Natasha K Martin1, Angela Devine, Jeffrey W Eaton, Alec Miners, Timothy B Hallett, Graham R Foster, Gregory J Dore, Philippa J Easterbrook, Rosa Legood, Peter Vickerman. 1. aSchool of Social and Community Medicine, University of Bristol, Bristol bSocial and Mathematical Epidemiology Group, London School of Hygiene and Tropical Medicine cDepartment of Health Services Research and Policy, London School of Hygiene and Tropical Medicine dDepartment of Infectious Disease Epidemiology, Imperial College London eBlizard Institute of Molecular Medicine, Queen Mary's University of London, London, UK fKirby Institute, University of New South Wales, Sydney, Australia gDepartment of HIV/AIDS, World Health Organization, Geneva, Switzerland.
Abstract
OBJECTIVE: There has been discussion about whether individuals coinfected with HIV and hepatitis C virus (HCV) or hepatitis B virus (HBV) (∼30% of all people living with HIV) should be prioritized for early HIV antiretroviral therapy (ART). We assess the relative benefits of providing ART at CD4 count below 500 cells/μl or immediate ART to HCV/HIV or HBV/HIV-coinfected adults compared with HIV-monoinfected adults. We evaluate individual outcomes (HIV/liver disease progression) and preventive benefits in a generalized HIV epidemic setting. METHODS: We modeled disease progression for HIV-monoinfected, HBV/HIV-coinfected, and HCV/HIV-coinfected adults for differing ART eligibility thresholds (CD4 <350 cells/μl, CD4 <500 cells/μl, immediate ART eligibility upon infection). We report disability-adjusted life-years averted per 100 person-years on ART (DALYaverted/100PYonART) as a measure of the health benefits generated from incremental changes in ART eligibility. Sensitivity analyses explored impact on sexual HIV and vertical HIV, HCV, and HBV transmission. RESULTS: For HBV/HIV-coinfected adults, a switch to ART initiation at CD4 count below 500 cells/μl from CD4 below 350 cells/μl generates 9% greater health benefits per year on ART (48 DALYaverted/100PYonART) than for HIV-monoinfected adults (44 DALYaverted/100PYonART). Additionally, ART at CD4 below 500 cells/μl could prevent 25% and 32% of vertical transmissions of HIV and HBV, respectively. For HCV/HIV-coinfected adults, ART at CD4 below 500 cells/μl generates 10% fewer health benefits (40 DALYaverted/100PYonART) than for HIV monoinfection, unless ART reduces progression to cirrhosis by more than 70% (33% in base-case). CONCLUSIONS: The additional therapeutic benefits of ART for HBV-related liver disease results in ART generating more health benefits among HBV/HIV-coinfected adults than HIV-monoinfected individuals, whereas less health benefits are generated amongst HCV/HIV coinfection in a generalized HIV epidemic setting.
OBJECTIVE: There has been discussion about whether individuals coinfected with HIV and hepatitis C virus (HCV) or hepatitis B virus (HBV) (∼30% of all people living with HIV) should be prioritized for early HIV antiretroviral therapy (ART). We assess the relative benefits of providing ART at CD4 count below 500 cells/μl or immediate ART to HCV/HIV or HBV/HIV-coinfected adults compared with HIV-monoinfected adults. We evaluate individual outcomes (HIV/liver disease progression) and preventive benefits in a generalized HIV epidemic setting. METHODS: We modeled disease progression for HIV-monoinfected, HBV/HIV-coinfected, and HCV/HIV-coinfected adults for differing ART eligibility thresholds (CD4 <350 cells/μl, CD4 <500 cells/μl, immediate ART eligibility upon infection). We report disability-adjusted life-years averted per 100 person-years on ART (DALYaverted/100PYonART) as a measure of the health benefits generated from incremental changes in ART eligibility. Sensitivity analyses explored impact on sexual HIV and vertical HIV, HCV, and HBV transmission. RESULTS: For HBV/HIV-coinfected adults, a switch to ART initiation at CD4 count below 500 cells/μl from CD4 below 350 cells/μl generates 9% greater health benefits per year on ART (48 DALYaverted/100PYonART) than for HIV-monoinfected adults (44 DALYaverted/100PYonART). Additionally, ART at CD4 below 500 cells/μl could prevent 25% and 32% of vertical transmissions of HIV and HBV, respectively. For HCV/HIV-coinfected adults, ART at CD4 below 500 cells/μl generates 10% fewer health benefits (40 DALYaverted/100PYonART) than for HIV monoinfection, unless ART reduces progression to cirrhosis by more than 70% (33% in base-case). CONCLUSIONS: The additional therapeutic benefits of ART for HBV-related liver disease results in ART generating more health benefits among HBV/HIV-coinfected adults than HIV-monoinfected individuals, whereas less health benefits are generated amongst HCV/HIV coinfection in a generalized HIV epidemic setting.
Authors: Samir Aoudjane; Mas Chaponda; Antonio Adrián González Del Castillo; Jemma O'Connor; Marc Noguera; Apostolos Beloukas; Mark Hopkins; Saye Khoo; Joep J van Oosterhout; Anna Maria Geretti Journal: Clin Infect Dis Date: 2014-08-06 Impact factor: 9.079
Authors: April D Kimmel; Rose S Bono; Olivia Keiser; Jean D Sinayobye; Janne Estill; Deo Mujwara; Olga Tymejczyk; Denis Nash Journal: J Virus Erad Date: 2018-11-15
Authors: Carlos D Rivera Saldana; Leo Beletsky; Annick Borquez; Susan M Kiene; Steffanie A Strathdee; María Luisa Zúñiga; Natasha K Martin; Javier Cepeda Journal: Addiction Date: 2021-03-03 Impact factor: 7.256
Authors: Aditya S Khanna; Sarah T Roberts; Susan Cassels; Roger Ying; Grace John-Stewart; Steven M Goodreau; Jared M Baeten; Pamela M Murnane; Connie Celum; Ruanne V Barnabas Journal: PLoS One Date: 2015-08-11 Impact factor: 3.240
Authors: Yan Zhao; Zunyou Wu; Jennifer M McGoogan; Yiyi Sha; Decai Zhao; Ye Ma; Ron Brookmeyer; Roger Detels; Julio S G Montaner Journal: Clin Infect Dis Date: 2019-01-01 Impact factor: 9.079
Authors: Nyashadzaishe Mafirakureva; Aaron G Lim; Gul Ghuttai Khalid; Khawar Aslam; Linda Campbell; Hassaan Zahid; Rafael Van den Bergh; Gregoire Falq; Camille Fortas; Yves Wailly; Rosa Auat; Dmytro Donchuk; Anne Loarec; Joanna Coast; Peter Vickerman; Josephine G Walker Journal: J Viral Hepat Date: 2020-11-04 Impact factor: 3.728
Authors: Lara K Marquez; Antoine Chaillon; Kyi Pyar Soe; Derek C Johnson; Jean-Marc Zosso; Andrea Incerti; Anne Loarec; Aude Nguyen; Josephine G Walker; Nyashadzaishe Mafirakureva; Vincent Lo Re Iii; Adriane Wynn; Craig McIntosh; Susan M Kiene; Stephanie Brodine; Richard S Garfein; Peter Vickerman; Natasha K Martin Journal: BMJ Glob Health Date: 2021-02
Authors: Nick Scott; Thin Mar Win; Tom Tidhar; Hla Htay; Bridget Draper; Phyo Thu Zar Aung; Yinzong Xiao; Anna Bowring; Christian Kuschel; Sonjelle Shilton; Khin Pyone Kyi; Win Naing; Khin Sanda Aung; Margaret Hellard Journal: Lancet Reg Health West Pac Date: 2021-03-23