Co-infection Status Research Articles

Safety of etravirine in HIV-1/hepatitis B and/or C virus co-infected patients: pooled 96 week results from the Phase III DUET trials

Human immunodeficiency virus (HIV)-infected patients are frequently co-infected with hepatitis B and/or C virus (HBV/HCV). The safety of etravirine was investigated over 96 weeks in patients co-infected with HIV type-1 (HIV-1) and HBV and/or HCV in the Phase III DUET trials. DUET-1 and DUET-2 are registered with clinicaltrials.gov (NCT00254046 and NCT00255099, respectively). Treatment-experienced, HIV-1-infected patients with documented non-nucleoside reverse transcriptase inhibitor (NNRTI) resistance were randomized to receive either etravirine 200 mg or placebo, both twice daily plus a background regimen of darunavir/ritonavir, investigator-selected nucleoside reverse transcriptase inhibitors and optional enfuvirtide. Hepatitis co-infection status was confirmed by hepatitis B surface antigen or HCV antibody and qualitative HCV RNA. Co-infected patients were eligible if they did not require anti-hepatitis treatment and were clinically stable, with aspartate aminotransferase (AST) and alanine aminotransferase (ALT) concentrations <5× the upper limit of normal. Adverse events (AEs) and laboratory parameters were analysed. Data were available for 566 etravirine- and 564 placebo-treated patients, of whom 72 (13%) and 68 (12%), respectively, were co-infected with HBV/HCV. Irrespective of co-infection status, the etravirine and placebo groups were comparable for the incidence of grade 3/4 AEs [co-infected: 31 (43%) versus 31 (46%) patients, respectively; non-co-infected: 200 (40%) versus 176 (35%), respectively] and serious AEs [co-infected: 25 (35%) versus 25 (37%), respectively; non-co-infected: 123 (25%) versus 119 (24%), respectively]. Consistent with the underlying hepatitis, relative to non-co-infected patients the co-infected patients, had a higher incidence of hepatic AEs [co-infected: 13 (18%) etravirine-treated versus 10 (15%) placebo-treated patients; non-co-infected: 36 (7%) versus 32 (6%), respectively], and grade 3/4 elevation of AST [co-infected: 8 (11%) versus 5 (7%), respectively; non-co-infected: 14 (3%) versus 9 (2%), respectively] and ALT [co-infected: 10 (14%) versus 6 (9%), respectively; non-co-infected: 14 (3%) versus 8 (2%), respectively]. Discontinuation due to hepatic AEs was low and comparable between the treatment groups, regardless of co-infection status (two co-infected patients in each treatment group; five etravirine-treated versus two placebo-treated non-co-infected patients). Etravirine demonstrated a similar safety profile to placebo in the subgroup of patients co-infected with HIV and HBV and/or HCV in the DUET trials. The incidence and severity of AEs with etravirine was generally comparable to placebo irrespective of co-infection status.

Cryptococcosis and tuberculosis co-infection at a university hospital in Taiwan, 1993–2006

The human immunodeficiency virus (HIV) epidemic and increasing use of immunosuppressive agents have increased the prevalence of both cryptococcosis and tuberculosis (TB). However, the status of co-infection with both pathogens remains unknown. This study retrospectively reviewed patient records of cryptococcosis and TB co-infection from 1993 to 2006. The temporal sequence of co-infection was defined as either concurrent or sequential. Data collected included patient demographics, HIV status, co-morbidities, clinical manifestations, treatment strategies, and outcome at 1-year follow-up. There were 23 patients with cryptococcosis and TB co-infection, representing 5.4% of cryptococcosis or 0.6% of TB cases. Eleven (48%) patients were HIV-infected, and no underlying disease or immunocompromised state could be identified in six (26%) patients. Twelve (52%) patients presented with concurrent infection, but diagnosis of co-infection could be achieved simultaneously in only three (13%). Constitutional symptoms, particularly fever and weight loss, were the most common presenting symptoms, developing in more than two-thirds of the patients. The majority (83%) of the patients made a good recovery following dual antifungal and anti-TB therapy. There were three mortalities at the 1-year follow-up, which might be attributable to a delay in diagnosis and treatment of co-infection. The outcomes of HIV-infected and non-HIV-infected patients were not significantly different. Cryptococcosis and TB co-infection, although rare, develops in both immunocompromised and healthy individuals. Early diagnosis and treatment may improve patient prognosis. There should be a high index of suspicion in order to achieve a timely diagnosis in a TB endemic area.

Death rates in HIV-positive antiretroviral-naive patients with CD4 count greater than 350 cells per μL in Europe and North America: a pooled cohort observational study

Whether people living with HIV who have not received antiretroviral therapy (ART) and have high CD4 cell counts have higher mortality than the general population is unknown. We aimed to examine this by analysis of pooled data from industrialised countries. We merged data on demographics, CD4 cell counts, viral-load measurements, hepatitis C co-infection status, smoking status, date of death, and whether death was AIDS-related or not from 23 European and North American cohorts. We calculated standardised mortality ratios (SMRs) standardised by age, sex, and year, stratifying by risk group. Data were included for patients aged 20-59 years who had at least one CD4 count greater than 350 cells per microL while ART naive. All pre-ART CD4 counts greater than 350 cells per microL from January, 1990, to December, 2004, were included. We investigated mortality for four risk groups--men who have sex with men, heterosexual people, injecting drug users, and those at other or unknown risk. The association between CD4 cell count and death rate was investigated by use of Poisson regression methods. Data were analysed for 40,830 patients contributing 80,682 person-years of follow-up. Of 419 deaths, 401 were used in the SMR analysis: 100 men who have sex with men (SMR 1.30, 95% CI 1.06-1.58); 68 heterosexual people (2.94, 2.28-3.73); 203 injecting drug users (9.37, 8.13-10.75); and 30 in the other or unknown risk category (4.57, 3.09-6.53). Compared with CD4 counts of 350-499 cells per microL, death rate was lower in patients with counts of 500-699 cells per microL (adjusted rate ratio 0.77, 95% CI 0.61-0.95) and counts of 700 cells per microL (0.66, 0.52-0.85). In HIV-infected ART-naive patients with high CD4 cell counts, death rates were raised compared with the general population. In men who have sex with men this was modest, suggesting that a substantial proportion of the increased risk in other groups is due to confounding by other factors. Even though the increased risk is small, new studies of potential benefits of ART in this group are merited. European Commission, FP6. European AIDS Treatment Network (NEAT). Project number LSHP-CT-2006-037570.

TB/HIV Co-Infection Status among the Newly Diagnosed TB Patients: A Study from Eastern Nepal

Tuberculosis (TB) is a leading public health problem worldwide particularly in the developing countries. The HIV epidemic has increased the global tuberculosis burden. Estimating the proportion of HIV infection among TB cases can act as early warning system for the spread of TB due to HIV in the country. The objective of the study was to know status of TB/HIV co-infection cases among the TB patients at DOTS clinic in BPKIHS, Dharan, Nepal. Three Hundred newly diagnosed TB cases attended to BPKIHS DOTS clinic were tested for HIV. Among 300 newly TB patients, 14 (4.7%) patients were HIV positive. All were males. The study has shown very high (4.7%) TB/HIV co-infection. This is an alarming situation. Similar operational research can be conducted in different parts of Nepal to know the exact scenario of TB/HIV co-infection, which is necessary for formulating national policy &amp; guidelines for TB/HIV control in the country. Keywords: TB &amp; HIV Co-infection; TB; HIV; Nepal DOI: 10.3126/saarctb.v5i2.3072 SAARC J. Tuber. Lung Dis. HIV/AIDS 2008 Vol.5(2) 22-25

Predicting the magnitude of short-term CD4+ T-cell recovery in HIV-infected patients during first-line highly active antiretroviral therapy

The extent of short-term CD4(+) T-cell recovery in patients tolerating first-line highly active antiretroviral therapy (HAART) and attaining undetectable HIV RNA levels is inadequately defined. We retrospectively analysed patients in four Italian cohorts who started HAART between January 1996 and September 2006. All patients had known HCV coinfection status, did not modify the regimen for 6 months and had <50 HIV RNA copies/ml at the end of the sixth month. The analysis involved 1,488 patients (1,096 males, 73.7%) with a median age of 43 years (interquartile range [IQR] 39-49); 435 (29.2%) were positive for HCV, 71 (4.8%) were positive for hepatitis B surface antigen (HBsAg) and 76 (5.1%) had experienced a previous AIDS-defining event. At baseline, patient CD4(+) T-cell counts were 226 cells/microl (IQR 99-332), CD4(+) T-cell percentages were 14.7% (IQR 8.7-21.2) and HIV RNA levels were 4.91 log(10) copies/ml (IQR 4.38-5.34). Overall, 24-week CD4(+) T-cell recovery was 144 cells/microl (IQR 70-240). At multivariable analysis, T-cell recovery was positively related to the use of a boosted protease inhibitor (P<0.0001) or thymidine analogues (P<0.0001), baseline HIV RNA levels (P<0.0001), the baseline percentage of CD4(+) T-cells (P<0.0001) and the absence of HCV coinfection (P=0.006). Age, gender, baseline CD4(+)/CD8(+) T-cell ratio and a history of AIDS-defining events had no independent effect on CD4(+) T-cell recovery. Among HIV-infected patients tolerating first-line HAART and with undetectable HIV RNA after 6 months, CD4(+) T-cell recovery is significantly greater in those without HCV coinfection, with a high baseline viral load, a high baseline percentage of CD4(+) T-cells and in those treated with a boosted protease inhibitor.

The relative importance of host characteristics and co-infection in generating variation inHeligmosomoides polygyrusfecundity

We examined the relative importance of intrinsic host factors and microparasite co-infection in generating variation in Heligmosomoides polygyrus fecundity, a parameter that serves as a proxy for infectiousness. We undertook extensive trapping of Apodemus flavicollis, the yellow-necked mouse in the woodlands of the Italian Alps and recorded eggs in utero from the dominant nematode species H. polygyrus, and tested for the presence of five microparasite infections. The results showed that sex and breeding status interact, such that males in breeding condition harboured more fecund nematodes than other hosts; in particular, worms from breeding males had, on average, 52% more eggs in utero than worms from non-breeding males. In contrast, we found a weak relationship between intensity and body mass, and no relationship between intensity and sex or intensity and breeding condition. We did not find any evidence to support the hypothesis that co-infection with microparasites contributed to variation in worm fecundity in this system. The age-intensity profiles for mice singly-infected with H. polygyrus and those co-infected with the nematode and at least one microparasite were both convex and not statistically different from each other. We concluded that intrinsic differences between hosts, specifically with regard to sex and breeding condition, contribute relatively more to the variation in worm fecundity than parasite co-infection status.

Persistent, triple-virus co-infections in mosquito cells

BackgroundIt is known that insects and crustaceans can carry simultaneous, active infections of two or more viruses without showing signs of disease, but it was not clear whether co-infecting viruses occupied the same cells or different cells in common target tissues. Our previous work showed that successive challenge of mosquito cell cultures followed by serial, split-passage resulted in stabilized cultures with 100% of the cells co-infected with Dengue virus (DEN) and an insect parvovirus (densovirus) (DNV). By addition of Japanese encephalitis virus (JE), we tested our hypothesis that stable, persistent, triple-virus co-infections could be obtained by the same process.ResultsUsing immunocytochemistry by confocal microscopy, we found that JE super-challenge of cells dually infected with DEN and DNV resulted in stable cultures without signs of cytopathology, and with 99% of the cells producing antigens of the 3 viruses. Location of antigens for all 3 viruses in the triple co-infections was dominant in the cell nuclei. Except for DNV, this differed from the distribution in cells persistently infected with the individual viruses or co-infected with DNV and DEN. The dependence of viral antigen distribution on single infection or co-infection status suggested that host cells underwent an adaptive process to accommodate 2 or more viruses.ConclusionsIndividual mosquito cells can accommodate at least 3 viruses simultaneously in an adaptive manner. The phenomenon provides an opportunity for genetic exchange between diverse viruses and it may have important medical and veterinary implications for arboviruses.

Seroprevalence of Cysticercosis in Children and Young Adults Living in a Helminth Endemic Community in Leyte, the Philippines

Cysticercosis is a significant public health problem in countries where pigs are raised for consumption and remains an important cause of neurological disease worldwide. The Philippines is considered an endemic area for cysticercosis because cases in both humans and pigs have been reported; however, epidemiologic information stays limited. We conducted a pilot survey of the seroprevalence of human cysticercosis in a village in Leyte, the Philippines, by measuring antibody specific for Taenia solium cyst-fluid antigen. There were 497 subjects aged 7–30 years in our study and most subjects were infected with one or more helminths. The overall cysticercosis seroprevalence in this population was 24.6% (95% CI: 20.82% ~ 28.58%) with no significant difference based on age, sex, or other helminth coinfection status. Although the sample may not be representative of the whole community, the findings suggest that cysticercosis is a significant, but underrecognized public health concern in the Philippines.

Characteristics and Behaviors Associated With HIV Infection Among Inmates in the North Carolina Prison System

We identified factors associated with testing HIV positive in a prison system performing voluntary HIV testing on inmates and estimated the number of undetected HIV cases to evaluate the efficacy of risk-factor-based HIV testing. We used logistic regression to estimate associations between HIV serostatus and HIV risk behaviors, mental health, coinfection status, and sociodemographic characteristics for prisoners entering the North Carolina Department of Correction from January 2004 through May 2006. We estimated the number of undetected HIV cases on the basis of age-, gender-, and race-specific HIV prevalences among prisoners and in the state. Nearly 3.4% (718/21 419) of tested prisoners were HIV positive. The strongest risk factors for infection among men were having sex with men (odds ratio [OR] = 8.0), Black race (OR = 6.2), other non-White race (OR = 7.4), and being aged 35 to 44 years (OR = 4.1). The strongest risk factor among women was Black race (OR = 3.8). Among HIV-positive prisoners, 65% were coinfected with HCV. We estimated that between 24% (223) and 61% (1101) of HIV cases remained undetected. The associations between HIV serostatus and a variety of factors highlight the potential limitations of risk-factor-based HIV testing in prisons, as do the high number of potential undetected HIV cases.

Detection of WU polyomavirus DNA by real-time PCR in nasopharyngeal aspirates, serum, and stool samples

Background The human WU polyomavirus (WUPyV) has been recently described as a novel virus in respiratory tract samples. Objective To investigate the viral load of WUPyV in nasopharyngeal aspirates (NPAs), stool, and serum samples of pediatric patients with acute respiratory tract diseases. Study design We established a real-time PCR for WUPyV DNA and tested NPA obtained between 2002 and 2007 from pediatric in-patients with acute respiratory tract diseases. In addition, 14 stool and 14 serum samples of children with WUPyV DNA positive NPA were analysed. Results WUPyV DNA was found in 5.2% of 1232 NPA. The median viral load in the NPA was 950 copies/ml (maximum 3.4E10 copies/ml). The WUPyV load in NPA was neither associated with the coinfection status nor with the clinical diagnoses. WUPyV DNA was found in 3 of 14 serum samples and in 2 of 14 stool samples. The WUPyV load in NPA tended to be higher in viremic children. Conclusion WUPyV DNA was found in NPA, serum, and stool of hospitalised children with acute respiratory tract diseases. Further studies are necessary to determine whether WUPyV is a human pathogen.

A population-based record linkage study of mortality in hepatitis C-diagnosed persons with or without HIV coinfection in Scotland

Infection with the hepatitis C virus (HCV) is known to increase the risk of death from severe liver disease and, because HCV status is strongly associated with a history of injecting drug use, the effect of a key disease progression cofactor, infection with human immunodeficiency virus (HIV), is of interest. We examined all-cause, liver-related and drug-related mortality and excess risk of death from these causes in a large cohort of HCV-monoinfected and HIV-coinfected persons in Scotland. The study population consisted of 20,163 persons confirmed to be infected with hepatitis C through laboratory testing in Scotland between 1991 and 2005. Records with sufficient identifiers were linked to the General Register Office for Scotland death register to retrieve associated mortality data, and were further linked to a national database of HIV-positive individuals to determine coinfection status. A total of 1715 HCV monoinfected and 305 HIV coinfected persons died of any cause during the follow-up period (mean of 5.4 and 6.4 years, respectively). Significant excess mortality was observed in both HCV monoinfected and HIV coinfected populations from liver-related underlying causes (standardised mortality ratios of 25, 95% CI = 23-27; and 37, 95% CI = 26-52 for the two groups, respectively) and drug-related causes (25, 95% CI = 23-27; 39, 95% CI = 28-53. The risk of death from hepatocellular carcinoma, alcoholic or non-alcoholic liver disease, or from a drug-related cause, was greatly increased compared with the general Scottish population, with the highest standardised mortality ratio observed for hepatocellular carcinoma in the monoinfected group (70, 95% CI = 57-85). This study has revealed considerable excess mortality from liver- and drug-related causes in the Scottish HCV-diagnosed population; these data are crucial to inform on the clinical management, and projected future public health burden, of HCV infection.

Comparative analysis of multidrug-resistant tuberculosis and extensively drug-resistant tuberculosis – Epidemiology and predictive factors

IntroductionExtensively drug-resistant tuberculosis (XDR-TB) is defined as a form of multidrug-resistant tuberculosis (MDR-TB) with additional resistance to fluoroquinolones and at least one of the injectable drugs used in tuberculosis treatment: amikacin, kanamycin and capreomycin. It was classified by WHO as a serious threat to tuberculosis (TB) control, with world-wide consequences, taking on the proportions of a real pandemic in some regions. AimTo compare patients with XDR-TB versus other MDR-TB profiles with regard to epidemiological and demographic characteristics, aetiopathogenic factors and inhospital outcomes. MethodsPatients admitted to Pulido Valente Hospital (Pulmonology Service III) in the period ranging from April 1999 to June 2007 with MDR-TB diagnosis microbiologically confirmed. The following variables were evaluated: gender, age, race, forms of TB presentation, treatment groups, resistance profile, immigrant status, number and duration of previous treatments, WHO classification, HIV co-infection, alcoholism and/or drug addiction, average length of hospital stay and inhospital mortality.Statistical analysis was performed using the SPSS (Statistical Package for the Social Sciences), version 15.0. In categorical variables, the statistical differences between groups were evaluated by the Chisquare test and numeric variables using the T-test. Logistical regression analysis was used to build the predictive model of XDR-TB existence (dependent variable), which included the following independent variables: WHO classification, HIV co-infection, immigrant status, alcoholism and/or drug addiction and number and duration of previous treatments. ResultsWe recorded 132 patients with MDR-TB, of which 69 (52.3%) were XDR-TB. Statistically significant differences were observed in the following variables: race (black race was associated with XDRTB in 74% of cases versus 46% of the Caucasian race); WHO classification (patients with retreatment for therapeutic failure, stopping treatment or relapse were 69.5% of XDR-TB cases versus 44.5% of Not XDR-TB cases; average duration of previous treatments (4.2 months for XDR-TB cases versus 2.8 months for Not XDR-TB cases); HIV co-infection (patients with HIV co-infection constituted 65.2% of XDR-TB cases versus 42.9% of Not XDR-TB cases), mortality (33.3% in patients with XDR-TB versus 14.3% in Not XDR-TB patients). ConclusionsThe variables with predictive value for the diagnosis of XDR-TB vs. Not XDR-TB were presence of HIV co-infection (odds ratio [OR] for XDRTB 2.5; 95% confidence interval [CI], 1.24–5.05) and increased average duration of previous treatments ([OR] for XDR-TB 1.2; 95% [CI], 1.11–2.30).

Análise comparativa entre tuberculose multirresistente e tuberculose extensivamente resistente – Epidemiologia e factores preditivos

Introduction: Extensively drug-resistant tuberculosis (XDR-TB) is defined as a form of multidrug-resis-tant tuberculosis (MDR-TB) with additional resistance to fluoroquinolones and at least one of the injectable drugs used in tuberculosis treatment: amikacin, kanamycin and capreomycin. It was classified by WHO as a serious threat to tuberculosis (TB) control, with world-wide consequences, taking on the proportions of a real pandemic in some regions.Aim: To compare patients with XDR-TB versus other MDR-TB profiles with regard to epidemiological and demographic characteristics, aetiopathogenic factors and inhospital outcomes.Methods: Patients admitted to Pulido Valente Hospital (Pulmonology Service III) in the period ranging from April 1999 to June 2007 with MDR-TB diagnosis microbiologically confirmed. The following variables were evaluated: gender, age, race, forms of TB presentation, treatment groups, resistance profile, immigrant status, number and duration of previous treatments, WHO classification, HIV co-infection, alcoholism and/or drug addiction, average length of hospital stay and inhospital mortality.Statistical analysis was performed using the SPSS (Statistical Package for the Social Sciences), version 15.0. In categorical variables, the statistical differences between groups were evaluated by the Chisquare test and numeric variables using the T-test. Logistical regression analysis was used to build the predictive model of XDR-TB existence (dependent variable), which included the following independent variables: WHO classification, HIV co-infection, immigrant status, alcoholism and/or drug addiction and number and duration of previous treatments.Results: We recorded 132 patients with MDR-TB, of which 69 (52.3%) were XDR-TB. Statistically significant differences were observed in the following variables: race (black race was associated with XDRTB in 74% of cases versus 46% of the Caucasian race); WHO classification (patients with retreatment for therapeutic failure, stopping treatment or relapse were 69.5% of XDR-TB cases versus 44.5% of Not XDR-TB cases; average duration of previous treatments (4.2months for XDR-TB cases versus 2.8months for Not XDR-TB cases); HIV co-infection (patients with HIV co-infection constituted 65.2% of XDR-TB cases versus 42.9% of Not XDR-TB cases), mortality (33.3% in patients with XDR-TB versus 14.3% in Not XDR-TB patients).Conclusions: The variables with predictive value for the diagnosis of XDR-TB vs. Not XDR-TB were presence of HIV co-infection (odds ratio [OR] for XDRTB 2.5; 95% confidence interval [CI], 1.24-5.05) and increased average duration of previous treatments ([OR] for XDR-TB 1.2; 95% [CI], 1.11 – 2.30).Rev Port Pneumol 2008; XIV (6): 829-842

Demographic Variables in Cryoglobulinaemic Expression in Hepatitic C Infection

Purpose: It is well documented that Hepatitis C virus is associated with cyroglobulinaemia. Despite the wide variation of cyroglobulinaemic expression in these patients, the demographic characteristics predisposing to cryoglobulinaemia in association with Hepatitis C are not very well understood. Although prior studies have looked at geographical differences, race as a predisposing factor for cryoglobulinaemic expression has not been well characterized. Aim: The main aim of our study is to determine if there is a racial difference in the expression of cyroglobulins in Hepatitis C infected patients. We also looked if the expression of cyroglobulinaemia was associated with Hepatitis B co-infection. Methods: With IRB approval we reviewed the charts of a cohort of 393 who presented from January 2006 to April 2008 with symptoms suggestive of cyroglobulinaemia. Of these, Hepatitis C infection was confirmed in 293 patients by serum HCV RNA measurement. Cryoglobulin and HBV co-infection status in these patients was also assessed. Results: Presence of cryoglobulins was found in 47 (16%) of patients studied. The mean age in this group was 50.9 years. Absence of cryoglobulins was found in 246 (84%) of patients. The mean age in this group was 51.67 years. Univariate analysis showed no association with either gender or Hepatitis B co-infection. However, analysis of race revealed a significant difference with a trend towards decreased number of African Americans being cryoglobulin positive when compared to Caucasians (8.1% Vs 17.8%, P= 0.04, OR 0.41, 95% CI 0.17 to 0.99) or Hispanics (8.1% vs 23.6%, P= 0.01, OR 0.29, 95% CI 0.11 to 0.77) Table.TableConclusion: Caucasians and Hispanics have an increased predilection for cryoglobulinaemic expression in association with Hepatitis C infection while the predilection for cyroglobulinaemia appears to be decreased in African-Americans. In contrast co-infection with Hepatitis B is not associated with cyroglobulinaemia response in Hepatitis C patients. The geographic differences in prevalence of HCV-related cryoglobulinaemia seen in previous studies could be in part explained by the racial differences of the various populations studied.

Mutation rate in hepatitis C virus NS3 protease is not influenced by HIV-1 protease inhibitor therapy

Mutation rate in hepatitis C virus NS3 protease is not influenced by HIV-1 protease inhibitor therapy

Epidemiology of hepatitis C virus infection among injection drug users in China: Systematic review and meta-analysis

Injection drug use (IDU) is the predominant mode of hepatitis C virus (HCV) transmission in China. This paper aims to provide a comprehensive and reliable tabulation of available data on the epidemiological characteristics and risk factors for HCV infection in injection drug users (IDUs) in China to help inform prevention programmes and guide future research. Data from articles and reports according to pre-defined criteria on HCV infection rates among IDUs of different regions, genders, ethnic backgrounds and risk factors (injecting practice, needle sharing, long duration, sex behaviour and co-infection status) were abstracted and pooled by meta-analysis. A systematic review was constructed based on both pooled data and representative viewpoints. Ninety-five percent confidence intervals (CI) of infection rates were calculated using the approximate normal distribution model. Odds ratios and 95% CI were calculated by fixed or random effects models. Publication bias was examined using Begg's test and Egger's test. Data manipulation and statistical analyses were undertaken using STATA 7.0 and RevMan 4.2. Epi Info 3.4.3 was used for map construction. The pooled prevalence of HCV infection among IDUs in China was 61.4% (95% CI 55.7-67.2%), and the epidemic was most severe in Hubei, Yunnan, Guangxi, Hunan and Xinjiang. No significant difference was found in HCV infection rates between male and female IDUs. A significant association was found between HCV infection and ethnic-minority status. IDUs were 9.24 times more likely to be infected with HCV than non-IDUs, while non-IDUs were more likely to be infected with HCV than members of the general population and other risk populations. There was no significant difference in the risk of HCV infection for needle-sharing IDUs and non-needle-sharing IDUs. A longer duration of IDU was associated with increased HCV prevalence. High-risk sexual practices were strongly associated with drug injection behaviours. Co-infection with human immunodeficiency virus (HIV) greatly increased the probability of HCV infection among IDUs, while the probability of hepatitis B virus infection remained similar for HCV-positive and HCV-negative IDUs in China. IDU continues to fuel the HCV/HIV epidemics spreading throughout China. Many pragmatic strategies are being implemented but need further evaluation.

Prevalence of hepatitis B and C seropositivity in a Nigerian cohort of HIV-infected patients: Original Article

Introduction: The clinical and public health implications of the convergence of the human immunodeficiency virus (HIV) epidemic and chronic viral hepatitis in sub-Saharan Africa are poorly understood. This study was designed to determine the seroprevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV), and the impact of co-infection on baseline serum alanine transaminase (ALT), CD4+ T lymphocyte (CD4) count, and plasma HIV-RNA (viral load) in a cohort of HIV-infected Nigerians. Methods: A retrospective study was conducted, on eligible treatment-naive patients who presented between August 2004 and February 2007 to the University College Hospital (UCH), Ibadan, Nigeria. Demographic data and pre-treatment laboratory results (hepatitis B surface antigen (HBsAg), HCV antibodies (anti-HCV), ALT, CD4 count and viral load) were retrieved from the medical records. Fisher’s exact, two sample t-tests, and the Wilcoxon rank sum tests were used to compare groups. A logistic regression model was fitted to explore characteristics associated with co-infection status. Results: A total of 1779 HIV-infected patients (male: female ratio, 1:2) met inclusion criteria. HBsAg was present in 11.9%, anti-HCV in 4.8% and both markers in 1%. HBsAg was more common among males than females (15.4% vs 10.1%, respectively p = 0.001) while anti-HCV was detected in a similar proportion of males and females (5.3% versus 4.6%, respectively p = 0.559). HIV-infected patients with anti-HCV alone had a lower mean baseline CD4 count compared to those without anti-HCV or HBsAg (197 cells/mm3vs247 cells/mm3, respectively p = 0.008). Serum ALT was higher among patients with HBsAg compared to those without HBsAg or anti-HCV (43 International Units (IU) vs. 39 IU, respectively p = 0.015). Male gender was associated with HBV co-infection on logistic regression (OR1.786; 95% CI, 1.306-2.443; p < 0.005). Conclusion: More HIV-infected females than males presented for care in this cohort. We identified a relatively high prevalence of HBV and HCV co-infection in general, and a higher rate of HBV co-infection among males than females. Pre-treatment CD4 count was significantly lower among those with HCV co-infection, while ALT was slightly higher among those with HBV co-infection. Triple infection with HIV, HBV and HCV was present in a small but significant proportion of patients. These findings underscore the importance of testing for HBV and HCV in all HIV-infected persons in our setting.

Epidemiological, immunological and virological characteristics, and disease progression of HIV-1/HCV-co-infectedc patients from a southern Brazilian population

A cross-sectional study was carried out in order to describe the epidemiological, immunological and virological characteristics, and the disease progression of hepatitis C virus (HCV)/human immunodeficiency virus type 1 (HIV-1)- co-infected patients from a southern Brazilian population. Of 778 HIV-1-infected individuals enrolled in the study from September 2001 to December 2003, and followed up until June 2004, 757 were tested for anti-HCV antibodies. Of these, 159 (21.0%) showed positive results for anti-HCV. Males, individuals in the 25 to 34 year age range, and individuals of lower economic levels were more likely to be seropositive for both viruses [prevalence rate (PR), 2.04; 95% confidence interval (95% CI), 1.43-2.92; p<0.001]. The anti-HCV reactivity was also associated with blood routes of transmission (PR, 2.20; 95% CI, 1.28-3.77; p<0.001), intravenous drug use (PR, 5.79; 95% CI, 4.74-7.07; p<0.001), self-reported previous sexually transmitted diseases (PR, 1.55; 95% CI, 1.18-2.04; p=0.002), VDRL positivity (PR, 2.87; 95% CI, 2.40-3.43; p<0.001), and anti-HTLV I/II reactivity (PR, 5.09; 95% CI, 4.16-6.23; p<0.001). In the follow-up period, the HCV/HIV-1-co-infected patients showed a trend toward lower CD4+ T-cell counts, higher HIV-1 RNA plasma viral load and faster disease progression than patients infected only with HIV-1, but significant differences were not observed. Although there were proportionately more deaths in the HCV/HIV-1-co-infected group, the use of highly active antiretroviral therapy (HAART) was a string predictor of increased CD4+ T-cell counts and decreased HIV-1 RNA plasma levels, suggesting that HAART is more important to the immunological and virological outcomes in HIV-1 infection than is HCV co-infection status.

Safety and tolerability of etravirine (ETR; TMC125) in hepatitis B and/or C co-infected patients in DUET-1 and DUET-2: pooled 48-week results

Methods HIV-1-infected patients on stable but virologically failing therapy were randomised to receive either ETR 200 mg twice daily or placebo, both in combination with a background regimen (BR) consisting of darunavir with lowdose ritonavir (DRV/r), investigator-selected NRTIs and optional enfuvirtide (ENF). Hepatitis B and/or C virus (HBV and/or HCV) co-infection status was confirmed by hepatitis B surface antigen or HCV antibody and qualitative HCV ribonucleic acid (RNA). Co-infected patients were eligible if they were clinically stable, with aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels <5 × the upper limit of normal and did not require anti-hepatitis treatment. Adverse events (AEs) and laboratory parameters were analysed.

HIV-1/HSV-2 co-infected adults in early HIV-1 infection have elevated CD4+ T cell counts.

IntroductionHIV-1 is often acquired in the presence of pre-existing co-infections, such as Herpes Simplex Virus 2 (HSV-2). We examined the impact of HSV-2 status at the time of HIV-1 acquisition for its impact on subsequent clinical course, and total CD4+ T cell phenotypes.MethodsWe assessed the relationship of HSV-1/HSV-2 co-infection status on CD4+ T cell counts and HIV-1 RNA levels over time prior in a cohort of 186 treatment naïve adults identified during early HIV-1 infection. We assessed the activation and differentiation state of total CD4+ T cells at study entry by HSV-2 status.ResultsOf 186 recently HIV-1 infected persons, 101 (54 %) were sero-positive for HSV-2. There was no difference in initial CD8+ T cell count, or differences between the groups for age, gender, or race based on HSV-2 status. Persons with HIV-1/HSV-2 co-infection sustained higher CD4+ T cell counts over time (+69 cells/ul greater (SD = 33.7, p = 0.04) than those with HIV-1 infection alone (Figure 1), after adjustment for HIV-1 RNA levels (−57 cells per 1 log10 higher HIV-1 RNA, p<0.0001). We did not observe a relationship between HSV-2 infection status with plasma HIV-1 RNA levels over time. HSV-2 acquistion after HIV-1 acquisition had no impact on CD4+ count or viral load. We did not detect differences in CD4+ T cell activation or differentiation state by HSV-2+ status.DiscussionWe observed no effect of HSV-2 status on viral load. However, we did observe that treatment naïve, recently HIV-1 infected adults co-infected with HSV-2+ at the time of HIV-1 acquisition had higher CD4+ T cell counts over time. If verified in other cohorts, this result poses a striking paradox, and its public health implications are not immediately clear.