Presentation is loading. Please wait.

Presentation is loading. Please wait.

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

Similar presentations


Presentation on theme: "Www.treatasia.org TREAT Asia cohort studies: Asia-Pacific region of the IeDEA collaboration Matthew Law Kirby Institute, UNSW Australia."— Presentation transcript:

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  Biostatistical centre at Kirby Institute, UNSW, Sydney, Australia

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

6 2 nd TREAT Asia Network Annual Meeting September 2002 Bangkok

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

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):

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

14 Factors associated with virologic failure Multivariate No of patientsNo of failuresOR95% CIp*Global p Total TDR No TDR TDR with susceptible ART (0.08 to 4.68)0.647 TDR with suboptimal ART (1.31 to 7.43)0.010 Pre-treatment CD4 (counts/uL) <= (0.49 to 1.57) (0.62 to 1.68) (0.22 to 0.74)0.003 Missing295 ~Adherence <0.001 >=95%~711 <95%~189.37(5.00 to 17.6)<.001 Missing~31 Phanuphak P, et al. JAIDS 2014;66:74-9.

15 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):e Chronic infectionRecent infection PercentagePercentage NNRTI NRTI

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 Bunupuradah, T et al. Int J Infect Dis 2013;17:e806-e810.  Ever received AZT > 3-fold risk of severe anaemia (Hb<7.5 g/dL)

24 Weight for age predicts survival Kariminia A et al. JAIDS 2014 in press.  After adjustment for time updated CD4%

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  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


Download ppt "Www.treatasia.org TREAT Asia cohort studies: Asia-Pacific region of the IeDEA collaboration Matthew Law Kirby Institute, UNSW Australia."

Similar presentations


Ads by Google