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TREAT Asia cohort studies: Asia-Pacific region of the IeDEA collaboration

TREAT Asia cohort studies: Asia-Pacific region of the IeDEA collaboration. Matthew Law Kirby Institute, UNSW Australia. TREAT Asia cohort studies. TREAT Asia and IeDEA TREAT Asia HIV Observational Database (TAHOD) TREAT Asia Studies Evaluating Resistance (TASER)

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TREAT Asia cohort studies: Asia-Pacific region of the IeDEA collaboration

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  1. TREAT Asia cohort studies:Asia-Pacific region of the IeDEA collaboration Matthew Law Kirby Institute, UNSW Australia

  2. TREAT Asia cohort studies TREAT Asia and IeDEA TREAT Asia HIV Observational Database (TAHOD) TREAT Asia Studies Evaluating Resistance (TASER) TREAT Asia Paediatric HIV Observational Database (TApHOD) TAHOD Low Intensity Transfer (TAHOD LITE) Conclusions

  3. TREAT Asia cohort studies TREAT Asia and IeDEA TREAT Asia HIV Observational Database (TAHOD) TREAT Asia Studies Evaluating Resistance (TASER) TREAT Asia Paediatric HIV Observational Database (TApHOD) TAHOD Low Intensity Transfer (TAHOD LITE) Conclusions

  4. TREAT Asia Therapeutics Research, Education and AIDS Training in Asia Supported by the Foundation for AIDS Research Network of clinicians at sites around the Asia-Pacific region TREAT Asia office in Bangkok Biostatisticalcentre at Kirby Institute, UNSW, Sydney, Australia

  5. Pediatric sites (16) Adult sites (21) TREAT Asia network

  6. 2nd TREAT Asia Network Annual Meeting 12-14 September 2002 Bangkok

  7. Region 1: • North America • Canada • United States • Region 5: • Asia and Australia • Australia • Cambodia • China • Hong Kong • India • Indonesia • Japan • Malaysia • Philippines • Singapore • South Korea • Taiwan • Thailand • Vietnam • Region 2: • Caribbean, Central • and South America • Argentina • Brazil • Chile • Haiti • Honduras • Mexico • Peru • Region 11: • Southern Africa • Botswana • Lesotho • Malawi • Mozambique • South Africa • Zambia • Zimbabwe • Region 9: • Central Africa • Burundi • Cameroon • Rwanda • Region 8: • West Africa • Benin • Burkina Faso • Côte d’Ivoire • Gambia • Ghana • Guinea-Bissau • Mali • Nigeria • Senegal • Togo • Region 10: • East Africa • Kenya • Tanzania • Uganda

  8. TREAT Asia cohort studies TREAT Asia and IeDEA TREAT Asia HIV Observational Database (TAHOD) TREAT Asia Studies Evaluating Resistance (TASER) TREAT Asia Paediatric HIV Observational Database (TApHOD) TAHOD Low Intensity Transfer (TAHOD LITE) Conclusions

  9. TAHOD/TASER TAHOD recruits a subset of patients at sites Designed to assess treatment outcomes and risk factors From 2003, all data entirely observational 6468 patients recruited, 4496 in active follow-up TASER recruited patients starting first or second ART Designed to assess resistance patterns Mandated viral load assessment annually – resistance testing in those failing 2025 patients recruited 1253 in active follow-up

  10. TAHOD/TASER Combined TAHOD/TASER dataset 8493 patients recruited, 5749 in active follow-up quite detailed data, good follow-up good resource for treatment outcomes and risk factors Not a surveillance mechanism subsample of patients seen at sites relatively small patient numbers

  11. CD4% and absolute CD4 counts in Asia Absolute CD4 counts lower in Asian populations for a given CD4% Uncertain significance Achhra AC, et al. JAIDS & CR 2010;1:1-4.

  12. Risk of AIDS or death by CD4 count strata CD4 count thresholds appear similar Achhra AC, et al. JIAPAC 2011;10(3):160-70.

  13. Survival by PCP prophylaxis and CD4 count • 67% of patients with CD4<200 receiving PCP prophylaxis Lim PL et al. JIAS 2012;15:1

  14. Factors associated with virologic failure Phanuphak P, et al. JAIDS 2014;66:74-9.

  15. Percentage NNRTI NRTI Recent infection Chronic infection Resistance patterns More resistance in recently infected than chronic: 6.1% vs 4.0% (p=0.065) Kiertiburanakul S, et al. PLoS One 2013;8(6):e62057.

  16. Factors associated with suboptimal adherence More frequent adherence assessment associated with improved adherence Jiamsakul A, et al. JIAS 2014;17(1):18911.

  17. Trends in CD4 count at ART initiation Kiertiburanakul S, et al. JIAS 2014;17:18804.

  18. Time trends in ART at initiation Boettiger D, et al. PloS One2014 in press.

  19. TREAT Asia cohort studies TREAT Asia and IeDEA TREAT Asia HIV Observational Database (TAHOD) TREAT Asia Studies Evaluating Resistance (TASER) TREAT Asia Paediatric HIV Observational Database (TApHOD) TAHOD Low Intensity Transfer (TAHOD LITE) Conclusions

  20. TApHOD recruits all children seen at sites More representative than TAHOD Commenced 2008 5227 children recruited, 3504 in active follow-up TApHOD

  21. Time to CD4≥25% after cART initiation Handsudewechakul, R et al. JAIDS 2010;55(4):503-9.

  22. Weight and height for age scores from cART Handsudewechakul, R et al. JAIDS 2010;55(4):503-9.

  23. Severe anaemia in first 6 months of HAART • Ever received AZT > 3-fold risk of severe anaemia (Hb<7.5 g/dL) Bunupuradah, T et al. Int J Infect Dis 2013;17:e806-e810.

  24. Weight for age predicts survival • After adjustment for time updated CD4% Kariminia A et al. JAIDS2014 in press.

  25. Rates of all OIs in TApHOD Mono/duo HAART Prasitsuebsai W et al. PIDJ2014;33:747-52.

  26. TREAT Asia cohort studies TREAT Asia and IeDEA TREAT Asia HIV Observational Database (TAHOD) TREAT Asia Studies Evaluating Resistance (TASER) TREAT Asia Paediatric HIV Observational Database (TApHOD) TAHOD Low Intensity Transfer (TAHOD LITE) Conclusions

  27. Aim is to create a larger, but simpler, database Include all patients seen at sites Data to be included Demographics ART, CD4, HIV viral load Lost to follow-up, transferred clinics, survival Eight sites currently will participate Anticipate ~50,000 patients who have started ART Data management and analysis at the Kirby Institute TAHOD LITE

  28. Creates something close to a surveillance mechanism More representative sampling frame Much bigger patient numbers Can answer more reliably questions like Trends in ART at initiation Trends in CD4 at initiation Rates of lost to follow-up TAHOD LITE

  29. TREAT Asia cohort studies TREAT Asia and IeDEA TREAT Asia HIV Observational Database (TAHOD) TREAT Asia Studies Evaluating Resistance (TASER) TREAT Asia Paediatric HIV Observational Database (TApHOD) TAHOD Low Intensity Transfer (TAHOD LITE) Conclusions

  30. Conclusions Are databases like TAHOD still relevant and useful? What are treatment outcomes as HIV-positive children age through adolescence and into adulthood? What are long-term ART outcomes in Asia? are rates of CVD, cancer, liver and kidney disease similar to those seen in developed countries? Will earlier and wider treatment across the region effect outcomes negatively? poor adherence? Viral failure and resistance?

  31. Conclusions TREAT Asia studies are region wide resource We have a dataset that might answer your questions TAHOD/TASER Long–term treatment outcomes in adults TApHOD Treatment use and outcomes in children TAHOD LITE Time trends and treatment guidelines

  32. Plug A Decade of Combination Antiretroviral Treatment in Asia: the TREAT Asia HIV Observational Database (TAHOD) Cohort Nicolas Durier on behalf of TAHOD WEPE070 – Wednesday 23 July 12.30-14.30

  33. TASER ACKNOWLEDGEMENTS The TREAT Asia Studies to Evaluate Resistance is an initiative of TREAT Asia, a program of amfAR, The Foundation for AIDS Research, with major support provided by the Dutch Ministry of Foreign Affairs through a partnership with Stichting Aids Fonds, and with additional support from amfAR and the National Institute of Allergy and Infectious Diseases (NIAID) of the U.S. National Institutes of Health (NIH) and the National Cancer Institute (NCI) as part of the International Epidemiologic Databases to Evaluate AIDS (IeDEA) (grant no. U01AI069907). Queen Elizabeth Hospital and the Integrated Treatment Centre are supported by the Hong Kong Council for AIDS Trust Fund. The Kirby Institute 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. The use of vircoTYPE™ HIV-1 is supported by Janssen Diagnostics BVBA. • Members of the TASER study include: • PCK Li† and MP Lee, Queen Elizabeth Hospital and KH Wong, Integrated Treatment Centre, Hong Kong, China; • N Kumarasamy and S Saghayam, YRG Centre for AIDS Research and Education, Chennai, India; • S Pujari and K Joshi, Institute of Infectious Diseases, Pune, India; • TP Merati‡ and F Yuliana, Faculty of Medicine, Udayana University & Sanglah Hospital, Bali, Indonesia; • A Kamarulzaman and LY Ong, University Malaya Medical Center, Kuala Lumpur, Malaysia; • C KC Lee and B HL Sim, Hospital Sungai Buloh, Sungai Buloh, Malaysia; • M Mustafa and N Nordin, Hospital Raja PerempuanZainab II, Kota Bharu, Malaysia; • R Ditangco and RO Bantique, Research Institute for Tropical Medicine, Manila, Philippines; • YMA Chen, YJ Chen and YT Lin, Taipei Veterans General Hospital and AIDS Prevention and Research Centre, National Yang-Ming University, Taipei, Taiwan; • P Kantipong and P Kambua, Chiang Rai Regional Hospital, Chiang Rai, Thailand; • P Phanuphak and S Sirivichayakul, HIV-NAT/Thai Red Cross AIDS Research Centre, Bangkok, Thailand; • W Ratanasuwan and R Sriondee, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand; • T Sirisanthana and J Praparattanapan, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand; • S Sungkanuparph, S Kiertiburanakul, and L Chumla, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; • R Kantor, Brown University, Rhode Island, U.S.A.; • AH Sohn, N Durier and T Singtoroj, TREAT Asia, amfAR -- The Foundation for AIDS Research, Bangkok, Thailand; • DA Cooper, MG Law, and A Jiamsakul, The Kirby Institute, University of New South Wales, Sydney, Australia. • † Steering Committee Chair, ‡ Co-Chair

  34. TAHOD ACKNOWLEDGEMENTS • CV Mean, V Saphonn* and K Vohith, National Center for HIV/AIDS, Dermatology & STDs, Phnom Penh, Cambodia; FJ Zhang*, HX Zhao and N Han, Beijing Ditan Hospital, Capital Medical University, Beijing, China; PCK Li* and MP Lee, Queen Elizabeth Hospital, Hong Kong, China; N Kumarasamy*, S Saghayam and C Ezhilarasi, YRG Centre for AIDS Research and Education, Chennai, India; S Pujari*, K Joshi and A Makane, Institute of Infectious Diseases, Pune, India; TP Merati*, DN Wirawan and F Yuliana, Faculty of Medicine Udayana University & Sanglah Hospital, Bali, Indonesia; • E Yunihastuti*, D Imran and A Widhani, Working Group on AIDS Faculty of Medicine, University of Indonesia/ Ciptomangunkusumo Hospital, Jakarta, Indonesia; • S Oka*, J Tanuma and T Nishijima, National Center for Global Health and Medicine, Tokyo, Japan; JY Choi*, Na S, and JM Kim, Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea; • CKC Lee*, BLH Sim and R David, Hospital Sungai Buloh, Kuala Lumpur, Malaysia; A Kamarulzaman* † and A Kajindran, University of Malaya Medical Centre, Kuala Lumpur, Malaysia; R Ditangco*, E Uy and R Bantique, Research Institute for Tropical Medicine, Manila, Philippines; YMA Chen*, WW Wong and LH Kuo, Taipei Veterans General Hospital and AIDS Prevention and Research Centre, National Yang-Ming University, Taipei, Taiwan; OT Ng*, A Chua , LS Lee, and A Loh, Tan Tock Seng Hospital, Singapore; P Phanuphak*, K Ruxrungtham and M Khongphattanayothin, HIV-NAT/Thai Red Cross AIDS Research Centre, Bangkok, Thailand; S Kiertiburanakul* ‡, S Sungkanuparph and N Sanmeema, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; R Chaiwarith*, T Sirisanthana and W Kotarathititum, Research Institute for Health Sciences, Chiang Mai, Thailand; P Kantipong and P Kambua, Chiang RaiPrachanukroh Hospital, Chiang Rai, Thailand; • VK Nguyen*, VH Bui and TT Cao, National Hospital for Tropical Diseases, Hanoi, Vietnam; • TT Pham*, DD Cuong and HL Ha, Bach Mai Hospital, Hanoi, Vietnam; • AH Sohn*, N Durier* and B Petersen, TREAT Asia, amfAR - The Foundation for AIDS Research, Bangkok, Thailand; • DA Cooper, MG Law*, A Jiamsakul* and D Boettiger, The Kirby Institute, The University of New South Wales, Sydney, Australia.* TAHOD Steering Committee member; † Steering Committee Chair; ‡ co-Chair.

  35. TApHODACKNOWLEDGEMENTS CV Mean, V Saphonn*, S Sarun, National Centre for HIV/AIDS, Dermatology and STDs, Phnom Penh, Cambodia; V Ung*†, M Pok, Y Kdan, B Chan, National Pediatric Hospital, Phnom Penh, Cambodia; J Tucker, New Hope for Cambodian Children, Phnom Penh, Cambodia; FJ Zhang, Beijing Ditan Hospital, Capital Medical University, Beijing, China; N Kumarasamy*, S Saghayam, E Chandrasekaran, YRGCARE Medical Centre, CART CRS, Chennai, India; DK Wati*, LPP Atmikasari, IY Malino, Sanglah Hospital, Udayana University, Bali, Indonesia; N Kurniati*, and D Muktiarti, CiptoMangunkusumo General Hospital, Jakarta, Indonesia; SM Fong*, M Thien, M Lim, F Daut, Hospital Likas, Kota Kinabalu, Malaysia; NK NikYusoff*, P Mohamad , Hospital Raja PerempuanZainab II, Kelantan, Malaysia; KA Razali*, TJ Mohamed, NF Abdul Rahman, NADR Mohammed, Pediatric Institute, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia; R Nallusamy*, KC Chan, Penang Hospital, Penang, Malaysia; V Sirisanthana*, P Oberdorfer, L Aurpibul, T Sudjaritruk, Research Institute for Health Sciences and Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; R Hansudewechakul*, S Denjanta, W Srisuk, A Kongphonoi, ChiangraiPrachanukroh Hospital, Chiang Rai, Thailand; P Lumbiganon*, P Kosalaraksa, P Tharnprisan, T Udomphanit, Division of Infectious Diseases, Department of Pediatrics, KhonKaen University, KhonKaen, Thailand; G Jourdain, PHPT-IRD UMI 174 (Institut de recherche pour le développement and Chiang Mai University), Chiang Mai, Thailand; T Bunupuradah*, T Puthanakit, W Prasitsuebsai, W Chanthaweethip, HIV-NAT/Thai Red Cross AIDS Research Centre, Bangkok, Thailand; K Chokephaibulkit*, K Lapphra, W Phongsamart, S Sricharoenchai, Siriraj Hospital, Mahidol University, Bangkok, Thailand; KH Truong*‡, QT Du, CH Nguyen, Children’s Hospital 1, Ho Chi Minh City, Vietnam; VC Do*, TM Ha, VT An, Children’s Hospital 2, Ho Chi Minh City, Vietnam; LV Nguyen*, DKT Khu, AN Pham, LT Nguyen, National Hospital of Pediatrics, Hanoi, Vietnam; ON Le, Worldwide Orphans Foundation, Ho Chi Minh City, Vietnam; AH Sohn*, N Durier, C Sethaputra, TREAT Asia, amfAR -- The Foundation for AIDS Research, Bangkok, Thailand; DA Cooper, MG Law*, A Kariminia, The Kirby Institute, UNSW Australia, Sydney, Australia; *Steering Committee member; † Current Steering Committee Chair; ‡ co-Chair

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