Late and Low Compliance with Hepatitis B Serology Screening among HIV-infected Patients in a Resource-limited Setting: An Issue to Improve HIV Care

Abstract WEPDB206

Sasisopin Kiertiburanakul, MD, MHSDarunee Chotiprasitsakul, MD,

Kalayanee Atamasirikul, MSc,

Somnuek Sungkanuparph, MD

Faculty of Medicine Ramathibodi Hospital Mahidol University

Bangkok, Thailand

IAC, Vienna (July 21, 2010)

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Hepatitis B serology screening for HIV-infected patients has not been routinely performed, particularly in resource-limited settings

Timing of ART initiation

Selection of initial ART regimen

To assess the compliance and timing of

hepatitis B serology screening

Factors associated with no HBsAg screening before ART initiation

Cross-sectional study in 2008

Kiertiburanakul S et al. Abstract WEPDB206

Results•416 adult HIV-infected patients were enrolled

HBsAg screening•Before/on the day of HIV testing: 9.1%•Before ART: 27.2%•Dramatically increased in 2007 (P-trend <0.001)

Kiertiburanakul S et al. Abstract WEPDB206

Laboratory tesitng Proportion of screening (%)

Percentage of positive result

HBsAg* 69.2 9.0

Anti-HBs 40.9 35.9

Anti-HBc 21.2 55.7

Anti-HCV 54.1 5.3

Characteristics and Laboratory Investigations of 383 HIV-infected Patients

Characteristics and laboratory investigations

HBsAg screening, n (%) P- value

Not screen (N = 115)

Before ART initiation

(N = 135)

After ART initiation(N = 133)

Median (IQR) age at HIV diagnosis, years

34.5 (30.3-41.5)

34.3 (28.9-41.7)

34.3 (28.5-41.1)

0.656

Male sex 69 (60.0) 79 (58.5) 87 (65.4) 0.479

Median (IQR) duration of HIV diagnosis, years

6.5 (4.4-9.2)

4.2 (2.2-7.6)

7.4 (4.7-11.0)

<0.001

Heterosexual risk 52 (45.2) 87 (64.4) 60 (45.1) 0.001

Median (IQR) CD4 cell count at HIV diagnosis, cells/ml

67(12-165)

95 (29-210)

61 (27-168)

0.040

NNRTI-based regimen 96 (83.5) 120 (88.9) 101 (75.9) 0.019

Used of lamivudine 115 (100) 132 (97.8) 129 (97.0) 0.193

Used of tenofovir 12 (10.4) 29 (21.5) 35 (26.3) 0.006

Known liver function test 93 (80.9) 114 (84.4) 111 (83.5) 0.745

Anti-HBs screening 15 (13.0) 71 (52.6) 70 (52.6) <0.001

Anti-HBc screening 2 (1.7) 40 (29.6) 45 (33.8) <0.001

Anti-HCV screening 17 (14.8) 75 (70.4) 89 (66.9) <0.001

Kiertiburanakul S et al. Abstract WEPDB206

Results•Median time from anti-HIV testing to HBsAg

screening: 56 (95% CI 44, 68) months•Factors associated with no HBsAg screening

before ART initiation

Kiertiburanakul S et al. Abstract WEPDB206

Factors Odds ratio

95% confidence interval

P-value

Duration of HIV diagnosis 1.14 1.07-1.21 <0.001

No anti-HBs screening 1.65 1.04-2.63 0.034

No anti-HCV screening 2.60 1.62-4.17 <0.001

Conclusions•Compliance with hepatitis B serology screening

was relatively low and late•Duration of HIV infection, no anti-HBs screening

and no anti-HCV screening were associated with no HBsAg screening before ART initiation•Educational program regarding hepatitis B

serology screening, identification of barriers, and interventions to eliminate these barriers in resource-limited settings are crucial to improve HIV care

Kiertiburanakul S et al. Abstract WEPDB206