European Journal of Medical Research - Deutsche AIDS ...

74 EUROPEAN JOURNAL OF MEDICAL RESEARCH
June 27, 2007
C.10 (Poster)
Risk factors for hepatitis C in HIV positive MSM.
A preliminary evaluation of a case control study
Schmidt A.J. 1 , Vogel M. 2 , Rockstroh J.K. 2 , Radun D. 1 ,
Study Group on Sexual Risk Factors for Hepatitis C
1 Robert Koch-Institut, Infektionsepidemiologie, Berlin,
Germany, 2 Universitätsklinikum Bonn, Medizinische Klinik
und Poliklinik I, Bonn, Germany
Objectives: Since 2001, clinicians in Europe have been reporting
increasing numbers of infections with the hepatitis C virus
(HCV) in HIV positive men who have sex with men (MSM).
The possible routes of HCV transmission are still uncertain and
controversial. Despite biological plausibility, major longitudinal
studies in HIV negative MSM showed no evidence for an
epidemiologically relevant sexual transmission. Therefore, the
aim of this study is to explore social, behavioural/sexual, or
nosocomial risk factors for hepatitis C in HIV positive MSM.
Methods: In 2006, we conducted a case control study embedded
in a survey on knowledge, attitudes and behaviour in German
MSM as to sexually transmitted infections. Cases consisted
of HIV positive MSM with known HCV infection and
no history of injecting drug use (IDU), as IDU and related
sharing of equipment is the leading risk factor for HCV infection
in industrialised countries. HIV positive MSM without
known HCV infection, matched for age group, served as controls.
The HCV serostatus of controls was confirmed by an
anti-HCV-antibody test from dried blot spots.
Results: So far, 22 cases and 44 controls were included for
preliminary evaluation. In the bivariate analysis, significant
risk factors were
(1)consumption of nasally applicable drugs like cocaine
(OR=10.5; 95%CI:2.2-50.8),
(2)history of major surgery (OR=9.1; 95%CI:1.7-48.9),
(3)“gangbanging” or group sex (OR=7.7; 95%CI: 2.0-29.1),
(4)a history of more than 5 episodes of unprotected anal intercourse
within the last 12 months (OR=7.5; 95%CI:2.1-26.2),
(5)bleeding anal injuries from any sort of sexual intercourse
(OR=7.13; 95%CI:1.3-39.1),
(6)“fisting” (OR=5.9; 95%CI:1.4-25.9), or
(7)use of sildenafil (OR=4.1; 95%CI:1.3-13.0).
In logistic regression, (1) and (5) remained in the model
(OR=13.2; 95%CI: 2.3-74.9 and OR=7,7; 95%CI:1.0-60.3).
Conclusion: There is evidence that in HIV positive MSM, a
complex interaction between certain sexual practices and associated
behaviour like consumption of cocaine are relevant risk
factors for HCV transmission. However, a history of major
surgery might be a non-sexual risk factor, and clinical studies
should be implemented to further focus on nosocomial risks.
More cases and controls are needed to fit adequate power.
C.11 (Vortrag)
Investigation of CD4+ T cell apoptosis rates in
HIV- and HIV/HCV-coinfected patients treated
with a highly active anti-retroviral therapy
(HAART)
Körner C. 1 , Schulte D. 1 , Nischalke H.-D. 1 , Nattermann J. 1 ,
Spengler U. 1 , Rockstroh J. 1
1 Universitätsklinikum Bonn, Medizinische Klinik 1, Bonn, Germany
Objective: Hepatis C virus-coinfection accelerates the progression
of HIV in infected patients. HIV-monoinfection has
been suggested to be associated with an increased apoptosis
rate. However it remained unclear how HCV-coinfection and
HAART affects parameters of apoptosis. Therefore, we studied
the level of apoptosis of CD4+ T cells in HIV-positive
subjects with HCV-coinfection.
Methods: For this study we selected HIV-monoinfected and
HIV/HCV-coinfected patients who were either treated with
HAART or not. Apoptosis rates of CD4+ T cells was performed
with isolated PBMCs by detection of apoptosis-specific
markers, such as DNA-fragmentation, expression of mitochondrial
membrane protein APO2.7 and cleavage of poly-
(ADP-ribose)-polymerase (PARP). Isolated PBMCs were also
used to study terminal deoxynucleotidyl-transferase dUTP
nick end labeling (TUNEL) in CD4+ T cells.
Results: We found that treatment-naiv HIV-infected patients
were associated with higher rates of apoptosis [n=4; 1.48%
(percentage of APO2.7-positive CD4+ T cells shown)] as
compared to healthy subjects (n=4; 0.65%). In HIV-monoinfection,
effective HAART was associated with a reduction of
CD4+ T cell apoptosis (n=8; 1.01%), although apoptosis rates
remained still higher than in healthy subjects. In contrast
apoptosis levels remained elevated in patients who did not respond
to HAART (n=4; 3.96%). Of note, CD4+ T lymphocytes
of HCV/HIV-coinfected patients receiving effective
HAART (n=3; 2.08%) displayed a markedly higher apoptosis
rate than the treated HIV-monoinfected patients.
Conclusions: Results suggest that loss of CD4+ T cells is associated
with increased apoptosis and effective HAART correlates
with CD4+ T cell recovery and reduced rates of CD4+
T cell apoptosis. Elevated rates of apoptosis in HIV/HCVcoinfected
patients despite effective HAART indicates increased
CD4+ T cell turnover in this special subgroup.
C.12 (Poster)
GBV-C coinfection in HIV-1 infected patients
influences phenotypic characteristics of
plasmacytoid dendritic cells
Bhatnagar N. 1 , Moenkemeyer M. 1 , Hong H. 1 ,
Schmidt R.E. 1 , Heiken H. 1
1 Medizinische Hochschule Hannover, Klinische Immunologie
K14, Hannover, Germany
Objective: Improved survival rate of HIV-1 patients co-infected
with the GB virus C (GBV-C, formerly known as hepatitis
G virus) has been shown previously. These patients
have lower viral load and higher CD4 counts. The mechanisms
underlying this favourable effect are still not understood.
Plasmacytoid dendritic cells (pDCs) are the main producers
of IFN-a and also stimulate T cells in response to viral
infection. Defective pDC number and function reported in
HIV-1 infection can be restored by antiretroviral therapy. We
investigated the role of pDCs in the beneficial effect of GBV-
C in HIV-1 infected patients.
Methods: Freshly isolated or CpG stimulated PBMCs were
analysed by multicolor flow cytometry. Frequency and phenotype
of pDCs were determined by gating on lin- CD123+
BDCA-4+ cells.
Results: Both the absolute numbers and percentage of pDCs
in the peripheral blood were comparable in GBV-C coinfected
and uninfected HIV-1 patients. However, the percentage of
pDCs expressing CD40 and CD83 was significantly higher in
GBV-C coinfected compared to uninfected HIV-1 patients:
8.2 ± 1.75% (n=7 GBV-C+) vs. 1.13% ± 0.256% (n=7 GBV-