HIV/Hepatitis co-infection situation in Romania. Oana Săndulescu, MD, PhD

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1 HIV/Hepatitis co-infection situation in Oana Săndulescu, MD, PhD Carol Davila University of Medicine and Pharmacy National Institute of Infectious Diseases Prof. Dr. Matei Balș Bucharest,

2 Disclosures Carol Davila University of Medicine and Pharmacy, Bucharest, National Institute for Infectious Diseases Prof. Dr. Matei Balș, No relevant conflicts of interest to declare in relation to this presentation

3 1 Calculated based on: Data current through 30 Jun 2017; 2 Constantinescu I, et al, Hepat Mon. 2014;14(10): e22072; 3 n National Institute for Public Health RO project; 5 Juganariu G et al, Rev Med Chir Soc Med Nat Iasi. 2014;118(2):339-45; 6 Ruță SM et al, MedGenMed. 2005; 7(1): 68. 3rd Central and Eastern European Meeting on 20 million people Prevalence Annual Incidence HIV % 0.002% Comments 725 new cases per year on average during : (538 cases/year) (850 cases/year) HBV 5.6% % 3 National vaccination: 21-fold decrease in incidence vs HCV 1.9% % 3 - Co-infected HIV/HBV 19.9% 5 0.3% % in the n cohort 6 Co-infected HIV/HCV 1.8% 6 0.2% % of IDUs

4 Prevalence of Different Subtype/Genotype in Country HIV Subtype Distribution: HCV Genotype Distribution: Historically: F1 = 95% New cases: F1 = 77% 1, B = 6.3% 2, C and A = 16.7% CRF14_BG = 20.3% in IDUs 3 Overall: 4 GT 1= 98% (1b = 92.6%, 1a = 5.4%), 4a = 1.2%, 3a = 0.8% IDUs: 5 1b = 45.2%, 1a = 24%, 3a = 14.4%, 4 = 7.7% 1 Stanojevic M et al, AIDS Rev. 2012;14(1): Paraschiv S et al, Infect Genet Evol. 2012;12(5): Niculescu I, et al. AIDS Res Hum Retroviruses. 2015; 31(5): Sultana C et al, J Gastrointestin Liver Dis. 2011;20(3): Ruță S, et al. J Infect Dev Ctries May 31;10(5):523-7

5 Main Risk factors for Transmission Historically: Epidemiologic accident = 68.9%, HIV 1 Unknown = 17.4%, IDU = 0.1%, Hetero = 0.1% New cases: Hetero = 64.5%, IDU = 15.5%, MSM = 18%, MTCT = 0.7% HBV 2 Hetero = 20.8%, Parenteral = 12.8% HCV Parenteral = 50% 2, IDU = 7.1% 3 1 Calculated based on: Data current through 30 Jun n National Institute for Public Health Sultana C et al, J Gastrointestin Liver Dis. 2011;20(3):261-6

6 Main Risk factors for Transmission Historically: Epidemiologic accident = 68.9%, HIV 1 Unknown = 17.4%, IDU = 0.1%, Hetero = 0.1% New cases: Hetero = 64.5%, IDU = 15.5%, MSM = 18%, MTCT = 0.7% HBV 2 Hetero = 20.8%, Parenteral = 12.8% HCV Parenteral = 50% 2, IDU = 7.1% 3 1 Calculated based on: Data current through 30 Jun n National Institute for Public Health Sultana C et al, J Gastrointestin Liver Dis. 2011;20(3):261-6

7 Antiviral Treatment Currently Available HIV HBV Treatment regimens: 59% 2 NRTIs + 1 PI 19% 2 NRTIs + 1 NNRTI 12% II-containing regimens pegifn, entecavir, tenofovir TDF, adefovir HCV DAAs reimbursed for: CP-A F4, all F3, some F2 cases: ombitasvir/paritaprevir/r+dasabuvir CP-B&C F4: sofosbuvir/ledipasvir Elbasvir-grazoprevir approved but not yet reimbursed

8 Patients on HAART patient suppressed (<50) Number Dying of AIDS HIV 87.2% 1 57% 192 patients/year on average during Calculated based on: Data current through 30 Jun 2017

9 Patients on Therapy Of Those Treated Patients Suppressed HBV 33.7% 1 Viral suppresion is required for treatment continuation Number Dying of Cirrhosis/ Hepatoma * * Data not available 1 Aramă V, et al, Antivir Ther. 2014;19(3):

10 Patients Received Therapy Of Those Treated Patients Cured Number Dying of Cirrhosis/ Hepatoma HCV 13.4% %2-64.9% 3 with peg/rbv 97% with DAA 4 * * Data not available. 1 Liakina V et al, J Viral Hep. 2015;22(S3):4-20, Gheorghe L, et al, J Gastrointestin Liver Dis 2010;19:161-7, Gheorghe LM, et al, J Contemp Clin Pract. 2016;2(2): Gheorghe L, et al, Germs 2015;5: Săndulescu O, et al, BMC Infect Dis 2016;16(S):A40.

11 HIV/Hepatitis co-infection situation in Oana Săndulescu, MD, PhD Carol Davila University of Medicine and Pharmacy National Institute of Infectious Diseases Prof. Dr. Matei Balș Bucharest,