Adverse Outcome in Lamivudine Resistant HBV-related Cirrhotic Patient Co-infected with HIV

Abstract

© 2011, INASL 5 12 patients, 9 were of CC genotype and 3 were CT. Finally 8 (66.66%) patients with CC genotype and 1 (8.33%) patient with CT genotype have achieved SVR besides 1 (8.33%) patient with CC genotype and 2 (16.66%) patients with CT genotype have not achieved SVR. Limitations: Small sample size and association of host genotype (IL28β) with the SVR of different viral genotypes is not classified. Conflict of Interest: None Prevalence of Coinfection of Hepatitis B in HIV-infected Patients of North Kerala TM Ramachandran*, G Ayyappan**, N Sona†, K Soopy‡, T Varghese¶ *Additional Professor of Gastroenterology, **Senior Resident, Department of Gastroenterology and Presenting Author, †Senior Medical Officer, ‡ART Center, Associate Professor of Medicine, ¶Professor and Head of Gastroenterology, Medical College, Calicut Background: Patients with HIV infection are likely to have high risk of HBV infection which share the same route of transmission with HIV. HBV coinfection has been shown to decrease the life expectancy in the HIV-infected patients and also influences the management of these patients. There are no studies from Kerala regarding the prevalence of hepatitis B coinfection in HIV-infected patients. Aim: To assess the prevalence of hepatitis B coinfection in HIV-infected patients in North Kerala. Materials and Methods: HIV-infected patients attending the ART Clinic, Medical College, Calicut from December 2009 to December 2010 were screened for hepatitis B infection using HBsAg ELISA test. History regarding risk factors was taken. LFT was done for all patients. Results: Five hundred and twenty six HIV-positive patients were screened (male 317, M:F = 1.5). Mean age was 39.1 (range 20–85) years. History of high-risk sexual behavior was present in 376/526 (71.4%), prior surgery and blood transfusions in 66/526 (12.5%) and 35/526 (6.6%). History of i.v. drug abuse in 8/526 (1.5%). 489/526 (93.1%) of patients were on anti-retroviral therapy. Mean bilirubin level was 0.54 mg/dL. Mean albumin level was 3.6 g/dL. ALT was elevated in 321/526 (61%) of patients. 6/526 patients (1.14%) were found to be HBsAg positive (males – 4). Intravenous drug abuse was present in 1/6 (16.6%) and high risk sexual behavior in 3/6 (50%). ALT elevation was present in 4/6 (66.6%) of HBsAg positive patients. Conclusion: The prevalence of hepatitis B infection in HIV-infected patients of North Kerala is 1.14%. The prevalence is low compared to other regions of India. However the prevalence of HBV infection was 2-fold higher in this high-risk group when compared to our general population (0.52%). The LFT abnormalities seen in HIV patients need to be evaluated by further studies. Conflict of Interest: None Adverse Outcome in Lamivudine Resistant HBV-related Cirrhotic Patient Co-infected with HIV R Maheswari, R Rai, R Trimukhe Department of Medicine, NSCB Medical College, Jabalpur Background: An estimated 360 million persons worldwide are chronically infected with HIV; nearly 10% of them are co-infected with chronic HBV. These individuals tend to have higher levels of HBV DNA, lower rates of spontaneous HBeAg seroconversion, more severe liver disease and increased rates of liver related mortality. Until few years lamivudine was frequently prescribed for chronic HBV infection and as component of HAART. However lamivudine was frequently associated with development of resistance, more so in patients with HIV co-infection and is associated with adverse outcomes. Aim: To describe the clinical sequel of lamivudine resistance in HBV-related cirrhotic patient co-infected with HIV on HAART. Methods: A HIV co-infected HBV related HBe-Ag-negative cirrhotic patient was followed for 2 years on HAART (Stauvudine/ Lamivudine-300 mg daily/Efavirenz). Routine hematological, biochemical tests, LFT, PT, HBV-DNA and radiological investigations were done on follow-up. Results: A 40-year-old male, non-alcoholic, presented on July 2010 with oral candidiasis, appetite loss and fever for 3 months. Two years back he had raised bilirubin (4 mg/dL), ALT: 144U/L, HBV-DNA: 27160 IU/mL and CD4 count: 300 cells/cumm. Anti-HCV and HDV RNA were negative. After 1 year he had normal bilirubin and ALT; HBV-DNA: 266 IU/mL and CD4 count: 410 cells/cumm. In July 2010 there was a virological breakthrough (HBV-DNA: 34258 IU/mL) with bilirubin: 3 mg/dL, ALT levels: 345 U/L and CD4 count: 278 cells/cumm. This patient probably developed lamivudine resistance. Tenofovir was added but patient died after 2 months. Conclusion: Few years back patients with HBV HIV co-infection in resource constrained settings received lamivudine as the only drug active against HBV and as a part of HAART which has led to emergence of lamivudine-resistant HBV. Despite newly licensed drug like tenofovir for HBV; treatment of co-infection is difficult especially when there is suspected failure of HAART and has to be addressed. Conflict of Interest: None 03_JCEH-Abstract.indd 5 3/18/2011 11:13:03 AM