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

1. 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

3. HEPATITIS C VIRUS

4. 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.

5. NORMAL LIVER AND CIRRHOTIC LIVER BY HCV INFECTION

6. 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.

7. 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.

8. HCV PREVALENCE IN THE HIV/AIDS COHORT N=2,996

9. GENDER DISTRIBUTION IN CO-INFECTED CASES n= 592

10. AGE, CD4+ COUNT AND AIDS AT HCV INFECTION

11. AIDS DEFINE CONDITION PREVALENCE n=592

12. EMPLOYMENT, EDUCATION LEVEL AND HOUSING

13. INJECTING DRUG USE IN CO-INFECTED CASES n=592

14. CLASS OF DRUG USED BY THE CO-INFECTED IDU PATIENTS

15. MORTALITY RATE BY THE END OF FOLLOW UP n=592

16. MORTALITY RATE DIFFERENCES

17. MORTALITY RISK FOR HIV-HCV INFECTED CASES BY COX PROPORTIONAL HAZARD

18. 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%).

19. 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.

20. 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.

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