Viral hepatitis and the cascade of care among people living with HIV in the Asia‐Pacific

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 (...

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Published inHIV medicine Vol. 23; no. 9; pp. 959 - 968
Main Authors Rupasinghe, Dhanushi, Choi, Jun Yong, Kumarasamy, Nagalingeswaran, Pujari, Sanjay, Sun, Ly Penh, Merati, Tuti Parwati, Lee, Man Po, Kinh, Nguyen Van, Kiertiburanakul, Sasisopin, Do, Cuong Duy, Avihingsanon, Anchalee, Ross, Jeremy, Jiamsakul, Awachana
Format Journal Article
LanguageEnglish
Published England Wiley Subscription Services, Inc 01.10.2022
Subjects
Antibodies
Antigens
Antiretroviral agents
Antiretroviral therapy
Asia‐Pacific
cascade of care
Deoxyribonucleic acid
DNA
DNA testing
HBV
HCV
Hepatitis
Hepatitis B
Hepatitis B surface antigen
Hepatitis C
HIV
Human immunodeficiency virus
Patients
PLHIV
Public health
Ribonucleic acid
RNA
viral hepatitis
Asia
Asia-Pacific
viral hepatitis
HCV
PLHIV
HBV
cascade of care
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Summary: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.
Bibliography:Funding information
This study was supported by the TREAT Asia HIV Observational Database Low‐Intensity Transfer study which is an initiative of TREAT Asia, a program of amfAR, The Foundation for AIDS Research, with support from the US National Institutes of Health's National Institute of Allergy and Infectious Diseases, the
National Institute of Child Health and Human Development, the National Cancer Institute, the National Institute of Mental Health, the National Institute on Drug Abuse, the National Heart, Lung, and Blood Institute, the National Institute on Alcohol Abuse and Alcoholism, the National Institute of Diabetes and Digestive and Kidney Diseases, and the Fogarty International Center, as part of the International Epidemiology Databases to Evaluate AIDS (IeDEA; U01AI069907). The Kirby Institute is funded by the Australian Government Department of Health and Ageing and is affiliated with the Faculty of Medicine, UNSW Sydney, Australia. The content of this publication is solely the responsibility of the authors and does not necessarily represent the official views of any of the governments or institutions mentioned. Data are not publicly available because of the conditions of the ethics agreements.
Eunice Kennedy Shriver
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Author Contributions
DR conducted data analysis and prepared the manuscript. JYC and AJ provided guidance on analysis and critically reviewed the study and its content. All authors reviewed the results and manuscript, provided clinical expertise, and approved the final version of the paper.
ISSN:1464-2662
1468-1293
DOI:10.1111/hiv.13280