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 of 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 − Case definition : Acute HIV-Seroconverter Documented HIV-Seroconverter • ELISA positive and Westernblot • Duration between last negative and indeterminate oder first positive HIV- test ≤ 3 years • ELISA negative/borderline and HIV • Date of infection (calculated): RNA positive midpoint between those two tests • Date of infection: date of first reactive test − Informed consent mandatory − Recent vote of ethical committee given (2013)
The cohort (reporting period: 01.07.1997 - 1.2.2013) 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) Precision of date of HIV 1-seroconversion 8,7% 34,3% 19,9% 1,5% 6,2% 29,1% acute <=1 months 1-3 months 4-12 months 13-24 months 25-36 months
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 2.0% 1.7% 2.6% 13.0% 13.0%
STI-Screening: HBV Acute/chronic p occult 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 (+) occult 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
Thank you to our sites: Aachen Dres. Knechten, Habets Hamburg ifi Allg.Krankenhaus St. Georg Augsburg Klinikum Augsburg ICH, Infektionsmedizinisches Centrum Hamburg Berlin Ärzteforum Seestraße Dr. Gellermann Augusta-Viktoria Krankenhaus (Vivantes) Universitätsklinik Eppendorf Dres. Bienieck, Cordes Dr. Claus Dr. Dobao Hannover Med. Hochschule Hannover Dres. Dupke, Carganico Dres. Buch, Leugner Dres. Freiwald, Rausch Karlsruhe Landratsamt Karlsruhe Dr. Glaunsinger Koblenz Krankenhaus Kemperhof Dres. Gölz, Moll, Schleehauf Köln Dr. Bihari Dr. Hintsche Dr. Ferdinand Dres. Jessen Dr. Scholten Dres. Köppe Universitätsklinik Köln Dr. Reuter Leipzig Universitätsklinik Leipzig Dres. Schlote, Lauenroth-Mai, Schuler Magdeburg Universitätsklinik Otto-v.-Guericke Universität Klinikum Dr. Schmidt Mainz Joh.-Gutenberg-Universität Dr. Schüler-Maué München Ludwig-Maximilians-Universität München Dres. Schranz, Fischer Dr. Malm Universitätsmedizin Berlin Charité Dres. Jäger, Jägel-Guedes Dr. Rieger Technische Universität München Münster Universitätsklinik Münster Bielefeld Krankenhaus MARA II Norderstedt Dr. Soldan Bochum St. Joseph Hospital Nürnberg Klinikum Nürnberg Bonn Universitätsklinik Bonn Osnabrück Städt. Klinik Natruper Holz Dortmund Klinikum Dortmund,ID Ambulanz Regensburg Universitätsklinik Regensburg Dresden Universitätsklinikum Carl Gustav Carus Dresden Remscheid Dres. Steege, Walter Klinik und Poliklinik für Dermatologie Dr. Kreft Duisburg Dr. Becker-Boost Rostock Universitätsklinik Rostock Dr. Kwirant Düsseldorf Universitätsklinik Düsseldorf Stuttgart Dres. Schnaitmann, Schaffert, Trein, Ißler Frankfurt/M Universitätsklinik Joh.-W.-Goethe-Universität Dres. Ulmer, Frietsch, Müller Frankfurt/O. Dr. Markus Justizvollzugsanstalt Stuttgart Freudenstadt Landratsamt Freudenstadt Halle/Saale Universitätsklinik M.-Luther-Universität Ulm Universitätsklinik Ulm Viernheim Dr. van Treek b d k
Thank you Seroconverter-Team RKI-unit 18: Katrin Arndt, Norbert Bannert, Andrea Hauser, Karolin Meixenberger, Sabrina Neumann, Sybille Somogyi, Hanno von Spreckelsen, our 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“
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