9TH EUROPEAN AIDS CONFERENCE (EACS)
1st EACS RESISTANCE & PHARMACOLOGY WORKSHOP

 October 25 - 29, 2003 Warsaw, Poland

13.2 Other Hepatitis

 13.2/20 - HAART NON-ADHERENCE AND HCV/HIV CO-INFECTION
* Ammassari A.1, Trotta M.P.2, Cozzi-Lepri A.3, De Luca A.1, Melzi S.4, Zaccarelli M.2, Castelli F.5, Narciso P.2, Soscia F.6, Murri R.1, Scasso A.7, Izzo C.M.8, Baldelli F.9, d'Arminio Monforte A.4, Antinori A.2, for the AdICoNA Study Group
 
(1) Istituto di Clinica delle Malattie Infettive, Università Cattolica del Sacro Cuore, Roma, Italy,2 Istituto Nazionale delle Malattie Infettive, Lazzaro Spallanzani IRCCS, Roma, Italy,3 Royal Free and University College Medical School, London, UK,4 Istituto di Malattie Infettive e Tropicali, Università di Milano, Milano, Italy,5 Istituto di Malattie Infettive e Tropicali, Università di Brescia, Brescia, Italy,6 Divisione di Malattie Infettive, Ospedale S. Maria Goretti, Latina, Italy,7 Divisione di Malattie Infettive, Ospedale Campo di Marte, Lucca, Italy,8 Div. di Malattie Infettive, Ospedale Cotugno, Napoli, Italy,9 Clinica di Malattie Infettive, Universita di Perugia, Perugia, Italy
 

Background: HCV infection is associated with increased hepatotoxicity, poorer immunorecovery and increased risk of progression in HAART-treated persons.

Objectives: Investigate whether worse HAART adherence could explain the lower effectiveness of antiretroviral therapy in co-infected patients.

Methods: Participants in the AdICoNA study receiving PI-/NNRTI-based HAART for >1 month and with known serology for HCV were enrolled. Self-reported non-adherence: to have missed at least one dose in the last week or to have experienced an interruption in drug supply. A checklist of 24 symptoms was also included in the questionnaire.

Results: 310 patients included: median age 35 y, 73% male, 35% IDU, 13% reported alcohol abuse. HAART prescribed at the questionnaire included PIs in 72%. Positivity of HCV was found in 126 (39%) pts: 75 had ALT>50 UI/l. Non-adherence was reported by 98 (32%) pts: 44% chronic HCV+ with elevated ALT, 41% HCV+ with normal ALT, and 24% HCV- (P=0.002). In a multivariate model, only chronic HCV+ pts with ALT >50 UI/l showed an increased risk of non-adherence (OR 3.80; 95%CI 1.03-14.03 vs HCV-) after adjustment for several variables. Further, non-adherence was independently associated with reporting diarrhoea (OR 3.77; 1.30-10.90) and sexual dysfunction (OR 4.23; 1.02-17.51).

Conclusion: HIV+ pts with chronic HCV infection and abnormal ALT reported poorer HAART adherence compared to those HCV+ with normal ALT or not co-infected. This effect was independent from active IDU and might be due to a lower HAART tolerability. Adherence measurement should be included as cofactor in longitudinal investigations of clinical progression in HIV+/HCV+ co-infection.

Presenting Author: MD Adriana Ammassari, Catholic University, l.go A. Gemelli, 00168, Rome, Italy, Phone: +39 06 30155527

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