CROI 2016 Abstract eBook

Abstract Listing

Poster Abstracts

544 Incidence of Hepatitis C Virus Infection in the HIV Outpatient Study Cohort 2000-2013

Taraz Samandari 1 ; Kate Buchacz 1 ; Carl Armon 2 ; Dana Franklin 2 ; Rachel Hart 2 ; Joan S. Chmiel 3 ; JohnT. Brooks 1 ; EllenTedaldi 4 ; for the HIV Outpatient Study Investigators 1 CDC, Atlanta, GA, USA; 2 Cerner Corporation, Kansas City, MO, USA; 3 Feinberg Sch of Med, Northwestern Univ, Chicago, IL, USA; 4 Temple Univ, Philadelphia, PA, USA Background: Recent data on incidence of hepatitis C virus infection (HCV) in the United States (U.S.) are limited. We examined the rates and correlates of incident HCV in a multi- site U.S. cohort of HIV-infected patients in care. Methods: We studied HIV Outpatient Study (HOPS) participants seen in 9 HIV-specialty clinics. We selected patients who had ≥1 clinical encounter between 2000 and 2013 and ≥2 HCV-related tests; their first negative HCV antibody (Ab) test in that interval defined the baseline date for each patient’s analysis and the follow-up accrued until the later of either the last negative HCV Ab test or the midpoint between the last negative HCV Ab test and the first positive HCV Ab, viral load, or genotype test. We assessed rates of incident HCV per 100 person-years (py) overall and by demographic and HIV risk strata using chi-square test of trend over time: 2000-2003, 2004-2007, 2008-2010, and 2011-2013. Risk factors for incident HCV were analyzed using multivariable Cox proportional hazards models. Results: The 1,941 eligible patients (median age 40 years, 23% female, 61%with men who have sex with men as an HIV risk factor (MSM) and 3%with injection drug use [IDU] risk) had a median of two post-baseline HCV Ab tests during observation (interquartile range: 1-4). There were 102 (5.2%) incident HCV infections for an overall incidence of 1.07 (0.87-1.30) per 100py. HCV incidence tended to be higher in earlier calendar years and among persons with IDU risk than among other risk groups; over time, HCV incidence decreased among heterosexuals and persons with IDU risk, but not among MSM (p for trend=0.97) (Figure). In multivariable analyses of 2000-2013 data, factors associated with incident HCV infection were having IDU risk (adjusted hazard ratio [aHR] 3.76, 95% confidence interval [CI] 1.76-8.03 compared with heterosexual risk), and having no insurance (aHR 1.84, 95% CI 1.09-3.11 compared with private insurance). Conclusions: Among HIV-infected patients in care with repeated HCV screening tests during 2000-2013, we observed a high (1% per year) rate of incident HCV infection that over time declined among heterosexuals and persons with IDU risk but remained unchanged among MSM who accounted for the majority of observed events. Rates were also elevated among those with no insurance. Our data support recommendations for annual HCV screenings for HIV-infected persons with MSM risk to enable HCV diagnosis and treatment, if co-infected.

Poster Abstracts

545 Sexual Behaviour is AssociatedWith Recently Acquired HCV in HIV/HCV Coinfected MSM

Marianne Martinello 1 ; Gregory J. Dore 1 ; Jasmine Skurowski 1 ; Janaki Amin 1 ; Rohan I. Bopage 2 ; Robert Finlayson 3 ; David Baker 4 ; Mark Bloch 5 ; GailV. Matthews 1 1 Kirby Inst, Univ of New South Wales, Sydney, Australia; 2 The Albion Cntr, Sydney, Australia; 3 Taylor Square Private Clinic, Sydney, Australia; 4 East Sydney Doctors, Sydney, Australia; 5 Holdsworth House Med Practice, Sydney, Australia Background: Epidemics of HCV infection have emerged in HIV-positive men-who-have-sex-with-men (MSM) in many countries over the past decade. Knowledge of sexual and drug use behaviour in these populations may help target health strategies and interventions. Methods: The Control and Elimination of HCV from HIV-infected individuals within Australia (CEASE-D) cohort study aims to characterise socio-demographic, clinical and behavioural features of individuals with HIV/HCV co-infection. This analysis included individuals enrolled between July 2014 and August 2015 who had completed the screening behavioural questionnaire regarding sexual behaviour, drug use and HCV knowledge. Logistic regression analysis assessed factors associated with recently acquired (<2 years) HCV. Results: 175 HIV/HCV infected individuals (mean age 47 years [SD 9], MSM 89%, cART 97%) were included. Median time since HCV infection was 7 years (IQR 2-15) in MSM and 16 years (IQR 10-24) in the remainder (p<0.001), with 25% and 0% having recently acquired HCV (p=0.014). Injecting drug use (IDU, 53%) and sexual exposure with a partner of the same sex (33%) were the predominant modes of HCV acquisition. IDU ever and within 6 months were reported by 81% and 37%, respectively, with amphetamines the most commonly injected drug (ever 72%). Age at first injecting was older in MSM (27 years [IQR 20-35] vs 17 years [IQR 16-21], p=0.001). Knowledge regarding behaviours associated with HCV transmission was variable; 83% and 73% correctly identified needle sharing and sharing other drug paraphernalia as high risk, whereas fisting, sex toys and group sex were identified as risk factors by 51%, 46% and 52%. Only 69%were aware of the potential for HCV reinfection. In the MSM population (n=155), 34% had a regular male partner (RMP) (HIV-positive 65%) and 66% casual male partners (CMP). Current high-risk sexual behaviour was reported by the majority (condom-less anal intercourse 74%, group sex 35%). While 74% ‘always’ or ‘sometimes’ disclosed their HIV status, only 41% disclosed their HCV status. Recently acquired HCV in MSM was associated with younger age (AOR 0.9, 95% CI 0.9, 1.0; p=0.002), full or part time employment (AOR 3.0, 95% CI 1.1, 8.0; p=0.028), sexual acquisition (AOR 13.6, 95% CI 4.5, 41.2; p<0.001) and CMPs (AOR 4.0, 95% CI 1.2, 13.4; p=0.023). Conclusions: Sexual behaviour was associated with recently acquired HCV in HIV/HCV co-infected MSM. Limited knowledge around sexual transmission risk and HCV status disclosure is concerning.

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CROI 2016