Results of the viral hepatitis screening among HIV-1 seroconverters - - PowerPoint PPT Presentation

Joana Hausig, Daniel Schmidt, Karolin Meixenberger, Barbara Bartmeyer

Robert Koch-Institut

Results of the viral hepatitis screening among HIV-1 seroconverters in Germany

2

Background

• Study population: 3.200 patients of the HIV-1 seroconverter study (1997-2016)
• Serological screening for hepatitis B and hepatitis C from HIV-1 seroconvetrers

in 2016

• Recent screenings among HIV-1 seroconverters:
• 2009: HSV2, Syphilis (Spielmann et al., Sex. Transm. Infect., 2010)

HBV, HCV

• 2012: HBV, HCV, Syphilis (Jansen et al., PLOS ONE, 2015)

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Objective

• Prevalence of hepatitis B and hepatitis C co-infections among HIV1-

seroconverters

• Serological screening for prevalence of HBV vaccination
• Identification of new HBV and HCV infections between 2012-2016

among HIV-seroconverters without any hepatitis infection

• Comaprison of serological results with reported information on

HBV vaccination on the questionnaire

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Inclusion criteria for serological testing 2016

• HBV:

− Persons tested HBV negative and/or not vaccinated against HBV at the last screening in 2012 (baseline) − Samples from newly included persons with unknown HBV serostatus at baseline

• HCV:

− Persons tested HCV negative at baseline − Samples from newly included persons with unknown HCV status at baseline

 Testing of the last available sample

• Analysis of information about HBV vaccination from routine

questionnaires

All Patients Enrolled after 2012 N (%) N (%) Total 2.944 (100%) 713 (100%) Sex Men 2.783 (95%) 688 (96%) Women 161 (5%) 25 (4%) Age at Seroconversion Median (IQR) 33 (27-39) 32 (27-42) Age at HBV-testing Median (IQR) 36 (30-44) 34 (28-43) Age at HCV-testing Median (IQR) 37 (30-46) 34 (28-43) Risk MSM 2.556 (87%) 643 (90%) Heterosexual 208 (7%) 33 (5%) HPC 49 (2%) 7 (1%) PWID 40 (1%) 5 (1%) Job Exposition 11 (0%) 4 (1%) Unknown 80 (3%) 21 (3%) Region Germany 2.495 (85%) 563 (79%) Europe (not G) 268 (9%) 45 (6%) America 76 (3%) 27 (4%) Africa 65 (2%) 26 (4%) Asia 31 (1%) 19 (3%) Caribbean 7 (0%) 12 (2%) Unknown 2 (0%) 6 (1%)

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Study population

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Hepatitis B

HBV negative vaccinated Cleared HBV infection HBV infection Unkown if cured or not unclear unlikely HBV negative

Early acute infection

Testing algorithm HBV

anti-HBc

+

• HBsAg

+

• anti-HBc

+

• Acute/chronic

HBV-infection

+

• HBsAg confirmation assay

+

• anti-HBs

+

• anti-HBs

+

• anti-HBs

+

• anti-HBs

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HBV-status of persons ever tested in the HIV seroconverter study , N=2.944 (1997-2016)

Total N 684 (23%) 1.482 (50%) 778 (26%) 2.944 Männer 620 (22%) 1.417 (51%) 746 (27%) 2.783 Frauen 64 (40%) 65 (40%) 32 (20%) 161 MSM 539 (21%) 1.327 (52%) 690 (27%) 2.556 Heterosexual 98 (47%) 88 (42%) 22 (11%) 208 HPL 12 (24%) 13 (27%) 24 (49%) 49 PWID 7 (18%) 7 (18%) 26 (65%) 40 Job Exposition 1 (9%) 8 (73%) 2 (18%) 11 unbekannt 27 (34%) 39 (49%) 14 (18%) 80 Deutschland 580 (23%) 1.294 (52%) 621 (25%) 2.495 Europa (nicht D) 64 (24%) 119 (44%) 85 (32%) 268 Amerika 16 (21%) 32 (42%) 28 (37%) 76 Afrika 18 (28%) 22 (34%) 25 (38%) 65 Asien 3 (10%) 13 (42%) 15 (48%) 31 Karibik 2 (40%) 1 (20%) 2 (40%) 5

• hne Angabe

1 (50%) 0 (0%) 1 (50%) 2 HBV negativ HBV-geimpft HBV-infiziert Herkunftsregion Total Sex Risiko HBV Status

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N=252 N=1.105 N=958 N=487 N=142 N=2.944

HBV-status of persons ever tested in the HIV seroconverter study , N=2.944 (1997-2016)

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Serological results from HBV negative persons in the last screening 2012, N=234

• 234 HBV negative persons in 2012 with new available sample
• Between 2012-2016:
• 9,0% (n= 21) new HBV-infections identified
• 29% (n= 69) effective HBV vaccination
• 62% (n= 144) sensitive for HBV

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HBV-status of persons included into the HIV seroconverter study after 2012, N=713 (2012-2016)

N=72 N=320 N=179 N=105 N=37 N=713

Information on HBV vaccination in the HIV-1 seroconverter study questionnaire

persons n=2.944 persons n=1.332 (45%) persons n=1.612 (55%)

Vaccination

(unkown number of shots)?

yes

No (no information) Vaccination <180 days

persons n=564 (19%) persons n=768 (26%) yes No

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HBV negative n=119 (21%) HBV vaccinated n=397 (70%) Cleared HBV n=48 (9%) Incomplete vaccination? False reporting or non-responder???

Questionnaire

Serology

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Hepatitis C

HCV negative Cleared HCV-infection Active HCV-infection unclear Active HCV-infection (genotype) Genotyping

Anti-HCV

+

• PCR

+

• +
• anti-HCV-Immunoblot

HCV negative

Testing algorithm HCV

15 Total N 2.677 (91%) 121 (4%) 146 (5%) 2.944 Männer 2.541 (91%) 108 (4%) 134 (5%) 2.783 Frauen 136 (84%) 13 (8%) 12 (7%) 161 MSM 2.347 (92%) 88 (3%) 121 (5%) 2.556 Heterosexual 194 (93%) 5 (2%) 9 (4%) 208 HPL 49 (100%) 0 (0%) (0%) 49 PWID 3 (8%) 25 (63%) 12 (30%) 40 Job Exposition 10 (91%) 0 (0%) 1 (9%) 11 unbekannt 74 (93%) 3 (4%) 3 (4%) 80 Deutschland 2.261 (91%) 99 (4%) 135 (5%) 2.495 Europa (nicht D) 242 (90%) 16 (6%) 10 (4%) 268 Amerika 73 (96%) 3 (4%) (0%) 76 Afrika 63 (97%) 1 (2%) 1 (2%) 65 Asien 30 (97%) 1 (3%) (0%) 31 Karibik 6 (86%) 1 (14%) (0%) 7

• hne Angabe

2 (100%) 0 (0%) (0%) 2 HCV Status Zustand nach HCV Total Sex Risiko Herkunftsregion HCV negativ aktive HCV

HCV-status of persons ever tested in the HIV seroconverter study , N=2.944 (1997-2016)

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Serological HCV-status from HCV negative persons in the last screening 2012, N=1.011

• 1.011 HCV negative persons in 2012 with one new sample available

for HCV testing

• 4,8% (48/1.011) new HCV-infections identified
• 2,3% active-HCV infections
• 2,5% cleared HCV infections

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HCV Genotypes

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Hepatitis B and Hepatitis C

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Hepatitis B & Hepatitis C co-infected persons

N (%) N (%) 121 (100%) 2.944 (100%) Männer 110 (91%) 2.783 (95%) Frauen 11 (9%) 161 (5%) < 25 16 (13%) 460 (16%) 25-34 44 (36%) 1.296 (44%) 35-44 45 (37%) 814 (28%) 45-54 12 (10%) 292 (10%) > 55 4 (3%) 82 (3%) MSM 87 (72%) 2.556 (87%) Heterosexuell 3 (2%) 208 (7%) HPL 0 (0%) 49 (2%) PWID 26 (21%) 40 (1%) Job Exposition 0 (0%) 11 (0%) unbekannt 5 (4%) 80 (3%) Deutschland 103 (85%) 2.495 (85%) Europa (nicht D) 14 (12%) 268 (9%) Amerika 2 (2%) 76 (3%) Afrika 0 (0%) 65 (2%) Asien 1 (1%) 31 (1%) Karibik 1 (1%) 7 (0%)

• hne Angabe

0 (0%) 2 (0%) Risiko Herkunftsregion HBV & HCV & HIV Total Sex Alter bei Serokonversion Alle Personen

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Conclusions – Hepatitis B

• High proportion of HBV coinfection among HIV infected seroconverters
• Only half of the patients are vaccinated against HBV
• One third is still sensitive for a new HBV infection
• Higher vaccination rates among younger patients
• 9% new HBV-infections identified (2012-2016)

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Conclusions – Hepatitis C

• High proportion of HCV-infektionen in the study population,

especially age group of 35-44 and PWID

• 5% new HCV-infections between 2012-2016 identified
• 4% HBV-HCV-HIV co-infections (121/2.944)
• More co-infections with HBV and HCV among PWID

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Recommendations

The proportion of hepatitis co-infections is high among HIV seroconverters in Germany. There is need of broader vaccine campaigns against hepatitis B and A in this high risk population and continous awareness among physicians for regular screening of hepatitis C.

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Thank you

FG34

• Christian Kollan, Andrea Sailer, Andrea Kühne,

Klaus Jansen, Viviane Bremer FG18

• Hanno von Spreckelsen, Patrycja Machnowska, Sabrina Neumann,

Norbert Bannert

HBV negativ Zustand nach Impfung Zustand nach HBV- Infektion Zustand nach HBV- Infektion, nicht komplett ausgeheilt unklar unwahrscheinlich HBV negativ

Frühe akute Infektion

Methoden: Laboranalysen HBV

anti-HBc

+

• HBsAg

+

• anti-HBc

+

• Akute/chronische

HBV-Infektion

+

• HBsAg Bestätigungstest

+

• anti-HBs

+

• anti-HBs

+

• anti-HBs

+

• anti-HBs

1 3 1 4 103 28 526 317 Screening 2016

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Verteilung der HCV Genotypen in Deutschland

G1 62% G3 28% G2 7% G4 3% G5/G6 0,2%

Genotypen (Hüppe et al. 2008, N=10.326)

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Patients receiving HCV treatment DAAs prescribed in 2015 and genotype distribution

G1 62,3% G4 3,0% G5, G6 0,2% G2 6,9% G3 27,7%

Genotypen (Hüppe et al., 2015)

LPV+ SOF OBV+ PTVr+ DBV SOF+ SIM OBV+ PTVr SOF SOF+ DCV

Therapien 01-06/2015