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CMV, Hepatitis B, and hepatitis C seropositivity among HIV positive adolescents compared with controls
164
POSTERPRESENTATIONS
JOURNALOF ADOLESCENTHEALTHVol. 22, No. 2
HIV-1 VIRAL LOADS AND CD4 LEVELS IN TREATED AND UNTREATED ADOLESCENTS. Christie
A. Holland,Ph.D.,*StevenD. Douglas,M.D.,JonasEllenberg,Ph.D.,CraigWilson,M.D., SueEllen Abadalirm,M.D., DonnaFutteman,M.D.,*Children’sResearchInstitute,Children’sNationalMedicalCenter, Washington,D.C. OBJECTIVE:A majorobjectiveof the REACHProjectof the AdolescentMedicineHIV/AIDSResearch Networkis to examinethe pathogenesisanddiseaseprogressionof HIVinfectionin treatedanduntreated adolescents.Sincefew clinicalendpointsareexpectedin the firstyearsof the study,the networkproposedto assesdiseaseprogressionby the absolutelevelsandrateof declineof CD4T cellsandbythe absolutelevels andchangesin HIV-1viral load. Todetermineif this approachis feasible,the absolutelevelsof CD4T cells andthe HIV-1viral loadof treatedanduntreatedadolescentswereexaminedat the subjectserrtryintotbe REACHprotocol. METHODS:TheCD4levelin peripheralbloodof eachHIV+subjectwasmeasuredat eachof the 15 clinicalsitesusingstandardizedreagentsandprocedures.Quantitativemeasurementsof HIV-1viral loadwere completedat a certified,centrallaboratoryusingthe NASBAassayonplasmasamples. TheNASBAassay has a lowerlimitof detectionof400 RNAcopieslml,an upperlimitof7.5 x 105copiestml. Studysubjects previousexposureto andcurrenttreatmentwithantiretroviraltherapywasdeterminedusingmedicalrecord abstractionandinterviewdatacollectedas partof the initialstudyvisit. RESULTS:Wereporthereon the first 133HIVpositivesubjectsenrolledin the REACHprotocol betweenMarch 1996andMay 1997.A largepercentage(46’%0) of the cohortwereanti-retroviraltreatment naiveand48°/0werebeingtreatedat studyentry. Sixtypercentof the subjectsin boththe naiveandtreated groupshadCD4levelsof>400 cells/mmandonly 10Yo hadCD4levelsof s200 cells/mm3.Sixty-onepercent of the initialcohorthadquantitativeviralloadsof <10,000copiesper ml. CONCLUSIONS: Sincea majorityof the REACHcohorthas higherCD4levels(>400)and lowerviral loads(<10,000),the CD4levelsandviralloadswillbe usetirlin assessingdiseaseprogression.In addition,the CD4levelssuggestthatmostof the individualsinthis cohortarerelativelyearlyintheir HIV-I disease progression.Furthermore,this groupcouldserveas a targetedcohortfor assessingearly,aggressive antiretroviralinterventionstrategies.
CMV, HEPATITIS B, AND HEPATITIS C SEROPOSITIVITY AMONG HIV POSITIVE ADOLESCENTS COMPARED WITH CONTROLS.
JonathanFanburgM.D., ZhihuanHM.D., M.P.H.,MarkGuagliardo,Ph.D., andLawrenceD’Angelo,M.D.,M.P.H.Childnm’sNationalMedicalCenter,Washington,DC. OBJECTIVE: CMV, Hepatitis B, and Hepatitis C aremoreprewalmtinsexuallyactiveadoleacmts thanin adolescentswithouta historyof sexualintercourse.CMV,HepatitisB, andHepatitisC are evenmoreprevalentinHIVseropositiveadoleawntathaninHIVnqytive adolescents. DESIGN: Retrospective analysisof serologyfor CMV,HepatitisB, andHepatitisC among 143HIVpositiveadolescentsfollowedfrom1986-96itIan urbanadolescentchic. Thecomparison patientswere976HIVnegativeroutineadolesomtclinicpatientshavingblooddrawnfor other purposesbetween1994-96.Allpatientswereaged12-21yearsat timeofHepatitisB, HepatitisC, andCMVtesting. CMVpositivitywas definedbyIgGor IgMantibodies,HepatitisB byHBsAgor HBcAb,HepatitisC byHCVIgGor RIB~ andHIVbyELISAandWeatemBlot. Sexualhistory was determinedthrougha questionnaire. RESULTS: HIV positive
HIVnegative
CMV Dositive
m~
82?4(112/137)* 57% (5471968)*
16% (22/135)* 5% (53/976)*
H~ C positive
7“A(5/68)* 1% (7/974)*
63Y0(529/834)* 16% (135/835) SexuaSlyActive 1% (8/767) 47% (121/260)* 6% (15/266) 2’Yo(4/265) Not Sex.Active (*=z.KO.001) l“herewas no dentonatrabledifferemeinageand gendergroups. CONCLUSION: HIV seropositive adolescentsaremorelikelytobepositiveforCMV,HepatitisB, andHepatitisCthantheirpeers,eva whencontrollingforhistoryof sexualactivity. Furthermore,a historyof sexualactivityis an independent predictorof seropositivity for CMV,althoughnot a predictorof HepatitisB or C. Healthcareprofeasionalsmustrecognizethatthere is an increased prevalmceof CMV,HepatitisB, andHepatitisC amongHIVseropositiveadolescmtsandthatthis mayposea significanthealthriskto theseindividuals.
POSTERPRESENTATIONS
JOURNALOF ADOLESCENTHEALTHVol. 22, No. 2
HIV-1 VIRAL LOADS AND CD4 LEVELS IN TREATED AND UNTREATED ADOLESCENTS. Christie
A. Holland,Ph.D.,*StevenD. Douglas,M.D.,JonasEllenberg,Ph.D.,CraigWilson,M.D., SueEllen Abadalirm,M.D., DonnaFutteman,M.D.,*Children’sResearchInstitute,Children’sNationalMedicalCenter, Washington,D.C. OBJECTIVE:A majorobjectiveof the REACHProjectof the AdolescentMedicineHIV/AIDSResearch Networkis to examinethe pathogenesisanddiseaseprogressionof HIVinfectionin treatedanduntreated adolescents.Sincefew clinicalendpointsareexpectedin the firstyearsof the study,the networkproposedto assesdiseaseprogressionby the absolutelevelsandrateof declineof CD4T cellsandbythe absolutelevels andchangesin HIV-1viral load. Todetermineif this approachis feasible,the absolutelevelsof CD4T cells andthe HIV-1viral loadof treatedanduntreatedadolescentswereexaminedat the subjectserrtryintotbe REACHprotocol. METHODS:TheCD4levelin peripheralbloodof eachHIV+subjectwasmeasuredat eachof the 15 clinicalsitesusingstandardizedreagentsandprocedures.Quantitativemeasurementsof HIV-1viral loadwere completedat a certified,centrallaboratoryusingthe NASBAassayonplasmasamples. TheNASBAassay has a lowerlimitof detectionof400 RNAcopieslml,an upperlimitof7.5 x 105copiestml. Studysubjects previousexposureto andcurrenttreatmentwithantiretroviraltherapywasdeterminedusingmedicalrecord abstractionandinterviewdatacollectedas partof the initialstudyvisit. RESULTS:Wereporthereon the first 133HIVpositivesubjectsenrolledin the REACHprotocol betweenMarch 1996andMay 1997.A largepercentage(46’%0) of the cohortwereanti-retroviraltreatment naiveand48°/0werebeingtreatedat studyentry. Sixtypercentof the subjectsin boththe naiveandtreated groupshadCD4levelsof>400 cells/mmandonly 10Yo hadCD4levelsof s200 cells/mm3.Sixty-onepercent of the initialcohorthadquantitativeviralloadsof <10,000copiesper ml. CONCLUSIONS: Sincea majorityof the REACHcohorthas higherCD4levels(>400)and lowerviral loads(<10,000),the CD4levelsandviralloadswillbe usetirlin assessingdiseaseprogression.In addition,the CD4levelssuggestthatmostof the individualsinthis cohortarerelativelyearlyintheir HIV-I disease progression.Furthermore,this groupcouldserveas a targetedcohortfor assessingearly,aggressive antiretroviralinterventionstrategies.
CMV, HEPATITIS B, AND HEPATITIS C SEROPOSITIVITY AMONG HIV POSITIVE ADOLESCENTS COMPARED WITH CONTROLS.
JonathanFanburgM.D., ZhihuanHM.D., M.P.H.,MarkGuagliardo,Ph.D., andLawrenceD’Angelo,M.D.,M.P.H.Childnm’sNationalMedicalCenter,Washington,DC. OBJECTIVE: CMV, Hepatitis B, and Hepatitis C aremoreprewalmtinsexuallyactiveadoleacmts thanin adolescentswithouta historyof sexualintercourse.CMV,HepatitisB, andHepatitisC are evenmoreprevalentinHIVseropositiveadoleawntathaninHIVnqytive adolescents. DESIGN: Retrospective analysisof serologyfor CMV,HepatitisB, andHepatitisC among 143HIVpositiveadolescentsfollowedfrom1986-96itIan urbanadolescentchic. Thecomparison patientswere976HIVnegativeroutineadolesomtclinicpatientshavingblooddrawnfor other purposesbetween1994-96.Allpatientswereaged12-21yearsat timeofHepatitisB, HepatitisC, andCMVtesting. CMVpositivitywas definedbyIgGor IgMantibodies,HepatitisB byHBsAgor HBcAb,HepatitisC byHCVIgGor RIB~ andHIVbyELISAandWeatemBlot. Sexualhistory was determinedthrougha questionnaire. RESULTS: HIV positive
HIVnegative
CMV Dositive
m~
82?4(112/137)* 57% (5471968)*
16% (22/135)* 5% (53/976)*
H~ C positive
7“A(5/68)* 1% (7/974)*
63Y0(529/834)* 16% (135/835) SexuaSlyActive 1% (8/767) 47% (121/260)* 6% (15/266) 2’Yo(4/265) Not Sex.Active (*=z.KO.001) l“herewas no dentonatrabledifferemeinageand gendergroups. CONCLUSION: HIV seropositive adolescentsaremorelikelytobepositiveforCMV,HepatitisB, andHepatitisCthantheirpeers,eva whencontrollingforhistoryof sexualactivity. Furthermore,a historyof sexualactivityis an independent predictorof seropositivity for CMV,althoughnot a predictorof HepatitisB or C. Healthcareprofeasionalsmustrecognizethatthere is an increased prevalmceof CMV,HepatitisB, andHepatitisC amongHIVseropositiveadolescmtsandthatthis mayposea significanthealthriskto theseindividuals.