Coinfections with HBV, HCV and Syphilis in MSM with known date of - - PowerPoint PPT Presentation

Coinfections with HBV, HCV and Syphilis in MSM with known date of HIV 1-seroconversion in Germany

Klaus Jansen Barbara Bartmeyer, Claus Bock, Claudia Kücherer, Osamah Hamouda, Karolin Meixenberger, Ramona Scheufele, Michael Thamm

Robert Koch-Institute HIV/AIDS and STI unit (FG 34)

The cohort: methods

• Type of study: Germany-wide, multicentric cohort study since 1997
• Study population: HIV+ patients having known or well definable timepoint
• f HIV 1-seroconversion („seroconverters“)

− Sites: 110 HIV-specialised clinic ambulances and private practitioners involved − Data collection:

− Yearly collection of plasma sample and clinical /epidemiological data − Central blood bank and analyses of viral sequences at RKI laboratory − Idenfication of resistance associated mutation via webbased interface to Standford Database

The cohort: methods

Acute HIV-Seroconverter

• ELISA positive and Westernblot

indeterminate oder

• ELISA negative/borderline and HIV

RNA positive

• Date of infection: date of first

reactive test

Documented HIV-Seroconverter

• Duration between last negative and

first positive HIV-test ≤ 3 years

• Date of infection (calculated):

midpoint between those two tests

− Case definition: − Informed consent mandatory − Recent vote of ethical committee given (2013)

Study population 2,660 Sex Men 93.4% Women 6.5% Transsexuals 0.1% Age at infection Median (IQR) 33 years (27-39) Risk of transmission MSM 84.7% Hetero 9.2% IVDU 2.6% HPC 1.5% Other/unkown 2.0% Deaths 2.4% Ever received ART 62.0%

The cohort

(reporting period: 01.07.1997 - 1.2.2013)

• ≥ 1 plasma sample at RKI: 90.4%
• Successful sequencing of therapy-naive samples: 97.7%
• Median duration of observation between HIV-infection and last event: 3

years, 8 months

• Person years: 12,417
• Currently under follow-up: 1,651 patients

The cohort

(reporting period: 01.07.1997 - 1.2.2013)

34,3% 1,5% 6,2% 29,1% 19,9% 8,7% acute <=1 months 1-3 months 4-12 months 13-24 months 25-36 months

Precision of date of HIV 1-seroconversion

The cohort

(reporting period: 01.07.1997 - 1.2.2013)

STI-Screening: Background

• HBV, HCV and Syphilis have partly similar transmission routes as HIV
• HBV and Syphilis assumed as frequent coinfections in HIV+ MSM in

Germany

• HCV-outbreaks in MSM since 2000 in large Western cities
• Coinfections can worsen course of HIV and vice versa
• More frequent and faster progression to liver fibrosis/cirrhosis in HIV+
• HBV vaccination recommended for MSM in Germany, but few data
• Success of HCV- and HIV-therapy constrained by drug-drug-interaction and

increased toxicity

STI-Screening: Methods

− Screening of baseline and follow-up samples for

− anti-HBc − anti-HBs − HBs-AG − signs of acute/chronic HBV-infection were confirmed by qualitative PCR − anti-HCV, replication activity tested by qualitative PCR − TP-CLIA, confirmed by TPPA, FTA-ABS-IgM, VDRL

− Calculation of prevalences of coinfections on patient basis

STI-Screening: Results

− 5,603 samples of 1,945 HIV+ MSM screened − Collected 1996 – 2012 − Median age at HIV 1-seroconversion: 33 years − 55.7% HIV+ MSM with at least 1 STI-coinfection

STI-Screening: Coinfection Status

13.0%

2.0% 2.6% 1.7% 13.0%

STI-Screening: HBV

Acute/chronic p

• ccult

p cleared p vaccinated p Age groups .311 .053 <.001 <.001 < 25 years 0.4% 3.5% 14.1% 62.9% 25-34 years 2.3% 4.0% 23.0% 51.6% 35-44 years 2.2% 6.7% 34.6% 43.9% 45-54 years 1.2% 3.1% 47.2% 33.1% ≥ 55 years 0% 9.4% 50.0% 21.9%

Acute/chronic HBV: Anti-HBc (+), Anti-HBs (-), HBs-AG (+)

• ccult HBV: Anti-HBc (+), Anti-HBs (-), HBs-AG (-)

cleared HBV: Anti-HBc (+), Anti-HBs (+), HBs-AG (-) HBV-vaccination: Anti-HBc (-), Anti-HBs (+), HBs-AG (-)

STI-Screening: HCV and Syphilis

− 49.1% of HCV-antibody-positive MSM with replicative sample after HIV 1- seroconversion − HCV-genotype distribution:

− GT 1: 70.5% − GT 2: 2.6% − GT 3: 7.7% − GT 4: 19.2%

HCV p Syphilis p Age groups .394 .019 < 25 years 8.2% 30.1% 25-34 years 7.0% 36.1% 35-44 years 9.6% 41.7% 45-54 years 9.8% 39.9% ≥ 55 years 9.4% 40.6%

Conclusion

− High prevalences of HBV, HCV, and Syphilis in HIV+ MSM in Germany − Significant subgroup of patients having signs of occult HBV-infection − Despite extensive vaccination campaigns against HBV, less than 50% of HIV+ MSM were vaccinated − HCV-prevalence 28-fold higher than in general population in Germany − For ~50% of HIV+ MSM, HCV-related therapy could be indicated simultaneously to ART − GT 1 and 4 predominant: unfavorable for treatment success in standard therapy, PIs important option − Trend for Syphilis-coinfections in HIV+ MSM in line with trend of mandatory Syphilis reporting

Conclusions

− Demand for ongoing comprehensive STI-prevention in HIV+ MSM − Need for more extensive and tailored campaigns for HBV-vaccination for HIV+ MSM in Germany, especially for higher age groups − Physicians specialised in HIV could be important actors for counseling about HBV prevention and vaccination − More in-depth analyses of data within next months, special regard to HIV- seroconversion

Aachen Augsburg Berlin Bielefeld Bochum Bonn Dortmund Dresden Duisburg Düsseldorf Frankfurt/M Frankfurt/O. Freudenstadt Halle/Saale

• Dres. Knechten, Habets

Klinikum Augsburg Ärzteforum Seestraße Augusta-Viktoria Krankenhaus (Vivantes)

• Dres. Bienieck, Cordes
• Dr. Claus
• Dr. Dobao
• Dres. Dupke, Carganico
• Dres. Freiwald, Rausch
• Dr. Glaunsinger
• Dres. Gölz, Moll, Schleehauf
• Dr. Hintsche
• Dres. Jessen
• Dres. Köppe
• Dr. Reuter
• Dres. Schlote, Lauenroth-Mai, Schuler
• Dr. Schmidt
• Dr. Schüler-Maué
• Dres. Schranz, Fischer

Universitätsmedizin Berlin Charité Krankenhaus MARA II

• St. Joseph Hospital

Universitätsklinik Bonn Klinikum Dortmund,ID Ambulanz Universitätsklinikum Carl Gustav Carus Dresden Klinik und Poliklinik für Dermatologie

• Dr. Becker-Boost
• Dr. Kwirant

Universitätsklinik Düsseldorf Universitätsklinik Joh.-W.-Goethe-Universität

• Dr. Markus

Landratsamt Freudenstadt Universitätsklinik M.-Luther-Universität Hamburg Hannover Karlsruhe Koblenz Köln Leipzig Magdeburg Mainz München Münster Norderstedt Nürnberg Osnabrück Regensburg Remscheid Rostock Stuttgart Ulm Viernheim b d ifi Allg.Krankenhaus St. Georg ICH, Infektionsmedizinisches Centrum Hamburg

• Dr. Gellermann

Universitätsklinik Eppendorf

• Med. Hochschule Hannover
• Dres. Buch, Leugner

Landratsamt Karlsruhe Krankenhaus Kemperhof

• Dr. Bihari
• Dr. Ferdinand
• Dr. Scholten

Universitätsklinik Köln Universitätsklinik Leipzig Universitätsklinik Otto-v.-Guericke Universität Klinikum Joh.-Gutenberg-Universität Ludwig-Maximilians-Universität München

• Dr. Malm
• Dres. Jäger, Jägel-Guedes
• Dr. Rieger

Technische Universität München Universitätsklinik Münster

• Dr. Soldan

Klinikum Nürnberg Städt. Klinik Natruper Holz Universitätsklinik Regensburg

• Dres. Steege, Walter
• Dr. Kreft

Universitätsklinik Rostock

• Dres. Schnaitmann, Schaffert, Trein, Ißler
• Dres. Ulmer, Frietsch, Müller

Justizvollzugsanstalt Stuttgart Universitätsklinik Ulm

• Dr. van Treek

k

Thank you to our sites:

Thank you

Seroconverter-Team RKI-unit 18: Katrin Arndt, Norbert Bannert, Andrea Hauser, Karolin Meixenberger, Sabrina Neumann, Sybille Somogyi, Hanno von Spreckelsen,

• ur students

Seroconverter-Team RKI-unit 34: Barbara Bartmeyer, Parvin Ghassim, Osamah Hamouda, Claudia Houareau, Fabia zu Knyphausen, Ramona Scheufele, our students The colleagues of the network project „Monitoring of resistant HIV in Germany“