1. 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, MHS Darunee Chotiprasitsakul, MD, Kalayanee Atamasirikul, MSc, Somnuek Sungkanuparph, MD Faculty of Medicine Ramathibodi Hospital Mahidol University Bangkok, Thailand IAC, Vienna (July 21, 2010)

2. Background and Methods 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

3. 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*69.29.0 Anti-HBs40.935.9 Anti-HBc21.255.7 Anti-HCV54.15.3

4. 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 sex69 (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 risk52 (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 regimen96 (83.5)120 (88.9)101 (75.9)0.019 Used of lamivudine115 (100)132 (97.8)129 (97.0)0.193 Used of tenofovir12 (10.4)29 (21.5)35 (26.3)0.006 Known liver function test93 (80.9)114 (84.4)111 (83.5)0.745 Anti-HBs screening15 (13.0)71 (52.6)70 (52.6)<0.001 Anti-HBc screening2 (1.7)40 (29.6)45 (33.8)<0.001 Anti-HCV screening17 (14.8)75 (70.4)89 (66.9)<0.001 Kiertiburanakul S et al. Abstract WEPDB206

5. 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 diagnosis1.141.07-1.21<0.001 No anti-HBs screening1.651.04-2.630.034 No anti-HCV screening2.601.62-4.17<0.001

6. 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

7. Points for Discussion In a real world situation in a resource-limited setting Low compliance of HBsAg screening  What are the factors/barriers?  Strategies to improve Timing of HBsAg screening was late  How importance of the timing? How does the screening affect the long-term HIV care? How does the screening impact on morbidity and mortality? Kiertiburanakul S et al. Abstract WEPDB206