Journal Article

Access to treatment for HBV infection and its consistency with 2008 European guidelines in a multicentre cross-sectional study of HIV/HBV co-infected patients in Italy

Antonucci, Giorgio, Pagano, Gabriella, Cassola, Giovanni, Orani, Anna, Sagnelli, Caterina, De Stefano, Giulio, Puoti, Massimo, Mazzotta, Francesco, Girardi, Enrico, Petrosillo, Nicola, Sagnelli, Evangelista, Angeletti, Claudio, Grossi, Paolo, Armignacco, Orlando

2013

Overview

Background A survey was performed in 2008 to evaluate the profiles of patients with chronic hepatitis B cared for by Italian Infectious Diseases Centers (IDCs). This analysis describes: i) factors associated with access to the anti-HBV treatment in a cohort of HIV/HBV co-infected patients cared for in tertiary centers of a developed country with comprehensive coverage under the National Health System (NHS); ii) consistency of current anti-HBV regimens with specific European guidelines in force at the time of the study and factors associated with the receipt of sub-optimal regimens. Methods The study focuses on 374 (87.6%) treated patients at some point in their life out of the 427 tested HIV/HBV positive. It is multicentre, cross-sectional in the design. To account for missing values, a Multiple Imputation method is used. Results Three hundred and thirty-four (89.3%) patients were currently treated. The most common current regimen was combination therapy of tenofovir (TDF) plus LAM/FTC (lamivudine/emtricitabine) (n = 235, 70.4%), as part of antiretroviral treatment. In the multivariate analysis, an increased chance of getting treated was independently associated with increasing years since HBV diagnosis (2–10 years, p <0.001; >10 years, p <0.001). Patients consistently treated with European AIDS Clinical Society (EACS) 2008 guidelines were 255 (76.6%), of whom 202 (79.2%) with an indication to an anti-HIV treatment, 30 (11.8%)without an indication, and 21 (8.2%) with cirrhosis. Among the 78 not-consistent patients, LAM mono-therapy (n = 60, 76.9%) was the most common regimen, 34 (56.7%) of them showing HBV DNA load below 1x10 3 IU/mL. Previous anti-HBV treatment (p = 0.01) and a triple HDV co-infection (p = 0.03) reduced the chance of not-consistent regimens. Conversely, HCV co-infection was independently associated with an increased odds ratio of being inconsistently treated (p = 0.004). Conclusion Our study shows that Italian IDCs treat for HBV infection the vast majority of HIV/HBV co-infected patients with no disparities limiting access to antiviral therapy. In approximately two-thirds of the patients on treatment, anti-HBV regimens are consistent with 2008 EACS guidelines. Finally, our study identifies scenarios in which clinical practice deviates from recommendations, as in case of sub-optimal regimens with effective anti-HBV response.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V
• Subject: Acquired immune deficiency syndrome / Adenine - analogs & derivatives / Adenine - therapeutic use / Adult / AIDS / AIDS treatment / Analysis / Anti-HIV agents / Anti-Retroviral Agents - therapeutic use / Antiviral agents / Biomedical and Life Sciences / Biomedicine / Chronic illnesses / Coinfection - virology / Colleges & universities / Communicable diseases / Cross-Sectional Studies / Deoxycytidine - analogs & derivatives / Deoxycytidine - therapeutic use / Deoxyribonucleic acid / DNA / Drug therapy / Emtricitabine / Europe / Female / Guideline Adherence / Health Services Accessibility / Hepatitis / Hepatitis B / Hepatitis B - complications / Hepatitis B - drug therapy / Hepatitis B virus / Hepatitis C virus / Hepatitis D virus / Highly active antiretroviral therapy / Histology / HIV / HIV Infections - complications / HIV Infections - drug therapy / HIV testing / Hospitals / Human immunodeficiency virus / Humans / Infections / Infectious Disease Medicine - methods / Infectious Disease Medicine - standards / Italy / Lamivudine - therapeutic use / Life Sciences / Male / Medical care / Medicine/Public Health / Multivariate Analysis / Organophosphonates - therapeutic use / Practice Guidelines as Topic / Regression Analysis / Research Article / Tenofovir / Treatment Outcome / Tropical diseases / Ultrasonic imaging / Utilization