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HIV and viral hepatitis co-infection: informing management strategies through dedicated cohort studies in sub-Saharan Africa and Switzerland

Applicant Wandeler Gilles Olivier
Number 177118
Funding scheme Ambizione
Research institution Klinik und Poliklinik für Infektiologie Inselspital
Institution of higher education University of Berne - BE
Main discipline Internal Medicine
Start/End 01.09.2017 - 31.08.2018
Approved amount 195'320.00
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Keywords (4)

Cohort studies; Africa; Hepatitis B; HIV

Lay Summary (French)

Lead
Les hépatites virales comptent parmi les causes les plus importantes de mortalité au sein de la population infectée par le VIH. Malgré cela, peu d’étude ont évalué l’impact du VIH sur les complications liées à l’infection par le virus de l’hépatite B (VHB). Suite à l’étude des aspects épidémiologiques du VHB chez les personnes infectées par le VIH en Afrique sub-Saharienne et en Suisse durant les trois années passées, le but de la quatrième année de ce projet sera de mieux comprendre l’évolution au long terme de ces patients.
Lay summary

Contenu et objectifs du travail de recherche

L’objectif principal de la quatrième année de mon projet est d’analyser la réponse au long-terme au traitement de l’hépatite B chez les patients infectés par le VIH et le VHB en Afrique sub-Saharienne et en Suisse. Les objectifs secondaires seront d’analyser l’impact du VHB sur l’évolution des paramètres liés au VIH et de valider des score sérologiques pour l’évaluation de la fibrose hépatique. Le projet s’appuie sur le réseau de cohortes IeDEA, une plateforme de recherche dans le domaine du VIH établie depuis plusieurs années en Afrique sub-Saharienne, et l’étude de Cohorte VIH Suisse. Plus spécifiquement, mes travaux seront basés sur les cohortes VHB que j’ai établi durant ces dernières trois années dans ces collaborations de recherche.

Contexte scientifique et social du projet de recherche

Les hépatites virales sont un problème de santé publique majeur au sein de populations infectées par le VIH. Ce projet a permis de décrire de nombreux aspects importants concernant la prise en charge des patients coinfectés par le VIH et le VHB. Durant la quatrième année de ce projet, il s’agira de disséminer des résultats qui aideront à mettre en place des lignes de conduites cliniques spécifiques au traitement au long-terme des patients coinfectés. Ces données seront également importantes pour le mise en évidence de failles dans la prise en charge du VHB en Afrique sub-Saharienne et l’élaboration d’interventions ciblées.


Direct link to Lay Summary Last update: 23.10.2017

Responsible applicant and co-applicants

Employees

Publications

Publication
High prevalence of binge drinking among people living with HIV in four African countries
Nouaman Marcellin, Vinikoor Michael, Seydi Moussa, Ekouevi Didier, Coffie Patrick, Mulenga Lloyd, Tanon Aristophane, Egger Matthias, Dabis François, Jaquet Antoine, Wandeler Gilles (2018), High prevalence of binge drinking among people living with HIV in four African countries, in Journal of the International AIDS Society, 21(12), e25202.
Adherence to Nucleos(t)ide Analogue Therapies for Chronic Hepatitis B Infection: A Systematic Review and Meta-Analysis
Ford Nathan, Scourse Roz, Lemoine Maud, Hutin Yvan, Bulterys Marc, Shubber Zara, Donchuk Dmytro, Wandeler Gilles (2018), Adherence to Nucleos(t)ide Analogue Therapies for Chronic Hepatitis B Infection: A Systematic Review and Meta-Analysis, in Hepatology Communications, 2(10), 1160-1167.
No Impact of Hepatitis B Virus Infection on Early Mortality Among Human Immunodeficiency Virus–Infected Patients in Southern Africa
Hector Jonas, Vinikoor Michael, Chilengi Roma, Ehmer Jochen, Egger Matthias, Wandeler Gilles (2018), No Impact of Hepatitis B Virus Infection on Early Mortality Among Human Immunodeficiency Virus–Infected Patients in Southern Africa, in Clinical Infectious Diseases, 67(8), 1310-1311.
Chronic hepatitis B virus monoinfection at a university hospital in Zambia
Vinikoor Michael J, Sinkala Edford, Kanunga Annie, Muchimba Mutinta, Nsokolo Bright, Chilengi Roma, Wandeler Gilles, Mulenga Joseph, Chisenga Tina, Bhattacharya Debika, Saag Michael S, Foster Graham, Fried Michael W, Kelly Paul (2018), Chronic hepatitis B virus monoinfection at a university hospital in Zambia, in World Journal of Hepatology, 10(9), 622-628.
Hepatitis B therapy as HIV prevention in Africa: a case series from Zambia
Vinikoor Michael J., Sinkala Edford, Chihota Belinda, Kanunga Annie, Wandeler Gilles (2018), Hepatitis B therapy as HIV prevention in Africa: a case series from Zambia, in Hepatology, 69(1), 458-460.
The current situation and challenges of screening for and treating hepatitis B in sub-Saharan Africa
Béguelin Charles, Fall Fatou, Seydi Moussa, Wandeler Gilles (2018), The current situation and challenges of screening for and treating hepatitis B in sub-Saharan Africa, in Expert Review of Gastroenterology & Hepatology, 12(6), 537-546.
Issues with measuring hepatitis prevalence in resource-limited settings
Wandeler Gilles, Coffie Patrick A, Kuniholm Mark H, Ocama Ponsiano, Egger Matthias (2018), Issues with measuring hepatitis prevalence in resource-limited settings, in The Lancet, 391(10123), 835-836.
Prevention and Care of Hepatitis B in Senegal; Awareness and Attitudes of Medical Practitioners
Tine Judicaël, Diallo Mouhamadou Baïla, Dabis François, Manga Noel M., Dia Ndeye Mery, Seydi Moussa, Wandeler Gilles, Jaquet Antoine, Fall Fatou (2017), Prevention and Care of Hepatitis B in Senegal; Awareness and Attitudes of Medical Practitioners, in The American Journal of Tropical Medicine and Hygiene, 97(2), 389-395.

Collaboration

Group / person Country
Types of collaboration
Institute of Social and Preventive Medicine, University of Bern Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
Treicheville University Hospital, Abidjan Ivory Coast (Africa)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
SolidarMed Mozambique (Africa)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
Center for Infectious Diseases Research in Zambia Zambia (Africa)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
University Hospital Dakar Senegal (Africa)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
University of Bordeaux France (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication

Scientific events

Active participation

Title Type of contribution Title of article or contribution Date Place Persons involved
FORUM Graduate Schools Infection & Immunity (Uni Geneva and Lausanne) Talk given at a conference Towards the functional cure of HBV infection: opportunities and challenges 29.06.2018 Geneva, Switzerland Wandeler Gilles Olivier;
Hepatitis Delta International Network session, EASL 2018 Talk given at a conference Hepatitis delta in HIV-infected individuals: diagnostic challenges and clinical outcomes 11.04.2018 Paris, France Wandeler Gilles Olivier;
Conférence AFRAVIH 2018 Talk given at a conference Mini-lecture: Suivi des hépatites chroniques B 07.04.2018 Bordeaux, France Wandeler Gilles Olivier;
6ième Congrès de la Société Africaine de Pathologie Infectieuse (SAPI) Talk given at a conference Hépatite C : Nouvelles stratégies thérapeutiques 10.11.2017 Dakar, Senegal Wandeler Gilles Olivier;


Associated projects

Number Title Start Funding scheme
154730 HIV and viral hepatitis co-infection: informing management strategies through dedicated cohort studies in sub-Saharan Africa and Switzerland 01.09.2014 Ambizione
154730 HIV and viral hepatitis co-infection: informing management strategies through dedicated cohort studies in sub-Saharan Africa and Switzerland 01.09.2014 Ambizione

Abstract

Background: Hepatitis B Virus (HBV) infection is a major cause of morbidity and mortality in HIV-infected patients across the world. Between 5 and 15% of HIV-infected individuals suffer from a chronic HBV infection, which is the main cause of hepatocellular carcinoma globally. HIV infection has a profound impact on the natural history of viral hepatitis including the acceleration of the progression to end-stage liver disease. Although it is now recognized that tenofovir should be part of the initial antiretroviral therapy in HIV/HBV-coinfected individuals, its impact on long-term HBV virological outcomes and liver-related disease in sub-Saharan Africa (SSA) has not been studied in detail. For instance, changes in liver fibrosis stage and the occurrence of cirrhosis during therapy have not been assessed over the long run in the region and simple tools to monitor the progression of liver disease have not been validated properly. Objectives: The overarching aim of my Ambizione-PROSPER follow-up proposal is to assess long-term HIV- and HBV-related clinical and virological outcomes among HIV/HBV-coinfected individuals in SSA and Switzerland. My main objectives for year 4 of this fellowship are:- Objective Y4.1: To assess the impact of HBV infection on HIV-related outcomes in SSA, including HIV suppression, CD4 recovery and mortality.- Objective Y4.2: To evaluate two-year virological outcomes in treated HIV/HBV-coinfected patients in southern Africa, West Africa and Switzerland, and to assess HBV resistance patterns and changes in liver fibrosis stage.- Objective Y4.3: To analyze the diagnostic validity of simple serologic scores in predicting liver fibrosis and cirrhosis in HIV/HBV-coinfected patients.Methods: My project is based on dedicated HBV cohorts within the International epidemiological Databases to Evaluate AIDS (IeDEA) in SSA and the Swiss HIV Cohort Study (SHCS). Clinical and virological outcomes in HIV/HBV-coinfected patients from SSA will be compared with data from the SHCS. The virological analyses will be performed in dedicated laboratories in SSA. Liver fibrosis assessment will be based on non-invasive serological scores and transient elastography. I will use time-to-event analyses taking into account competing risks for the analysis of longitudinal clinical data and multivariable linear mixed-effect models for assessing trajectories of markers of liver disease and CD4 cell counts. The validity of serologic scores in predicting liver fibrosis in Zambia will be undertaken by using the area under the receiving operating curve (AUROC).Significance: A better understanding of the burden and determinants of HBV infection in HIV-infected individuals is expected to improve its detection, treatment and monitoring. This project builds on existing, well-established cohorts in Southern Africa, West Africa and Switzerland with detailed, longitudinal clinical and virological data. This international network provides an ideal platform to study HBV epidemiology and treatment outcomes and will inform HBV clinical guidelines and related health policy.
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