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HCV HIV
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HCV HIV

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  1. HCV HIV Kees Brinkman afd Interne Geneeskunde

  2. Virale Hepatitis ( = geelzucht) leverontsteking veroorzaakt door virus “5” soorten: • hepatitis A via “ poep” • hepatitis B via bloed / naalden / M-K / sex • hepatitis C via bloed / naalden / (M-K) niet per se via sex! • hepatitis D alleen samen met HBV • hepatitis E via “poep” (Azië)

  3. Virale Hepatitisgenezing? • hepatitis A spontaan 99,9 % • hepatitis B spontaan 95% 5% chronisch • hepatitis C spontaan 20-30% 70 - 80% chronisch • hepatitis E spontaan 99,9 % chronische hepatitis B/C: besmettelijk voor anderen

  4. Chronische Hepatitis→ cirrose • duur: 15 – 60 jaar • alcohol !! • therapie: levertransplantatie • extra risico: leverkanker

  5. HCV & HIV • bekende associatie • chronische HIV & chronische HCV • risicogroepen: • (ex) IVDU • bloedtransfusies • hemofilie e.d. NB geen duidelijke sexuele overdracht bekend

  6. Prevalence of HCV and HBV Co-infection in persons living with HIV EuroSIDA cohort • Among 9803 subjects in the EuroSIDA Cohort: • of 5883 HBsAgtest available attime of enrollment • 530 (9%) positive • of 5957 HCVAb test available • 1960 (33%) positive HBV:9.7% Argentina HBV+: 7.8% North: HCV+ 24,5 % HBV 6% HBV 9.2% East: HCV+ 47,7 % Central: HCV+22,9 % HBV+ 9.1% Konopnicki D et al.; AIDS. 2005. Rockstroh J et al.; JID 2005 South: HCV+ 44,9 %

  7. HCV bij HIVin Nederland SHM 2005: • 9088 patienten • 839 HCV positief (10,6%) • IVDU: 94,4% • heterosex: 5,1 % • MSM: 3,0%

  8. Natural history of HCV infection in HIV+: HCV infection HIV  Resolved 10% Chronic Infection 90% Normal ALT 55% Mild disease Elevated ALT 45% HIV  Cirrhosis 25% HIV  HCC Liver failure Liver Related Mortality HIV 

  9. Incidence of HCV-related cirrhosis in HIV-infected patients Ten-Year Incidence Mean Time to of Cirrhosis Cirrhosis 23.2 20 25 14.9 20 15 P<0.001 15 P<0.01 Frequency (%) Time (years) 10 10 6.9 2.6 5 5 0 0 HCV HIV/HCV HCV HIV/HCV Soto et al. J Hepatol 1997;26:1-5

  10. The effect of HIV coinfection on the risk of cirrhosis and HCC in US veterans with HCV • 26,641 patients with HCV only and 4761 with HCV/HIV coinfection • An increased risk of cirrhosis and HCC in patients with coinfection was only found during the pre-HAART-era (before 10/1996) (hazard ratio 1.48, 1.06-2.07, p=0.02) but not among patients who entered the cohort during the HAART era Kramer JR et al., Am J Gastroenterol 2005

  11. Impact of ART on Overall Liver Mortalityin HIV/HCV-Coinfected Patients Overall Mortality • Bonn cohort (1990-2002) • 285 HIV/HCV coinfected patients • Liver-related mortality rates per 100 person-years • HAART: 0.45 • ART: 0.69 • No therapy: 1.70 • Predictors for liver-related mortality • No HAART • Low CD4 cell count • Increasing age HAART* Cumulative Survival ART No therapy *P<0.001 0 1000 2000 3000 4000 5000 6000 Days Liver-Related Mortality HAART* ART No therapy Cumulative Survival *P=0.018 0 1000 2000 3000 4000 5000 6000 Days Qurishi N, et al. Lancet. 2003:362:1708-1713.

  12. acute HCV bij HIV hoe ontdekt: - bij alle HIV patiënten: controle leverwaarden - bij stijging: onderzoek naar hepatitis NB: weinig kennis over acute HCV !