Professor Caroline Sabin

Transcription

1 Professor Caroline Sabin in partnership with Royal Free & University College Medical School London, UK COMPETING INTEREST OF FINANCIAL VALUE > 1,000 Statement Over the past five years, Caroline Sabin has received payment for membership of Data Safety and Monitoring Committees or Advisory Boards from Janssen-Cilag, GSK, Gilead Sciences and AbbVie. She has also received funding for the development of educational materials for Gilead Sciences, Janssen and ViiV Healthcare, and for speaking at company-sponsored events for MSD and AbbVie. She has received a personal grant for attending a conference from Bristol-Myers Squibb. Date: December 2015

2 HIV/hepatitis infection in the UK: who, when and where Caroline Sabin, UCL for the UK CHIC Hepatitis Subgroup

3 Hepatitis testing: BHIVA guidelines Newly diagnosed HIV-positive individuals screened for HBsAg, anti-hbc, anti-hbs and anti-hcv Individuals not infected or immune should receive hepatitis B vaccination and response to vaccine tested Individuals not shown to be infected or immune should be screened annually thereafter More frequent testing for individuals with known risk factors for infection

4 Early data on hepatitis/hiv co-infection Basic information on hepatitis co-infection has been captured in UK CHIC for several years HCV testing increased from 9.2% in 1996 to 79.9% in 2007; prevalence of HCV was 4.1% 1 HBV testing increased from 33% in 1997 to 88% in ; prevalence of HBsAg was 6.9% BUT major limitations with the quantity and quality of dataset 1 Turner J et al. J Vir Hep 2010; 17: ; 2 Price H et al. PLoS One 2012; 7:e49314

5 UK CHIC: Objectives Initiated in 2001 to collate routinely collected data from HIV-positive persons attending some of the largest clinical centres in the UK since 1 st January 1996, with the aims of: Describing the characteristics of patients with HIV under care, Providing information on exposure to combination antiretroviral therapy (cart) and changes to the immunological and virological status of patients over time, and Monitoring the frequency of AIDS and survival over time Subsequently updated to reflect ongoing questions related to drug resistance, ageing, pregnancy, molecular epidemiology and hepatitis co-infection

6 UK CHIC: hepatitis co-infection sub-study Aim: to supplement data collection on persons co-infected with HIV and HBV and/or HCV in UK CHIC Objectives: To describe the testing patterns for hepatitis in UK CHIC participants, and the epidemiology of co-infection To describe the uptake and outcome of therapies for hepatitis To describe the long-term clinical outcomes of co-infection and the impact of co-infection on both HIV and hepatitis disease progression Team: Alicia Thornton, Ashley Moyes, Laura Phillips, Elisha Seah, Mark Nelson, Caroline Sabin Funding: BMS, Abbvie, BI, Gilead, MSD

7 Hepatitis data collection (11 clinics) Royal Free Hospital Mortimer Market Chelsea & Westminster Edinburgh Bristol St. Mary s Hospital Woolwich North Middlesex Middlesbrough Brighton Kings College Hospital

8 Changes in testing over time 82.2% ever tested for HBsAg 87.6% ever tested for anti-hcv

9 Changes in testing over time

10 Factors associated with testing Probability of being tested associated with: Younger age (HCV) MSM mode of HIV infection Advanced (CD4<200) or uncontrolled (detectable HIV RNA) infection Black (non-african) ethnicity (HCV)

11 Probability Probability Probability Probability of first HBsAg test a) Age < > b) Ethnicity White Black African c) HIV exposure group MSM IDU Male heterosexual Female heterosexual Other

12 Probability Porbability Probability Probability of first anti-hcv test 0.6 a) Age < b) Ethnicity White > Black African c) HIV exposure group MSM IDU Male heterosexual Female heterosexual Other

13 Cumulative prevalence of HBV 10% 8% 6% f) Total 4% 2% 0% Prevalence: 6.7% (95% CI 6.4%-7.0%)

14 Factors associated with HBV infection Older age IDU and MSM (vs. heterosexuals) Non-white ethnicity Earlier calendar year Advanced (CD4 count <200) or controlled (VL<50) HIV infection

15 HBV infection status over time 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Unknown Never exposed Vaccinated Resolved/isolated anti- HBc Infected

16 Cumulative prevalence of HCV 14% 12% 10% 8% 6% 4% 2% 0% f) Total Prevalence: 10.4% (95% CI 10.1%-10.8%)

17 Cumulative prevalence of HCV 100% c) Exposure group 80% 60% 40% 20% 0% MSM IDU Male Heterosexual Female Heterosexual Other/Unknown exposure

18 Factors associated with HCV infection IDU mode of infection (OR 55.2) Older age White ethnicity Heterosexual men (vs. MSM) Advanced HIV (CD4 count <200) status

19 Challenges for use of routine data Lack of data in clinic datasets, often a consequence of shared care between HIV and hepatology clinics Testing is still not universal, despite guidelines Trends in prevalence/incidence must be interpreted with caution Problems with ascertaining HBV status due to incomplete, missing or inconsistent HBV test results Difficulties in determining SVR after HCV treatment due to lack of HCV RNA results in dataset

20 Summary Overall testing for HBV and HCV has increased over time Evidence of a change over time in the groups of individuals most likely to be tested may introduce bias Higher prevalence of HCV than recently reported On-going incidence of both HBV and HCV Implications for prevention and clinical practice, particularly in terms of the likely need for new drugs in the coming years

21 Acknowledgements UCL: Alicia Thornton, Teresa Hill, Sophie Jose, Colette Smith, Caroline Sabin Chelsea and Westminster: Mark Nelson, Ashley Moyes, Laura Phillips, Elisha Seah UK CHIC steering committee hepatitis subgroup: Sanjay Bhagani, Andrew Burroughs, David Chadwick, David Dunn, Martin Fisher, Richard Gilson, Janice Main, Mark Nelson, Alison Rodger, Chris Taylor Participating UK CHIC centres: Brighton (M Fisher, E Youssef, Elton John Centre Staff); St Mary s (N Perry, G Cooke, J Main, S Reeves, Wharfside clinic staff) ; Chelsea and Westminster (M Nelson, C Fletcher, A Moyes, L Phillips, E Seah); Mortimer Market (R Gilson, P Muniina, N Brima); Kings (F Post, L Campbell, K Childs, C Taylor); Royal Free (A Rodger, S Bhagani, C Chaloner, K Singh); Edinburgh (C Leen, S Morris, A Wilson); North Middlesex (A Schwenk, A Waters, S Miller); Bristol (M Gompels, S Allen, H Wilson); Middlesbrough (D Chadwick, J Gibson); Woolwich (S Kegg, T Leitao) Funders: The UK CHIC study is funded by the MRC, UK (grants G and G ). Alicia Thornton has a UCL studentship funded by the MRC. Additional funding for hepatitis data collection was received from Bristol Myers Squibb, Abbott, Boehringer Ingelheim, Gilead Sciences and Merck, Sharp & Dohme

22 in partnership with