Profile of Patients Triply Infected with HIV, HBV, and HCV in the HAART Era
By
Liz Highleyman Due
to overlapping transmission routes, a proportion of people with HIV
are also coinfected with hepatitis B virus (HBV),
hepatitis C virus (HCV), or both. At
the 47th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC)
this week in Chicago, Marina Nunez, MD, presented data on individuals triply infected
with HIV, HBV, and HCV. The
researchers identified all HIV positive patients with detectable anti-HCV antibodies
and hepatitis B surface antigen (HBsAg) at 5 HIV clinics in Europe and North America.
They collected data about levels of HIV RNA, HCV RNA, and HBV DNA, presence of
hepatitis B "e" antigen (HBeAg), HBV and HCV genotypes, and antibodies
against hepatitis delta virus (HDV), which occurs only in conjunction with HBV. Results •
67 patients were identified who were triply infected with HIV, HBV, and HCV.
•
84% were men, 82% were injection drug users, and the median age was 44 years.
•
The median
CD4 cell count was 333 cells/mm3,
73% were on HAART, and 59%
had HIV viral load below 50 copies/mL.
•
52%
had detectable HCV RNA.
•
37%
had detectable HBV DNA.
•
32%
had positive HBeAg.
•
28%
had positive HDV antibodies, indicating possible quadruple infection.
•
CD4
cell counts tended to be higher among patients with undetectable HCV RNA, regardless
of whether they were taking anti-HIV therapy (447 vs 321 cells/mm3; P=0.05).
•
In
a multivariate analysis, HDV antibody positivity predicted undetectable HCV RNA
(RR 20.1; P=0.01).
•
Predictors
of undetectable HBV DNA were absence of HBeAg (RR 13.73; P=0.001) and use of anti-HBV
therapy (RR 8.85; P=0.006).
•
Neither
HBV nor HCV levels or genotypes had an impact on the replication of the other
virus.
•
Further
details regarding anti-HBV treatment are shown in the table below:
|
|
|
HCV
RNA+ |
HCV
RNA neg |
All |
| Current | HBV DNA+ | 4 (9%) | 5 (11%) | 9 (20%) |
|
anti-HBV |
HBV DNA-neg |
19 (41%) |
18 (39%) |
37 (80%) |
|
treatment |
All |
23 (50%) |
23 (50%) |
46 (100% |
|
No current |
HBV DNA+ |
8 (42%) |
7 (37%) |
15 (79%) |
|
anti-HBV |
HBV DNA-neg |
3 (16%) |
1 (5%) |
4 (21%) |
|
treatment |
All |
11 (58%) |
8 (42%) |
19 (100%) |
|
All patients |
HBV DNA+ |
12 (18.5%) |
12 (18.5%) |
24 (37%) |
|
regardless of |
HBV DNA-neg |
22 (34%) |
19 (29%) |
41 (63%) |
| anti-HBV Rx | All | 34 (52.5%) | 31 (47.5%) | 65 (100%) |
Conclusion Based
on these findings, the investigators concluded:
•
About
half of patients with markers for HBV/HCV/HIV triple infection had undetectable
HCV RNA.
•
This
was significantly more frequent among HDV antibody positive patients.
•
The
absence of HBeAg and the presence of anti-HBV therapy were the factors determining
undetectable HBV DNA.
•
A
direct impact of active HBV or HCV replication on the replication of the other
virus was not found.
Inst.
Malattie Infettive, Sassari, Italy; Hosp. Carlos III, Madrid, Spain; Hosp. Virgen
de la Macarena, Sevilla, Spain; Hosp. de Especialidades CRM SXXI, Mexico DF,
Mexico; Wake Forest Univ. Hlth. Sci., Winston Salem, NC. 09/18/07 Reference
I
Maida, M Rios, L. Perez-Saleme, and others. Profile of Patients Triply Infected
with HIV and the Hepatitis B and C Viruses in the HAART Era. 47th Interscience
Conference on Antimicrobial Agents and Chemotherapy. Chicago, September 17-20,
2007. Abstract V-1901.
|
