Occult hepatitis B virus HBV and hepatitis C virus HCV viremia in women with and atrisk for HIVAIDS - PowerPoint PPT Presentation

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Occult hepatitis B virus HBV and hepatitis C virus HCV viremia in women with and atrisk for HIVAIDS

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Title: Occult hepatitis B virus HBV and hepatitis C virus HCV viremia in women with and atrisk for HIVAIDS


1
Occult hepatitis B virus (HBV) and hepatitis C
virus (HCV) viremia in women with and at-risk
for HIV/AIDS
  • Taylor L, Gholam P, Delong A, Rompalo A, Klein R,
    Schuman P, Gardner L, Carpenter C for the HIV
    Epidemiology Research (HER) Study Group

2
Background
  • Sensitive nucleic acid detection methods reveal
    low levels HBV DNA in serum in absence HBsAg
  • Occult HBV viremia (OHBV)
    hidden HBV viral replication
  • HBcAb typically only detectable serological
    marker of prior exposure though serologically
    negative cases reported
  • Occult HCV viremia (OHCV) HCV
    viremia in absence HCV Ab

3
Limits of Knowledge To Date
  • Single time point analyses
  • May misclassify acute infection with viremia
    prior to development HBsAg or HCV Ab, as
    occult infection
  • May misclassify HBV during viral clearance with
    HBsAg loss, near clearance of HBV DNA, as OHBV
  • Different assays, varied sensitivities
  • Reported OHBV 0 - 89, OHCV 0 -13
  • HIV women understudied

4
Objectives
  • Assess prevalence OHBV and OHCV in women with and
    at-risk for HIV/AIDS
  • To confirm true occult infections with
    persistent viremia, no serologic markers,
    repeat nucleic
    acid and serologic testing 2 distant time points
  • Examine demographic, behavioral, serological
    characteristics associated with OHBV and OHCV

5
Methods
  • HIV Epidemiology Research (HER) Study
  • Multi-center, prospective, longitudinal study
    natural history HIV in women
  • 1993 - 2000
  • Enrolled 871 HIV, 439 demographically matched
    HIV(-) at-risk women
  • Ages 16 55
  • Interviews conducted, plasma obtained semiannually

6
Methods
  • Study population subset with stored plasma
  • 845 (65), 549 HIV, 296 HIV(-)
  • Representative of entire cohort at baseline
  • HIV (65 vs. 67)
  • HCV Ab (54 vs. 57)
  • HBcAb (52 vs. 54)
  • HBsAg (2.6 vs. 2.5)
  • All other demographic, biochemical, serological
    characteristics comparable
  • 60 Black, 15 Latina, 1 Other, 22 White

7
Analyzed Data from 3 Timepoints
  • 1st Baseline serologies
  • HBcAb, HBsAg for HBcAbs
  • HCV Ab
  • 2nd Visit 4 samples HBV DNA/HCV RNA
  • Real-time PCR assays
  • COBAS TaqMan system, Roche Diagnostics
  • LOD 15 IU/ml HBV, 11 IU/ml HCV
  • 3rd Visit 5 HBcAb, sAg, HCVAb, HBV DNA/HCV RNA
  • Subjects viremic 2nd timepoint, HBsAg-, HCV Ab-
  • Potentially had occult infection based on single
    point or infected after baseline serologic
    testing

8
Methods
  • Calculated prevalence OHBV/OHCV 3rd time point
  • Univariate, multivariate analyses for
    associations between OHBV/OHCV and covariates
  • Demographic
  • HIV-related, Liver-related
  • STIs, drug and sexual behavior

9
OHBV Prevalence
4.7 HIV (95 CI 3.1-6.9) 3.1 cohort (95 CI
2.0-4.5)
BASELINE
845 HBcAb
400 cAb-
445 cAb
423 sAg-
22 sAg
VISIT 4
16 cAb-/DNA
12 DNA
10 DNA-
47 cAb/DNA
376 DNA-
384 DNA-
HBsAg aviremic carrier
Exposure with viremia
Prior exposure without viremia
No exposure
HBsAg Viremia
44
VISIT 5
20 DNA-/sAg-
2 DNA/sAg
12 DNA-
4 DNA
22 DNA/sAg-
HBsAg viremia
Resolved viremia
Resolved viremia
OHBV cAb-
OHBV cAb
10
OHBV vs. HBsAg viremia
all significant p lt 0.05
11
OHBV vs. HBcAb aviremia
12
Analysis Restricted to HIV women
  • OHBV vs. HBcAb aviremia
  • lower median CD4 count (205 vs. 326 cells/mm3)
  • higher median HIV RNA (36,725 vs. 4,480 c/ml)
  • more likely currently inject drugs (54 vs. 32)
  • more likely to drink alcohol heavily (23 vs. 9)
  • predictor OHBV higher HIV VL
  • OHBV vs. HBV-unexposed predictors OHBV
  • IDU
  • higher HIV viral load

13
Prevalence OHCV
HCV Ab available 840
BASELINE
459 HCVAb
381 HCVAb-
VISIT 4
36 HCV RNA
345 HCV RNA -
97 HCV RNA -
362 HCV RNA
Exposure with spontaneous clearance viremia
HCV Ab viremia
No exposure
33 HCV Ab-/HCV RNA
VISIT 5
24 Ab, RNA
1 Ab-, RNA
8 Ab-, RNA-
Spontaneous clearance
without seroconversion
HCV Ab viremia
OHCV 0.12
14
Conclusions
  • OHBV is associated with HIV
  • 4.7 of HIV women had OHBV
  • May be larger problem for women with poor control
    of HIV
  • OHBV may be parenterally transmitted
  • OHCV occurs rarely

15
Acknowledgements
Delong A
Wands J
Cu-Uvin S
Gholam P
Carpenter C
Klein R, Rompalo A, Schuman P, Gardner L Stacey
Chapman RN Women of HER Study
This research was funded by a 2007 developmental
grant from the Lifespan/Tufts/Brown Center for
AIDS Research, P30AI042853.
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