly increased in HbsAg+ individuals (IRR 1.55 for global-; 95% CI 1.24 to 1.93 and 3.77 for liver-related mortality 95% CI: 2.07 to 6.87). Among patients starting HAART, no significant difference in the median time to reach viral load below 400 copies/ml was found comparing HBV-pos. and neg. patients (7 vs 6 months; p = 0.26) as well as for HCV-pos and HCV- patients (7 vs 6 months; p = 0.63) . Moreover, the initial immunologic response (defined as a 50% increase in the CD4 count over baseline) showed no significant difference when comparing HBV-pos. and neg. patients or HCV+ and HCV- co-infected individuals.

Conclusions: Prevalences of HBV and HCV coinfection in HIV-infected patients in Eurosida are 9 and 34%, respectively. HBV or HCV co-infection do not influence virological and immunologic response to HAART but significantly increases  liver-related mortality.

Keywords: hepatitis; liver mortality; HAART