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

Results of the viral hepatitis screening among HIV-1 seroconverters in Germany Joana Hausig, Daniel Schmidt, Karolin Meixenberger, Barbara Bartmeyer Robert Koch-Institut

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) 2

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 3

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 4

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

Hepatitis B 6

Testing algorithm HBV + + Acute/chronic anti-HBs HBV-infection - + anti-HBc + unlikely - + anti-HBs Early acute infection - HBsAg confirmation assay unclear - HBsAg HBV negative + Cleared HBV infection + anti-HBs - HBV infection Unkown if cured or not - anti-HBc + vaccinated - anti-HBs - HBV negative

HBV-status of persons ever tested in the HIV seroconverter study , N=2.944 (1997-2016) HBV Status Total HBV negativ HBV-geimpft HBV-infiziert N Total 684 (23%) 1.482 (50%) 778 (26%) 2.944 Männer 620 (22%) 1.417 (51%) 746 (27%) 2.783 Sex 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 Risiko 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 Herkunftsregion Afrika 18 (28%) 22 (34%) 25 (38%) 65 Asien 3 (10%) 13 (42%) 15 (48%) 31 Karibik 2 (40%) 1 (20%) 2 (40%) 5 ohne Angabe 1 (50%) 0 (0%) 1 (50%) 2 8

HBV-status of persons ever tested in the HIV seroconverter study , N=2.944 (1997-2016) N=252 N=1.105 N=958 N=487 N=142 N=2.944 9

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 10

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 11

Information on HBV vaccination in the HIV-1 seroconverter study questionnaire persons n=2.944 Vaccination No (no yes (unkown number of persons n=1.612 (55%) information) shots)? Questionnaire persons n=1.332 (45%) Vaccination yes No <180 days persons n=768 (26%) persons n=564 (19%) HBV negative HBV vaccinated Cleared HBV Serology n=119 (21%) n=397 (70%) n=48 (9%) Incomplete vaccination? False reporting or non-responder??? 12

Hepatitis C 13

Testing algorithm HCV + Genotyping Active HCV-infection Active HCV-infection (genotype) + PCR + Cleared HCV-infection - anti-HCV-Immunoblot unclear Anti-HCV - HCV negative - HCV negative

HCV-status of persons ever tested in the HIV seroconverter study , N=2.944 (1997-2016) HCV Status Total HCV negativ aktive HCV Zustand nach HCV N Total 2.677 (91%) 121 (4%) 146 (5%) 2.944 Männer 2.541 (91%) 108 (4%) 134 (5%) 2.783 Sex 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 (0%) 49 Risiko 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 (0%) 76 Herkunftsregion Afrika 63 (97%) 1 (2%) 1 (2%) 65 Asien 30 (97%) 1 (3%) 0 (0%) 31 Karibik 6 (86%) 1 (14%) 0 (0%) 7 ohne Angabe 2 (100%) 0 (0%) 0 (0%) 2 15

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 17

HCV Genotypes 19

Hepatitis B and Hepatitis C 20

Hepatitis B & Hepatitis C co-infected persons HBV & HCV & HIV Alle Personen N (%) N (%) Total 121 (100%) 2.944 (100%) Männer 110 (91%) 2.783 (95%) Sex Frauen 11 (9%) 161 (5%) < 25 16 (13%) 460 (16%) 25-34 44 (36%) 1.296 (44%) Alter bei 35-44 45 (37%) 814 (28%) Serokonversion 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%) Risiko 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%) Herkunftsregion Afrika 0 (0%) 65 (2%) Asien 1 (1%) 31 (1%) Karibik 1 (1%) 7 (0%) ohne Angabe 0 (0%) 2 (0%) 21

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) 22

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 23

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 . 24

Thank you FG34  Christian Kollan, Andrea Sailer, Andrea Kühne, Klaus Jansen, Viviane Bremer FG18  Hanno von Spreckelsen, Patrycja Machnowska, Sabrina Neumann, Norbert Bannert 25

Methoden: Laboranalysen HBV Screening 2016 + 1 + Akute/chronische anti-HBs HBV-Infektion - 3 + anti-HBc + 1 unwahrscheinlich - + anti-HBs Frühe akute Infektion 4 - unklar HBsAg Bestätigungstest - HBsAg HBV negativ + Zustand nach HBV- 103 Infektion + anti-HBs Zustand nach HBV- - 28 Infektion, nicht komplett ausgeheilt - anti-HBc + 526 Zustand nach Impfung - anti-HBs - 317 HBV negativ

Verteilung der HCV Genotypen in Deutschland Genotypen (Hüppe et al. 2008, N=10.326) G5/G6 0,2% G4 G2 3% 7% G3 28% G1 62% 27

Patients receiving HCV treatment DAAs prescribed in 2015 and genotype distribution Genotypen Therapien 01-06/2015 (Hüppe et al., 2015) SOF+ G3 DCV 27,7% OBV+ PTVr SOF SOF+ G1 SIM LPV+ 62,3% G2 SOF 6,9% OBV+ G5, G6 G4 PTVr+ 0,2% 3,0% DBV 28