1st Central Eastern European Meeting on Viral Hepatitis and Co-Infection with HIV

HIV/Hepatitis co-infection situation in Czech and Slovak Repl.

Viktor ASTER, MD, PHD

Department of Infectious and Tropical Diseases, Hospital Bulovka, First Faculty of Medicine, Charles University in Prague,

District Hospital Liberec.

1st Central Eastern European Meeting on Viral Hepatitis and Co-Infection with HIV

Disclosure:

I have nothing to disclosure

HIV infection in the Czech Republic Czech Republic : 10,5 mil. inhabitants (about 0,5 mil. residents)

HIV+: total number: 2430 persons 1)

(2035 Czech citizens and 395 foreign residents)

living with HIV: 2113 persons 1)

died: 317 HIV+ persons (jan 1986-apr 2015) 1)

Prevalence: 0,023% =231/1 000 000

inhabitants (y. 2014) 1)

Annual incidence: 209 new cases/year

=19,89/1 000 000 inhabitants (may 2014-apr 2015) 1)

HIV Genotype: 1 (all)

0

0,05

0,1

1

0,02% 0,079%

Prevalence HIV+ Czech vs. foreign residents in %

Czech Foreigners

1) apr 2015, NIPH (National Institute of Public Health)

HIV subtype (only in ARV resistence tested patients)

B 75%

A 11%

C 3%

CRF1AE 4%

others 7% Maly M, Nemecek V,NIH

0

2000

4000

317

2113

Living and died HIV+ persons in the Czech Republic april 2015

(Czech citizens and foreign residents n=24301)

died living

0 0 3 26 50 85 93 108 121 144 171 209 249 300

362 392 442

500 551

601 664

736 826

917

1038

1186

1342

1522

1675

1887

2122

2354 2430

0

500

1000

1500

2000

2500

3000

Cumulative numbers of HIV+ persons in the Czech Republic

1.1.1983-20.4.2015 adapted according to NIH

Blood donors testing Since 1987

1983-1985: „not possible to became HIV infected in a socialist country“

2045; 84% 385;

16%

Sex distribution of HIV+ persons Czech Republic No=2430 april 2015, NIH

men women

1543; 64%

95; 4% 51; 2%

17; 1%

14; 1%

614; 25%

7; 0%

4; 0%

1; 0% 84; 3%

Distribution of HIV+ persons according to the mode of acquisition Czech Republic No=2430 april 2015, NIH MSM + bisexual

IDU

IDU+MSM+bisexual

haemophiliac

blood transfusion

heterosexual

mother to child

nosocomial

other

unknown

apr 2015, NIPH (National Institute of Public Health)

HIV infection in the Czech Republic o 7 HIV centers o 14 HIV experts o Prague take care of 70% patients o Local guidelines: revision in 2015 to follow

new EASC, DHHS, WHO o Currently in care: 1870 patients (89%) 1)

o On treatment: 1320 patients (71%)1)

o On treatment supressed: 90% (<50)

1) NIPH (National Institute of Public Health)

ART in the Czech Rep. (survey in 100 pts)1)

2 NRTI + 1 PI 47% 2 NRTI + 1 NNRTI 32%

2 NRTI + 1 integr. inh. 13% 3 NRTI 8%

ARV drugs available in the Czech Rep 2015 TENOFOVIR

EMTRICITABINE/ TENOFOVIR FTC/ TDF /ELVITEGR./COBI

EMTRICITABINE/ TENOFOVIR /rilpivirine ABC/3TC

LAMIVUDIN/ZIDOVUDIN 150 ralvitegravir

darunavir lopinavir/ritonavir

atazanavir efavirenz etravirin rilpivirin ritonavir

dolutegravir

366 342

300 271

213 232 275 295

260 285

0

50

100

150

200

250

300

350

400

y.2006

y.2007

y.2008

y.2009

y.2010

y.2011

y.2012

y.2013

y.2014

y.2015

New cases of VHC/year since 2006 till april 2015 Czech Republic, adapted according to NIH

No of

Annual incidence of VHC (both acute and chronic): - 260 new cases/year 2014 =25/1 000 000 inhabitants1) Prevalence : anti-HCV + 0,37% (y. 2014, tested in 3 centers: Brno, Ceske Budejovice, Hradec Kralove, in1872 persons, age: 18-87) 2)

Viral hepatitis C in the Czech Republic

Viral hepatitis B in the Czech Republic

Annual incidence of acute VHB: -105 new cases/year 2014 =10/1 000 000 inhabitants 1)

Prevalence HBsAg+: 0,14% Prevalence anti-HBc IgG+: 3,2% (y. 2014 both VHB markers tested in 1442 persons, age: 25-64. SD= 1,6-6,4)2)

361

307 307 306

247 244

192 154

133 105

0

50

100

150

200

250

300

350

400

y.2005

y.2006

y.2007

y.2008

y.2009

y.2010

y.2011

y.2012

y.2013

y.2014

New cases of acute VHB/year since 2006 till april 2015 Czech Republic, adapted according to NIH

1) National institute of Health, 2015 2) Chlibek R, University of Defence, 2014

Anti-HBV drugs available in the Czech Republic in 2015

Anti-HCV drugs available in the Czech Republic in 2015 17 hepatologic centers for DAA´s

drug

registered by the

State Institute for Drug Control

covered by insurance

pegylated IFN alfa 2a

YES YES lamivudine

YES YES adefovir

YES YES entecavir

YES YES tenofovir

YES YES

drug

registered by the

State Institute for Drug Control

covered by insurance

pegylated IFN alfa 2a, alfa 2b YES YES

ribavirin YES YES

boceprevir YES YES

telaprevir YES YES NOT FOR HIV+

simeprevir YES YES

sofosbuvir YES NO

sofosbuvir/ledipasvir YES NO paritaprevir/ombitasvir/

ritonavir/dasabuvir YES NO

daclatasvir YES NO

??asunaprevir?? YES Specific programme

ASUNAPREVIR „specific programme“

Good idea?

Prevalence of HBV and HCV infections in HIV-positive persons in the Czech Republic

PRAGUE

BRNO

0

500

1000

1500

HBsAg anti-HBc IgG anti-HCV

24+= 2,1% 421+=37,5% 119+= 10,9%

1099- 702-

978-

Prevalence of HBV (n=1123) and HCV (n=1097) infections in HIV+ patients from Prague and Brno (about 50% of living HIV+ persons in the Czech Republic)

Aster V, Polakova A, Nemecek V, Maly M: September 2013, Snopkova S: June 2015

HBV infection in HIV-infected persons in the Czech Republic

Vaccination against VHA, VHB in HIV+ recommended according to the results of anti-HAV IgG and anti-HBc IgG

Acute HBV infection (and both chronic HBV and HCV infection) in common population: recommended HIV testing (with signed informed consent)

In anti-HBc IgG positive HIV+ patients: ART containing dual effect drug regimen (TDF, FTC)

21;

84% 4;

16%

Results of Vaccination of 25 HIV+ Patients against

VHA Aster V. AIDS Center Prague, ECCMID 2004

response + response -

18; 69% 8;

31%

Results of Vaccination of 26 HIV+ Patients against

VHB Aster V. AIDS Center Prague, ECCMID 2004

response + response -

21; 55%

8; 21% 9; 24%

Distribution of HCV GT in HIV/HCV+ patients treated for HCV in AIDS-Centrer Prague n=38 (only pts with known SVR 24)

GT1 GT3 GT4Aster V, April 2015

1a 36

1b 28

1a/b 36

GT1 subtypes %

52,90%

3,30% 29,70%

14,20%

Distribution of HCV GT 1-4 in HIV/HCV in Europe (EuroSIDA cohort)

GT 1 GT 2 GT3 GT4

Rockstroh J, et al. J Hepatol. 2013;59:213-20

0

2

4

6

8

10

12

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Num

ber o

f HC

V tr

eate

d pe

rson

s

Distribution HCV genotypes in time in HIV/HCV-coinfected pts treated for HCV infection

(AIDS-Centrum Prague 2003-2015) n=46

GT1 GT3 GT4

HCV GT 4 – free era

HCV GT4: „new genotype“ in HIV/HCV coinfected patients in the Czech Republic

HIV/HCV coinfections in the Czech Republic: supposed numbers of VHC and treatment results

0

10

20

GT1 GT3 GT4

9 4 3

12

4 6

SVR 24 according to HCV genotypes n=38 Aster V, AIDS-Center Prague, April 2015

SVR+ SVR-0

5016 22 n. of patients

42% pts HIV/HCV treated by P/R achieved SVR 24 n=38

Aster V, AIDS-Center Prague, April 2015

SVR+ SVR-

Czech Republic: supposed number of HCV/HIV co- infections HIV+ 2113

HIV+/anti-HCV+ ? (11%) 232 HIV+/HCV RNA+ ? (75% of HIV/anti-HCV+) 174

1039

114

86: 100% all HCV RNA+ 42: 49% treated 38

16: 19% SVR

0 200 400 600 800 1000 1200

Anti-HCV treatment of HCV/HIV (in supposed total HCV+ number of pts AIDS Center Prague )

SVR 24 +

HIV+/HCV with known SVR

HIV+/HCV treated

HIV+/HCV RNA+ ? (75% of HIV/anti-HCV+)

HIV+/anti-HCV+ ? (11%)

HIV+

n. of patients

HIV infection in the Slovak Republic

• Slovak Republic : 5,4 mil. inhabitants • HIV+: total number: 595 persons (Slovak citizens)

(June 2015)1)

• died (in AIDS): 44 persons (31-th December 2014)11)

• Prevalence: 0,011% =110/1 000 000 inhabitants (y. 2014) 1)

• Annual incidence: 80 new cases/year =14,81/1 000 000 inhabitants( 2014) 1)

• 5 HIV centers • 10 HIV experts • Bratislava take care of 80% patients • No local guidelines,

• physicians follow EASC or DHHS

• Currently supposed in care: patients 90% pts.

• On treatment: supposed (70%) pts.

1) Stanekova D, Jarcuska P 2014

386; 65%

13; 2% 1; 0%

142; 24%

53; 9%

Distribution of HIV+ persons according to the mode of acquisition

Slovak Republic No=595 December 20141)

MSM

IDU

blood transfusion

heterosexual

unknown

VHB and VHC in the Slovak Republic

Prevalence of VHC and VHB infections in Slovakia (VHB in common and Roma population)

HBsAg+1),2) anti-HBc IgG+1),2) HBV DNA+1),2) anti-HCV+3) HCV RNA+3)

common p. Roma p. common p. Roma p. common p. Roma p. common p. n=403 n=452 n=403 n=452 n=403 n=452 n=3608

2,80% 12,50% 15,90% 52,80% 1,80% 11,30% 1,52% 0,67% 1) Jarcusca P. HepaMeta Study 2013 2) Veseliny E, et al. High Hepatitis B and Low Hepatitis C Prevalence in Roma Population in Eastern Slovakia.Central European Journal of Public Health 2014, suppl 1, 1. 3) Schréter I, et al. Prevalence of hepatitis C virus infection in Slovakia. Klin Mikrobiol Infekc Lek. 2007 Apr;13(2):54-8.

HBV/HIV and HCV/HIV coinfections in the Slovak Republic

290; 90%

17; 5%

16; 5%

HBV/HIV and HCV/HIV coinfections in Slovakia n=323 Jarcucka P,June 2014

negative

HBsAg+

HCV RNA+

Conclusions • Still low prevalence of HIV infection in Czech and Slovak

Republic • HIV infection most common in MSM • Higher both VHB and HCV infections prevalence in Slovakia

than in The Czech Republic (both in common population and in HIV+)

• HCV GT 4: „new GT“ in the Czech Repl. • Higher prevalence of VHB infection in Roma population in

Eastern Slovakia, than in common population • Good access for HBV and HIV drugs, but still not satisfactory

for HCV drugs in the Czech Repl. • Simeprevir available since April 2015 (not for GT4) • The Czech Republic: SOF, LDV, 3D, DCV: covered at the end

of 2015?........2015: a year for treatment of „healthy VHC infected patients“

Acknowledgement SNOPKOVA Svatava, Clinic of Infectious Diseases, Faculty of Medicine, Masaryk University, Brno, Czech Republic

POLAKOVA Alena, Hospital Bulovka, Prague, Czech Republic

SEDLACEK Dalibor, Clinic of Infectious Diseases, Medical Faculty, University Hospital Plzen, Czech Republic

CHLIBEK Roman, 4Department of Epidemiology, Faculty of Military Health Sciences, University of Defence, Hradec Králové, Czech Republic MALY Marek, National Reference Laboratory for HIV/AIDS, National Institute of Health, Prague, Czech Republic

NEMECEK Vratislav, National Reference Laboratory for HIV/AIDS, National Reference Laboratory for Viral Hepatitis, National Institute of Health, Prague, Czech Republic

JARCUSKA Pavol, Department of Infectious Diseases, P. J. Šafárik University in Košice, Faculty of Medicine and L. Pasteur University Hospital, Košice, Slovakia

JARCUSKA Peter, 1st Department of Internal Medicine, P. J. Šafárik University in Košice, Faculty of Medicine and L. Pasteur University Hospital, Košice, Slovakia