www.treatasia.org
TREAT Asia cohort studies:
Asia-Pacific region of the
IeDEA collaboration
Matthew Law
Kirby Institute, UNSW Australia
www.treatasia.org
TREAT Asia cohort studies
 TREAT Asia and IeDEA
 TREAT Asia HIV Observational Database (TAHOD)
 TREAT Asia Studies Evaluating Resistance (TASER)
 TREAT Asia Paediatric HIV Observational Database
(TApHOD)
 TAHOD Low Intensity Transfer (TAHOD LITE)
 Conclusions
www.treatasia.org
TREAT Asia cohort studies
 TREAT Asia and IeDEA
 TREAT Asia HIV Observational Database (TAHOD)
 TREAT Asia Studies Evaluating Resistance (TASER)
 TREAT Asia Paediatric HIV Observational Database
(TApHOD)
 TAHOD Low Intensity Transfer (TAHOD LITE)
 Conclusions
www.treatasia.org
TREAT Asia
 Therapeutics Research, Education and AIDS Training
in Asia
 Supported by the Foundation for AIDS Research
 Network of clinicians at sites around the Asia-Pacific
region
 TREAT Asia office in Bangkok
 Biostatistical centre at Kirby Institute, UNSW, Sydney,
Australia
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TREAT Asia network
Pediatric sites (16)
Adult sites (21)
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2nd TREAT Asia Network Annual Meeting
12-14 September 2002
Bangkok
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Region 1:
North America
• Canada
• United States
Region 5:
Asia and Australia
• Australia
• Cambodia
• China
• Hong Kong
• India
• Indonesia
• Japan
• Malaysia
• Philippines
• Singapore
• South Korea
• Taiwan
• Thailand
• Vietnam
Region 2:
Caribbean, Central
and South America
• Argentina
• Brazil
• Chile
• Haiti
• Honduras
• Mexico
• Peru
Region 8:
West Africa
• Benin
• Burkina Faso
• Côte d’Ivoire
• Gambia
• Ghana
•
•
•
•
•
Guinea-Bissau
Mali
Nigeria
Senegal
Togo
Region 9:
Central Africa
• Burundi
• Cameroon
• Rwanda
Region 11:
Southern Africa
• Botswana
• Lesotho
• Malawi
• Mozambique
• South Africa
• Zambia
• Zimbabwe
Region 10:
East Africa
• Kenya
• Tanzania
• Uganda
www.treatasia.org
TREAT Asia cohort studies
 TREAT Asia and IeDEA
 TREAT Asia HIV Observational Database (TAHOD)
 TREAT Asia Studies Evaluating Resistance (TASER)
 TREAT Asia Paediatric HIV Observational Database
(TApHOD)
 TAHOD Low Intensity Transfer (TAHOD LITE)
 Conclusions
www.treatasia.org
TAHOD/TASER
 TAHOD recruits a subset of patients at sites
 Designed to assess treatment outcomes and risk factors
 From 2003, all data entirely observational
 6468 patients recruited, 4496 in active follow-up
 TASER recruited patients starting first or second ART
 Designed to assess resistance patterns
 Mandated viral load assessment annually – resistance testing
in those failing
 2025 patients recruited 1253 in active follow-up
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TAHOD/TASER
 Combined TAHOD/TASER dataset
 8493 patients recruited, 5749 in active follow-up
 quite detailed data, good follow-up
 good resource for treatment outcomes and risk factors
 Not a surveillance mechanism
 subsample of patients seen at sites
 relatively small patient numbers
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CD4% and absolute CD4 counts in Asia
 Absolute CD4
counts lower in
Asian populations
for a given CD4%
 Uncertain
significance
Achhra AC, et al. JAIDS & CR 2010;1:1-4.
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Risk of AIDS or death by CD4 count strata
Incidence rate per 100 person years
45
TAHOD (Asian)
40
AHOD (white)
35
30
25
20
15
10
5
0
<50
50-100 100-200 200-350 350-500
Latest CD4+ counts, lagged by 3 months
>500
 CD4 count thresholds appear similar
Achhra AC, et al. JIAPAC 2011;10(3):160-70.
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Survival by PCP prophylaxis and CD4 count

67% of patients with CD4<200 receiving
PCP prophylaxis
Lim PL et al. JIAS 2012;15:1
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Factors associated with virologic failure
Total
No of patients
1173
No of failures
120
OR
Multivariate
95% CI
p
TDR
No TDR
0.033
1122
112
1
TDR with susceptible ART
21
1
0.62
(0.08 to 4.68)
0.647
TDR with suboptimal ART
30
7
3.12
(1.31 to 7.43)
0.010
Pre-treatment CD4
(counts/uL)
<=50
368
46
1
51-100
183
19
0.88
(0.49 to 1.57)
0.662
101-200
288
32
1.02
(0.62 to 1.68)
0.930
201+
305
18
0.41
(0.22 to 0.74)
0.003
29
5
Missing
*Global p
0.012
~Adherence
<0.001
>=95%
~
71
1
<95%
~
18
9.37
Missing
~
31
(5.00 to 17.6)
<.001
Phanuphak P, et al. JAIDS 2014;66:74-9.
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Resistance patterns
P
e
r
c
e
n
t
a
g
e
NNRTI
NRTI
Recent infection
Chronic infection
 More resistance in recently infected than chronic: 6.1% vs 4.0%
(p=0.065)
Kiertiburanakul S, et al. PLoS One 2013;8(6):e62057.
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Factors associated with suboptimal adherence
 More frequent adherence assessment
associated with improved adherence
Jiamsakul A, et al. JIAS 2014;17(1):18911.
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Trends in CD4 count at ART initiation
Kiertiburanakul S, et al. JIAS 2014;17:18804.
www.treatasia.org
Time trends in ART at initiation
Boettiger D, et al. PloS One 2014 in press.
www.treatasia.org
TREAT Asia cohort studies
 TREAT Asia and IeDEA
 TREAT Asia HIV Observational Database (TAHOD)
 TREAT Asia Studies Evaluating Resistance (TASER)
 TREAT Asia Paediatric HIV Observational Database
(TApHOD)
 TAHOD Low Intensity Transfer (TAHOD LITE)
 Conclusions
www.treatasia.org
TApHOD
 TApHOD recruits all children seen at sites
 More representative than TAHOD
 Commenced 2008
 5227 children recruited, 3504 in active follow-up
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Time to CD4≥25% after cART initiation
Handsudewechakul, R et al. JAIDS 2010;55(4):503-9.
www.treatasia.org
Weight and height for age scores from cART
Handsudewechakul, R et al. JAIDS 2010;55(4):503-9.
www.treatasia.org
Severe anaemia in first 6 months of HAART
 Ever received AZT > 3-fold risk of severe anaemia
(Hb<7.5 g/dL)
Bunupuradah, T et al. Int J Infect Dis 2013;17:e806-e810.
www.treatasia.org
Weight for age predicts survival
12
Relative risk
10
8
6
4
2
0
<-3SD
>-3 to <2 SD
Weight for age Z-score
>-2SD
 After adjustment for time updated CD4%
Kariminia A et al. JAIDS 2014 in press.
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Rate per 100 pyrs
Rates of all OIs in TApHOD
100
90
80
70
60
50
40
30
20
10
0
Pre ART
First 6
months
After 6
months
Mono/duo
First 6
months
After 6
months
HAART
Prasitsuebsai W et al. PIDJ 2014;33:747-52.
www.treatasia.org
TREAT Asia cohort studies
 TREAT Asia and IeDEA
 TREAT Asia HIV Observational Database (TAHOD)
 TREAT Asia Studies Evaluating Resistance (TASER)
 TREAT Asia Paediatric HIV Observational Database
(TApHOD)
 TAHOD Low Intensity Transfer (TAHOD LITE)
 Conclusions
www.treatasia.org
TAHOD LITE
 Aim is to create a larger, but simpler, database
 Include all patients seen at sites
 Data to be included
 Demographics
 ART, CD4, HIV viral load
 Lost to follow-up, transferred clinics, survival
 Eight sites currently will participate
 Anticipate ~50,000 patients who have started ART
 Data management and analysis at the Kirby Institute

www.treatasia.org
TAHOD LITE
 Creates something close to a surveillance mechanism
 More representative sampling frame
 Much bigger patient numbers
 Can answer more reliably questions like
 Trends in ART at initiation
 Trends in CD4 at initiation
 Rates of lost to follow-up
www.treatasia.org
TREAT Asia cohort studies
 TREAT Asia and IeDEA
 TREAT Asia HIV Observational Database (TAHOD)
 TREAT Asia Studies Evaluating Resistance (TASER)
 TREAT Asia Paediatric HIV Observational Database
(TApHOD)
 TAHOD Low Intensity Transfer (TAHOD LITE)
 Conclusions
www.treatasia.org
Conclusions
 Are databases like TAHOD still relevant and useful?
 What are treatment outcomes as HIV-positive children
age through adolescence and into adulthood?
 What are long-term ART outcomes in Asia?
 are rates of CVD, cancer, liver and kidney disease similar to
those seen in developed countries?
 Will earlier and wider treatment across the region
effect outcomes negatively?
 poor adherence? Viral failure and resistance?
www.treatasia.org
Conclusions
 TREAT Asia studies are region wide resource
 We have a dataset that might answer your questions
 TAHOD/TASER
 Long–term treatment outcomes in adults
 TApHOD
 Treatment use and outcomes in children
 TAHOD LITE
 Time trends and treatment guidelines
www.treatasia.org
Plug
A Decade of Combination Antiretroviral Treatment in Asia:
the TREAT Asia HIV Observational Database (TAHOD)
Cohort
Nicolas Durier on behalf of TAHOD
WEPE070 – Wednesday 23 July 12.30-14.30
www.treatasia.org
TASER ACKNOWLEDGEMENTS
The TREAT Asia Studies to Evaluate Resistance is an initiative of TREAT Asia, a program of amfAR, The Foundation for AIDS Research,
with major support provided by the Dutch Ministry of Foreign Affairs through a partnership with Stichting Aids Fonds, and with additional support
from amfAR and the National Institute of Allergy and Infectious Diseases (NIAID) of the U.S. National Institutes of Health (NIH) and the National
Cancer Institute (NCI) as part of the International Epidemiologic Databases to Evaluate AIDS (IeDEA) (grant no. U01AI069907). Queen
Elizabeth Hospital and the Integrated Treatment Centre are supported by the Hong Kong Council for AIDS Trust Fund. The Kirby Institute is
funded by the Australian Government Department of Health and Ageing, and is affiliated with the Faculty of Medicine, The University of New
South Wales. The use of vircoTYPE™ HIV-1 is supported by Janssen Diagnostics BVBA.
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Members of the TASER study include:
PCK Li† and MP Lee, Queen Elizabeth Hospital and KH Wong, Integrated Treatment Centre, Hong Kong, China;
N Kumarasamy and S Saghayam, YRG Centre for AIDS Research and Education, Chennai, India;
S Pujari and K Joshi, Institute of Infectious Diseases, Pune, India;
TP Merati‡ and F Yuliana, Faculty of Medicine, Udayana University & Sanglah Hospital, Bali, Indonesia;
A Kamarulzaman and LY Ong, University Malaya Medical Center, Kuala Lumpur, Malaysia;
C KC Lee and B HL Sim, Hospital Sungai Buloh, Sungai Buloh, Malaysia;
M Mustafa and N Nordin, Hospital Raja Perempuan Zainab II, Kota Bharu, Malaysia;
R Ditangco and RO Bantique, Research Institute for Tropical Medicine, Manila, Philippines;
YMA Chen, YJ Chen and YT Lin, Taipei Veterans General Hospital and AIDS Prevention and Research Centre, National Yang-Ming
University, Taipei, Taiwan;
P Kantipong and P Kambua, Chiang Rai Regional Hospital, Chiang Rai, Thailand;
P Phanuphak and S Sirivichayakul, HIV-NAT/Thai Red Cross AIDS Research Centre, Bangkok, Thailand;
W Ratanasuwan and R Sriondee, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand;
T Sirisanthana and J Praparattanapan, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand;
S Sungkanuparph, S Kiertiburanakul, and L Chumla, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand;
R Kantor, Brown University, Rhode Island, U.S.A.;
AH Sohn, N Durier and T Singtoroj, TREAT Asia, amfAR -- The Foundation for AIDS Research, Bangkok, Thailand;
DA Cooper, MG Law, and A Jiamsakul, The Kirby Institute, University of New South Wales, Sydney, Australia.
† Steering Committee Chair, ‡ Co-Chair
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TAHOD ACKNOWLEDGEMENTS
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CV Mean, V Saphonn* and K Vohith, National Center for HIV/AIDS, Dermatology & STDs, Phnom Penh, Cambodia;
FJ Zhang*, HX Zhao and N Han, Beijing Ditan Hospital, Capital Medical University, Beijing, China;
PCK Li* and MP Lee, Queen Elizabeth Hospital, Hong Kong, China;
N Kumarasamy*, S Saghayam and C Ezhilarasi, YRG Centre for AIDS Research and Education, Chennai, India;
S Pujari*, K Joshi and A Makane, Institute of Infectious Diseases, Pune, India;
TP Merati*, DN Wirawan and F Yuliana, Faculty of Medicine Udayana University & Sanglah Hospital, Bali, Indonesia;
E Yunihastuti*, D Imran and A Widhani, Working Group on AIDS Faculty of Medicine, University of Indonesia/
Ciptomangunkusumo Hospital, Jakarta, Indonesia;
S Oka*, J Tanuma and T Nishijima, National Center for Global Health and Medicine, Tokyo, Japan;
JY Choi*, Na S, and JM Kim, Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of
Medicine, Seoul, South Korea;
CKC Lee*, BLH Sim and R David, Hospital Sungai Buloh, Kuala Lumpur, Malaysia;
A Kamarulzaman* † and A Kajindran, University of Malaya Medical Centre, Kuala Lumpur, Malaysia;
R Ditangco*, E Uy and R Bantique, Research Institute for Tropical Medicine, Manila, Philippines;
YMA Chen*, WW Wong and LH Kuo, Taipei Veterans General Hospital and AIDS Prevention and Research Centre, National
Yang-Ming University, Taipei, Taiwan;
OT Ng*, A Chua , LS Lee, and A Loh, Tan Tock Seng Hospital, Singapore;
P Phanuphak*, K Ruxrungtham and M Khongphattanayothin, HIV-NAT/Thai Red Cross AIDS Research Centre, Bangkok,
Thailand;
S Kiertiburanakul* ‡, S Sungkanuparph and N Sanmeema, Faculty of Medicine Ramathibodi Hospital, Mahidol University,
Bangkok, Thailand;
R Chaiwarith*, T Sirisanthana and W Kotarathititum, Research Institute for Health Sciences, Chiang Mai, Thailand;
P Kantipong and P Kambua, Chiang Rai Prachanukroh Hospital, Chiang Rai, Thailand;
VK Nguyen*, VH Bui and TT Cao, National Hospital for Tropical Diseases, Hanoi, Vietnam;
TT Pham*, DD Cuong and HL Ha, Bach Mai Hospital, Hanoi, Vietnam;
AH Sohn*, N Durier* and B Petersen, TREAT Asia, amfAR - The Foundation for AIDS Research, Bangkok, Thailand;
DA Cooper, MG Law*, A Jiamsakul* and D Boettiger, The Kirby Institute, The University of New South Wales, Sydney, Australia.
* TAHOD Steering Committee member; † Steering Committee Chair; ‡ co-Chair.
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TApHOD ACKNOWLEDGEMENTS
CV Mean, V Saphonn*, S Sarun, National Centre for HIV/AIDS, Dermatology and STDs, Phnom Penh, Cambodia;
V Ung*†, M Pok, Y Kdan, B Chan, National Pediatric Hospital, Phnom Penh, Cambodia;
J Tucker, New Hope for Cambodian Children, Phnom Penh, Cambodia;
FJ Zhang, Beijing Ditan Hospital, Capital Medical University, Beijing, China;
N Kumarasamy*, S Saghayam, E Chandrasekaran, YRGCARE Medical Centre, CART CRS, Chennai, India;
DK Wati*, LPP Atmikasari, IY Malino, Sanglah Hospital, Udayana University, Bali, Indonesia;
N Kurniati*, and D Muktiarti, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia;
SM Fong*, M Thien, M Lim, F Daut, Hospital Likas, Kota Kinabalu, Malaysia;
NK Nik Yusoff*, P Mohamad , Hospital Raja Perempuan Zainab II, Kelantan, Malaysia;
KA Razali*, TJ Mohamed, NF Abdul Rahman, NADR Mohammed, Pediatric Institute, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia;
R Nallusamy*, KC Chan, Penang Hospital, Penang, Malaysia;
V Sirisanthana*, P Oberdorfer, L Aurpibul, T Sudjaritruk, Research Institute for Health Sciences and Faculty of Medicine, Chiang Mai University,
Chiang Mai, Thailand;
R Hansudewechakul*, S Denjanta, W Srisuk, A Kongphonoi, Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand;
P Lumbiganon*, P Kosalaraksa, P Tharnprisan, T Udomphanit, Division of Infectious Diseases, Department of Pediatrics, Khon Kaen University,
Khon Kaen, Thailand;
G Jourdain, PHPT-IRD UMI 174 (Institut de recherche pour le développement and Chiang Mai University), Chiang Mai, Thailand;
T Bunupuradah*, T Puthanakit, W Prasitsuebsai, W Chanthaweethip, HIV-NAT/Thai Red Cross AIDS Research Centre, Bangkok, Thailand;
K Chokephaibulkit*, K Lapphra, W Phongsamart, S Sricharoenchai, Siriraj Hospital, Mahidol University, Bangkok, Thailand;
KH Truong*‡, QT Du, CH Nguyen, Children’s Hospital 1, Ho Chi Minh City, Vietnam;
VC Do*, TM Ha, VT An, Children’s Hospital 2, Ho Chi Minh City, Vietnam;
LV Nguyen*, DKT Khu, AN Pham, LT Nguyen, National Hospital of Pediatrics, Hanoi, Vietnam;
ON Le, Worldwide Orphans Foundation, Ho Chi Minh City, Vietnam;
AH Sohn*, N Durier, C Sethaputra, TREAT Asia, amfAR -- The Foundation for AIDS Research, Bangkok, Thailand;
DA Cooper, MG Law*, A Kariminia, The Kirby Institute, UNSW Australia, Sydney, Australia;
*Steering Committee member; † Current Steering Committee Chair; ‡ co-Chair