Transcript Slide 1

Bases de données
observationnelles AC12
Bilan 2007 et Objectifs 2008
Le modèle originel :
Antiretroviral Therapy (ART)
Cohort Collaboration
• France
• French Hospital Database on HIV
(FHDH)
• Aquitaine Cohort
• Germany
• 29 European countries
• Canada
• British Columbia Centre for Excellence
in HIV (BCCfE-HIV)
• South Alberta Clinic
• USA
• Italian Cohort of Antiretroviral-Naive
Patients (ICONA)
• Switzerland
• Swiss HIV Cohort Study
• Netherlands
• AIDS Therapy Evaluation project
Netherlands (ATHENA)
• Spain
• PISCIS, Catalonia and Balearic islands
• United Kingdom
• Royal Free Hospital Cohort, London
Cohort Collaboration
• The Multicenter Study Group on EuroSIDA
• Frankfurt HIV Cohort
• Köln / Bonn Cohort
• Italy
ART
• Collaborations in HIV Outcomes Research
US (CHORUS)
• 1917 Clinic Cohort, University of Alabama,
Birmingham
• University of Washington HIV Cohort,
Seattle
• Veterans Aging Cohort Study (VACS),
West Haven
www.art-cohort-collaboration.org
The Antiretroviral Therapy in Low-Income
Countries (ART-LINC) Collaboration
ANRS 12101 / 12138 & NIH/OAR
Dabis, Egger, Schechter
• A network of 21 HIV treatment programs and 47 clinical centers in
Africa (Morocco, Senegal, Côte d’Ivoire, Nigeria, Cameroon,
Uganda, Malawi, South Africa, Botswana), Latin America (Argentina,
Brazil), and Asia (India, Thailand)
– Sites identified through literature searches and personal contacts
• Site assessments conducted through self-administered surveys and on-site
assessments by ART-LINC central team (2004 and 2006) and through an
electronic system DataCol ® (2008)
– Pooling of existing databases with individual patient data:
• Merger # 1 : 2004-2005, N = 8.700
• Merger # 2 : 2006-2007, N = 40,000
80
80
A
B
60
S u b -S a h a ra n A frica
40
A sia
20
P e rce n ta g e w o m e n
% o f to ta l p a tie n ts in re g io n
Number of patients receiving ART (A); Proportion of women (B);
Median baseline CD4 (C); Proportion with viral load (D) - Kaiser (CROI 2008)
S u b -S a h a ra n A frica
60
S o u th A m e rica
40
20
A sia
S o u th A m e rica
0
0
250
C
S o u th A m e rica
200
150
100
A sia
S u b -S a h a ra n A frica
50
2 0 0 1 2 0 0 2 2 0 0 3 2 0 0 4 0 5 -0 6
Year
2001
% w ith H IV vira l lo a d a t 6 m o n th s
M e d ia n C D 4 ce ll co u n t (ce lls/u l)
2 0 0 1 2 0 0 2 2 0 0 3 2 0 0 4 0 5 -0 6
2002
2003
2 0 0 4 0 5 -0 6
80
D
S o u th A m e rica
60
40
S u b -S a h a ra n A frica
20
A sia
0
2001
2002
2003
Year
2 0 0 4 0 5 -0 6
C u m u la tiv e m o rta lity (% )
Mortality over four years
15
Sub-Saharan Africa
10
5
Europe & North America
0
0
12
24
36
M o n th s a fte r sta rt o f A R T
48
CROI 2007 – Egger Plenary
Sustained long-term CD4 response to ART among naïve
patients in low-income countries
Denis Nash - CROI 2008
450
400
395
372
350
355
376
377
366
336
300
301
263
250
230
200
150
100
114
50
0
Baseline
1
2
3
4
5
Sustained long-term CD4 response to ART among naïve
patients in low-income countries
D. Nash - CROI 2008
Most important determinant of CD4 trajectory after ART initiation is
baseline CD4 (increasing with calendar time at most sites)
700
600
500
Missing
0-<24
25-49
50-99
100-149
150-199
200-299
300+
400
300
200
100
0
Baseline
1
2
3
4
5
Tuberculosis in the first year after Initiation of ART in Low-Income and
High-Income Countries
The ART-LINC Collaboration and The ART Cohort Collaboration
Higher incidence in lower-income countries(7.4 vs 1.0 per 100 PY) but
relative reduction over time is comparable and low CD4 is the most
important risk factor
QuickTime™ et un
décompresseur TIFF (non compressé)
sont requis pour visionner cette image.
CID 2007:45 (1 December)
Probability of death or lost-to-follow-up in 2,710 adults starting
ART at WHO stage 1 or 2 and CD4 >200/mm3 or unknown,
according to CTX prescription (C. Lewden in progress)
P=0.006
0.20
Death or loss to follow-up probability
Adjusted HR: 046 (0.30-0.73)
0.16
0.12
0.08
0.04
0.00
0
6
12
Time (months)
CTX+HAART
Only HAART
18
24
Coût-efficacité de stratégies de rétention des
patients sous ART
Hapsatou Touré, Xavier Anglaret, Elena Losina
François Dabis, Ken Freedberg
Objectif général
Comparer l’efficacité et les ratios de
coût/efficacité de stratégies actives de
recherche de patients, initialement sous
traitement antirétroviral, perdus de vue dans
des cohortes sélectionnées de pays à
ressources limitées (Abidjan, Cape Town, …)
QuickTime™ et un
décompresseur TIFF (LZW)
sont requis pour visionner cette image.
ART-LINC: Box 5, P. 28-29
International epidemiological
Databases to Evaluate AIDS
• 7 regional networks
• North America
• South America / Caribbean
• West Africa
• Central Africa
• East Africa
• Southern Africa
• Australia / Asia
• Resource limited countries networks
• ART-LINC Collaboration
• Treat Asia HIV Observational Database (TAHOD)
www.iedea-hiv.org
www.art-linc.org
www.amfar.org
International epidemiological Database
to Evaluate AIDS (IeDEA)
IeDEA – West Africa
Coordinating Investigators
François DABIS (France)
Emmanuel BISSAGNENE (Côte d’Ivoire)
Project Manager
Didier K. EKOUEVI
Progress report - February 2008
Adult clinical centers in West Africa (N = 16,945)
Name
USAC
Location
Côte d’Ivoire
Number of patients on HAART
2442
CePReF
MTCT-Plus
SMIT
CIRBA
CNTS
Toure Hospital
Point G
CNHU
ANRS 1215
MRC
Côte d’Ivoire
Côte d’Ivoire
Côte d’Ivoire
Côte d’Ivoire
Côte d’Ivoire
Mali
Mali
Benin
Senegal
Gambia
3393
461
4608
2272
716
1113
431
872
404
233
Death probability in the first 12 months after ART
initiation for 11 adult cohorts in West Africa
according to baseline CD4 count (N = 14,832)
9.4%
4.6%
2.1%
Retention of the patients in the 11 participating adult
clinics in West Africa in the first 12 months
after ART initiation (N = 14,832 adults)
81.0%
[81.3-82.6]
International epidemiological Database
to evaluate AIDS (IeDEA) in West Africa
Cancer research proposal #1 - 2008
Prevalence of tobacco, alcohol and other
recreational drugs use within HIV-infected
adult cohorts
International epidemiological Database
to evaluate AIDS (IeDEA) in West Africa
Cancer research proposal #2 - 2008
HIV prevalence among patients hospitalized
for malignancy in Abidjan (Côte d’Ivoire)
Paediatric ART in Sub-Saharan Africa:
the multi-center KIDS-ART-LINC collaboration
Dabis, Mbori-Ngacha
ANRS 12147 & NIH/OAR
To define prognosis of children treated with
ART in sub-Saharan Africa in relation to the
type of treatment program
http://www.rcqhc.org/kids-art-linc
Scientific Output 2006-2007
• Site assessment and organization of collaboration
published in Cohort Profile section of Int J Epidemiol
2007;doi:10.1093/ije/dym216
• First data merger completed (individual clinical data from 8
sites, 3644 children, 2.666 on ART)
• Two-year survival analysis done and results presented
o CROI 2007 (Los Angeles) – February 2007
o PEPFAR 2007 (Kigali) – June 2007
o Manuscript submitted
Delay in start ART until immunodeficiency results in
excess mortality, most in 1st six months treatment
Arrive CROI 2007 (cité par Mofenson - CROI 2008)
Meta-analysis 1,195 children from 8 African data bases
53% >5 years of age, 66% severe age-related immune deficiency
ARV: NNRTI-based 58%, PI-based 37%
Months from
ART start
Probability of death after starting ART
Immune Deficient at Start
ART
6 months
12 months
0.4%
after
6 mos
7.8%
8.2%
Not Immune Deficient at
Start ART
6% excess mortality
1.8%
2.2%
0.4%
after
6 mos
QuickTime™ et un
décompresseur TIFF (LZW)
sont requis pour visionner cette image.
KIDS-ART-LINC: Box 3, P. 24-25
Scientific perspectives 2008
•
More analyses of the first merger :
– Sustained response to first-line ART regimens (durability, tolerance)
– Growth abnormalities and response to ART
– Incidence of tuberculosis, opportunistic infections, ART response in relation
to prior PMTCT exposure cannot be investigated with the currently available
data
•
Repeat site assessment within IeDEA framework and/or specific survey on the
practice of virological testing and viral resistance
•
Initiate the development of a medico-economic model of pediatric care in
Africa (“à la Freedberg”) using the KIDS-ART-LINC data set and network
•
No new merger outside of very specific objectives
International epidemiological
Databases to Evaluate AIDS
• 7 regional networks
• North America
• South America / Caribbean
• West Africa
• Central Africa
• East Africa
• Southern Africa
• Australia / Asia
• Resource limited countries networks
• KIDS-ART-LINC Collaboration
• Treat Asia HIV Observational Database (TAHOD)
www.iedea-hiv.org
www.anecca.org
www.amfar.org
International epidemiological Database to
Evaluate AIDS (IeDEA)
West Africa
Pediatric Working group
Valériane Leroy, Alain Azondékon
Study population
(N = 2204 children on HAART)
Country
Center
Number of
Children under
HAART
%
Bénin
UPEIV
71
3
Côte d’Ivoire
CePReF
309
14
Côte d’Ivoire
CHU Yopougon
669
31
Côte d’Ivoire
CIRBA
141
6
Côte d’Ivoire
MTCT-Plus
74
3
Gambie
FAJARA
23
1
Ghana
Korle BU Hosp
128
6
Mali
Hop G. Touré
674
31
Sénégal
Hop A Royer
115
5
2204
100
Total
Bases de données observationnelles
Conclusions (février 2008)
• L’ANRS seule ne peut pas maintenir des bases de
données internationales dans les pays à resources
limitées : quid de la politique de sites ?
• Le partenariat avec les NIH est possible, mais :
– La collaboration IeDEA est le nouveau cadre de référence
– On ne pourra constituer de nouveaux “mergers” de
données inter-régionales (adultes ou pédiatriques) qu’en
rapport avec des objectifs très spécifiques
• Réorienter les demandes de soutien à l’ANRS en
fonction de ce nouveau contexte