Serokonversi Hepatitis C pada Pasien Hemodialisis di Rumah Sakit Cipto Mangunkusumo

Pendahuluan. Pasien hemodialisis (HD) tergolong kelompok risiko tinggi terinfeksi virus hepatitis C. Penelitian mengenai serokonversi hepatitis C di RS Cipto Mangunkusumo belum pernah dilakukan. Agar transmisi hepatitis C dapat diturunkan, faktor risiko serokonversi hepatitis C penting diketahui. Penelitian ini bertujuan mengetahui proporsi dan faktor risiko serokonversi hepatitis C pada pasien yang menjalani HD di RS Cipto Mangunkusumo. Metode. Penelitian potong lintang terhadap pasien yang menjalani HD di RS Cipto Mangunkusumo pada bulan Juni-Juli 2011. Pemeriksaan anti-HCV menggunakan Roche Elecsys ECLIA, Analisis multivariat menggunakan regresi logistik. Hasil. Pada bulan Juni-Juli 2011 terdapat 135 pasien HD yang memenuhi kriteria inklusi dan eksklusi. Serokonversi mencapai 21,5%. Analisis bivariat menunjukkan hubungan yang bermakna antara lama dialisis (p=0,003) dan jenis kelamin pria (OR 2,43; 95%CI 0,99-5,98; p=0,048) dengan serokonversi hepatitis C. Pasien yang menjalani dialisis >42 bulan (sebelum pemrosesan ulang dialiser menggunakan mesin) lebih banyak yang mengalami serokonversi dibandingkan pasien yang mengalami dialysis ≤42 bulan. Terdapat dua variabel yang marginally statistically significant yaitu HBsAg negatif (p=0,07) dan menggunakan dialiser proses ulang (p=0,07). Pada analisis multivariat, didapatkan jenis kelamin pria (OR 2,91; 95%CI 1,14-7,48; p=0,03) dan lama dialisis (OR 1,02; 95%CI 1-1,03; p=0,007) berhubungan dengan serokonversi hepatitis C. Simpulan. Serokonversi hepatitis C pada pasien yang menjalani HD di RS Cipto Mangunkusumo mencapai 21,5%. Terdapat hubungan signifikan antara jenis kelamin pria dan lama dialisis dengan serokonversi hepatitis C

Chronic hepatitis C infection and liver disease in HIV-coinfected patients in Asia

Data on markers of hepatitis C virus (HCV) disease in HIV-HCV-coinfected patients in resource-limited settings are scarce. We assessed HCV RNA, HCV genotype (GT), IL28B GT and liver fibrosis (FibroScan®) in 480 HIV-infected patients with positive HCV antibody in four HIV treatment centres in South-East Asia. We enrolled 165 (34.4%) patients in Jakarta, 158 (32.9%) in Bangkok, 110 (22.9%) in Hanoi and 47 (9.8%) in Kuala Lumpur. Overall, 426 (88.8%) were male, the median (IQR) age was 38.1 (34.7-42.5) years, 365 (76.0%) reported HCV exposure through injecting drug use, and 453 (94.4%) were on combination antiretroviral therapy. The median (IQR) CD4 count was 446 (325-614) cells/mm3 and 208 (94.1%) of 221 patients tested had HIV-1 RNA <400 copies/mL. A total of 412 (85.8%) had detectable HCV RNA, at a median (IQR) of 6.2 (5.4-6.6) log10 IU/mL. Among 380 patients with HCV GT, 223 (58.7%) had GT1, 97 (25.5%) had GT3, 43 (11.3%) had GT6, eight (2.1%) had GT4, two (0.5%) had GT2, and seven (1.8%) had indeterminate GT. Of 222 patients with IL28B testing, 189 (85.1%) had rs12979860 CC genotype, and 199 (89.6%) had rs8099917 TT genotype. Of 380 patients with FibroScan®, 143 (37.6%) had no/mild liver fibrosis (F0-F1), 83 (21.8%) had moderate fibrosis (F2), 74 (19.5%) had severe fibrosis (F3), and 79 (20.8%) had cirrhosis (F4). One patient (0.3%) had FibroScan® failure. In conclusion, a high proportion of HIV-HCV-coinfected patients had chronic HCV infection. HCV GT1 was predominant, and 62% of patients had liver disease warranting prompt treatment (≥F2)

Renal dysfunction during tenofovir use in a regional cohort of HIV-infected individuals in the Asia-Pacific

Background: In resource-limited settings, routine monitoring of renal function during antiretroviral therapy (ART) has not been recommended. However, concerns for tenofovir disoproxil fumarate (TDF)-related nephrotoxicity persist with increased use. Methods: We investigated serum creatinine (S-Cr) monitoring rates before and during ART and the incidence and prevalence of renal dysfunction after starting TDF by using data from a regional cohort of HIV-infected individuals in the Asia-Pacific. Time to renal dysfunction was defined as time from TDF initiation to the decline in estimated glomerular filtration rate (eGFR) to 30% reduction from baseline using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation or the decision to stop TDF for reported TDF-nephrotoxicity. Predictors of S-Cr monitoring rates were assessed by Poisson regression and risk factors for developing renal dysfunction were assessed by Cox regression. Results: Among 2,425 patients who received TDF, S-Cr monitoring rates increased from 1.01 to 1.84 per person per year after starting TDF (incidence rate ratio 1.68, 95%CI 1.62-1.74, p 50 vs. ≤30, hazard ratio [HR] 5.39, 95%CI 2.52-11.50, p <0.001; and using PI-based regimen (HR 1.93, 95%CI 1.22-3.07, p = 0.005). Having an eGFR prior to TDF (pre-TDF eGFR) of ≥60 ml/min/1.73m2 showed a protective effect (HR 0.38, 95%CI, 0.17-0.85, p = 0.018). Conclusions: Renal dysfunction on commencing TDF use was not common, however, older age, lower baseline eGFR and PI-based ART were associated with higher risk of renal dysfunction during TDF use in adult HIV-infected individuals in the Asia-Pacific region

Factors associated with pre-treatment HIV RNA: Application for the use of abacavir and rilpivirine as the first-line regimen for HIV-infected patients in resource-limited settings

© 2017 The Author(s). Background: Abacavir and rilpivirine are alternative antiretroviral drugs for treatment-naïve HIV-infected patients. However, both drugs are only recommended for the patients who have pre-treatment HIV RNA 30 kg/m2 (OR 2.4 vs. 350 cells/mm3 (OR 3.9 vs. 2000 cells/mm3 (OR 1.7 vs. 25 yielded the sensitivity of 46.7%, specificity of 79.1%, positive predictive value of 67.7%, and negative predictive value of 61.2% for prediction of pre-treatment HIV RNA <100,000 copies/mL among derivation patients. Conclusion: A model prediction for pre-treatment HIV RNA <100,000 copies/mL produced an area under the ROC curve of 0.70. A larger sample size for prediction model development as well as for model validation is warranted

Renal dysfunction during tenofovir use in a regional cohort of HIV-infected individuals in the Asia-Pacific

10.1371/journal.pone.0161562PLoS ONE118e016156

Incidence of syphilis seroconversion among HIV-infected persons in Asia: Results from the TREAT Asia HIV Observational Database

Introduction: Outbreaks of syphilis have been described among HIV-infected men who have sex with men (MSM) in Western communities, whereas reports in Asian countries are limited. We aimed to characterize the incidence and temporal trends of syphilis among HIV-infected MSM compared with HIV-infected non-MSM in Asian countries. Methods: Patients enrolled in the TREAT Asia HIV Observational Database cohort and with a negative non-treponemal test since enrolment were analyzed. Incidence of syphilis seroconversion, defined as a positive non-treponemal test after previously testing negative, was evaluated among patients at sites performing non-treponemal tests at least annually. Factors associated with syphilis seroconversion were investigated at sites doing non-treponemal testing in all new patients and subsequently testing routinely or when patients were suspected of having syphilis. Results: We included 1010 patients from five sites that performed non-treponemal tests in all new patients; those included had negative non-treponemal test results during enrolment and subsequent follow-ups. Among them, 657 patients were from three sites conducting regular non-treponemal testing. The incidence of syphilis seroconversion was 5.38/100 person-years (PY). Incidence was higher in MSM than non-MSM (7.64/100 PY vs. 2.44/100 PY, p<0.001). Among MSM, the incidence rate ratio (IRR) for every additional year from 2009 was 1.19 (p=0.051). MSM status (IRR 3.48, 95% confidence interval (CI) 1.88-6.47), past syphilis diagnosis (IRR 5.15, 95% CI 3.69-7.17) and younger age (IRR 0.84 for every additional 10 years, 95% CI 0.706-0.997) were significantly associated with syphilis seroconversion. Conclusions: We observed a higher incidence of syphilis seroconversion among HIV-infected MSM and a trend to increasing annual incidence. Regular screening for syphilis and targeted interventions to limit transmission are needed in this population