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Fibrosis related factors in hepatitis C HIV co-infected patients
Poster Sessions
246
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HBV SUPERINFECTION IN HCV CHRONIC CARRIERS
Evangelista Sagnelli L2, Nicola Coppola 1,2, Vincenzo Messina 1, Domenico Di Caprio 1, Cecilia Marrocco 2, Anna Marotta l, Mirella Onofrio L2, Carlo Scolastico 2, Pietro Filippini 2. 1Unit of
Infectious Diseases, Azienda Ospedaliera di Caserta; 2Department of Infectious Diseases, Second University of Naples, Italy We investigated viral characteristic and clinical course of HBV acute hepatitis in 20 HCV chronic carriers (anti-HCV positive from at least one year: Case BC group) and in 19 anti-HCV negative cases (Control B group). For each case BC a subject with chronic HCV infection alone was selected (Control C group). Plasma HBV-DNA and HCV-RNA were determined by PCR. At the first observation 94.1% of patients in Case BC group and 80% of those in Control B group were HBV-DNA positive, with a similar trend towards a decrease and negativization in 20 days; in Case BC group seroconversion to anti-HBe was more rapid. HCV-RNA was undetectable in all Case BC patients but one, who shortly became negative, whereas 85% of Control C cases were positive (p < 0.001). Severe acute hepatitis was more frequent in Case BC group than in Control B group (30% vs. 0%, p < 0.005). Of the 14 patients in Control B group and of the 11 in Case BC group followed up for more than 6 months, only one in the latter group became HBsAg chronic carder. Of these 11, 5 turned HCV-RNA positive and 6 remained negative. HBV superinfection in chronic HCV careers has a severe clinical course and strongly depresses HCV, which in turn moderately impairs HBV.
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SPECTRUM OF LIVER DISEASE IN PATIENTS WITH HEPATITIS C VIRUS (HCV) AND HUMAN IMMUNODEFICIENCY VIRUS (HIV) COINFECTION AS COMPARED TO HCV INFECTED PATIENTS. A CASE-CONTROL STUDY
Justiniano Santos, Rosa Durandez, Cristina TuraI, Daniel Fuster, Rosa Mafia Morillas, Helena Guardiola, Jordi Tor, Isabel Ojanguern, Eduard Cabre, A. Ballesteros, Celestino Rey Joli, Buenaventura Clotet, Ramon Planas. Hospital Universitari Germans Trias i Pujol, Badalona,
Spain Introduction: With effective supression of HIV with HAART, HCV has now become a significant source of morbidity and mortality in coinfected patients. Aims: To compare the clinical, analytical and histological characteristics of HCV patients, with and without HIV coinfection. Methods: Case-control study including 75 HIV-HCV coinfected patients and a control group of 75 HCV infected patients matched for sex, age and time of HCV diagnosis. Advanced fibrosis was defined as bridging fibrosis (BF) or cirrhosis (C). Most of our patients were males (75%). At time of liver biopsy 88% and 57% of coinfected patients were on HAART and protease inhibitor (PI) treatment, respectively. Previous AIDS was present in 13 cases (17%). Results: As compared with HCV controls, coinfected HIV-HCV patients showed a higher prevalence of previous IVDU as risk factor for infection (88% vs 17.3%; p < 0.0001), lower prevalence of HCV genotype 1 infection (52% vs 72%; p = 0.018) but higher by genotype 4 (21.3 % vs 5.3%; p = 0.007) and more advanced fibrosis (BF: 40 + C: 6.7 = 46.7% vs 10.7 + 1.3 = 12%; p < 0.0001), without significant differences in mean ALT and HCV RNA levels. Univariate analysis showed that male sex, previous IVDU, HIV conifection and PI treatment were associated with advanced fibrosis. However, male sex (OR = 3.1; 95% CI = 1.1-8.7) and HIV coinfection (OR = 6.4; 95% CI = 2.7-14.7) were the only predictors of advanced liver fibrosis in the multivariate analysis. Condusious: Anti-HCV treatment is especially indicated in patients coinfected with HIV since almost half of them showed advanced fibrosis, independently of HCV genotype responsible of infection and HCV RNA levels.
~ 8 - ~ GRADING AND STAGING OF CHRONIC HEPATITIS C AND ITS RELATION TO GENOTYPES AND EPIDEMIOLOGICAL FACTORS IN BRAZILIAN BLOOD DONORS Giovanni Silva I , Kunie Coelho 1, Nancy Nishimura 3, Elza Soares 2.
t Department of lnternal Medicine, Botucatu School of Medicine, Botucatu, SP; 2Department of lnternal Medicine, Campinas State University, Campinas, SP; 3Department of Patology, Botucatu School of Medicine, Botucatu, SP, Brazil Background/Aims: The aims of this study were to test the association between the HCV genotypes and the ways of transmission of the disease and its staging, as to check which were the factors that have been associated with progression of the infection. Methodology: The studied population consisted of 100 consecutive blood donors with positive anti-HCV test. These patients were evaluated according to several risks factors, biochemical exams, HCV genotypes, hepatic fibrosis staging and necro-inflamatory activities grading. Results: In 89 patients the HCV genotypes were carried out. In 78 individuals hepatic biopsy was performed. Most of blood donors were man (84.3%). Only in 3.3% of them a risk factor for infection was not found. The contamination was found in intravenous drug users in 25.8%, and in 48.2% of patients using Ghiconergan ® in a non safe manner and in 14.9% blood transfusion. The HCV genotypes comprises 44.9% to 1 type, and from 40.5% to 3. The analysis of association among the several factors related to the infection with the stages of the fibrosis were not significant. The association between the progression of the disease and chronic etilism wasn't significant, as well as the age at infection and with the duration of the illness. There was a significant association between the aminotransferases activities and the fibrosis staging. The univaried analysis showed that the age at contamination, the patient's age, GT-gama level, and the aminotransferases activities over 3 times the upper normal limits, were associated to the variable staging 2 to 4 of the fibrosis. The multivaried analysis detected the age (Odds = 1.19), and the classifying GT-gama (Odds = 2.02) as independent factors influencing in the disease progression.
~']
FIBROSIS RELATED FACTORS IN HEPATITIS C HIV CO-INFECTED PATIENTS
J.A. Galeras l , S. Coll I , B. BaUeste 1, M. Salvador 3, Y. Ezquerra I , M.D. Gimenez I , R. Sola I . tLiver Section, Hospital del Mar, Universitat
Autonoma, Barcelona; 2pathology Department, Hospital del Mar; 3Laboratori De Referencia De Catalunya, Barcelona, Spain Progression of fibrosis is faster in hepatitis C patients (HC-HCV) with HIV co-infection. To investigate factors related to the fibrosis we included 129 HC-HCV HIV co-infected patients without cirrhosis. Activity and fibrosis scores (Metavir) and presence of steatosis were measured in liver biopsy in all patients. At inclusion we analyse demographic data, IV drug use and alcohol consumption, standard liver test, lymphocytes CD4 count, HCV RNA and HIV RNA serum levels, and HCV genotypes. Fibrosis was moderate or severe in 54 patients (41.9%). The following variables reached statistical significance in patients with fibrosis: age (P 0.002), alcohol consumption (P 0.05), serum levels of AST (P 0.006), alkaline phosphatase (P 0.02), protrombine (P 0.003) and blood count of platelets (P 0.003) and lymphocytes CD4 (P 0.001). Activity index was higher in patients with fibrosis (P 0.0005). No differences were observed in presence of steatosis, HCV RNA and HIV RNA serum levels, and HCV genotypes. Independent predictive factors in multivariate analysis were age > 33 years (OR 0.87; CI 0.79-0.95; P 0.002) and lymphocyte CD4 count < 450 (OR 1.002; CI 1-1.004; P 0.03). Conclusions: Fibrosis in HC-HCV HIV co-infected patients seems to depend of age and immunosupression more than HCV related factors.
246
8-~
HBV SUPERINFECTION IN HCV CHRONIC CARRIERS
Evangelista Sagnelli L2, Nicola Coppola 1,2, Vincenzo Messina 1, Domenico Di Caprio 1, Cecilia Marrocco 2, Anna Marotta l, Mirella Onofrio L2, Carlo Scolastico 2, Pietro Filippini 2. 1Unit of
Infectious Diseases, Azienda Ospedaliera di Caserta; 2Department of Infectious Diseases, Second University of Naples, Italy We investigated viral characteristic and clinical course of HBV acute hepatitis in 20 HCV chronic carriers (anti-HCV positive from at least one year: Case BC group) and in 19 anti-HCV negative cases (Control B group). For each case BC a subject with chronic HCV infection alone was selected (Control C group). Plasma HBV-DNA and HCV-RNA were determined by PCR. At the first observation 94.1% of patients in Case BC group and 80% of those in Control B group were HBV-DNA positive, with a similar trend towards a decrease and negativization in 20 days; in Case BC group seroconversion to anti-HBe was more rapid. HCV-RNA was undetectable in all Case BC patients but one, who shortly became negative, whereas 85% of Control C cases were positive (p < 0.001). Severe acute hepatitis was more frequent in Case BC group than in Control B group (30% vs. 0%, p < 0.005). Of the 14 patients in Control B group and of the 11 in Case BC group followed up for more than 6 months, only one in the latter group became HBsAg chronic carder. Of these 11, 5 turned HCV-RNA positive and 6 remained negative. HBV superinfection in chronic HCV careers has a severe clinical course and strongly depresses HCV, which in turn moderately impairs HBV.
[-~
SPECTRUM OF LIVER DISEASE IN PATIENTS WITH HEPATITIS C VIRUS (HCV) AND HUMAN IMMUNODEFICIENCY VIRUS (HIV) COINFECTION AS COMPARED TO HCV INFECTED PATIENTS. A CASE-CONTROL STUDY
Justiniano Santos, Rosa Durandez, Cristina TuraI, Daniel Fuster, Rosa Mafia Morillas, Helena Guardiola, Jordi Tor, Isabel Ojanguern, Eduard Cabre, A. Ballesteros, Celestino Rey Joli, Buenaventura Clotet, Ramon Planas. Hospital Universitari Germans Trias i Pujol, Badalona,
Spain Introduction: With effective supression of HIV with HAART, HCV has now become a significant source of morbidity and mortality in coinfected patients. Aims: To compare the clinical, analytical and histological characteristics of HCV patients, with and without HIV coinfection. Methods: Case-control study including 75 HIV-HCV coinfected patients and a control group of 75 HCV infected patients matched for sex, age and time of HCV diagnosis. Advanced fibrosis was defined as bridging fibrosis (BF) or cirrhosis (C). Most of our patients were males (75%). At time of liver biopsy 88% and 57% of coinfected patients were on HAART and protease inhibitor (PI) treatment, respectively. Previous AIDS was present in 13 cases (17%). Results: As compared with HCV controls, coinfected HIV-HCV patients showed a higher prevalence of previous IVDU as risk factor for infection (88% vs 17.3%; p < 0.0001), lower prevalence of HCV genotype 1 infection (52% vs 72%; p = 0.018) but higher by genotype 4 (21.3 % vs 5.3%; p = 0.007) and more advanced fibrosis (BF: 40 + C: 6.7 = 46.7% vs 10.7 + 1.3 = 12%; p < 0.0001), without significant differences in mean ALT and HCV RNA levels. Univariate analysis showed that male sex, previous IVDU, HIV conifection and PI treatment were associated with advanced fibrosis. However, male sex (OR = 3.1; 95% CI = 1.1-8.7) and HIV coinfection (OR = 6.4; 95% CI = 2.7-14.7) were the only predictors of advanced liver fibrosis in the multivariate analysis. Condusious: Anti-HCV treatment is especially indicated in patients coinfected with HIV since almost half of them showed advanced fibrosis, independently of HCV genotype responsible of infection and HCV RNA levels.
~ 8 - ~ GRADING AND STAGING OF CHRONIC HEPATITIS C AND ITS RELATION TO GENOTYPES AND EPIDEMIOLOGICAL FACTORS IN BRAZILIAN BLOOD DONORS Giovanni Silva I , Kunie Coelho 1, Nancy Nishimura 3, Elza Soares 2.
t Department of lnternal Medicine, Botucatu School of Medicine, Botucatu, SP; 2Department of lnternal Medicine, Campinas State University, Campinas, SP; 3Department of Patology, Botucatu School of Medicine, Botucatu, SP, Brazil Background/Aims: The aims of this study were to test the association between the HCV genotypes and the ways of transmission of the disease and its staging, as to check which were the factors that have been associated with progression of the infection. Methodology: The studied population consisted of 100 consecutive blood donors with positive anti-HCV test. These patients were evaluated according to several risks factors, biochemical exams, HCV genotypes, hepatic fibrosis staging and necro-inflamatory activities grading. Results: In 89 patients the HCV genotypes were carried out. In 78 individuals hepatic biopsy was performed. Most of blood donors were man (84.3%). Only in 3.3% of them a risk factor for infection was not found. The contamination was found in intravenous drug users in 25.8%, and in 48.2% of patients using Ghiconergan ® in a non safe manner and in 14.9% blood transfusion. The HCV genotypes comprises 44.9% to 1 type, and from 40.5% to 3. The analysis of association among the several factors related to the infection with the stages of the fibrosis were not significant. The association between the progression of the disease and chronic etilism wasn't significant, as well as the age at infection and with the duration of the illness. There was a significant association between the aminotransferases activities and the fibrosis staging. The univaried analysis showed that the age at contamination, the patient's age, GT-gama level, and the aminotransferases activities over 3 times the upper normal limits, were associated to the variable staging 2 to 4 of the fibrosis. The multivaried analysis detected the age (Odds = 1.19), and the classifying GT-gama (Odds = 2.02) as independent factors influencing in the disease progression.
~']
FIBROSIS RELATED FACTORS IN HEPATITIS C HIV CO-INFECTED PATIENTS
J.A. Galeras l , S. Coll I , B. BaUeste 1, M. Salvador 3, Y. Ezquerra I , M.D. Gimenez I , R. Sola I . tLiver Section, Hospital del Mar, Universitat
Autonoma, Barcelona; 2pathology Department, Hospital del Mar; 3Laboratori De Referencia De Catalunya, Barcelona, Spain Progression of fibrosis is faster in hepatitis C patients (HC-HCV) with HIV co-infection. To investigate factors related to the fibrosis we included 129 HC-HCV HIV co-infected patients without cirrhosis. Activity and fibrosis scores (Metavir) and presence of steatosis were measured in liver biopsy in all patients. At inclusion we analyse demographic data, IV drug use and alcohol consumption, standard liver test, lymphocytes CD4 count, HCV RNA and HIV RNA serum levels, and HCV genotypes. Fibrosis was moderate or severe in 54 patients (41.9%). The following variables reached statistical significance in patients with fibrosis: age (P 0.002), alcohol consumption (P 0.05), serum levels of AST (P 0.006), alkaline phosphatase (P 0.02), protrombine (P 0.003) and blood count of platelets (P 0.003) and lymphocytes CD4 (P 0.001). Activity index was higher in patients with fibrosis (P 0.0005). No differences were observed in presence of steatosis, HCV RNA and HIV RNA serum levels, and HCV genotypes. Independent predictive factors in multivariate analysis were age > 33 years (OR 0.87; CI 0.79-0.95; P 0.002) and lymphocyte CD4 count < 450 (OR 1.002; CI 1-1.004; P 0.03). Conclusions: Fibrosis in HC-HCV HIV co-infected patients seems to depend of age and immunosupression more than HCV related factors.