Hepatitis B and C virus Coinfection in the TREAT Asia HIV Observational Database

1
Hepatitis B and C virus Coinfection in the TREAT
Asia HIV Observational Database
Zhou J1, Zhang FJ2, Lim PL3, Dore GJ1, Chen
YMA4on behalf of The TREAT Asia HIV
Observational Database
1. National Centre in HIV Epidemiology and
Clinical Research The University of New
South Wales, Sydney, Australia 2. Ditan Hospital,
Beijing, China 3. Tan Tock Seng Hospital,
Singapore 4. AIDS Prevention and Research Centre
and Institute of Public Health National
Yang-Ming University, Taipei, Taiwan
2
Background

• Funded by amfAR
• A cooperative network of clinicians throughout
  the Asia-Pacific that aims to expand capacity
  for the broader introduction of HIV/AIDS
  treatments in the region

• First collaborative study by the TREAT Asia
  network
• A multi-centre, observational cohort of patients
  with HIV

3
Existing TAHOD sites
New TAHOD sites
Potential TAHOD sites
15 TAHOD sites at June 2006
4
Introduction

• WHO and UNAIDS estimate, worldwide
• 40 million living with HIV (2005)
• 370 million with chronic HBV infection
• 130 million with chronic HCV infection
• HAART leads to marked reduction of mortality and
  morbidity in patients with HIV
• HIV patients coinfected HBV and/or HCV
• Impact of coinfection on HIV disease progression
  and survival remains uncertain
• Much poorer liver disease outcome

5
Objective

• Prevalence of HBV and HCV coinfection in TAHOD
• Response to antiretroviral treatment
• CD4 count at 180 days after treatment initiation
• Time to undetectable HIV viral load (lt400
  copies/mL)
• Time to elevated liver enzyme (ALT)
• Overall survival after entry to TAHOD

6
Methods

• Definition of coinfection
• HBV coinfection HBsAg positive
• HCV coinfection anti-HCV antibody positive
• Patients who ever tested positive for HBV or HCV
  were regarded as coinfected for the duration
  of the study
• Statistical analyses
• Mean CD4 change from starting treatment
  multiple linear regression models
• Time to undetectable HIV RNA, time to elevated
  ALT from starting treatment and survival from
  TAHOD entry Cox proportional hazards models

7
Testing for hepatitis coinfection

• Testing for coinfection varies across TAHOD
  sites
• lt10 gt90
• Patients more likely to have an HBsAg test
• Higher baseline CD4 count
• Lower baseline HIV viral load
• Patients more likely to have an HCV test
• Reporting injecting drug use
• Higher baseline CD4 count
• Patients tested for EITHER HBsAg OR HCV
  antibody were included in the following
  analysis

8
Hepatitis coinfection in TAHOD

• 2979 patients in TAHOD as at September 2005
• HBsAg positive 171 / 1641 (10.4)
• - Older age and reporting homosexual contact
• HCV antibody positive 153 / 1469 (10.4)
• - Reporting injecting drug use and blood products
• Initial antiretroviral treatment combination
• Stavudine lamivudine nevirapine
• Zidovudine lamivudine efavirenz
• - Regardless of hepatitis status

9
Mean CD4 change at 180 days after treatment
initiation
10
Time to undetectable HIV viral load
11
Survival after entry to TAHOD
12
Time to elevated abnormal liver function test
13
Conclusion

• Prevalence of hepatitis coinfection in TAHOD
  10
• Responses of antiretroviral treatment
• Mean CD4 recovery
• - Similar in HBV coinfected patients
• - Poorer in HCV coinfected patients (albeit not
  statistically significant)
• Time to undetectable HIV viral load
• - Similar in HCV and/or HBV coinfected patients
• No independent effect of coinfection on survival
• IDU and hepatitis testing
• Hepatitis coinfection associated with more
  hepatotoxicity

14
Discussion

• Limitations
• Hepatitis and liver enzyme tests limited in
  TAHOD patients
• Limited power due to short follow up
• Interpretation
• Coinfected patients do benefit from
  antiretroviral treatment
• Some evidence of increased hepatotoxicity
• Need to monitor liver function and other adverse
  events

15
The TREAT Asia HIV Observational Database
CV Mean, V Saphonn, National Center for
HIV/AIDS, Dermatology STDs, Phnom Penh,
Cambodia F Zhang, H Zhao and N Han, Beijing
Ditan Hospital, Beijing, China P Li and MP Lee,
Queen Elizabeth Hospital, Hong Kong, China N
Kumarasamy and JA Cecelia, YRG Centre for AIDS
Research and Education, Chennai, India S
Pujari and K Joshi, HIV Project, Ruby Hall
Clinic, Pune, India TP Merati and F Yuliana,
Faculty of Medicine Udayana University Sanglah
Hospital, Bali, Indonesia S Oka and M Honda,
International Medical Centre of Japan, Tokyo,
Japan C KC Lee and J Pang, Hospital Kuala
Lumpur, Kuala Lumpur, Malaysia A Kamarulzaman
and C Sim, University of Malaya, Kuala Lumpur,
Malaysia R Ditangco and R Capistrano, Research
Institute for Tropical Medicine, Manila,
Philippine YMA Chen, WW Wong and YR Chang,
Taipei Veterans General Hospital and AIDS
Prevention and Research Centre, National
Yang-Ming University, Taipei, Taiwan PL Lim, CC
Lee and LC Koh, Tan Tock Seng Hospital,
Singapore P Phanuphak, and M Khongphattanayothin
g, HIV-NAT/The Thai Red Cross AIDS Research
Centre, Bangkok, Thailand A Vibhagool, S
Kiertiburanakul, and B Piyavong, Ramathibodi
Hospital, Bangkok, Thailand T Sirianthana and W
Kotarat, Research Institute for Health Sciences,
Chiangmai, Thailand J Chuah, Gold Coast Sexual
Health Clinic, Miami, Queensland, Australia K
Frost and S Wong, American Foundation for AIDS
Research, New York, USA DA Cooper, MG Law, K
Petoumenos and J Zhou, National Centre in HIV
Epidemiology and Clinical Research, The
University of New South Wales, Sydney, Australia.
Steering Committee member. Current Steering
Committee chair.
The National Centre in HIV Epidemiology and
Clinical Research is funded by the Australian
Government Department of Health and Ageing, and
is affiliated with the Faculty of Medicine, The
University of New South Wales.
TREAT Asia and TAHOD are funded by a grant from
the American Foundation for AIDS Research.
16
Exposure category Mar. 2006
17
Ethnicity Mar. 2006
18
Patient follow up (Mar. 05 Mar. 06)
Follow up rate 82

• Patient with follow up is defined as seen in the
  last 12 months (between 30 September 2005 to
  30 September 2006)
• Patients died were considered as complete follow
  up
• Follow up rate (BCE) / (BCDEF) 100

19
Follow up by site (Mar. 05 Mar. 06)
20
Patient demographics Mar. 2006
21
Publications from TAHOD

• The TREAT Asia HIV Observational Database
  Baseline and Retrospective Data. J Acquir
  Immune Defic Syndr 200538(2)174-179.
• Predicting short-term disease progression among
  HIV-infected patients in Asia and the Pacific
  region preliminary results from the TREAT Asia
  HIV Observational Database. HIV Med
  20052005(6)1-8.
• Experience with the use of a first-line regimen
  of stavudine, lamivudine and nevirapine among
  TAHOD patients, HIV Medicine, in press.
• Highly active antiretroviral treatment
  containing efavirenz or nevirapine and related
  toxicity in the TREAT Asia HIV Observational
  Database, JAIDS, in press.
• AIDS defining illness diagnosed within 90 days
  after starting HAART among TAHOD patients,
  submitted to Intl J STD AIDS, under review.

NEW
NEW
NEW