14th ICID - Poster Abstracts - International Society for Infectious ...

When citing these abstracts please use the following reference:
Author(s) of abstract. Title of abstract [abstract]. Int J Infect Dis 2010;14S1: Abstract number.
Please note that the official publication of the International Journal of Infectious Diseases 2010, Volume 14, Supplement 1
is available electronically on http://www.sciencedirect.com
Final Abstract Number: 78.015
Session: HIV: Opportunistic Infections & Malignancies
Date: Friday, March 12, 2010
Time: 12:30-13:30
Room: Poster & Exhibition Area/Ground Level
Type: Poster Presentation
Strategies to enhance Hepatitis B disease surveillance in Human Immunodeficiency Virus /
Hepatitis B Virus co-infected patients
C. Bannan 1 , D. Gallagher 1 , G. Farrell 1 , S. Akin 1 , C. Bergin 2
1 St James's Hospital, Dublin, Ireland, 2 St. James's Hospital, Dublin, Ireland
Background: Human immunodeficiency virus (HIV) and Hepatitis B virus (HBV) infection share
common routes of transmission and hence co-infection is common. Co-infection with HBV/HIV is
associated with higher levels of HBV DNA, lower rates of spontaneous HBV e-antigen seroconversion,
more severe liver disease and increased rates of liver-related mortality.
Chronic viral hepatitis has become an important cause of morbidity and mortality in HIV coinfected
patients. Starting treatment appropriately, monitoring both HIV and HBV response to
treatment appropriately and surveillance for liver disease progression is imperative. Current
guidelines recommend 6 monthly alpha fetoprotein (AFP) and liver ultrasound scans for
hepatocellular carcinoma (HCC) surveillance.
In 2009 an audit of HBV/HIV co-infected patients at our hospital revealed that while HIV disease
was being monitored as per guidelines, markers for HBV replication and sero-conversion were
measured on a variable basis. We found suboptimal rates of monitoring for the development of
HCC using either AFP or liver ultrasound. Finally, liver biopsies were infrequently requested in
those who meet the criteria.
Methods: As a result of the above findings a number of interventions were made:
Generation of a frequent specific clinic for HIV/HBV co-infected patients with multidisciplinary
team input.
Establishment of a regular teaching program with regards to current practice guidelines for
managing and monitoring patients co-infected with HIV/HBV.
Collaboration with the Radiology Department to create a more efficient and effective method of
surveillance radiology for these patients including automatic recall for surveillance scans.
Results: Since establishment of the co-infection clinic HBV DNA continues to be monitored
appropriately. More patients had AFP levels checked on a 6 monthly basis (73% vs 20%). A
greater proportion of patients (89% vs 45%) were booked for surveillance ultrasound.
Conclusion: Cohorting of HIV/HBV co-infected patients results in improved adherence to
guidelines for HBV surveillance and will facilitate future HBV studies including HBV surface
antigen quantification, delta virus surveillance and hepatic elastography.