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

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.

Current practice and recommendations for management of hepatitis B virus in people living with HIV in Asia

“…The median prevalence of HBV infection among people living with HIV has been estimated to be 9.4% in East Asia, 8.8% in South and South-East Asia, and 5.3% in the Western Pacific (limited to Japan, Korea, and Australasia) [1]. This is consistent with data from people receiving ART in the TREAT Asia, HIV Observational Database Low-Intensity Transfer (TAHOD-LITE) cohort, where the prevalence of HBV co-infection was 8% of those screened [3], across sites in Cambodia, Hong Kong SAR, India, Indonesia, South Korea, Thailand, and Vietnam. The rates observed in Asia were higher than in west and central Europe (6.0%) and North America (4.3%) [1].…”

“…The proportion of viral suppression may be an underestimate because of a lack of regular HBV DNA monitoring. The authors recommended routine HBV DNA testing to identify those in need of treatment [3]. The 39% screening rate is lower than in countries such as the USA, where the rate is approximately 80% [3].…”

“…The authors recommended routine HBV DNA testing to identify those in need of treatment [3]. The 39% screening rate is lower than in countries such as the USA, where the rate is approximately 80% [3]. Furthermore, the testing rate varied based on country income: 35% and 36% in low‐ and middle‐income countries, respectively, and 88% in high‐income countries in the Asia‐Pacific region [3].…”

“…The 39% screening rate is lower than in countries such as the USA, where the rate is approximately 80% [3]. Furthermore, the testing rate varied based on country income: 35% and 36% in low‐ and middle‐income countries, respectively, and 88% in high‐income countries in the Asia‐Pacific region [3]. The differential rates of HBV screening may be due to limitations in healthcare provider training, laboratory resources, and lack of screening in vaccinated individuals [3].…”

Increased All-cause Mortality in People With HIV and Comorbidities: Hepatitis B and C Virus Seropositivity and Hyperglycemia in Myanmar, 2005–2017

“…At the time of our study, HCV treatment was unavailable in Myanmar, which likely contributed to the increased mortality among HCV-seropositive PWH with hyperglycemia. Although HCV treatment in PWH has become available in Myanmar and other settings, access to HCV treatment for PWH remains challenging in low- and middle-income countries including Myanmar [ 35 ]. Even in a high-income country like the United States, only an estimated 56% of insured PWH who have HCV infection received HCV RNA testing and only 27% received treatment in 2014–2019 [ 36 ].…”