HIV-hepatitis B and C Co-infections: The Unmet Need for Treatment in Argentina.

JORGE QUARLERI; NATALIA LAUFER; MARÍA BELÉN BOUZAS; GERARDO JUNCOS; FRANCO MORETTI; FEDERICO BOLCIC; LILIA MAMMANA; SILVINA FERNÁNDEZ GIULIANO; HÉCTOR PÉREZ; HORACIO SALOMÓN; PEDRO CAHN

Paris, Francia

Simposio; 12th International Symposium on viral hepatitis and liver diseases; 2006

Introduction: In Argentina HAART is provided free of charge by the Federal Government since 1993, but treatment for HBV and HCV is not. Our objective was to study HBV and HCV coinfection in order to estimate the proportion of potential candidates for specific treatment for viral hepatitis. Methods: In a single clinic, taking care of 2,400 HIV+ patients, 593 consecutive cases, were tested for HBV and HCV markers, after obtaining patient’s consent. Demographics: 65% male; 39.3% heterosexuals, 31%MSM, 12.6% IDU. Diagnostic procedures included: HCV Ab (MEIA and HCV 3.0 Murex), HBV: HBsAg, anti-HBs, HBeAg, anti-HBe and anti-HBc (IgM and total) by MEIA (AXSYM Abbott). Viral load HBV and HCV was performed by Amplicor( Roche) and HCV Versant 3.0 (Bayer) respectively.  Viral genotypes were also determined. Results:  Overall 41.6% (246) had markers of HBV infection and 20% did so for HCV, 65 cases (11%) showed markers for both viruses. HBV: 50% MSM, 19.5% heterosexuals, 15.8% IDU. A total of 22 specimens (3.7%) were HBsAg +: 4 HBeAg+ without HBV anticore (total Ig and IgM negative), 11 HBeAg+ presented all markers, 4 HBeAb+/HBeAg-,  and 3 were HBeAg and HBeAb negative. Genotype A2 was identified in 77% of the 22 HBV described samples, genotype D in 9%, one F1, 2 non-typeable. Median viral load was: 12,600,000 copies/ml (r:< 1000-> 40,000,000). Mutations in the reverse transcriptase domain was found in 4 patients, all exposed to lamivudine (median 70.5 months r:60-96). Regarding HCV 125/593 (21 %) were found to be positive for anti-HCV, (48.8% IDUs, 28% heterosexuals and 11.2% MSM). Median HCV viral load: 338,737 IU/ml (r: