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Rupasinghe D, Choi JY, Kumarasamy N, Pujari S, Ly PS, Merati TP, Lee MP, Van Nguyen K, Kiertiburanakul S, Do CD, Avihingsanon A, Ross J, Jiamsakul A. Viral hepatitis and the cascade of care among people living with HIV in the Asia-Pacific. HIV Med 2022; 23:959-968. [PMID: 35218151 PMCID: PMC9402797 DOI: 10.1111/hiv.13280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 02/03/2022] [Accepted: 02/10/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although the prevalence and mortality of hepatitis is high in the Asia-Pacific region, few studies are available on the diagnosis, treatment, and cure rates for viral hepatitis among people living with HIV in this area. This study aims to report the cascade of care (CoC) for hepatitis B (HBV) and C (HCV) among people living with HIV receiving combined antiretroviral therapy (ART). METHODS Patients enrolled in the TREAT Asia HIV Observational Database Low Intensity Transfer (TAHOD-LITE) cohort, on ART, and with follow-up data from 2010 to 2019 were included. Patients were determined as positive for HCV or HBV co-infection if they ever tested positive for HCV antibody (anti-HCV) or HBV surface antigen (HBsAg), respectively. RESULTS In total, 39% (8612/22 340) of the adult HIV cohort had undergone HBsAg testing, with 8% (672/8612) testing positive. HBV CoC demonstrated that 71% (474/672) of those with HBsAg positive results initiated treatment, 67% (318/474) of those on treatment had HBV DNA testing to evaluate treatment progression, and 18% (58/318) of those tested reached viral suppression. Of the cohort, 37% (8231/22 340) had anti-HCV testing, of whom 10% (779/8231) tested positive. The HCV CoC showed that 68% (526/779) of those with positive anti-HCV tests had HCV RNA tests, of whom 51% (267/526) had detectable HCV RNA. Among those with detectable HCV RNA, 65% (174/267) initiated HCV treatment. Of the 40% (69/174) who initiated HCV treatment, 90% (62/69) reached sustained virological response. CONCLUSION Our findings identified less frequent testing in the healthcare system and limited access to treatment as gaps in the CoC for viral hepatitis. More routine HCV RNA and HBV DNA testing is required for patients with positive screening tests to identify those in need of treatment.
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Affiliation(s)
| | - Jun Yong Choi
- Division of Infectious Diseases, Department of Internal
Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | | | | | - Penh Sun Ly
- National Center for HIV/AIDS, Dermatology & STDs, Phnom
Penh, Cambodia
| | | | | | | | | | | | - Anchalee Avihingsanon
- HIV-NAT/ Thai Red Cross AIDS Research Centre and
Tuberculosis research unit, Faculty of Medicine, Chulalongkorn University, Bangkok,
Thailand
| | - Jeremy Ross
- TREAT Asia, amfAR - The Foundation for AIDS Research,
Bangkok, Thailand
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Ramírez Mena A, Tine JM, Fortes L, Ndiaye O, Ka D, Ngom NF, Ramette A, Bittel P, Seydi M, Wandeler G. Hepatitis B screening practices and viral control among persons living with HIV in urban Senegal. J Viral Hepat 2022; 29:60-68. [PMID: 34610183 PMCID: PMC9293347 DOI: 10.1111/jvh.13615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 09/03/2021] [Accepted: 09/03/2021] [Indexed: 01/15/2023]
Abstract
Chronic hepatitis B virus (HBV) infection affects >10% of the general population and is the leading cause of liver cirrhosis and cancer in West Africa. Despite current recommendations, HBV is often not tested for in clinical routine in the region. We included all people living with HIV (PLWH) in care between March and July 2019 at Fann University Hospital in Dakar (Senegal) and proposed hepatitis B surface antigen (HBsAg) test to those never tested. All HBsAg-positive underwent HIV and HBV viral load (VL) and liver stiffness measurement. We evaluated, using logistic regression, potential associations between patient characteristics and (a) HBV testing uptake; (b) HIV/HBV co-infection among individual HBsAg tested. We determined the proportion of co-infected who had HBV DNA >20 IU/ml on ART and sequenced HBV polymerase in those with HBV replication.of 1076 PLWH in care, 689 (64.0%) had never had an HBsAg test prior to our HBV testing intervention. Women and individuals >40 years old were less likely to have been previously tested. After HBV testing intervention,107/884 (12.1%) PLWH were HBsAg-positive. Seven of 58 (12.1%) individuals newly diagnosed with HIV/HBV co-infection had a detectable HBV VL, of whom five were HIV-suppressed. Two patients on ART including 3TC and AZT as backbone showed the presence of the triple resistance mutation 180M/204I/80V. In this Senegalese urban HIV clinic, the majority of patients on ART had never been tested for HBV infection. One in ten co-infected individuals had a detectable HBV VL despite HIV suppression, and 8% were not receiving a TDF-containing regimen.
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Affiliation(s)
- Adrià Ramírez Mena
- Department of Infectious DiseasesBern University HospitalUniversity of BernBernSwitzerland,Department of Infectious and Tropical DiseasesFann University HospitalDakarSenegal,Graduate School for Health SciencesUniversity of BernSwitzerland
| | - Judicaël M. Tine
- Department of Infectious and Tropical DiseasesFann University HospitalDakarSenegal
| | - Louise Fortes
- Department of Infectious and Tropical DiseasesFann University HospitalDakarSenegal
| | - Ousseynou Ndiaye
- Department of Infectious and Tropical DiseasesFann University HospitalDakarSenegal
| | - Daye Ka
- Department of Infectious and Tropical DiseasesFann University HospitalDakarSenegal
| | - Ndeye Fatou Ngom
- Department of Infectious and Tropical DiseasesFann University HospitalDakarSenegal
| | - Alban Ramette
- Institute of Infectious DiseasesUniversity of BernBernSwitzerland
| | - Pascal Bittel
- Institute of Infectious DiseasesUniversity of BernBernSwitzerland
| | - Moussa Seydi
- Department of Infectious and Tropical DiseasesFann University HospitalDakarSenegal
| | - Gilles Wandeler
- Department of Infectious DiseasesBern University HospitalUniversity of BernBernSwitzerland,Department of Infectious and Tropical DiseasesFann University HospitalDakarSenegal,Institute of Social and Preventive MedicineUniversity of BernSwitzerland
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Reeves I, Cromarty B, Deayton J, Dhairyawan R, Kidd M, Taylor C, Thornhill J, Tickell-Painter M, van Halsema C. British HIV Association guidelines for the management of HIV-2 2021. HIV Med 2021; 22 Suppl 4:1-29. [PMID: 34927347 DOI: 10.1111/hiv.13204] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Iain Reeves
- Consultant in HIV Medicine, Homerton University Hospital NHS Trust, London, UK
| | | | - Jane Deayton
- Clinical Senior Lecturer in HIV, Barts and the London, Queen Mary University of London, London, UK
| | - Rageshri Dhairyawan
- Consultant in Sexual Health and HIV Medicine, Barts Health NHS Trust, London, UK
| | - Mike Kidd
- Consultant Virologist, National Infection Service, Public Health England, UK
| | - Chris Taylor
- Consultant Physician Sexual Health and HIV, Kings College Hospital, London, UK
| | - John Thornhill
- Consultant in Sexual Health and HIV Medicine, Barts Health NHS Trust, London, UK
| | - Maya Tickell-Painter
- Specialist Registrar in Infectious Diseases and Microbiology, Manchester University NHS Foundation Trust, Manchester, UK
| | - Clare van Halsema
- Consultant in Infectious Diseases, North Manchester General Hospital, Manchester, UK
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Jepkemei KB, Ochwoto M, Swidinsky K, Day J, Gebrebrhan H, McKinnon LR, Andonov A, Oyugi J, Kimani J, Gachara G, Songok EM, Osiowy C. Characterization of occult hepatitis B in high-risk populations in Kenya. PLoS One 2020; 15:e0233727. [PMID: 32463824 PMCID: PMC7255601 DOI: 10.1371/journal.pone.0233727] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 05/11/2020] [Indexed: 12/18/2022] Open
Abstract
Occult hepatitis B infection (OBI) is defined as the presence of hepatitis B virus (HBV) DNA in the liver or serum in the absence of detectable HBV surface antigen (HBsAg). OBI poses a risk for the development of cirrhosis and hepatocellular carcinoma. The prevalence of OBI in Kenya is unknown, thus a study was undertaken to determine the prevalence and molecular characterization of OBI in Kenyan populations at high risk of HBV infection. Sera from two Nairobi cohorts, 99 male sex workers, primarily having sex with men (MSM-SW), and 13 non-MSM men having HIV-positive partners, as well as 65 HBsAg-negative patients presenting with jaundice at Kenyan medical facilities, were tested for HBV serological markers, including HBV DNA by real-time PCR. Positive DNA samples were sequenced and MSM-SW patients were further tested for hepatitis C virus (HCV) infection. Of the 166 HBsAg-negative samples tested, 31 (18.7%; 95% confidence interval [CI] 13.5–25.3) were HBV DNA positive (i.e., occult), the majority (20/31; 64.5%) of which were HBV core protein antibody positive. HCV infection was not observed in the MSM-SW participants, although the prevalence of HBsAg positivity was 10.1% (10/99; 95% CI 5.6–17.6). HBV genotype A was predominant among study cases, including both HBsAg-positive and OBI participants, although the data suggests a non-African network transmission source among MSM-SW. The high prevalence of HBV infection among MSM-SW in Kenya suggests that screening programmes be instituted among high-risk cohorts to facilitate preventative measures, such as vaccination, and establish entry to treatment and linkage to care.
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Affiliation(s)
| | | | - Ken Swidinsky
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Jacqueline Day
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Henok Gebrebrhan
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lyle R. McKinnon
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| | - Anton Andonov
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Julius Oyugi
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | - Joshua Kimani
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | - George Gachara
- Department of Medical Laboratory Sciences, Kenyatta University, Nairobi, Kenya
| | - Elijah Maritim Songok
- Kenya Medical Research Institute, Nairobi, Kenya
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Carla Osiowy
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada
- * E-mail:
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