1st Central Eastern European Meeting on Viral Hepatitis and Co-Infection with HIV
HIV/Hepatitis co-infection situation in Czech and Slovak Repl.
Viktor ASTER, MD, PHD
Department of Infectious and Tropical Diseases, Hospital Bulovka, First Faculty of Medicine, Charles University in Prague,
District Hospital Liberec.
1st Central Eastern European Meeting on Viral Hepatitis and Co-Infection with HIV
Disclosure:
I have nothing to disclosure
HIV infection in the Czech Republic Czech Republic : 10,5 mil. inhabitants (about 0,5 mil. residents)
HIV+: total number: 2430 persons 1)
(2035 Czech citizens and 395 foreign residents)
living with HIV: 2113 persons 1)
died: 317 HIV+ persons (jan 1986-apr 2015) 1)
Prevalence: 0,023% =231/1 000 000
inhabitants (y. 2014) 1)
Annual incidence: 209 new cases/year
=19,89/1 000 000 inhabitants (may 2014-apr 2015) 1)
HIV Genotype: 1 (all)
0
0,05
0,1
1
0,02% 0,079%
Prevalence HIV+ Czech vs. foreign residents in %
Czech Foreigners
1) apr 2015, NIPH (National Institute of Public Health)
HIV subtype (only in ARV resistence tested patients)
B 75%
A 11%
C 3%
CRF1AE 4%
others 7% Maly M, Nemecek V,NIH
0
2000
4000
317
2113
Living and died HIV+ persons in the Czech Republic april 2015
(Czech citizens and foreign residents n=24301)
died living
0 0 3 26 50 85 93 108 121 144 171 209 249 300
362 392 442
500 551
601 664
736 826
917
1038
1186
1342
1522
1675
1887
2122
2354 2430
0
500
1000
1500
2000
2500
3000
Cumulative numbers of HIV+ persons in the Czech Republic
1.1.1983-20.4.2015 adapted according to NIH
Blood donors testing Since 1987
1983-1985: „not possible to became HIV infected in a socialist country“
2045; 84% 385;
16%
Sex distribution of HIV+ persons Czech Republic No=2430 april 2015, NIH
men women
1543; 64%
95; 4% 51; 2%
17; 1%
14; 1%
614; 25%
7; 0%
4; 0%
1; 0% 84; 3%
Distribution of HIV+ persons according to the mode of acquisition Czech Republic No=2430 april 2015, NIH MSM + bisexual
IDU
IDU+MSM+bisexual
haemophiliac
blood transfusion
heterosexual
mother to child
nosocomial
other
unknown
apr 2015, NIPH (National Institute of Public Health)
HIV infection in the Czech Republic o 7 HIV centers o 14 HIV experts o Prague take care of 70% patients o Local guidelines: revision in 2015 to follow
new EASC, DHHS, WHO o Currently in care: 1870 patients (89%) 1)
o On treatment: 1320 patients (71%)1)
o On treatment supressed: 90% (<50)
1) NIPH (National Institute of Public Health)
ART in the Czech Rep. (survey in 100 pts)1)
2 NRTI + 1 PI 47% 2 NRTI + 1 NNRTI 32%
2 NRTI + 1 integr. inh. 13% 3 NRTI 8%
ARV drugs available in the Czech Rep 2015 TENOFOVIR
EMTRICITABINE/ TENOFOVIR FTC/ TDF /ELVITEGR./COBI
EMTRICITABINE/ TENOFOVIR /rilpivirine ABC/3TC
LAMIVUDIN/ZIDOVUDIN 150 ralvitegravir
darunavir lopinavir/ritonavir
atazanavir efavirenz etravirin rilpivirin ritonavir
dolutegravir
366 342
300 271
213 232 275 295
260 285
0
50
100
150
200
250
300
350
400
y.2006
y.2007
y.2008
y.2009
y.2010
y.2011
y.2012
y.2013
y.2014
y.2015
New cases of VHC/year since 2006 till april 2015 Czech Republic, adapted according to NIH
No of
Annual incidence of VHC (both acute and chronic): - 260 new cases/year 2014 =25/1 000 000 inhabitants1) Prevalence : anti-HCV + 0,37% (y. 2014, tested in 3 centers: Brno, Ceske Budejovice, Hradec Kralove, in1872 persons, age: 18-87) 2)
Viral hepatitis C in the Czech Republic
Viral hepatitis B in the Czech Republic
Annual incidence of acute VHB: -105 new cases/year 2014 =10/1 000 000 inhabitants 1)
Prevalence HBsAg+: 0,14% Prevalence anti-HBc IgG+: 3,2% (y. 2014 both VHB markers tested in 1442 persons, age: 25-64. SD= 1,6-6,4)2)
361
307 307 306
247 244
192 154
133 105
0
50
100
150
200
250
300
350
400
y.2005
y.2006
y.2007
y.2008
y.2009
y.2010
y.2011
y.2012
y.2013
y.2014
New cases of acute VHB/year since 2006 till april 2015 Czech Republic, adapted according to NIH
1) National institute of Health, 2015 2) Chlibek R, University of Defence, 2014
Anti-HBV drugs available in the Czech Republic in 2015
Anti-HCV drugs available in the Czech Republic in 2015 17 hepatologic centers for DAA´s
drug
registered by the
State Institute for Drug Control
covered by insurance
pegylated IFN alfa 2a
YES YES lamivudine
YES YES adefovir
YES YES entecavir
YES YES tenofovir
YES YES
drug
registered by the
State Institute for Drug Control
covered by insurance
pegylated IFN alfa 2a, alfa 2b YES YES
ribavirin YES YES
boceprevir YES YES
telaprevir YES YES NOT FOR HIV+
simeprevir YES YES
sofosbuvir YES NO
sofosbuvir/ledipasvir YES NO paritaprevir/ombitasvir/
ritonavir/dasabuvir YES NO
daclatasvir YES NO
??asunaprevir?? YES Specific programme
ASUNAPREVIR „specific programme“
Good idea?
Prevalence of HBV and HCV infections in HIV-positive persons in the Czech Republic
PRAGUE
BRNO
0
500
1000
1500
HBsAg anti-HBc IgG anti-HCV
24+= 2,1% 421+=37,5% 119+= 10,9%
1099- 702-
978-
Prevalence of HBV (n=1123) and HCV (n=1097) infections in HIV+ patients from Prague and Brno (about 50% of living HIV+ persons in the Czech Republic)
Aster V, Polakova A, Nemecek V, Maly M: September 2013, Snopkova S: June 2015
HBV infection in HIV-infected persons in the Czech Republic
Vaccination against VHA, VHB in HIV+ recommended according to the results of anti-HAV IgG and anti-HBc IgG
Acute HBV infection (and both chronic HBV and HCV infection) in common population: recommended HIV testing (with signed informed consent)
In anti-HBc IgG positive HIV+ patients: ART containing dual effect drug regimen (TDF, FTC)
21;
84% 4;
16%
Results of Vaccination of 25 HIV+ Patients against
VHA Aster V. AIDS Center Prague, ECCMID 2004
response + response -
18; 69% 8;
31%
Results of Vaccination of 26 HIV+ Patients against
VHB Aster V. AIDS Center Prague, ECCMID 2004
response + response -
21; 55%
8; 21% 9; 24%
Distribution of HCV GT in HIV/HCV+ patients treated for HCV in AIDS-Centrer Prague n=38 (only pts with known SVR 24)
GT1 GT3 GT4Aster V, April 2015
1a 36
1b 28
1a/b 36
GT1 subtypes %
52,90%
3,30% 29,70%
14,20%
Distribution of HCV GT 1-4 in HIV/HCV in Europe (EuroSIDA cohort)
GT 1 GT 2 GT3 GT4
Rockstroh J, et al. J Hepatol. 2013;59:213-20
0
2
4
6
8
10
12
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Num
ber o
f HC
V tr
eate
d pe
rson
s
Distribution HCV genotypes in time in HIV/HCV-coinfected pts treated for HCV infection
(AIDS-Centrum Prague 2003-2015) n=46
GT1 GT3 GT4
HCV GT 4 – free era
HCV GT4: „new genotype“ in HIV/HCV coinfected patients in the Czech Republic
HIV/HCV coinfections in the Czech Republic: supposed numbers of VHC and treatment results
0
10
20
GT1 GT3 GT4
9 4 3
12
4 6
SVR 24 according to HCV genotypes n=38 Aster V, AIDS-Center Prague, April 2015
SVR+ SVR-0
5016 22 n. of patients
42% pts HIV/HCV treated by P/R achieved SVR 24 n=38
Aster V, AIDS-Center Prague, April 2015
SVR+ SVR-
Czech Republic: supposed number of HCV/HIV co- infections HIV+ 2113
HIV+/anti-HCV+ ? (11%) 232 HIV+/HCV RNA+ ? (75% of HIV/anti-HCV+) 174
1039
114
86: 100% all HCV RNA+ 42: 49% treated 38
16: 19% SVR
0 200 400 600 800 1000 1200
Anti-HCV treatment of HCV/HIV (in supposed total HCV+ number of pts AIDS Center Prague )
SVR 24 +
HIV+/HCV with known SVR
HIV+/HCV treated
HIV+/HCV RNA+ ? (75% of HIV/anti-HCV+)
HIV+/anti-HCV+ ? (11%)
HIV+
n. of patients
HIV infection in the Slovak Republic
• Slovak Republic : 5,4 mil. inhabitants • HIV+: total number: 595 persons (Slovak citizens)
(June 2015)1)
• died (in AIDS): 44 persons (31-th December 2014)11)
• Prevalence: 0,011% =110/1 000 000 inhabitants (y. 2014) 1)
• Annual incidence: 80 new cases/year =14,81/1 000 000 inhabitants( 2014) 1)
• 5 HIV centers • 10 HIV experts • Bratislava take care of 80% patients • No local guidelines,
• physicians follow EASC or DHHS
• Currently supposed in care: patients 90% pts.
• On treatment: supposed (70%) pts.
1) Stanekova D, Jarcuska P 2014
386; 65%
13; 2% 1; 0%
142; 24%
53; 9%
Distribution of HIV+ persons according to the mode of acquisition
Slovak Republic No=595 December 20141)
MSM
IDU
blood transfusion
heterosexual
unknown
VHB and VHC in the Slovak Republic
Prevalence of VHC and VHB infections in Slovakia (VHB in common and Roma population)
HBsAg+1),2) anti-HBc IgG+1),2) HBV DNA+1),2) anti-HCV+3) HCV RNA+3)
common p. Roma p. common p. Roma p. common p. Roma p. common p. n=403 n=452 n=403 n=452 n=403 n=452 n=3608
2,80% 12,50% 15,90% 52,80% 1,80% 11,30% 1,52% 0,67% 1) Jarcusca P. HepaMeta Study 2013 2) Veseliny E, et al. High Hepatitis B and Low Hepatitis C Prevalence in Roma Population in Eastern Slovakia.Central European Journal of Public Health 2014, suppl 1, 1. 3) Schréter I, et al. Prevalence of hepatitis C virus infection in Slovakia. Klin Mikrobiol Infekc Lek. 2007 Apr;13(2):54-8.
HBV/HIV and HCV/HIV coinfections in the Slovak Republic
290; 90%
17; 5%
16; 5%
HBV/HIV and HCV/HIV coinfections in Slovakia n=323 Jarcucka P,June 2014
negative
HBsAg+
HCV RNA+
Conclusions • Still low prevalence of HIV infection in Czech and Slovak
Republic • HIV infection most common in MSM • Higher both VHB and HCV infections prevalence in Slovakia
than in The Czech Republic (both in common population and in HIV+)
• HCV GT 4: „new GT“ in the Czech Repl. • Higher prevalence of VHB infection in Roma population in
Eastern Slovakia, than in common population • Good access for HBV and HIV drugs, but still not satisfactory
for HCV drugs in the Czech Repl. • Simeprevir available since April 2015 (not for GT4) • The Czech Republic: SOF, LDV, 3D, DCV: covered at the end
of 2015?........2015: a year for treatment of „healthy VHC infected patients“
Acknowledgement SNOPKOVA Svatava, Clinic of Infectious Diseases, Faculty of Medicine, Masaryk University, Brno, Czech Republic
POLAKOVA Alena, Hospital Bulovka, Prague, Czech Republic
SEDLACEK Dalibor, Clinic of Infectious Diseases, Medical Faculty, University Hospital Plzen, Czech Republic
CHLIBEK Roman, 4Department of Epidemiology, Faculty of Military Health Sciences, University of Defence, Hradec Králové, Czech Republic MALY Marek, National Reference Laboratory for HIV/AIDS, National Institute of Health, Prague, Czech Republic
NEMECEK Vratislav, National Reference Laboratory for HIV/AIDS, National Reference Laboratory for Viral Hepatitis, National Institute of Health, Prague, Czech Republic
JARCUSKA Pavol, Department of Infectious Diseases, P. J. Šafárik University in Košice, Faculty of Medicine and L. Pasteur University Hospital, Košice, Slovakia
JARCUSKA Peter, 1st Department of Internal Medicine, P. J. Šafárik University in Košice, Faculty of Medicine and L. Pasteur University Hospital, Košice, Slovakia