Overview of HCV and HBV co-infections in patients with HIV in               Serbia            Jovan Ranin
Course of HIV                           infection             HAART – Highly Active Anti-Retroviral            Therapy – d...
Importance of HCV and HBV co-     infections in patients with HIV     infection1. similar mode of transmission   longer su...
Prevalence of HCV and HBV co-           infections in the world    number of cases             •   HIV –      33 million ...
Impact of HIV infection and HAART           on the course of HCV and HBV co-           infections    HIV infection 1, 2  ...
Impact of HCV and HBV co-      infections on the course of HIV      infection          remains unclear          controve...
Design of     study   longitudinal cohort study   840 patients with HIV infection were followed   study period was 1997...
1.      before HAART     discriminators for groups of patients with HCV and HBV co-infections     compared with HIV mono-i...
Prevalence of HCV and HBVco-infection in studiedpatients                N = 840             HIV/HBV   HIV/HCV/HBV   HIV/HC...
Discriminators for patients withHIV/HCV co-infection before HAART negative discriminators                            posit...
Discriminators for patients with HIV/HCVco-infection before HAART  negative discriminators                positive discrim...
Discriminators for patients with HIV/HBVco-infection before HAART               negative discriminators                   ...
Predictors forimmunological failure afterone year on HAART                                       CD4 < 350               p...
Predictors for devolopingof IRIS after one year onHAART    IRIS – Immune Restoration Inflammatory    Syndrome     negative...
Predictors for virological-immunological success with long-term HAART                              success – und pVL and C...
Causes of deaths of patients  with HIV infection in Serbia                             N = 113                      the mo...
Predictors for deaths of patientswith HIV infection on long-termHAART   negative predictors                  positive pred...
Conclusion       (I)   prevalence of HCV and HBV co-infection in Serbia         • similar as in other Europian countries ...
Conclusion     (II)    HCV co-infection        •   intensify CD4 limfopeny in natural history of HIV infection        •  ...
It is necessery to improve treatmentof HCV infection for patient withHIV/HCV co-infection
Eternal struggle of thesethree viruses                            LIVE TOGETHER
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jovan ranin - overview of HCV and HBV co-infections in patients with HIV in Serbia

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jovan ranin - overview of HCV and HBV co-infections in patients with HIV in Serbia

  1. 1. Overview of HCV and HBV co-infections in patients with HIV in Serbia Jovan Ranin
  2. 2. Course of HIV infection HAART – Highly Active Anti-Retroviral Therapy – dramatically changed the course of HIV infection art era HAART era high incidence of OI  lower incidence of OI the incubation period of 7 - 10  the incubation period of several years decades short survival period  longer survival time high rate of morbidity and  improved quality of life mortality  comorbidities: poor quality of life • metabolic diseases • non-AIDS malignancies • ESLD caused by HCV or/and HBV co- infections
  3. 3. Importance of HCV and HBV co- infections in patients with HIV infection1. similar mode of transmission longer survival with HAART2. high rate of chronicity high incidence of progression of co-infections co-infections is more frequently increased rate of morbidity and mortality of ESLD in HIV infection
  4. 4. Prevalence of HCV and HBV co- infections in the world number of cases • HIV – 33 million (60 million) 1 • HCV – 170 million 2 • HBV – 500 million 3 prevalence of HCV and HBV co-infections • HIV/HCV – 15 – 33 % 4 • HIV/HBV – 6 – 14 % 5 • up to 90 % of HIV patients are seropositive for HBV antibodies 51 Del Rio C PPID 2010; 2 WHO 2007; 3 Koziel MJ PPID 2010; 4 Alberti A J Hepatol 2005; 5 Alter MJ J Hepatol 2006
  5. 5. Impact of HIV infection and HAART on the course of HCV and HBV co- infections HIV infection 1, 2 • increased the frequency of viral persistence after acute infection • higher level of HCV RNA in peripheral blood • more frequently reappearance of HBV markers • faster progression to cirrhosis • higher prevalence of devolopment of ESLD and HCC • higher rate of mortality HAART 3, 4 • hepatotoxicity of HIV drugs • “flare” of HCV or HBV infection - IRIS • immune reconstitution improve surveillance of HCV and HBV co- infections 1 Goedert JJ i sar J Infect Dis 2000; 2 Goedert JJ i sar Blood 2002; 3 Qurishi N i sar Lancet 2004; 4 Mehta SH i sar Hepatology 2005
  6. 6. Impact of HCV and HBV co- infections on the course of HIV infection  remains unclear  controversial results of the studies • interfere with immune reconstitution induced by HAART 1 • no influence on immune reconstitution 2 • interfere with immune reconstitution, but without influence on progression of HIV infection to AIDS 3 • no impact on rate of mortality in patients with HIV infection 3 • interaction with HAART 4 • decreased drug metabolism • decreased HCV – specific immune reconstitution • increased susceptibility to mitochondrial dysfunction1 Greub G i sar. Lancet 2000; 2 Sulkowski MS i sar. JAMA 2002; 3 Sullivan PS i sar. AIDS 2006; 4 Wit FW i sar. J InfectDis 2002
  7. 7. Design of study longitudinal cohort study 840 patients with HIV infection were followed study period was 1997 – 2010 patients were included into the study until June 2009 mean time of follow-up was 71,9 ± 42,2 months inclusion criteriums: • HIV infection diagnosed accordingly with CDC clasification system from 1993 and revised in 2008 • using HAART logistic regression and Cox proportional hazards regression models within SPSS three parts of study
  8. 8. 1. before HAART discriminators for groups of patients with HCV and HBV co-infections compared with HIV mono-infection: immunological, epidemiological and clinical features2. one - year HAART predictors of immunological, virological and clinical effects of HAART: HCV and HBV co-infections3. long - term HAART predictors of immunological, virological and clinical effects of HAART: HCV and HBV co-infections
  9. 9. Prevalence of HCV and HBVco-infection in studiedpatients N = 840 HIV/HBV HIV/HCV/HBV HIV/HCV 4,5% 1,7% 23,9% HIV 69,4%
  10. 10. Discriminators for patients withHIV/HCV co-infection before HAART negative discriminators positive discriminators 95% CI gender OR msm heterosex 0.070 2.525 hemophilia ivdu 0.276 10.079 30.295 3.807 transfusion 1.012 ALT 1.020 AST 1.775 CD4 < 100 CD4 baseline 0.997 1.660 AIDS 0.01 0.1 1 10 100 logistic regression univariate model
  11. 11. Discriminators for patients with HIV/HCVco-infection before HAART negative discriminators positive discriminators gender 95% CI 6.851 OR heterosex 9.500 hemophilia 0.113 1.735 AIDS 0.01 0.1 1 10 100 logistic regression multivariate model
  12. 12. Discriminators for patients with HIV/HBVco-infection before HAART negative discriminators 95% CI gender OR 0.079 ivdu 0.113 0.01 0.1 1 logistic regression multivariate model
  13. 13. Predictors forimmunological failure afterone year on HAART CD4 < 350 positive predictors no significant: HBV co-infection HCV/HBV co-infection AIDS 4.122 age 1.042 95% CI HCV 1.580 OR 1 10 logistic regression multivariate model
  14. 14. Predictors for devolopingof IRIS after one year onHAART IRIS – Immune Restoration Inflammatory Syndrome negative predictors positive predictors no significant: HBV co-infection AIDS HCV/HBV co-infection 1.545 age 1.015 STI 0.554 95% CI 1.375 HCV HR 0.1 1 10 multivariate Cox proportional hazards regression model
  15. 15. Predictors for virological-immunological success with long-term HAART success – und pVL and CD4 ≥ 350 negative predictors positive predictors no significant: AIDS 0.733 HBV co-infection gender STI 0.218 0.673 HCV/HBV co-infection HCV 0.607 CD4 < 100 95% CI 0.563 HR 1.001 CD4 prim 0.1 1 10 multivariate Cox proportional hazards regression model
  16. 16. Causes of deaths of patients with HIV infection in Serbia N = 113 the mortality is 13.5 % other AIDS 33.6% 23.9%non-AIDS Ca 15.0% cardio 12.5% ESLD 15.0%
  17. 17. Predictors for deaths of patientswith HIV infection on long-termHAART negative predictors positive predictors 95%CI HR age 1.032 no significant: gender 0.574 HBV co-infection CD4 prim 0.998 HCV/HBV co-infection 2.081 HCV 0.1 1 10 multivariate Cox proportional hazards regression model
  18. 18. Conclusion (I) prevalence of HCV and HBV co-infection in Serbia • similar as in other Europian countries • HCV – 23,9 % • HBV – 4,5 % • HCV/HBV – 1,7 % mortality of HIV patients in Serbia • mortality is 13,5 % • ESLD caused 15 % of deaths which is higher rate compared with era before HAART (12 %) 1 • HCV co-infection is predictor for mortality, while HBV co-infection is not associated with risk for death 1 Brmbolić B. Phd 1992.
  19. 19. Conclusion (II) HCV co-infection • intensify CD4 limfopeny in natural history of HIV infection • cause faster progression of natural history of HIV infection to AIDS • interfere with immune reconstitution in first year of HAART • provocate devolopment of IRIS • cause immunological-virological failure of long-term HAART • has negative effect on survival of patient with HIV infection HBV co-infection • it is not associate with immunological, virological and clinical characteristics of simultaneous HIV infection
  20. 20. It is necessery to improve treatmentof HCV infection for patient withHIV/HCV co-infection
  21. 21. Eternal struggle of thesethree viruses LIVE TOGETHER
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