HIV/HCV CO-INFECTIONS AMONG PATIENTS AT RISK FOR SEXUALLY TRANSMITTED INFECTIONS (STI)

Nosotti L., Latini A., Giuliani M., Pimpinelli F., Battista M., Trincone S., Impara G., Sindico S., Morrone A., Palamara G.

7° Congresso Nazionale SIMIT
Bergamo, 19-22 Novembre 2008

Introduction
One third of the estimated 40 million people infected with HIV-1 worldwide, suffers from chronic hepatitis C virus (HCV) infection. In Italy hepatitis C virus infection affects more than half of HIV- 1 infected individuals, according to the high proportion of intravenous drug use (IDU) individuals who have been infected by parental route. Sexual transmission of HCV occurs but with low efficiency, but is observed in partners of HIV/HCV co-infected individuals.
Objectives: To assess prevalence and correlates of HCV infection among a clinical cohort of HIV-1 infected patients.
Materials and methods
From a clinical survey of HIV-1 positive individuals attending the HIV/AIDS Unit in Istituto S. Gallicano (IRCCS) in Rome, Italy, data on HCV prevalence and behavioural correlates have been extracted.
Results
From January 2006 to December 2007, 310 HIV-1 positive individuals were examined and screened for HCV infection. Two hundred eighteen (70,3%) were Italians and 92 (29,7%) foreigners. According to the risk groups, 82 (26,4%) HIV-1 individuals were non IDU heterosexuals, 203 (65,5%) homosexuals (MSM), 15 (4,9%) IDU and 10 (3,2%) were individuals with unknown risk. Patients with HIV/HCV co-infection were 22 (overall HCV prevalence 7,1%). Among Italian
patients the HCV prevalence was 7,8% (17/218), among the non-Italians 5,4% (5/92). Among HIV- 1 infected non-IDU heterosexuals HCV prevalence was 3/82 (3,7%), among MSM 5/203 (2,5%), and among IDU 14/15 (93’3%). Fifteen (83,3%) out of 18 eligible co-infected patients have been included in a treatment programme for HCV infection. Ten out of 15 HIV-1/HCV co-infected patients have been undergoing to treatment, and 5 have refused the therapy.
Conclusions
The low overall prevalence of HIV/HCV co-infection in our cohort is consistent with the high proportion of non/IDU individuals, particularly of MSM. Nevertheless, the prevalence of HCV infection by group of exposure confirms the role of parental route in the occurrence of infection, but also suggest that sexual exposure can play a role in the HCV acquisition among MSM and promiscuous non-IDU heterosexuals. High rate of eligibility to treatment and low rate of drop-out, in the management of HIV-1/HCV co-infected patients, can be reached using a multidisciplinary clinical approach.