HCV HIV
description
Transcript of HCV HIV
HCV
HIV
Kees Brinkmanafd Interne Geneeskunde
Virale Hepatitis ( = geelzucht)
leverontsteking veroorzaakt door virus
“5” soorten:– hepatitis A via “ poep”– hepatitis B via bloed / naalden / M-K / sex– hepatitis C via bloed / naalden / (M-K)
niet per se via sex!
– hepatitis D alleen samen met HBV– hepatitis E via “poep” (Azië)
Virale Hepatitis
genezing? – hepatitis A spontaan 99,9 %– hepatitis B spontaan 95%
5% chronisch
– hepatitis C spontaan 20-30% 70 - 80% chronisch
– hepatitis E spontaan 99,9 %chronische hepatitis B/C: besmettelijk voor anderen
Chronische Hepatitis
→ cirrose
• duur: 15 – 60 jaar • alcohol !!• therapie: levertransplantatie• extra risico: leverkanker
HCV & HIV
• bekende associatie– chronische HIV & chronische HCV– risicogroepen:
• (ex) IVDU• bloedtransfusies• hemofilie e.d.
NB geen duidelijke sexuele overdracht bekend
Prevalence of HCV and HBV Co-infection in persons living with HIV
EuroSIDA cohort
• Among 9803 subjects in the EuroSIDA Cohort:
– of 5883 HBsAgtest available attime of enrollment
• 530 (9%) positive
– of 5957 HCVAb test available
• 1960 (33%) positive
HBV:9.7%HBV:9.7%
HBV 9.2%HBV 9.2%
HBV+ 9.1%HBV+ 9.1%
HBV 6%HBV 6%
ArgentinaArgentina
HBV+: 7.8%HBV+: 7.8%
Konopnicki D et al.; AIDS. 2005.
Rockstroh J et al.; JID 2005South: HCV+ 44,9 %
North: HCV+ 24,5 %
Central: HCV+22,9 %East: HCV+ 47,7 %
SHM 2005: • 9088 patienten• 839 HCV positief (10,6%)
– IVDU: 94,4% – heterosex: 5,1 %– MSM: 3,0%
HCV bij HIVin Nederland
Natural history of HCV infection in HIV+:
HCV infection
Resolved 10%Chronic Infection 90%
Normal ALT55%
Mild disease
Elevated ALT45%
Cirrhosis
25%
Liver failure
HIV
HIV
HIV
Liver Related MortalityHIV
HCC
Incidence of HCV-related cirrhosis in HIV-infected patients
Ten-Year Incidence of Cirrhosis
2.6
14.9
0
5
10
15
20
HCV HIV/HCV
Fre
qu
ency
(%
)
P<0.01
Mean Time to Cirrhosis
23.2
6.9
0
5
10
15
20
25
HCV HIV/HCV
Tim
e (y
ears
)
P<0.001
Soto et al. J Hepatol 1997;26:1-5
The effect of HIV coinfection on the risk of cirrhosis and HCC in US veterans with HCV
26,641 patients with HCV only and 4761 with HCV/HIV coinfection
An increased risk of cirrhosis and HCC in patients with coinfection was only found during the pre-HAART-era (before 10/1996) (hazard ratio 1.48, 1.06-2.07, p=0.02) but not among patients who entered the cohort during the HAART era
Kramer JR et al., Am J Gastroenterol 2005
11
Impact of ART on Overall Liver MortalityImpact of ART on Overall Liver Mortalityin HIV/HCV-Coinfected Patientsin HIV/HCV-Coinfected Patients
• Bonn cohort (1990-2002)Bonn cohort (1990-2002)
- 285 HIV/HCV coinfected 285 HIV/HCV coinfected patientspatients
• Liver-related mortality rates Liver-related mortality rates per 100 person-yearsper 100 person-years
- HAART: 0.45HAART: 0.45
- ART: 0.69ART: 0.69
- No therapy: 1.70No therapy: 1.70
• Predictors for liver-related Predictors for liver-related mortalitymortality
- No HAARTNo HAART
- Low CD4 cell countLow CD4 cell count
- Increasing ageIncreasing ageQurishi N, et al. Lancet. 2003:362:1708-1713.
0,2
0,4
0,6
0,8
1
DaysDays
Overall MortalityOverall Mortality
Cu
mu
lati
ve S
urv
ival
Cu
mu
lati
ve S
urv
ival
0 1000 2000 3000 4000 5000 60000 1000 2000 3000 4000 5000 6000
ARTART
HAART*HAART*
0,2
0,4
0,6
0,8
1
DaysDays
Liver-Related MortalityLiver-Related Mortality
Cu
mu
lati
ve S
urv
ival
Cu
mu
lati
ve S
urv
ival
0 1000 2000 3000 4000 5000 60000 1000 2000 3000 4000 5000 6000
HAART*HAART*
No therapyNo therapy
ARTART
No therapyNo therapy
**PP=0.018=0.018
**PP<0.001<0.001
acute HCV bij HIV
hoe ontdekt:- bij alle HIV patiënten: controle leverwaarden- bij stijging: onderzoek naar hepatitis
NB: weinig kennis over acute HCV !