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Prevalence and correlates of HCV monoinfection and HIV and HCV coinfection among persons who inject drugs in Vietnam. Eur J Gastroenterol Hepatol 2015; 27:550-6. [PMID: 25769097 PMCID: PMC4380662 DOI: 10.1097/meg.0000000000000321] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Vietnam bears a high burden of hepatitis C virus (HCV) and HIV infection among persons who inject drugs (PWID). The high prevalence of HCV and HIV occurs in a context of stigma and limited preventive interventions for PWID. OBJECTIVES This study aims to estimate the prevalence of HCV, HIV, and HIV/HCV coinfection among PWID and to explore their associations with lifetime injection behaviors. METHODS A total of 1434 PWID were recruited from the Thai Nguyen Province of Vietnam between 2005 and 2007. Participants responded to a structured questionnaire and provided blood samples at baseline. A cross-sectional analysis of data collected at baseline was carried out. Factors associated with HCV monoinfection and HIV/HCV coinfection were evaluated by multinomial logistic regression. RESULTS The prevalences of HIV and HCV were 35.1 and 88.8%, respectively, and the prevalences of HIV/HCV coinfection and HCV monoinfection were 34.8 and 53.9%, respectively. After adjusting for confounders in multivariate analysis, ever reusing a syringe and needle was found to be significantly associated with HIV monoinfection [adjusted odds ratio (AOR), 3.13; 95% confidence interval (CI), 1.99-4.94] and HIV/HCV coinfection (AOR, 3.34; 95% CI, 2.02-5.51). Ever sharing diazepam or novocaine was also found to be significantly associated with HIV monoinfection (AOR, 2.14; 95% CI, 1.38-3.32) and HIV/HCV coinfection (AOR, 2.47; 95% CI, 1.57-3.90). CONCLUSION Our findings demonstrate a high burden of HIV and HCV infection among PWID in Vietnam. Lifetime injection behaviors, including sharing of diazepam or novocaine, may account for the high prevalence of HIV and HCV. Improving prevention and ensuring access to care remain critically important for this vulnerable population.
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102
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Pan W, Wu Z, Wu S, Guo D, Gong X, Po T. Human immunodeficiency virus coinfection with hepatitis B virus leads to a decrease in extracellular and intracellular hepatitis B antigen. AIDS Res Hum Retroviruses 2015; 31:461-9. [PMID: 25517882 DOI: 10.1089/aid.2014.0291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Chronic hepatitis B virus (HBV) infection could cause severe liver disease including cirrhosis, hepatocellular carcinoma, and end-stage liver failure in HIV-positive individuals. The available data from clinical studies suggest that HIV infection modulates the HBV-specific T cell response. However, the virological and molecular aspects of HIV-HBV coinfection are currently poorly understood due to the lack of appropriate model systems. In this study, the effect of HIV infection on the life cycle of HBV was explored using an in vitro model system. The present data show that the extracellular and intracellular hepatitis B surface antigen (HBsAg) and e antigen (HBeAg) decrease significantly in HepG2 cells cotransfected with HIV NL4-3 and pHBV1.3 as compared to those cells transfected only with pHBV1.3. Moreover, a significant decrease in HBV DNA and mRNA expression was also observed in the cotransfected cells. HIV Rev protein, an RNA-bound regulatory protein, could significantly decrease the expression levels of extracellular and intracellular HBsAg and HBeAg by mediating the expression of HBV mRNA in cells cotransfected with plasmids containing HIV-1 Rev and pHBV1.3. Further experiments demonstrate that HIV Rev manipulated neither the promoters of HBV nor the nuclear export of HBV mRNA. These results from the in vitro model system might provide clues to further understand the rapid progression of liver disease in HIV-HBV-coinfected patients.
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Affiliation(s)
- Wei Pan
- College of Life Sciences, Wuhan University, Wuhan, China
| | - Zuoqiao Wu
- College of Life Sciences, Wuhan University, Wuhan, China
| | - Shuwen Wu
- College of Life Sciences, Wuhan University, Wuhan, China
| | - Deyin Guo
- College of Life Sciences, Wuhan University, Wuhan, China
| | - Xiaoyan Gong
- College of Chemistry and Molecular Sciences, Wuhan University, Wuhan, China
| | - Tien Po
- College of Life Sciences, Wuhan University, Wuhan, China
- Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
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Nadol P, O’connor S, Duong H, Le LVN, Thang PH, Tram TH, Ha HTT, Mcconnell MS, Partridge J, Kaldor J, Law M, Nguyen TA. Findings from integrated behavioral and biologic survey among males who inject drugs (MWID) - Vietnam, 2009-2010: evidence of the need for an integrated response to HIV, hepatitis B virus, and hepatitis C virus. PLoS One 2015; 10:e0118304. [PMID: 25692469 PMCID: PMC4333571 DOI: 10.1371/journal.pone.0118304] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 01/14/2015] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Given the overlapping modes of transmission of HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV), understanding the burden and relationship of these infections is critical for an effective response. Representative data on these infections among males who inject drugs (MWID), the key high-risk population for HIV in Vietnam, are currently lacking. METHODS Data and stored specimens from Vietnam's 2009-2010 Integrated Biologic and Behavioral Survey, a cross-sectional study among high-risk populations, were used for this analysis. Plasma samples were tested for HIV, HBV, and HCV using commercial assays. A questionnaire was administered to provide demographic, behavior, and service-uptake information. Provincial-level analyses were conducted to profile MWID enrollees and to provide estimates on the prevalence of HIV, HBV, and HCV infection. RESULTS Among 3010 MWID sampled across 10 provinces, the median (range) HIV prevalence was 28.1% (1.0%-55.5%). Median prevalence for current HBV infection (HBsAg+) was 14.1% (11.7%-28.0%), for previous exposure to HBV (total anti-HBc+) was 71.4% (49.9%-83.1%), and for current or past HCV infection (HCV Ag/Ab+) was 53.8% (10.9%-80.8%). In adjusted analysis, HBsAg+ (aOR: 2.09, 1.01-4.34) and HCV Ag/Ab+ (aOR: 19.58, 13.07-29.33) status were significantly associated with HIV infection; the association with total anti-HBc+ approached significance (aOR: 1.29, 0.99-1.68). CONCLUSION The prevalence and association between HIV, HBV, and HCV are high among MWID in Vietnam. These findings indicate the need for integrated policies and practice that for the surveillance, prevention, screening, and treatment of both HIV and viral hepatitis among MWID in Vietnam.
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Affiliation(s)
- Patrick Nadol
- U.S. Centers for Disease Control and Prevention, Division of Global HIV/AIDS, Hanoi, Vietnam
- Kirby Institute for Infection and Immunity, University of New South Wales, Sydney, Australia
| | - Siobhan O’connor
- U.S. Centers for Disease Control and Prevention, Division of Viral Hepatitis, Atlanta, Georgia, United States of America
| | - Hao Duong
- U.S. Centers for Disease Control and Prevention, Division of Global HIV/AIDS, Hanoi, Vietnam
| | - Linh-Vi N. Le
- U.S. Centers for Disease Control and Prevention, Division of Global HIV/AIDS, Hanoi, Vietnam
| | - Pham Hong Thang
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Tran Hong Tram
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | | | - Michelle S. Mcconnell
- U.S. Centers for Disease Control and Prevention, Division of Global HIV/AIDS, Hanoi, Vietnam
| | - Jeff Partridge
- U.S. Centers for Disease Control and Prevention, Division of Influenza Control, Atlanta, Georgia, United States of America
| | - John Kaldor
- Kirby Institute for Infection and Immunity, University of New South Wales, Sydney, Australia
| | - Matthew Law
- Kirby Institute for Infection and Immunity, University of New South Wales, Sydney, Australia
| | - Tuan Anh Nguyen
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
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104
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Wu JQ, Saksena MM, Soriano V, Vispo E, Saksena NK. Differential regulation of cytotoxicity pathway discriminating between HIV, HCV mono- and co-infection identified by transcriptome profiling of PBMCs. Virol J 2015; 12:4. [PMID: 25623235 PMCID: PMC4312599 DOI: 10.1186/s12985-014-0236-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 12/30/2014] [Indexed: 01/01/2023] Open
Abstract
Background Despite the easy accessibility and diagnostic utility of PBMCs and their potential to show distinct expression patterns associated with the accelerated disease progression in HIV/HCV co-infection, there has not been a systematic study focusing on the global dysregulations of the biological pathways in PBMCs from HIV, HCV mono- and co-infected individuals. This study aimed at identifying the transcriptome distinctions of PBMCs between these patient groups. Methods Genome-wide transcriptomes of PBMCs from 10 HIV/HCV co-infected patients, 7 HIV+ patients, 5 HCV+ patients, and 5 HIV/HCV sero-negative healthy controls were analyzed using Illumina microarray. Pairwise comparisons were performed to identify differentially expressed genes (DEGs), followed by gene set enrichment analysis (GSEA) to detect the global dysregulations of the biological pathways between HIV, HCV mono- and co-infection. Results Forty-one, 262, and 44 DEGs with fold change > 1.5 and FDR (false discovery rate) <0.05 for the comparisons of HCV versus co-infection, HIV versus co-infection, and HIV versus HCV were identified, respectively. Significantly altered pathways (FDR < 0.05), featured by those involved in immune system, signaling transduction, and cell cycle, were detected. Notably, the differential regulation of cytotoxicity pathway discriminated between HIV, HCV mono- and co-infection (up-regulated in the former versus the latter group: co-infection versus HIV or HCV, HIV versus HCV; FDR <0.001 ~ 0.019). Conversely, the cytokine-cytokine receptor interaction pathway was down-regulated in co-infection versus either HCV (FDR = 0.003) or HIV (FDR = 0.028). For the comparison of HIV versus HCV, the cell cycle (FDR = 0.016) and WNT signaling (FDR = 0.006) pathways were up- and down-regulated in HIV, respectively. Conclusions Our study is the first to identify the differential regulation of cytotoxicity pathway discriminating between HIV, HCV mono- and co-infection, which may reflect the distinct patterns of virus-host cell interactions underlying disease progression. Further inspection of cytotoxicity pathway has pinned down to the expression of the KIR genes to be associated with specific patterns of particular virus-host interactions. Between HIV and HCV, the altered cell cycle and WNT signaling pathways may suggest the different impact of HIV and HCV on cell proliferation and differentiation. Electronic supplementary material The online version of this article (doi:10.1186/s12985-014-0236-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jing Qin Wu
- School of Biomedical Sciences and Pharmacy, Faculty of Health, The University of Newcastle, University Drive, Callaghan, Newcastle, NSW, 2308, Australia.
| | - Monica Miranda Saksena
- Herpes Virus Pathogenesis Lab, Center for Virus Research, Westmead Millennium Institute, University of Sydney, Westmead, Sydney, NSW, 2145, Australia.
| | - Vincent Soriano
- Department of Infectious Diseases, Hospital Carlos III, Sinesio Delgado 10, 28029, Madrid, Spain.
| | - Eugenia Vispo
- Department of Infectious Diseases, Hospital Carlos III, Sinesio Delgado 10, 28029, Madrid, Spain.
| | - Nitin K Saksena
- Retroviral Genetics Division, Center for Virus Research, Westmead Millennium Institute & Westmead Hospital, University of Sydney, Westmead, Sydney, NSW, 2145, Australia.
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105
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Zhang F, Zhu H, Wu Y, Dou Z, Zhang Y, Kleinman N, Bulterys M, Wu Z, Ma Y, Zhao D, Liu X, Fang H, Liu J, Cai WP, Shang H. HIV, hepatitis B virus, and hepatitis C virus co-infection in patients in the China National Free Antiretroviral Treatment Program, 2010-12: a retrospective observational cohort study. THE LANCET. INFECTIOUS DISEASES 2014; 14:1065-1072. [PMID: 25303841 DOI: 10.1016/s1473-3099(14)70946-6] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Hepatitis-related liver diseases are a leading cause of mortality and morbidity among people with HIV/AIDS taking combination antiretroviral therapy. We assessed the effect of hepatitis B virus (HBV) and hepatitis C virus (HCV) co-infection on HIV outcomes in patients in China. METHODS We did a nationwide retrospective observational cohort study with data from the China National Free Antiretroviral Treatment Program from 2010-11. Patients older than 18 years starting standard antiretroviral therapy for HIV who had tested positive for HBV and HCV were followed up to Dec 31, 2012. We used Kaplan-Meier analysis and Cox proportional hazard models to evaluate survival, and logistic regression models to estimate virological failure, immunological response, and retention in care. FINDINGS 33 861 patients with HIV met eligibility criteria. 2958 (8·7%) participants had HBV co-infection, 6149 (18·2%) had HCV co-infection, and 1114 (3·3%) had triple infection. All-cause mortality was higher in participants with triple infection (adjusted hazard ratio 1·90, 95% CI 1·53-2·37) and HCV co-infection (1·46, 1·25-1·70) than in those with HIV only, but not in those with HBV co-infection (1·06, 0·89-1·26). People with triple infection were also more likely to have virological failure (adjusted odds ratio [OR] 1·26, 95% CI 1·02-1·56) than were those with HIV only, whereas the difference was not significant for those with HBV co-infection (0·93, 0·80-1·10) or HCV co-infection (1·10, 0·97-1·26). No co-infection was significantly associated with a difference in CD4 cell count after 1 year of treatment. Loss to follow-up was more common among participants with triple infection (OR 1·37, 95% CI 1·16-1·62) and HCV co-infection (1·30, 1·17-1·45), but not HBV co-infection (0·93, 0·82-1·05), than among those with HIV only. INTERPRETATION Screening for viral hepatitis is important in individuals diagnosed as HIV positive. Effective management for viral hepatitis should be integrated into HIV treatment programmes. Long-term data are needed about the effect of hepatitis co-infection on HIV disease progression. FUNDING The National Center for AIDS/STD Control and Prevention, China Center for Disease Control and Prevention.
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Affiliation(s)
- Fujie Zhang
- National Center for AIDS/STD Control and Prevention, China Center for Disease Control and Prevention, Beijing, China; First Affiliated Hospital of China Medical University, Liaoning, China
| | - Hao Zhu
- Global AIDS Program, China Office, US Centers for Disease Control and Prevention, Beijing, China
| | - Yasong Wu
- National Center for AIDS/STD Control and Prevention, China Center for Disease Control and Prevention, Beijing, China
| | - Zhihui Dou
- National Center for AIDS/STD Control and Prevention, China Center for Disease Control and Prevention, Beijing, China
| | - Yao Zhang
- National Center for AIDS/STD Control and Prevention, China Center for Disease Control and Prevention, Beijing, China
| | - Nora Kleinman
- Global AIDS Program, China Office, US Centers for Disease Control and Prevention, Beijing, China; Association of Schools and Programs of Public Health, Washington, DC, USA
| | - Marc Bulterys
- Global AIDS Program, China Office, US Centers for Disease Control and Prevention, Beijing, China; Department of Defense HIV/AIDS Prevention Program, Naval Health Research Center, San Diego, CA, USA
| | - Zunyou Wu
- National Center for AIDS/STD Control and Prevention, China Center for Disease Control and Prevention, Beijing, China
| | - Ye Ma
- National Center for AIDS/STD Control and Prevention, China Center for Disease Control and Prevention, Beijing, China
| | - Decai Zhao
- National Center for AIDS/STD Control and Prevention, China Center for Disease Control and Prevention, Beijing, China
| | - Xia Liu
- National Center for AIDS/STD Control and Prevention, China Center for Disease Control and Prevention, Beijing, China
| | - Hua Fang
- National Center for AIDS/STD Control and Prevention, China Center for Disease Control and Prevention, Beijing, China
| | - Jing Liu
- First Affiliated Hospital of China Medical University, Liaoning, China
| | - Wei-Ping Cai
- Department of Infectious Diseases, Guang Zhou Eighth People's Hospital, Guangdong, China
| | - Hong Shang
- First Affiliated Hospital of China Medical University, Liaoning, China.
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106
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Seaberg EC, Witt MD, Jacobson LP, Detels R, Rinaldo CR, Young S, Phair JP, Thio CL. Differences in hepatitis C virus prevalence and clearance by mode of acquisition among men who have sex with men. J Viral Hepat 2014; 21:696-705. [PMID: 25280229 PMCID: PMC4187219 DOI: 10.1111/jvh.12198] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 09/21/2013] [Indexed: 01/29/2023]
Abstract
We examined the characteristics associated with hepatitis C virus (HCV) antibody (anti-HCV) prevalence and HCV clearance between injection drug using (IDU) and non-IDU men who have sex with men (MSM). Stored serum and plasma samples were tested for anti-HCV and HCV RNA to determine the HCV status of 6925 MSM at enrolment into the Multicentre AIDS Cohort Study (MACS). Prevalence and clearance ratios were calculated to determine the characteristics associated with HCV prevalence and clearance. Multivariable analyses were performed using Poisson regression methods with robust variance estimation. Anti-HCV prevalence was significantly higher among IDU than among non-IDU MSM (42.9% vs 4.0%), while clearance was significantly lower among IDU MSM (11.5% vs 34.5% among non-IDU MSM). HIV infection, Black race, and older age were independently associated with higher prevalence in both groups, while smoking, transfusion history, and syphilis were significantly associated with prevalence only among non-IDU MSM. The rs12979860-C/C genotype was the only characteristic independently associated with HCV clearance in both groups, but the effects of both rs12979860-C/C genotype [clearance ratio (CR) = 4.16 IDUs vs 1.71 non-IDUs; P = 0.03] and HBsAg positivity (CR = 5.06 IDUs vs 1.62 non-IDUs; P = 0.03) were significantly larger among IDU MSM. HIV infection was independently associated with lower HCV clearance only among non-IDU MSM (CR = 0.59, 95% CI = 0.40-0.87). IDU MSM have higher anti-HCV prevalence and lower HCV clearance than non-IDU MSM. Differences in the factors associated with HCV clearance suggest that the mechanisms driving the response to HCV may differ according to the mode of acquisition.
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Affiliation(s)
- Eric C Seaberg
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, 21205 USA
| | - Mallory D Witt
- David Geffen School of Medicine, University of California, Los Angeles, CA and Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, California, 90509 USA
| | - Lisa P Jacobson
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, 21205 USA
| | - Roger Detels
- Department of Epidemiology, UCLA School of Public Health, Los Angeles, California, 90095 USA
| | - Charles R Rinaldo
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, 15261 USA
| | - Steve Young
- TriCore Reference Laboratory, Albuquerque, New Mexico, 87131 USA
| | - John P Phair
- Howard Brown Health Center and Department of Medicine, Northwestern University, Chicago, Illinois, 60611 USA
| | - Chloe L Thio
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, 21205 USA
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107
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Sustained virological response to peginterferon therapy in patients infected with HCV (genotypes 2 and 3), with or without HIV. BMC Infect Dis 2014; 14 Suppl 5:S4. [PMID: 25236496 PMCID: PMC4160898 DOI: 10.1186/1471-2334-14-s5-s4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND HIV infection leads to a faster progression of liver disease in subjects infected with HCV, as compared with HCV mono-infected patients. Previous reports suggest that sustained virological response (SVR) rates are lower in HIV/HCV coinfection than in HCV monoinfection. We aimed to compare SVR rates of these two populations. METHODS We retrospectively analyzed clinical, biochemical and virological data of HCV and HIV/HCV infected patients with HCV genotypes 2 and 3 who started anti-HCV treatment between March 2004 and November 2012, at a single large center. Intention-to-treat (ITT) and per-protocol (PP) analysis were performed. Univariate and multivariate logistic regression analyses were performed to assess predictors of SVR. RESULTS 461 patients were analyzed: 307 (66.6%) males, 76 (16.5%) infected with HIV. Several differences at baseline between HCV monoinfected and HIV/HCV coinfected patients were observed. HCV monoinfected group was characterized by higher prevalence of genotype 2 (53% vs 5.3%), higher baseline HCV viral load (50% vs 35%), shorter mean duration of treatment (19 vs 41 weeks), more frequent use of peginterferon alfa-2a (84.5% vs 69.7%), lower prevalence of cirrhosis (6% vs 31.6%). Globally, SVR was achieved by 353 (76.6%) patients and 321 (83.8%) in the PP analysis. No statistically relevant differences were found in SVR rates between the two groups, either in ITT [78.2% (n = 301/385) vs 68.4% (n = 52/76), p =0.066, respectively] than in PP analysis [83.6% (n = 276/330) vs 84.9% (n = 45/53), p = 0.8]. CONCLUSIONS Higher baseline viral loads and interruption of peginterferon and/or ribavirin were associated with a poor outcome of anti-HCV treatment while HIV infection was not related to major or minor probability to achieve SVR.
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108
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Carvalho ARM, Pinto CMA. A coinfection model for HIV and HCV. Biosystems 2014; 124:46-60. [PMID: 25174999 DOI: 10.1016/j.biosystems.2014.08.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 08/06/2014] [Accepted: 08/19/2014] [Indexed: 01/28/2023]
Abstract
We study a mathematical model for the human immunodeficiency virus (HIV) and hepatites C virus (HCV) coinfection. The model predicts four distinct equilibria: the disease free, the HIV endemic, the HCV endemic, and the full endemic equilibria. The local and global stability of the disease free equilibrium was calculated for the full model and the HIV and HCV submodels. We present numerical simulations of the full model where the distinct equilibria can be observed. We show simulations of the qualitative changes of the dynamical behavior of the full model for variation of relevant parameters. From the results of the model, we infer possible measures that could be implemented in order to reduce the number of infected individuals.
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Affiliation(s)
- Ana R M Carvalho
- Faculty of Sciences, University of Porto, Rua do Campo Alegre s/n, 4440-452 Porto, Portugal.
| | - Carla M A Pinto
- School of Engineering, Polytechnic of Porto, and Centre for Mathematics of the University of Porto, Rua Dr António Bernardino de Almeida, 431, 4200-072 Porto, Portugal.
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109
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Bessimbaye N, Moussa AM, Mbanga D, Tidjani A, Mahamat SO, Ngawara MN, Ngarnayal G, Fissou HY, Sangare L, Ndoutamia G, Barro N. [Seroprevalence of HBs Ag and of anti-HCV antibodies among HIV infected people in N'Djamena, Chad]. ACTA ACUST UNITED AC 2014; 107:327-31. [PMID: 25158842 DOI: 10.1007/s13149-014-0386-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Accepted: 07/01/2014] [Indexed: 01/28/2023]
Abstract
This is a prospective study conducted as part of a voluntary testing for HBV, HCV and HIV. The aim of the study is to determine the seroprevalence of HBs Ag and anti-HCV antibodies among HIV infected people and a control group of HIV negative people. HIV prevalence among newly diagnosed volunteers is 9.1%. The overall seroprevalence of HBs Ag and anti-HCV antibodies is respectively 13.5% and 2.0%. The seroprevalence of HBs Ag and anti-HCVantibodies in the control group (HIV-negative) is respectively 12.2% and 2%. The seroprevalence of HBs Ag and anti-HCV antibodies among HIV infected people (old and new) is respectively 16.1% and 1%.This study, the first one conducted in Chad, has allowed us to know the seroprevalence of HBs Ag and anti-HCV antibodies among HIV infected people.
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Affiliation(s)
- N Bessimbaye
- Centre de prise en charge des PVVIH de N'Djamena, N'Djamena, Tchad
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110
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Relationship between CD4 cell count and serious long-term complications among HIV-positive individuals. Curr Opin HIV AIDS 2014; 9:63-71. [PMID: 24275674 DOI: 10.1097/coh.0000000000000017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW To summarize recent findings on the relationship between CD4 cell count metrics and selected serious clinical outcomes, and to deduce implications for CD4 cell count monitoring in treated HIV infection and the timing of combination antiretroviral therapy initiation. RECENT FINDINGS In treated HIV infection, a higher latest CD4 cell count is associated with a lower short-term risk of serious non-AIDS events (often composite endpoints) even in CD4 cell count strata more than 350/μl. Knowledge of alternate CD4 cell count metrics, such as CD4 cell count slope, nadir level and time spent under specific CD4 cell count thresholds, does not seem to confer additional prognostic information beyond that achieved by current CD4 cell count. Latest CD4 cell count is strongly associated with a short-term risk of infection-related non-AIDS malignancies, and serious hepatic events; however, the evidence is inconsistent for cardiovascular outcomes. Studies vary significantly in definitions of composite endpoints as well as the rigorousness of outcome ascertainment, which could explain the heterogeneity in results. SUMMARY Current CD4 cell count, but not other metrics, could be an important clinical tool to predict the short-term risk of serious non-AIDS events in treated HIV-positive individuals. An earlier initiation of therapy at CD4 cell count more than 350/μl or above 500/μl is likely to improve long-term CD4 cell count metrics. Whether it provides net individual clinical benefit requires a randomized trial.
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111
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Do the epidemiology, physiological mechanisms and characteristics of hepatocellular carcinoma in HIV-infected patients justify specific screening policies? AIDS 2014; 28:1379-91. [PMID: 24785953 DOI: 10.1097/qad.0000000000000300] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Reducing the incidence of hepatocellular carcinoma (HCC) in HIV-infected patients has become a serious problem when managing these patients. There are many explanations for this disease evolution, which notably include their longer survival under effective antiviral therapy and also the more rapid evolution of chronic liver disease. Despite recent advances in the management of hepatitis B (HBV) and hepatitis C (HCV) viral diseases, which will probably increase the number of patients achieving a virological response, HIV-infected patients with cirrhosis are still at risk of the onset of HCC. This evolution to HCC is also correlated to other comorbidities such as excessive alcohol consumption and nonalcoholic steatohepatitis (NASH). HCC thus remains a public health issue in this population. The poor prognosis and aggressiveness of HCC have been fully demonstrated, but the mechanisms underlying this aggressiveness are not yet well defined. As well as underlying mechanisms that contribute to accelerating hepatocarcinogenesis in HIV-infected patients, there are other reasons why HIV-infected patients should be considered a higher risk population. This review discusses the principal epidemiological determinants; the mechanisms of pathogenesis; and the treatment of HCC in HIV/HBV and HIV/HCV coinfected patients. It also discusses the probable need to develop a specific screening policy for HCC in this population in order to prevent the rapid development and to make them more amenable to a curative treatment.
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112
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Liu Y, Zeng P, Wang J, Liu G, Xu M, Ke L, He M, Liu Z. Hepatitis B virus infection in a cohort of HIV infected blood donors and AIDS patients in Sichuan, China. J Transl Med 2014; 12:164. [PMID: 24923206 PMCID: PMC4067527 DOI: 10.1186/1479-5876-12-164] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Accepted: 05/09/2014] [Indexed: 12/15/2022] Open
Abstract
Background Co-infections of HBV and HIV are frequent due to similar routes of transmission. In that transmission through blood is an important route for both HBV and HIV, evaluation of the prevalence of HBV in HIV infected blood donors may be important for transfusion safety. In addition, because the epidemiological characteristics of HBV in HIV infected patients and blood donors may differ from each other, understanding of it could be significant for therapy and prevention of HBV in HIV infected adults. However, data reported on these in Chinese people remains limited. Methods 614 HIV confirmed positive samples were collected from blood donors and patients and were screened for HBsAg and HBV DNA. The samples screened reactive for HBsAg or positive for HBV DNA were tested for the other serological markers of HBV including anti-HBs, HBeAg, anti-HBe and anti-HBc. For the samples tested positive for HBV DNA, the S region of HBV was amplified by nested PCR and the HBV genotypes were determined. Results HBV coinfections were found in 12.9% (79/614) HIV infected individuals including 42/417(10.1%) blood donors and 37/197 (18.8%) AIDS patients. In the HBsAg positive individuals, 80.0% were HBeAg negative in which 10.0% were HBV DNA negative and 38.3% with HBV DNA lower than 2000 IU/ml. The average HBV DNA levels were lower in donors than in patients. In the HBV DNA positive populations, HBV genotypes B, A and C accounted for 48.1%, 22.8% and 8.86% respectively. Mutations related to the failure of HBsAg detection were found in 2 of the 4 HBsAg-/HBV DNA + subjects. Conclusions High prevalence of HBV in HIV infected individuals was found in this study. Hence, we recommend routine testing of HBV for patients newly diagnosed with HIV/AIDS in China. Some HIV-HBV co-infected patients remain undiagnosed if only conventional serological markers for HBV are used and it’s important to detect HBV DNA for HIV infected patients. HBV DNA levels were relatively low in HBeAg negative patients, thus this serologic marker may be useful in prioritizing patients on their need for HBV treatment in settings in which HBV DNA is not available.
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Affiliation(s)
| | | | | | | | | | | | - Miao He
- Experimental center of transfusion medicine, Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Hua Cai Road 26 Hao, Dong San Huan Road Er Duan, Chengdu, Sichuan, China.
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Different interaction profiles of direct-acting anti-hepatitis C virus agents with human organic anion transporting polypeptides. Antimicrob Agents Chemother 2014; 58:4555-64. [PMID: 24867984 DOI: 10.1128/aac.02724-14] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Simeprevir (SMV), asunaprevir (ASV), daclatasvir (DCV), and sofosbuvir (SFV), which are newly developed direct-acting antiviral agents (DAAs) against hepatitis C virus (HCV) infection, are among the key components of anti-HCV regimens. Preclinical studies have identified inhibitory properties for some of these DAAs against organic anion transporting polypeptide 1B (OATP1B) functions. However, their details remain mostly uncharacterized. Because OATP1B1 and OATP1B3 play determinant roles in the pharmacokinetics of various drugs via their uptake into human hepatocytes, it is plausible that the inhibition of these OATP1Bs by a DAA would create a potential risk of drug-drug interaction, which has been an emerging concern in anti-HCV therapy. Accordingly, in the present study, we intended to clarify the inhibitory characteristics of newly developed DAAs toward OATP1B1 and -1B3 functions. The results of our coincubation inhibition assays have shown that all tested DAAs could inhibit OATP1B1 functions and that SMV, ASV, and DCV (to a lesser extent), but not SFV, exhibited long-lasting preincubation inhibitory effects on OATP1B1 functions. It was also found that the preincubation inhibitory effects of SMV and ASV could augment their coincubation inhibition potency. Furthermore, significant, but differential, inhibitory effects of the DAAs on the OATP1B3 function were identified. To summarize, our results clearly show that the newly developed DAAs are newly identified OATP1B1 and OATP1B3 inhibitors with distinctive interaction properties. It is believed that these inhibition profiles will provide essential information to all concerned parties with respect to the clinical significance of DAA-mediated inhibition of OATP1Bs in anti-HCV therapy.
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Gyar S, Agbo P, Reuben C. Assessment of Hepatitis B Co-infection among HIV/AIDS Patients Attending Antiretroviral Therapy (ART) Clinic in Garaku, Central Nigeria. ACTA ACUST UNITED AC 2014. [DOI: 10.3923/jm.2014.232.238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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115
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Eze JC, Ibeziako NS, Ikefuna AN, Nwokoye IC, Uleanya ND, Ilechukwu GC. Prevalence and risk factors for hepatitis C and human immunodeficiency virus coinfection among children in enugu, Nigeria. Afr J Infect Dis 2014; 8:5-8. [PMID: 24653810 DOI: 10.4314/ajid.v8i1.2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) and Human Immunodeficiency virus (HIV), are major public health challenges in the developing world especially sub-Saharan Africa. The aim of this study was to determine the prevalence and risk factors of Hepatitis C virus infection among children infected with HIV. METHODS This was a cross-sectional study conducted at the Paediatric HIV Clinic, UNTH, Enugu between July and December 2009. Antibodies to HCV were analyzed by newer generation rapid chromatographic immunoassay method using the Chromatest one step HCV test kit. The data was analysed using the Statistical Package for Social Sciences (SPSS) version 15 statistical software. The chi squared test was used to test for significant association of categorical variables. A p-value of <0.05 was accepted as significant. RESULTS One hundred and eighteen children HIV-infected children, aged between eighteen months to fifteen years were included in the data analysis. Eight of the HIV infected subjects were positive for HCV, giving an HIV-HCV co-infection prevalence of 6.8%. Co-infection was more prevalent among males and in those in age group 11-15 years. Blood transfusion, irrespective of frequency (p<0.015), and injections for immunization (p<0.049) were the significant risk factors noted. CONCLUSION There is need for strengthening of existing preventive strategies against HCV and HIV infections such as screening of donor blood and safe injection practices in our locality.
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Affiliation(s)
| | | | | | - Ikenna C Nwokoye
- Department of Paediatrics, Enugu State University of Technology Teaching Hospital, Enugu
| | | | - Gideon C Ilechukwu
- Whiston Hospital, St Helen's and Knowsley Teaching Hospital Trust, Prescot, UK
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116
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Kang W, Tong HI, Sun Y, Lu Y. Hepatitis C virus infection in patients with HIV-1: epidemiology, natural history and management. Expert Rev Gastroenterol Hepatol 2014; 8:247-66. [PMID: 24450362 DOI: 10.1586/17474124.2014.876357] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Hepatitis C virus (HCV)-related liver diseases have contributed to increased morbidity and mortality in HIV-1-infected individuals in the era of effective antiretroviral therapy. HCV transmission patterns have changed among the HIV co-infected population during the last decade, with acute HCV infection emerging worldwide. HIV infection accelerates the progression of HCV-related liver diseases and consequently cirrhosis, liver failure, and hepatocellular carcinoma. However, the current standard treatment of HCV infection with pegylated interferon plus ribavirin results in only a limited viral response. Furthermore, cumbersome pill regimens, antiretroviral related hepatotoxicity, and drug interactions of HCV and HIV regimens complicate therapy strategies. Fortunately, in the near future, new direct-acting anti-HCV agents will widen therapeutic options for HCV/HIV co-infection. Liver transplantation is also gradually accepted as a therapeutic option for end stage liver disease of HCV/HIV co-infected patients.
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Affiliation(s)
- Wen Kang
- Department of Public Health Sciences, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
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117
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Assessment of hepatitis B virus and hepatitis C virus infections and associated risk factors in HIV infected patients at Debretabor hospital, South Gondar, Northwest Ethiopia. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2014. [DOI: 10.1016/s2222-1808(14)60304-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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118
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Viral hepatitis B, C and HIV coinfection: Evaluation of some immunological and epidemiological aspects. HIV & AIDS REVIEW 2014. [DOI: 10.1016/j.hivar.2014.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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119
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Kiser JJ, Burton JR, Everson GT. Drug-drug interactions during antiviral therapy for chronic hepatitis C. Nat Rev Gastroenterol Hepatol 2013; 10:596-606. [PMID: 23817323 PMCID: PMC4634866 DOI: 10.1038/nrgastro.2013.106] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The emergence of direct-acting antiviral agents (DAAs) for HCV infection represents a major advance in treatment. The NS3 protease inhibitors, boceprevir and telaprevir, were the first DAAs to receive regulatory approval. When combined with PEG-IFN and ribavirin, these agents increase rates of sustained virologic response in HCV genotype 1 to ∼70%. However, this treatment regimen is associated with several toxicities. In addition, both boceprevir and telaprevir are substrates for and inhibitors of the drug transporter P-glycoprotein and the cytochrome P450 enzyme 3A4 and are, therefore, prone to clinically relevant drug interactions. Several new DAAs for HCV are in late stages of clinical development and are likely to be approved in the near future. These include the protease inhibitors, simeprevir and faldaprevir, the NS5A inhibitor, daclatasvir, and the nucleotide polymerase inhibitor, sofosbuvir. Herein, we review the clinical pharmacology and drug interactions of boceprevir, telaprevir and these investigational DAAs. Although boceprevir and telaprevir are involved in many interactions, these interactions are manageable if health-care providers proactively identify and adjust treatments. Emerging DAAs seem to have a reduced potential for drug interactions, which will facilitate their use in the treatment of HCV.
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Affiliation(s)
- Jennifer J Kiser
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, 12850 East Montview Boulevard, V20-C238, Aurora, CO 80045, USA
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French AL, Evans CT, Agniel DM, Cohen MH, Peters M, Landay AL, Desai SN. Microbial translocation and liver disease progression in women coinfected with HIV and hepatitis C virus. J Infect Dis 2013; 208:679-89. [PMID: 23687224 PMCID: PMC3719907 DOI: 10.1093/infdis/jit225] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 02/13/2013] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Microbial translocation has been implicated in the pathogenesis of liver fibrosis and cirrhosis. We sought to determine whether markers of microbial translocation are associated with liver disease progression during coinfection with human immunodeficiency virus (HIV) and hepatitis C virus (HCV). METHODS We measured serial plasma lipopolysaccharide (LPS), endotoxin core antibody, intestinal fatty acid-binding protein (I-FABP), soluble CD14 (sCD14), interleukin 6 (IL-6), interleukin 10, and tumor necrosis factor α (TNF-α) levels over a 5-year period in 44 HIV/HCV-coinfected women, 21 of whom experienced liver disease progression and 23 were nonprogressors. RESULTS While LPS levels did not differ significantly over time between progressors and nonprogressors (P = .60), progressors had significantly higher plasma levels of sCD14, a marker of monocyte activation by LPS, at the first time point measured (P = .03) and throughout the study period (P = .001); progressors also had higher IL-6 and I-FABP levels over the 5-year study period (P = .02 and .03, respectively). The associations between progression and sCD14, I-FABP, and IL-6 levels were unchanged in models controlling for HIV RNA and CD4(+) T-cell count. CONCLUSIONS Although LPS levels did not differ between liver disease progressors and nonprogressors, the association of sCD14, I-FABP, and IL-6 levels with liver disease progression suggests that impairment of gut epithelial integrity and consequent microbial translocation may play a role in the complex interaction of HIV and HCV pathogenesis.
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Affiliation(s)
- Audrey L French
- Department of Medicine, CORE Center/Stroger Hospital of Cook County, Chicago, IL 60612, USA.
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121
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Validation of an electrospray ionisation LC–MS/MS method for quantitative analysis of telaprevir and its R-diastereomer. J Chromatogr B Analyt Technol Biomed Life Sci 2013; 932:100-10. [DOI: 10.1016/j.jchromb.2013.06.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 05/09/2013] [Accepted: 06/09/2013] [Indexed: 11/18/2022]
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Tsui JI, Cheng DM, Libman H, Bridden C, Saitz R, Samet JH. Risky alcohol use and serum aminotransferase levels in HIV-infected adults with and without hepatitis C. J Stud Alcohol Drugs 2013; 74:266-70. [PMID: 23384374 DOI: 10.15288/jsad.2013.74.266] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE The purpose of this study was to examine the association between risky drinking amounts and serum aminotransferase levels in HIV-infected adults with and without hepatitis C virus (HCV) infection. METHOD In a prospective cohort of HIV-infected adults with current or past alcohol problems, we assessed whether drinking risky amounts (as defined by the National Institute on Alcohol Abuse and Alcoholism) was associated with higher levels of serum aspartate aminotransferase [AST] and alanine aminotransferase [ALT]) over time, stratifying analyses by HCV status. Generalized linear mixed effects regression models were used to examine the association between risky drinking and natural log-transformed AST and ALT over time. RESULTS Among HIV/HCV-coinfected persons (n = 200), risky drinking was associated with a higher adjusted mean AST (62.2 vs. 51.4 U/L; adjusted ratio of means 1.2, 95% CI [1.07, 1.37], p = .003) and ALT (51.3 vs. 41.6 U/L; adjusted ratio of means 1.2, 95% CI [1.07, 1.42], p = .004) compared with non-risky drinking. In contrast, among HIV-infected adults without HCV infection (n = 197), there were no significant differences between those who did and did not drink risky amounts in AST (34.7 vs. 33.3 U/L; adjusted ratio of means = 1.0, 95% CI [0.95, 1.14], p = .36) or ALT (29.1 vs. 28.7 U/L; adjusted ratio of means = 1.0, 95% CI [0.91, 1.13], p = .78). CONCLUSIONS Among HIV-infected adults with HCV, those who drink risky amounts have higher serum aminotransferase levels than those who do not drink risky amounts. These results suggest that drinking risky amounts may be particularly harmful in HIV/HCV-coinfected adults and supports recommendations that providers pay special attention to drinking in this population.
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Affiliation(s)
- Judith I Tsui
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, and Boston University School of Medicine, Boston, Massachusetts 02118, USA.
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Brunet L, Moodie EEM, Rollet K, Cooper C, Walmsley S, Potter M, Klein MB. Marijuana smoking does not accelerate progression of liver disease in HIV-hepatitis C coinfection: a longitudinal cohort analysis. Clin Infect Dis 2013; 57:663-70. [PMID: 23811492 PMCID: PMC3739469 DOI: 10.1093/cid/cit378] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background. Marijuana smoking is common and believed to relieve many symptoms, but daily use has been associated with liver fibrosis in cross-sectional studies. We aimed to estimate the effect of marijuana smoking on liver disease progression in a Canadian prospective multicenter cohort of human immunodeficiency virus/hepatitis C virus (HIV/HCV) coinfected persons. Methods. Data were analyzed for 690 HCV polymerase chain reaction positive (PCR-positive) individuals without significant fibrosis or end-stage liver disease (ESLD) at baseline. Time-updated Cox Proportional Hazards models were used to assess the association between the average number of joints smoked/week and progression to significant liver fibrosis (APRI ≥ 1.5), cirrhosis (APRI ≥ 2) or ESLD. Results At baseline, 53% had smoked marijuana in the past 6 months, consuming a median of 7 joints/week (IQR, 1–21); 40% smoked daily. There was no evidence that marijuana smoking accelerates progression to significant liver fibrosis (APRI ≥ 1.5) or cirrhosis (APRI ≥ 2; hazard ratio [HR]: 1.02 [0.93–1.12] and 0.99 [0.88–1.12], respectively). Each 10 additional joints/week smoked slightly increased the risk of progression to a clinical diagnosis of cirrhosis and ESLD combined (HR, 1.13 [1.01–1.28]). However, when exposure was lagged to 6–12 months before the diagnosis, marijuana was no longer associated with clinical disease progression (HR, 1.10 [0.95–1.26]). Conclusions In this prospective analysis we found no evidence for an association between marijuana smoking and significant liver fibrosis progression in HIV/HCV coinfection. A slight increase in the hazard of cirrhosis and ESLD with higher intensity of marijuana smoking was attenuated after lagging marijuana exposure, suggesting that reverse causation due to self-medication could explain previous results.
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Affiliation(s)
- Laurence Brunet
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada, H2X 2P4
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Zaw SKK, Tun STT, Thida A, Aung TK, Maung W, Shwe M, Aye MM, Clevenbergh P. Prevalence of hepatitis C and B virus among patients infected with HIV: a cross-sectional analysis of a large HIV care programme in Myanmar. Trop Doct 2013; 43:113-5. [PMID: 23800421 DOI: 10.1177/0049475513493416] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Co-infection with the hepatitis C virus (HCV) and/or hepatitis B virus (HBV) influences the morbidity and mortality of patients with HIV. A cross sectional analysis was of 11,032 HIV-infected patients enrolled in the Integrated HIV Care Program from May 2005 to April 2012 and Epi-info 3.5 was used to determine the serological prevalence of chronic hepatitis B and hepatitis C. The mean ± standard deviation age of patients was 36 ± 8.4 years (adult cohort) and 7 ± 3 years (paediatric cohort). The sero prevalence of hepatitis B surface antigen, hepatitis C (anti HCV antibodies) and triple infection are 8.7%, 5.3% and 0.35%, respectively. Men who have sex with men are at the highest risk of being co-infected with hepatitis B while intravenous drug users are at the highest risk of being co-infected with hepatitis C. It is important to screen for hepatitis B and C in HIV infected people in order to provide quality care for HIV patients with co-infection.
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Affiliation(s)
- Sai Ko Ko Zaw
- International Union Against Tuberculosis and Lung Disease, Mandalay, Myanmar
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125
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Pugi A, Bonaiuti R, Maggini V, Moschini M, Tuccori M, Leone R, Rossi M, Motola D, Piccinni C, Ferrazin F, Sottosanti L, Mugelli A, Vannacci A, Lapi F. Safety profile of antiviral medications: A pharmacovigilance study using the Italian spontaneous-reporting database. Am J Health Syst Pharm 2013; 70:1039-46. [DOI: 10.2146/ajhp120665] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- Alessandra Pugi
- Department of Neuroscience, Psychology, Drug Research and Child Health, Interuniversity Center of Molecular Medicine and Applied Biophysics (CIMMBA), University of Florence, and Pharmacovigilance Center of Tuscan County (PCTC), Florence, Italy
| | - Roberto Bonaiuti
- Department of Neuroscience, Psychology, Drug Research and Child Health, Interuniversity Center of Molecular Medicine and Applied Biophysics (CIMMBA), University of Florence, and Pharmacovigilance Center of Tuscan County (PCTC), Florence, Italy
| | - Valentina Maggini
- Department of Neuroscience, Psychology, Drug Research and Child Health, Interuniversity Center of Molecular Medicine and Applied Biophysics (CIMMBA), University of Florence, and Pharmacovigilance Center of Tuscan County (PCTC), Florence, Italy
| | - Martina Moschini
- Department of Neuroscience, Psychology, Drug Research and Child Health, Interuniversity Center of Molecular Medicine and Applied Biophysics (CIMMBA), University of Florence, and Pharmacovigilance Center of Tuscan County (PCTC), Florence, Italy
| | - Marco Tuccori
- PCTC, and Interdepartmental Center for Research in Clinical Pharmacology and Experimental Therapeutics, University of Pisa, Pisa, Italy
| | - Roberto Leone
- Clinical Pharmacology Unit, University of Verona, Verona, Italy
| | - Marco Rossi
- PCTC, and University Hospital of Siena, Siena, Italy
| | - Domenico Motola
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Carlo Piccinni
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Fernanda Ferrazin
- National Pharmacovigilance Office, Pharmacovigilance Unit, Italian Medicines Agency, Rome
| | - Laura Sottosanti
- National Pharmacovigilance Office, Pharmacovigilance Unit, Italian Medicines Agency, Rome
| | - Alessandro Mugelli
- Department of Neuroscience, Psychology, Drug Research and Child Health, CIMMBA, and PCTC
| | - Alfredo Vannacci
- Department of Neuroscience, Psychology, Drug Research and Child Health, CIMMBA, and PCTC
| | - Francesco Lapi
- Department of Neuroscience, Psychology, Drug Research and Child Health, CIMMBA, PCTC, and the Center for Clinical Epidemiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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Northcott MJ, Ong WL, Walsh M, McCarthy P, Belleli D, Tran H, Street A, Kemp W, Davis AK. Prevalence of transfusion-acquired hepatitis C in an Australian bleeding disorders population. Haemophilia 2013; 19:847-52. [DOI: 10.1111/hae.12204] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2013] [Indexed: 12/30/2022]
Affiliation(s)
- M. J. Northcott
- Ronald Sawers Haemophilia Centre; The Alfred Hospital; Melbourne Australia
| | - W. L. Ong
- Ronald Sawers Haemophilia Centre; The Alfred Hospital; Melbourne Australia
| | - M. Walsh
- Ronald Sawers Haemophilia Centre; The Alfred Hospital; Melbourne Australia
| | - P. McCarthy
- Ronald Sawers Haemophilia Centre; The Alfred Hospital; Melbourne Australia
| | - D. Belleli
- Ronald Sawers Haemophilia Centre; The Alfred Hospital; Melbourne Australia
| | - H. Tran
- Ronald Sawers Haemophilia Centre; The Alfred Hospital; Melbourne Australia
| | - A. Street
- Ronald Sawers Haemophilia Centre; The Alfred Hospital; Melbourne Australia
| | - W. Kemp
- Gastroenterology Department; The Alfred Hospital; Melbourne Australia
| | - A. K. Davis
- Ronald Sawers Haemophilia Centre; The Alfred Hospital; Melbourne Australia
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Wondimeneh Y, Alem M, Asfaw F, Belyhun Y. HBV and HCV seroprevalence and their correlation with CD4 cells and liver enzymes among HIV positive individuals at University of Gondar Teaching Hospital, Northwest Ethiopia. Virol J 2013; 10:171. [PMID: 23721493 PMCID: PMC3670208 DOI: 10.1186/1743-422x-10-171] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Accepted: 05/29/2013] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The co-existence of viral hepatitis caused by HBV and HCV become common causes of severe liver complication and immunological impairment among HIV infected individuals. The aim of this study was to assess the seroprevalence of HBV and HCV and their correlation with CD4 and liver enzyme levels among HAART naïve HIV positive individuals. METHOD A Cross-sectional study was conducted from March-May, 2011 at University of Gondar Teaching Hospital, Northwest Ethiopia. HBV and HCV serological tests and liver enzymes as well as CD4 T cell level determination were assessed following the standard procedures. Socio-demographic data was collected by using structured questionnaire. The data was entered and analyzed by using SPSS version 20.0 statistical software and p < 0.05 was considered as statistically significant. RESULT Among 400 study participants, the overall prevalence of HIV-viral hepatitis co-infection was 42(11.7%). The prevalence of HIV-HBV, HIV-HCV and HIV-HBV-HCV co-infections were 20(5.6%), 18(5.0%) and 4(1.1%) respectively. Study participants who had HIV-HBV, HIV-HCV and HIV-HBV-HCV co-infection have relatively raised mean liver enzyme levels (ALT, AST and ALP) than HIV mono-infected once. Individuals with HIV-HBV, HIV-HCV and HIV-HBV-HCV co-infection also had a lower mean CD4 levels than HIV mono-infected study participants. The mean CD4 value in males was lower than females. CONCLUSION The prevalence of HBV and HCV was higher than reports from general population of the country. Raised levels of liver enzymes and lowered mean CD4 counts were seen in HIV-HBV, HIV-HCV and HIV-HBV-HCV co-infections. These findings underscore the importance of screening all HIV positive individuals before initiating antiretroviral treatment.
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Affiliation(s)
- Yitayih Wondimeneh
- School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, Ethiopia
| | - Meseret Alem
- School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, Ethiopia
| | - Fanaye Asfaw
- School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, Ethiopia
| | - Yeshambel Belyhun
- School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, Ethiopia
- Institute of Virology, Faculty of Medicine, University of Leipzig, Johannisallee 30, Leipzig, 04103, Germany
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128
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Rodríguez-Torres M. Challenges in the treatment of chronic hepatitis C in the HIV/HCV-coinfected patient. Expert Rev Anti Infect Ther 2013. [PMID: 23199398 DOI: 10.1586/eri.12.107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Hepatitis C virus (HCV) and HIV are common coinfections that convey a shortened lifespan, mostly related to liver disease. Treatment against HCV in the coinfected patient is notoriously more complex and challenging. There are no optimal treatment algorithms for HIV/HCV coinfected patients as efficacy of approved anti-HCV therapies is low with relevant side effects. The use of direct-acting antivirals for anti-HCV therapy has the potential to improve therapeutic efficacy, but also increase side effects and drug-drug interactions. In spite of all of this, the most important and significant fact is that chronic hepatitis C is potentially curable, and the eradication of the HCV infection is a crucial outcome in this population. The establishment of a productive collaboration among the regulatory agencies, the medical community and the pharmaceutical industry could lead to faster access to more effective HCV therapies for the coinfected patient and eventually stop the progression of liver disease in these patients.
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Focus on drug interactions: the challenge of treating hepatitis C virus infection with direct-acting antiviral drugs in the HIV-positive patient. Curr Opin Infect Dis 2013; 26:50-7. [PMID: 23242341 DOI: 10.1097/qco.0b013e32835c2027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE OF REVIEW Successful treatment of hepatitis C virus (HCV) infection is necessary for the survival of HIV-infected patients. This review covers the outcomes of current therapy, first-generation HCV direct-acting antivirals (DAAs) and their drug-to-drug interactions (DDIs). Understanding DDIs between HIV antiretroviral therapy (ART) and the DAAs in development is important to assure the best management of the HIV/HCV coinfected individuals. RECENT FINDINGS The two first-in-class DAAs were approved for clinical use in 2011. The first trials with boceprevir or telaprevir added to standard therapy in HIV/HCV coinfected patients revealed triple therapy to be efficacious with significantly improved sustained virological response rates. However, these DAAs were associated with more and worse adverse effects, as well as with significant DDIs with multiple drugs, including ART. Early data on DAAs in development suggest improved efficacy and safety and the potential for lesser DDIs. SUMMARY Anti-HCV therapy is fundamental in coinfected patients, but the approved therapies are suboptimal. The first-generation of approved HCV DAAs improved efficacy of therapy in coinfected patients, but have multiple safety concerns, including potentially serious drug interactions with ART. Early results from newer DAAs are promising.
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Nwolisa E, Mbanefo F, Ezeogu J, Amadi P. Prevalence of hepatitis B co-infection amongst HIV infected children attending a care and treatment centre in Owerri, South-eastern Nigeria. Pan Afr Med J 2013; 14:89. [PMID: 23646225 PMCID: PMC3641926 DOI: 10.11604/pamj.2013.14.89.1711] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Accepted: 05/29/2012] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Hepatitis B infection impacts negatively on disease progression in HIV infected children thereby increasing morbidity and mortality. In spite of the foregoing, there is paucity of data on Hepatitis B co-infection in children living with HIV in Owerri, South Eastern Nigeria.This study set out to determine the prevalence of Hepatitis B Co- infection in HIV infected children attending the Paediatric HIV Care and Treatment clinic of the Federal Medical Centre Owerri. METHODS The study period was between February and July 2010. Testing for Hepatitis B infection was done using the ACON Hepatitis B surface antigen Rapid test strip. (Acon Laboratories Inc. San Diego.CA). RESULTS A total of 139 HIV infected children were enrolled during the study period. The overall prevalence of Hepatitis B Co- infection was 5.8% (8/139). The prevalence in males was 8.2% (5/61) while in females it was 3.8% (3/78). The prevalence of Hepatitis B Co- infection amongst patients on antiretroviral therapy was 4.6%. They accounted for 62.5% of Hepatitis B Co- infection in our study. Previous blood transfusion, gender and age of patient did not show statistically significant relationship with Hepatitis B Co-infection. CONCLUSION Though our study shows a low prevalence of Hepatitis B co infection in HIV infected children in our centre, reduction of the rate is still strongly desirable. Reduction can be achieved by strengthening the uptake of Hepatitis B vaccine as part of the routine childhood immunization programme.
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Affiliation(s)
- Emeka Nwolisa
- Paediatric Infectious diseases Unit, Department of Paediatrics, Federal Medical Centre, Owerri Imo State, Nigeria
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131
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Pharmacokinetic interaction between boceprevir and etravirine in HIV/HCV seronegative volunteers. J Acquir Immune Defic Syndr 2013; 62:67-73. [PMID: 23075915 DOI: 10.1097/qai.0b013e318275da93] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE The primary aim of this study was to determine the bioequivalence of boceprevir, an HCV protease inhibitor and etravirine, an HIV non-nucleoside reverse transcriptase inhibitor; area under the concentration time curve (AUC(0,τ)); maximum concentration (C(max)); and trough concentration (C(8) or C(min)) when administered in combination versus alone. DESIGN Open-label crossover study in healthy volunteers. METHODS Boceprevir, etravirine, and the combination were administered for 11-14 days with intensive sampling between days 11 and 14 of each sequence. Boceprevir and etravirine were quantified using validated liquid chromatography coupled with tandem mass spectrometry and high-performance liquid chromatography/ultraviolet assays, respectively and pharmacokinetics determined using noncompartmental methods. Geometric mean ratios (GMRs) and 90% confidence interval (CI) for the combination versus each drug alone were evaluated using 2 one-sided t tests. The hypothesis of equivalence was rejected if 90% GMR CI was not contained in the interval (0.8-1.25). RESULTS Twenty subjects completed study. GMRs (90% CI) for etravirine AUC(o,τ), C(max), and C(min) were 0.77 (0.66 to 0.91), 0.76 (0.68 to 0.85), and 0.71 (0.54 to 0.95), respectively, in combination versus alone. Boceprevir GMRs (90% CI) for AUC(o,τ), C(max), and C(8) were 1.10 (0.94 to 1.28), 1.10 (0.94 to 1.29), and 0.88 (0.66 to 1.17), respectively, in combination versus alone. All adverse events (n = 112) were mild or moderate. Six subjects discontinued: 4 due to rash, 1 due to central nervous system effects, and 1 for a presumed viral illness. CONCLUSIONS Etravirine AUC(o,τ), C(max), and C(min)decreased 23%, 24%, and 29%, respectively, with boceprevir. Boceprevir AUC(0,τ) and C(max) increased 10% and C(8) decreased 12% by etravirine. Additional research is needed to elucidate the mechanism(s) and therapeutic implications of the observed interaction.
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Smith RL, de Boer R, Brul S, Budovskaya Y, van Spek H. Premature and accelerated aging: HIV or HAART? Front Genet 2013; 3:328. [PMID: 23372574 PMCID: PMC3556597 DOI: 10.3389/fgene.2012.00328] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 12/29/2012] [Indexed: 01/09/2023] Open
Abstract
Highly active antiretroviral therapy (HAART) has significantly increased life expectancy of the human immunodeficiency virus (HIV)-positive population. Nevertheless, the average lifespan of HIV-patients remains shorter compared to uninfected individuals. Immunosenescence, a current explanation for this difference invokes heavily on viral stimulus despite HAART efficiency in viral suppression. We propose here that the premature and accelerated aging of HIV-patients can also be caused by adverse effects of antiretroviral drugs, specifically those that affect the mitochondria. The nucleoside reverse transcriptase inhibitor (NRTI) antiretroviral drug class for instance, is known to cause depletion of mitochondrial DNA via inhibition of the mitochondrial specific DNA polymerase-γ. Besides NRTIs, other antiretroviral drug classes such as protease inhibitors also cause severe mitochondrial damage by increasing oxidative stress and diminishing mitochondrial function. We also discuss important areas for future research and argue in favor of the use of Caenorhabditis elegans as a novel model system for studying these effects.
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Affiliation(s)
- Reuben L Smith
- Swammerdam Institute for Life Sciences, University of Amsterdam Amsterdam, Netherlands
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133
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Abstract
We report an autochthonous hepatitis E virus (HEV)-hepatitis B virus co-primary infection in a 41-year-old man having sex with men and infected with human immunodeficiency virus (HIV). This case prompts testing for HEV in HIV-infected patients with acute hepatitis even if primary infection with another hepatitis virus is diagnosed.
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134
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Wang LJ, Lin SK, Chiang SC, Su LW, Chen CK. Risk factors for HIV, viral hepatitis, and syphilis among heroin users in northern Taiwan. Subst Use Misuse 2013; 48:89-98. [PMID: 23077983 DOI: 10.3109/10826084.2012.731131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A total of 125 heroin users were recruited from a detention center and two psychiatric hospitals in northern Taiwan during 2006 in order to investigate the prevalence and correlates of blood-borne infections among heroin users. The seroprevalence rates of the human immunodeficiency virus (HIV), hepatitis C virus (HCV), HBV, HDV, and syphilis were 15.2%, 74.4%, 15.2%, 6.4%, and 8%, respectively. Injection risk behaviors were associated with HIV, HCV, and syphilis infections, but not with HBV infections. Meanwhile, HCV and HBV infections were correlated with the duration of heroin use and age of the subjects, respectively. The results of this study suggest that a comprehensive public health program is needed to prevent transmission of these blood-borne infections. The study's limitations are noted.
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Affiliation(s)
- Liang-Jen Wang
- Department of Psychiatry, Chang Gung Memorial Hospital, Keelung, Taiwan
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135
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Differences in HCV viral decline between low and standard-dose pegylated-interferon-alpha-2a with ribavirin in HIV/HCV genotype 3 patients. PLoS One 2012; 7:e48959. [PMID: 23145040 PMCID: PMC3493612 DOI: 10.1371/journal.pone.0048959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 10/02/2012] [Indexed: 12/15/2022] Open
Abstract
Background The aim of the study was to analyze the different impact of standard and low-dose Peg-IFN-α2a/RBV therapies on HCV viral decline in HIV/HCV genotype 3 co-infected patients during the first weeks of treatment. Methods Plasma HCV viral decline was analyzed between baseline and weeks 1, 2 and 4 in two groups of treatment-naïve HCV genotype 3 patients with HIV co-infection. The Standard Dose Group (SDG) included patients who received Peg-IFN at 180 µg/per week with a weight-adjusted dose of ribavirin; Low-Dose Group (LDG) patients received Peg-IFN at 135 µg/per week with 800 mg/day ribavirin. The effect of IL28B genotype on HCV viral decline was evaluated in both groups. HCV viral decline was analyzed using a multivariate linear regression model. Results One hundred and six patients were included: 48 patients in the SDG and 58 in the LDG. HCV viral decline for patients in the LDG was less than for those in the SDG (week 1∶1.72±0.74 log10 IU/mL versus 1.78±0.67 log10 IU/mL, p = 0.827; week 2∶2.3±0.89 log10 IU/mL versus 3.01±1.02 log10 IU/mL, p = 0.013; week 4∶3.52±1.2 log10 IU/mL versus 4.09±1.1 log10 IU/mL, p = 0.005). The linear regression model identified the Peg-IFN/RBV dose as an independent factor for HCV viral decline at week 4. Conclusions Our results showed that HCV viral decline was less for patients in the low-dose group compared to those receiving the standard dose. Until a randomized clinical trial is conducted, clinicians should be cautious about using lower doses of Peg-IFN/RBV in HIV/HCV genotype 3 co-infected patients.
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136
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Shen YZ, Wang ZY, Qi TK, Jiang XY, Song W, Tang Y, Wang JR, Liu L, Zhang RF, Zheng YF, Dai ZS, Lu HZ. Serological survey of viral hepatitis markers among newly diagnosed patients with HIV/AIDS in China. HIV Med 2012; 14:167-75. [DOI: 10.1111/j.1468-1293.2012.01048.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2012] [Indexed: 01/29/2023]
Affiliation(s)
- YZ Shen
- Department of Infectious Diseases; Shanghai Public Health Clinical Center; Fudan University; Shanghai; China
| | - ZY Wang
- Department of Infectious Diseases; Shanghai Public Health Clinical Center; Fudan University; Shanghai; China
| | - TK Qi
- Department of Infectious Diseases; Shanghai Public Health Clinical Center; Fudan University; Shanghai; China
| | - XY Jiang
- Department of Infectious Diseases; Shanghai Public Health Clinical Center; Fudan University; Shanghai; China
| | - W Song
- Department of Infectious Diseases; Shanghai Public Health Clinical Center; Fudan University; Shanghai; China
| | - Y Tang
- Department of Infectious Diseases; Shanghai Public Health Clinical Center; Fudan University; Shanghai; China
| | - JR Wang
- Department of Infectious Diseases; Shanghai Public Health Clinical Center; Fudan University; Shanghai; China
| | - L Liu
- Department of Infectious Diseases; Shanghai Public Health Clinical Center; Fudan University; Shanghai; China
| | - RF Zhang
- Department of Infectious Diseases; Shanghai Public Health Clinical Center; Fudan University; Shanghai; China
| | - YF Zheng
- Department of Infectious Diseases; Shanghai Public Health Clinical Center; Fudan University; Shanghai; China
| | - ZS Dai
- Department of Infectious Diseases; Shanghai Public Health Clinical Center; Fudan University; Shanghai; China
| | - HZ Lu
- Department of Infectious Diseases; Shanghai Public Health Clinical Center; Fudan University; Shanghai; China
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Telan EFO, Samonte GMJ, Abellanosa-Tac-An IP, Alesna ET, Leaño PSA, Emphasis YEE, Tsuneki A, Matsumoto K, Kageyama S. The early phase of an HIV epidemic in a population exposed previously to HCV in the Philippines. J Med Virol 2012; 83:941-7. [PMID: 21503904 DOI: 10.1002/jmv.22070] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Human immunodeficiency virus (HIV) sentinel surveillance program for injecting drug users has been conducted in Metro Cebu, the Philippines. A low prevalence (0-0.52%) of anti-HIV-positivity had been detected in this population from 2002 to 2007. However, a 10-fold increase in HIV prevalence was detected in the 2009 national HIV sentinel surveillance program. It prompted an additional outreach program to be conducted in Metro Cebu in January 2010, which recorded the highest HIV prevalence rate ever documented in the Philippines (75%, 44/59). HIV genes from fourteen 2009 to 2010 Metro Cebu strains were clustered closely in the phylogenetic tree, but no other strain collected outside Metro Cebu and none stored in the International Nucleotide Sequence Database was allocated to the same phylogenetic cluster. All these HIV infections have emerged in the anti-hepatitis C virus (HCV)-positive population (100%, 62/62) in Metro Cebu from 2009 to 2010. The five HCV strains from the individuals harboring the closely related HIV strains were categorized into different subtypes. These results strongly suggest that HIV infections occurred recently and spread rapidly among injecting drug users, while HCV had been circulating previously among them. Considering the fact that injecting drug use was the first mode of HIV transmission in Asia, extensive monitoring of injecting drug users and associated bridging populations is necessary. Therefore, HCV-guided characterization of the spread of HIV to populations that are vulnerable to blood-borne infections could play an important role in alerting health authorities to the early phase of an HIV epidemic.
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138
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Abstract
Co-infection with either HIV or HBV in chronic hepatitis C patients is common, since all these viruses share transmission routes and geographical distribution. Interaction between these viruses generally amplifies liver damage, increasing the risk of developing end-stage liver disease and hepatocellular carcinoma. HIV-HCV co-infection is associated with poorer response to antiviral therapy. New antivirals against HCV are eagerly awaited for this population. HBV-HCV dual infections are less common. The principles guiding indication of therapy in monoinfected patients should be followed considering which virus replicates in persons with serological markers of dual HBV-HCV infection. Although there is growing evidence supporting the use of direct acting antivirals (DAA) in dually infected patients with active HCV replication, prospective trials should be conducted to demonstrate their benefit, assessing carefully the rate and clinical consequences of HBV rebounds.
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139
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EASL clinical practice guidelines: Management of chronic hepatitis B virus infection. J Hepatol 2012; 57:167-85. [PMID: 22436845 DOI: 10.1016/j.jhep.2012.02.010] [Citation(s) in RCA: 2352] [Impact Index Per Article: 196.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 02/28/2012] [Indexed: 02/06/2023]
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140
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Bourcier V, Winnock M, Ait Ahmed M, Sogni P, Pambrun E, Poizot-Martin I, Chaffaut C, Chevret S, Trinchet JC, Salmon D. Primary liver cancer is more aggressive in HIV-HCV coinfection than in HCV infection. A prospective study (ANRS CO13 Hepavih and CO12 Cirvir). Clin Res Hepatol Gastroenterol 2012; 36:214-21. [PMID: 22189509 DOI: 10.1016/j.clinre.2011.11.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Accepted: 11/02/2011] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Since HAART, primary liver cancer has emerged as an increasing cause of morbidity and mortality in patients with HIV infection. Our aim was to compare characteristics and outcome of primary liver cancer according to HIV status in HCV cirrhotic patients submitted to periodic ultrasonographic surveillance. METHODS All patients with primary liver cancer and cirrhosis were selected from two prospective cohorts (ANRS CO12 Cirvir, viral cirrhosis, n=1081; ANRS CO13 Hepavih, HIV-HCV coinfection, n=1175). Cirrhosis was diagnosed by liver biopsy in monoHCV group and biopsy and/or non-invasive tests in HIV-HCV group. Ultrasonographic surveillance was performed every 6 months. Diagnosis of primary liver cancer was established according to EASL-AASLD guidelines. RESULTS Primary liver cancer was diagnosed in 32 patients, 16 in each group, and corresponded to hepatocellular carcinoma in all except for two cholangiocarcinomas in HIV-HCV patients. Ultrasonographic follow-up was similar (median time since last ultrasonographic without focal lesion: 237 days in HIV-HCV group (n=12) versus 208 days in HCV group, NS). At primary liver cancer diagnosis HIV-HCV patients were markedly younger (48 vs. 60 yrs, P<0.001), primary liver cancer was more advanced in HIV-HCV patients (single nodule: 43% vs. 75%, P=0.07; mean diameter of main nodule: 24 vs. 16 mm, P=0.006; portal obstruction: 3 vs. 0). Curative treatment was performed in four HIV-HCV patients versus 11 HCV patients (P=0.017). During follow-up, 10 HIV-HCV patients died versus only one HCV patient (P=0.0005). CONCLUSIONS This result suggests more aggressiveness for tumors in HIV infected patients and, if confirmed, could result in shortening the length between ultrasonographic examinations.
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Affiliation(s)
- Valérie Bourcier
- Service d'hépato-gastroentérologie, hôpital Jean-Verdier, Assistance publique-Hôpitaux de Paris, UFR SMBH, université Paris-13, 93143 Bondy cedex, France.
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141
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Kiser JJ, Burton JR, Anderson PL, Everson GT. Review and management of drug interactions with boceprevir and telaprevir. Hepatology 2012; 55:1620-8. [PMID: 22331658 PMCID: PMC3345276 DOI: 10.1002/hep.25653] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Boceprevir (BOC) and telaprevir (TPV), when added to pegylated interferon and ribavirin for the treatment of chronic hepatitis C virus (HCV) infection, increase the rates of sustained virologic response in treatment-naïve persons to approximately 70%. Though these agents represent an important advance in the treatment of chronic HCV, they present new treatment challenges to the hepatology community. BOC and TPV are both substrates and inhibitors of the hepatic enzyme, cytochrome P450 3A, and the drug transporter, P-glycoprotein, which predisposes these agents to many drug interactions. Identification and appropriate management of potential drug interactions with TPV and BOC is critical for optimizing therapeutic outcomes during hepatitis C treatment. This review highlights the pharmacologic characteristics and drug-interaction potential of BOC and TPV and provides guidance on the management of drug interactions with these agents.
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Affiliation(s)
- Jennifer J. Kiser
- University of Colorado Denver School of Pharmacy, Aurora, CO,Corresponding Author Jennifer J. Kiser, PharmD, Assistant Professor, Department of Pharmaceutical Sciences, University of Colorado Denver Anschutz Medical Campus, School of Pharmacy, 12850 E Montview Blvd, V20-C238, Aurora, CO 80045, Office (303) 724-6131, Fax (303) 724-6135,
| | - James R. Burton
- University of Colorado Denver School of Medicine, Aurora, CO
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Abstract
PURPOSE OF REVIEW Compared with vast literature on the clinical, imaging, and in-vivo microbiology aspects of HIV disease, there is less on biopsy pathology and even less on autopsy data. This review focuses on some current clinico-pathological issues, with indications of where there is less certainty than we would like. RECENT FINDINGS The most important change in causes of death in HIV disease, since the advent of highly active antiretroviral therapy (HAART), is the reduction of classical AIDS-defining opportunistic diseases, with the compensating increase in background comorbidities related to lifestyle, infections including the hepatitis viruses and HHV8, ageing, drug toxicity and immune reconstitution inflammatory syndrome phenomena. In low-income countries, HIV contributes significantly to maternal mortality. SUMMARY To understand HIV disease better and manage future patients better, we need more tissue clinico-pathological correlation, including quality biopsy and autopsy evaluations.
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143
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Abstract
Hepatitis C virus (HCV) is the leading cause of liver transplantation in Europe and is associated with an increased risk of hepatocellular carcinoma (HCC). Because of the chronic nature of the disease, estimates suggest that the burden on healthcare will increase dramatically for this entity. Clinical care of patients with HCV-related liver disease has advanced considerably in the last two decades, thanks to increasing knowledge about the mechanisms of the disease, development of diagnostic procedures, and advances in therapeutic and preventive approaches. HCV RNA testing, HCV genotyping and staging of liver disease are essential for the diagnosis and the management of HCV therapy. Furthermore, the important role of host polymorphisms of the IL28B gene on virological response to treatment with pegylated interferon (PEG-IFN) alpha and ribavirin (RBV) has recently been clearly demonstrated. In relation to treatment, although numerous drugs for HCV are in various stages of preclinical and clinical development, the current standard of care (SoC) is the combination of PEG-IFN-α and RBV for chronic hepatitis C. With SoC, a sustained viral response (SVR) is achieved in approximately 45% of patients infected with HCV genotype 1 and in approximately 80% of patients infected with HCV genotypes 2 and 3. The EASL HCV guidelines recommend treating all naïve patients with compensated disease from HCV without contraindications to treatment and strongly suggest initiating SoC promptly in patients with advanced fibrosis. Further recommendations on monitoring treatment efficacy, treatment duration, dose reduction indications and the role of co-factors are provided.
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Affiliation(s)
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- Sezione di Gastroenterologia ed Epatologia, Di.Bi.M.I.S., University of Palermo, Italy.
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Forrester JE, Rhee MS, McGovern BH, Sterling RK, Knox TA, Terrin N. The association of HIV viral load with indirect markers of liver injury. J Viral Hepat 2012; 19:e202-11. [PMID: 22239520 PMCID: PMC3261587 DOI: 10.1111/j.1365-2893.2011.01529.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This study assessed the association of HIV RNA with indirect markers of liver injury including FIB-4 index, liver enzymes and platelet counts in a high-risk Hispanic population. The data were derived from a prospective study that included 138 HIV/hepatitis C (HCV)-coinfected and 68 HIV-infected participants without hepatitis C or B co-infection (mono-infected). In unadjusted analyses, detectable HIV viral load (vs undetectable, <400 copies/mL) was associated with a 40% greater odds (OR 1.4, 95% CI: 1.1-1.9, P = 0.016) of FIB-4 > 1.45 in the HIV/HCV-coinfected group and 70% greater odds of FIB-4 > 1.45 (OR 1.7, 95% CI: 1.0-2.8; P = 0.046) in the HIV-mono-infected group. In multivariable analyses, a 1 log(10) increase in HIV RNA was associated with a median increase in FIB-4 of 12% in the HIV/HCV-coinfected group and 11% in the HIV-mono-infected group (P < 0.0001). Among the HIV/HCV-coinfected group, the elevating effect of HIV RNA on FIB-4 was strongest at low CD4 counts (P = 0.0037). Among the HIV-mono-infected group, the association between HIV RNA and FIB-4 was independent of CD4 cell counts. HIV RNA was associated with alterations in both liver enzymes and platelet counts. HIV antiretroviral therapy was not associated with any measure of liver injury examined. This study suggests that HIV may have direct, injurious effects on the liver and that HIV viral load should be considered when these indirect markers are used to assess liver function.
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Affiliation(s)
- Janet E. Forrester
- Tufts University School of Medicine, Department of Public Health and Community Medicine, Boston, Massachusetts
| | | | - Barbara H. McGovern
- Lemuel Shattuck Hospital, Division of Infectious Diseases, Jamaica Plain, Massachusetts
| | - Richard K. Sterling
- Virginia Commonwealth University Health System, Division of Gastroenterology, Hepatology, and Nutrition, Richmond, Virginia
| | - Tamsin A Knox
- Tufts University School of Medicine, Department of Public Health and Community Medicine, Boston, Massachusetts
| | - Norma Terrin
- Tufts Medical Center, Institute for Clinical Research and Health Policy Studies, Boston, Massachusetts
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145
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Price JC, Seaberg EC, Badri S, Witt MD, D'Acunto K, Thio CL. HIV monoinfection is associated with increased aspartate aminotransferase-to-platelet ratio index, a surrogate marker for hepatic fibrosis. J Infect Dis 2012; 205:1005-13. [PMID: 22291196 DOI: 10.1093/infdis/jir885] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Although liver disease commonly causes morbidity and mortality among human immunodeficiency virus (HIV)-infected individuals, data are limited on its prevalence in HIV monoinfection. We used the aspartate aminotransferase-to-platelet ratio index (APRI) as a surrogate marker of hepatic fibrosis to characterize liver disease in the Multicenter AIDS Cohort Study. METHODS Men were categorized based on their HIV and viral hepatitis status: uninfected (n = 1170), HIV monoinfected (n = 509), viral hepatitis monoinfected (n = 74), and HIV-viral hepatitis coinfected (n = 66). RESULTS The median APRI in the HIV-monoinfected group was similar to that in the hepatitis-monoinfected group (0.42 vs 0.43; P > .05), higher than in the uninfected group (0.42 vs 0.27; P < .001) but lower than in the coinfected group (0.42 vs 1.0; P < .001). On multivariable analysis, HIV infection (1.39-fold increase [FI]; P < .001), viral hepatitis infection (1.52-FI; P < .001), and the interaction between HIV and viral hepatitis infections were independently associated with a higher APRI (1.57-FI; P < .001). Among the HIV-infected men, viral hepatitis coinfection (2.34-FI; P < .001), HIV RNA ≥100 000 copies/mL (1.26-FI; P = .007), and CD4 count ≤200 cells/mL (1.23-FI; P = .022) were independently associated with a higher APRI. CONCLUSIONS HIV and viral hepatitis are independently associated with an increased APRI. Further studies are needed to understand the biological basis for the association between HIV and liver disease.
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Affiliation(s)
- Jennifer C Price
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
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Jardi R, Crespo M, Homs M, van den Eynde E, Girones R, Rodriguez-Manzano J, Caballero A, Buti M, Esteban R, Rodriguez-Frias F. HIV, HEV and cirrhosis: evidence of a possible link from eastern Spain. HIV Med 2012; 13:379-83. [PMID: 22257075 DOI: 10.1111/j.1468-1293.2011.00985.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2011] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The aim of the study was to assess the seroprevalence of hepatitis E virus (HEV) infection in an HIV-infected population, as determined by HEV immunoglobulin G (IgG) antibodies (anti-HEV). METHODS The design of the study was cross-sectional. Serum anti-HEV IgG was determined by enzyme immunoassay in 238 HIV-infected patients consecutively attending our out-patient clinic between April and May 2011. In HEV-seropositive patients, HEV RNA was analysed by nested reverse transcriptase-polymerase chain reaction (RT-PCR). Associations between anti-HEV and liver cirrhosis, route of HIV infection, hepatitis B virus (HBV) and hepatitis C virus (HCV) serological markers, age, sex and alanine aminotransferase (ALT) levels were examined by univariate and multivariate analysis. RESULTS One hundred and forty patients (59%) had chronic liver disease (99% were HBV- and/or HCV-coinfected). Liver cirrhosis was detected in 44 individuals (19%). Two hundred and twelve patients (89%) were on antiretroviral treatment; the median CD4 T-cell count was 483 cells/μL [interquartile range (IQR) 313-662 cells/μL] and the HIV viral load was <25 HIV-1 RNA copies/mL. Overall, 22 patients (9%) were anti-HEV positive. Liver cirrhosis was the only factor independently associated with the presence of anti-HEV, which was documented in 23% of patients with cirrhosis and 6% of patients without cirrhosis (P=0.002; odds ratio 5.77). HEV RNA was detected in three seropositive patients (14%), two of whom had liver cirrhosis. CONCLUSIONS Our findings show a high prevalence of anti-HEV in HIV-infected patients, strongly associated with liver cirrhosis. Chronic HEV infection was detected in a significant number of HEV-seropositive patients. Further research is needed to ascertain whether cirrhosis is a predisposing factor for HEV infection and to assess the role of chronic HEV infection in the pathogeneses of cirrhosis in this population.
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Affiliation(s)
- R Jardi
- Department of Biochemistry, Vall d'Hebron Hospital, University "Autonoma" of Barcelona, Barcelona, Spain
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147
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Pourkarim MR, Lemey P, Amini-Bavil-Olyaee S, Houspie L, Verbeeck J, Rahman M, Maes P, Vanwijngaerden E, Nevens F, Van Ranst M. Molecular characterization of hepatitis B virus strains circulating in Belgian patients co-infected with HIV and HBV: overt and occult infection. J Med Virol 2012; 83:1876-84. [PMID: 21915860 DOI: 10.1002/jmv.22174] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Hepatitis B virus (HBV) and human immunodeficiency virus (HIV) have similar transmission routes, implying that patients infected with HIV are at particular risk for HBV infection. Patients who are co-infected with HIV and HBV progress more rapidly to end-stage liver disease and different HBV genotypes may have a distinct impact on disease progression. One hundred ninety-one anti-HBc-positive sera from Belgian patients co-infected with HIV and HBV were collected during 1998-2008. Full-length HBV genomes as well as large S or partial S genes were amplified and their molecular evolutionary history was analyzed. Clinically, 30 (65.8%) patients were categorized as "overt infection" and 16 (34.7%) cases were categorized as "occult infection." Five distinct HBV genotypes comprising A (69.6%), E (19.6%), followed by D, C, and G were detected. HBV genotype A was observed in all clinical groups and in patients with varying ethnical background. HBV genotype E could be detected in African patients who were mostly infected by heterosexual contacts. Several clinically important mutations at the HBs major hydrophilic region were detected in the new isolates but with no significant difference between occult and overt infection. The high prevalence of HBV genotype A in overt and occult cases, and in particular the detection of certain HBV subgenotypes in patients co-infected with HIV and HBV that carry diagnostic escape mutations, may provide useful information for national guidelines for prophylaxis and treatment.
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Affiliation(s)
- Mahmoud Reza Pourkarim
- Laboratory of Clinical Virology, Rega Institute for Medical Research, Katholieke Universiteit, Leuven, Belgium
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148
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López-Cortés LF, Ruiz-Valderas R, Jimenez-Jimenez L, González-Escribano MF, Torres-Cornejo A, Mata R, Rivero A, Pineda JA, Marquez-Solero M, Viciana P. Influence of IL28B polymorphisms on response to a lower-than-standard dose peg-IFN-α 2a for genotype 3 chronic hepatitis C in HIV-coinfected patients. PLoS One 2012; 7:e28115. [PMID: 22235243 PMCID: PMC3250391 DOI: 10.1371/journal.pone.0028115] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2011] [Accepted: 11/01/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Data on which to base definitive recommendations on the doses and duration of therapy for genotype 3 HCV/HIV-coinfected patients are scarce. We evaluated the efficacy of a lower peginterferon-α 2a dose and a shorter duration of therapy than the current standard of care in genotype 3 HCV/HIV-coinfected patients. METHODS AND FINDINGS Pilot, open-label, single arm clinical trial which involved 58 Caucasian HCV/HIV-coinfected patients who received weekly 135 µg peginterferon-α 2a plus ribavirin 400 mg twice daily during 20 weeks after attaining undetectable viremia. The relationships between baseline patient-related variables, including IL28B genotype, plasma HCV-RNA, ribavirin dose/kg, peginterferon-α 2a and ribavirin levels with virological responses were analyzed. Only 4 patients showed lack of response and 5 patients dropped out due to adverse events related to the study medication. Overall, sustained virologic response (SVR) rates were 58.3% by intention-to-treat and 71.4% by per protocol analysis, respectively. Among patients with rapid virologic response (RVR), SVR and relapses rates were 92.6% and 7.4%, respectively. No relationships were observed between viral responses and ribavirin dose/kg, peginterferon-α 2a concentrations, ribavirin levels or rs129679860 genotype. CONCLUSIONS Weekly 135 µg pegIFN-α 2a could be as effective as the standard 180 µg dose, with a very low incidence of severe adverse events. A 24-week treatment duration appears to be appropriate in patients achieving RVR, but extending treatment up to just 20 weeks beyond negativization of viremia is associated with a high relapse rate in those patients not achieving RVR. There was no influence of IL28B genotype on the virological responses. TRIAL REGISTRATION ClinicalTrials.gov NCT00553930.
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Affiliation(s)
- Luis F López-Cortés
- Unidad Clínica de Enfermedades Infecciosas, Hospitales Universitarios Virgen del Rocío/Instituto de Biomedicina de Sevilla, Seville, Spain.
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149
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Lekas HM, Siegel K, Leider J. Challenges facing providers caring for HIV/HCV-coinfected patients. QUALITATIVE HEALTH RESEARCH 2012; 22:54-66. [PMID: 21825278 PMCID: PMC4323265 DOI: 10.1177/1049732311418248] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Despite the high prevalence of hepatitis C virus (HCV) infection among injection drug users also infected with human immunodeficiency virus (HIV), and the synergistic adverse effect of the two diseases on patients' health and survival, research on the clinical management of these patients and particularly the low uptake of HCV therapy is limited. We conducted qualitative interviews with 17 HIV providers from two urban public hospitals. We discovered that the limitations of the current state of medical knowledge, the severe side effects of HIV and HCV therapies, and the psychosocial vulnerability of HIV/HCV-coinfected patients combined with their resistance to becoming informed about HCV posed significant challenges for providers. To contend with these challenges, providers incorporated key dimensions of patient-centered medicine in their practice, such as considering their patients' psychosocial profiles and the meaning patients assign to being coinfected, and finding ways to engage their patients in a therapeutic alliance.
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150
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Lada O, Gervais A, Branger M, Peytavin G, Roquebert B, Collin G, Fraqueiro G, Moucari R, Hamet G, Martinot-Peignoux M, Matheron S, Marcellin P. Long-term outcome of primary non-responders to tenofovir therapy in HIV/HBV-co-infected patients: impact of HBV genotype G. Liver Int 2012; 32:93-101. [PMID: 22097898 DOI: 10.1111/j.1478-3231.2011.02601.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Accepted: 06/08/2011] [Indexed: 12/12/2022]
Abstract
AIM To evaluate the early virological response (EVR) to combined tenofovir-lamivudine or emtricitabine regimen in HBV/HIV-co-infected patients and the long-term efficacy of tenofovir. METHODS In this retrospective monocentric study, among the 166 HIV/HBV-co-infected patients regularly followed from 2003 to 2008 at Bichat Claude Bernard Hospital, 61 patients had received, either de novo combination therapy with tenofovir and lamivudine or emtricitabine (group I, n = 15) or add-on tenofovir to lamivudine therapy (group II, n = 46). The HBV polymerase region was sequenced and analysed for all patients with available samples. RESULTS All 15 group I patients achieved EVR vs 32 (82%) of group II patients (P = 0.15). Seven adherent group II patients met criteria for primary non-response, but achieved delayed response (DR) to therapy. In these seven patients, when compared with the 39 group II patients, there was a trend to longer duration of lamivudine pre-treatment and to higher rate of lamivudine-resistant mutants; and HBV genotype-G proportion was higher (P = 0.026). No virological breakthrough occurred after a median of 46 months follow up. CONCLUSION In these HBV/HIV-co-infected patients, first-line HBV therapy with tenofovir and emtricitabine or lamivudine was associated with EVR. However, DR to tenofovir was observed in 15% of patients who added tenofovir to lamivudine therapy, of whom four of seven (57%) had genotype G-HBV infection. No resistance was evidenced after 46 months of therapy even in patients with DR to tenofovir. At last, a good renal safety profile of TDF was observed after a median follow-up of 4 years of therapy.
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Affiliation(s)
- Olivier Lada
- Service d'Hépatologie and INSERM U773 CRB3, AP-HP Hôpital Beaujon, Clichy, France.
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