933 
Comparison of Triple Infection with HIV/HBV/HCV to HIV/HCV and HIV/HBV
Mamta Jain*, R Joshi, N Attar, P Keiser, and W Lee
Univ of Texas Southwestern Med Ctr, Dallas, US
Background: Co-infections with ≥1 hepatitis virus
are seen in patients with HIV. We examined the interaction of hepatitis B (HBV)
and hepatitis C virus (HCV) with HIV by comparing viral load and all-cause
mortality in those with co-infection with HIV/HBV or HIV/HCV or HIV/HBV/HCV.
Methods: Patients studied had available serum samples
(~50% baseline/pre-treatment), and were from an inner city HIV clinic. HBV DNA
was quantified using VERSANT HBV 3.0 (bDNA) and HCV
RNA with VERSANT HCV RNA 3.0 (bDNA) from stored sera.
Medical records and the national death registry were reviewed for demographic
data including mortality, CD4 cell count, HIV viral load, liver function tests,
and HBV, HCV, and hepatitis delta (HDV) serologies,
and radiologic images. ANOVA was used to compare continuous variables across
the three groups and chi square for dichotomous variables.
Results: The table shows patients with HIV/HBV (n = 45, baseline n = 35), HIV/HCV (n = 43,
baseline n = 12), and HIV/HBV/HCV (n = 41, baseline n = 13). Differences observed in viral load were associated with
having HIV/HBV versus HIV/HBV/HCV (p =
0.007) for HBV DNA, but changes in HIV RNA were associated with having a
baseline sample or not, p = 0.008.
The HIV/HBV/HCV group had a higher portion of HDV+ (n = 6 of 15) than the HIV/HBV group (n = 0 of 14), and also had more
cirrhosis (31%) than patients with HIV/HBV (9%) or HIV/HCV (10%) among those
who had an abdominal ultrasound. A higher proportion of deaths were seen in HIV/HCV
(33%) compared to HIV/HBV (20%) and HIV/HBV/HCV (23%;NS).
A significantly higher proportion of deaths were seen in those with AIDS
compared to non-AIDS in those with HIV/HCV but not in those with co-HBV or
triple infection.
|
Median
|
HIV/HBV
|
HIV/HCV
|
HIV/HBV/HCV
|
p
value
|
|
Log HIV viral
load
|
5.01
|
4.17
|
4.65
|
0.003
|
|
Log HCV viral load
|
|
5.08
|
5.37
|
0.92
|
|
Log HBV viral load
|
7.25
|
|
2.57
|
<0.001
|
|
Baseline log
HIV viral load
|
5.05
|
4.54
|
4.83
|
0.59
|
|
Baseline log
HCV viral load
|
|
6.21
|
5.32
|
0.59
|
|
Baseline log
HBV viral load
|
7.25
|
|
5.55
|
0.08
|
Conclusions: The presence of HCV in those with triple
infection appears to diminish HBV DNA levels as compared with the HIV/HBV
setting but the reverse is not true. Triply infected persons appear to have
more severe disease and are more likely to have delta virus, possibly due to
injection drug use and should be evaluated for these features. Among those with
HIV/HCV but not HIV/HBV or HIV/HBV/HCV, mortality was higher in those with
AIDS.
|
