1. Matthew Law Kirby Institute, UNSW Australia
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
Biostatistical centre at Kirby Institute, UNSW, Sydney, Australia

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

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

7. Region 5: Asia and Australia Australia Cambodia China Hong Kong India
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
Guinea-Bissau
Burkina Faso
Mali
Côte d’Ivoire
Nigeria
Gambia
Senegal
Ghana
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 Not a surveillance mechanism
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):

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
Multivariate
No of patients
No of failures OR
95% CI p
*Global p
Total
1173
120
TDR
0.033
No TDR
1122
112 1
TDR with susceptible ART 21
0.62
(0.08 to 4.68)
0.647
TDR with suboptimal ART 30 7
3.12
(1.31 to 7.43)
0.010
Pre-treatment CD4 (counts/uL)
0.012
<=50
368 46
51-100
183 19
0.88
(0.49 to 1.57)
0.662
288 32
1.02
(0.62 to 1.68)
0.930
201+
305 18
0.41
(0.22 to 0.74)
0.003
Missing 29 5
~Adherence
<0.001
>=95% ~ 71
<95%
9.37
(5.00 to 17.6)
<.001 31
Phanuphak P, et al. JAIDS 2014;66:74-9.

15. Resistance patterns
Chronic infection
Recent infection
P e r c e n t a g e
NNRTI
NRTI
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 One 2014 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 TApHOD recruits all children seen at sites
More representative than TAHOD
Commenced 2008
5227 children recruited, 3504 in active follow-up

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. JAIDS 2014 in press.

25. Rates of all OIs in TApHOD
Mono/duo HAART
Prasitsuebsai W et al. PIDJ 2014;33:

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. TAHOD LITE 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

28. TAHOD LITE 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

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 TAHOD/TASER
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

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 Perempuan Zainab 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 Rai Prachanukroh 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. TApHOD ACKNOWLEDGEMENTS
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, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia; SM Fong*, M Thien, M Lim, F Daut, Hospital Likas, Kota Kinabalu, Malaysia; NK Nik Yusoff*, P Mohamad , Hospital Raja Perempuan Zainab 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, Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand; P Lumbiganon*, P Kosalaraksa, P Tharnprisan, T Udomphanit, Division of Infectious Diseases, Department of Pediatrics, Khon Kaen University, Khon Kaen, 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