HIVHEPATITIS C COINFECTION IN A PUERTO RICAN HIVAIDS COHORT

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HIV-HEPATITIS C CO-INFECTION IN A PUERTO RICAN
HIV/AIDS COHORT

• Angel M. Mayor, MD, MS
• Diana M. Fernández, MS, Ed.D. (Candidate)
• Maria A. Gómez, Ph.D.
• Eddy Ríos-Olivares, Ph.D., MPH
• Robert F. Hunter-Mellado, MD, FACP
• Retrovirus Research Center, Universidad Central
  del Caribe, School of Medicine. Hospital Ramón
  Ruiz Arnau, Bayamón, Puerto Rico

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HEPATITIS C VIRUS
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INTRODUCTION

• Life expectancy of HIV infected persons has
  increase since the introduction of antiretroviral
  therapies.
• Hepatitis C (HCV) is becoming a great
  contributor for HIV morbidity and mortality.
• HCV prevalence in USA 2. HCV prevalence in HIV
  infected persons 30-50.
• HCV transmission Principally by contact with
  infected blood (infected needles) and few by high
  risk sexual behaviors.
• Injecting drug users (IDUS) have a higher risk of
  harboring HCV co-infected (Prevalence 50-90).
• 80 of the HCV become a chronic infection, of
  them 75 develop chronic liver disease and 15-20
  develop Liver Cirrhosis.

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NORMAL LIVER AND CIRRHOTIC LIVER BY HCV INFECTION
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OBJECTIVES

• Determine the prevalence of Hepatitis C infection
  in a cohort of Puerto Ricans HIV/AIDS patients.
• Describe the sociodemographic characteristics,
  risk profile, HIV clinical manifestations, CD4
  and antiretroviral therapy (ART) in the
  co-infected patients.
• Define the factors that could be associated with
  the HIV-HCV co-infection.
• Explore the risk factor that increase the
  mortality risk of HIV-HCV patients.

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METHODS

• Population 2,996 Puerto Ricans HIV patients,
  followed by the Retrovirus Research Center in the
  Universidad Central del Caribe School of
  Medicine, at Bayamón Puerto Rico, between January
  1992 and December 2001.
• Sample 592 HIV infected patients with a positive
  ELISA HCV test.
• Variables Sociodemographic, HIV risk factors,
  HIV clinical manifestations, CD4 cell count ,
  ART and mortality data was explored.
• Data Analysis Percentage, Fisher, Chi Square and
  Cox Proportional Hazard analysis were performed.

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HCV PREVALENCE IN THE HIV/AIDS COHORT
N2,996
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GENDER DISTRIBUTION IN CO-INFECTED CASES
n 592
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AGE, CD4 COUNT AND AIDS AT HCV INFECTION
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AIDS DEFINE CONDITION PREVALENCE
n592
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EMPLOYMENT, EDUCATION LEVEL AND HOUSING
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INJECTING DRUG USE IN CO-INFECTED CASES
n592
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CLASS OF DRUG USED BY THE CO-INFECTED IDU
PATIENTS
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MORTALITY RATE BY THE END OF FOLLOW UP
n592
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MORTALITY RATE DIFFERENCES
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MORTALITY RISK FOR HIV-HCV INFECTED CASES
BY COX PROPORTIONAL HAZARD
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CONCLUSIONS

• HIV-HCV co-infection prevalence (20) is lower
  than reported in other studies (30-50). An
  underreport of cases could explain this issue,
  HCV screening test was implement in 1998.
• The co-infection is a potential Public Health
  problem.
• The IDU risk in HIV-HCV patients (80) was higher
  than the reported in the whole HIV cohort
  (57.2).

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CONCLUSIONS 2

• High prevalence of unemployment, low formal
  education and isolation are common in the group.
• Significant mortality increment in patients with
  high degree of immunological damage and in
  patients with AIDS.
• Significant mortality decrement in patients with
  Anti Retroviral Treatment.

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RECOMMENDATIONS

• Active HCV surveillance in HIV/AIDS patients,
  for early disease diagnosis.
• Primary prevention strategies to reduce the
  co-infection , specially in IDU persons.
• Secondary prevention strategies to reduce the
  hepatic damage.
• Early multi ART will improve the immunological
  system of the patients, reducing their HIV
  morbidity and mortality.

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ACKNOWLEDGMENTS

• This study was sponsored by RCMI/NIH Grant number
  G12RR03035, 1U54RR01950701 and CDC/ASD Grant
  number U62/CCU206209