CROI 2016 Abstract eBook

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Poster Abstracts

compared to HBsAg negative patients (median CD4 cell count increase 110 cells/mLvs135 cells/mL, p=0.03), despite similar rates of virological suppression (90%vs88%, p=0.32). HBsAg positivity remained an independent predictor of mortality in adjusted analysis (aHR1.84, 95%CI 1.3-2.6, p=0.001). Among patients initiating tenofovir-containing regimens ( n =3125), HBsAg positivity ( n =350) was no longer significantly associated with increased risk of mortality (aHR 1.45, 95%CI 0.9-2.2, p=0.1) in contrast to the markedly increased risk in patients receiving non-tenofovir based regimens (aHR 3.32, 95%CI 1.8-6.2, p<0.001), p-value for interaction = 0.03. Conclusions: Hepatitis B co-infection was associated with impaired immunological responses to ART and increased risk of mortality in this large cohort of Kenyan patients initiating ART despite adequate HIV virological suppression and no evidence for severe liver disease. Use of tenofovir-containing regimens significantly reduced mortality risk in HIV/HBV co-infected patients.

563 Incidence and Risk Factors for Hepatitis B in HIV-Infected Adults in Rakai, Uganda

Emmanuel Seremba 1 ;Victor Ssempijja 2 ; Sarah Kalibbala 3 ; Ronald H. Gray 4 ; Maria J.Wawer 4 ; Fred Nalugoda 5 ; Corey Casper 6 ; Ponsiano Ocama 1 ; David Serwadda 7 ; Reynolds Steven 8 1 Makerere Univ Coll of Hlth Scis, Kampala, Uganda; 2 Leidos Biomed Rsr, Inc, Frederick, MD, USA; 3 Rakai Hlth Scis Prog, Rakai, Uganda; 4 Johns Hopkins Bloomberg Sch of PH, Baltimore, MD, USA; 5 Rakai Hlth Scis Prog, Entebbe, Uganda; 6 Fred Hutchinson Cancer Rsr Cntr, Seattle, WA, USA; 7 Makerere Univ Schoool of PH, Kampala, Uganda; 8 Johns Hopkins Univ, Baltimore, MD, USA Background: Objective: Coinfection with Hepatitis B (HBV) and HIV is common in sub Saharan Africa (SSA) and accelerates progression of liver disease to cirrhosis and other complications. Vaccination of HIV infected adults for HBV is standard of care in developed countries but not commonly performed in SSA where HBV is primarily believed to be acquired in childhood and where there is a lack of HBV incidence data. We investigated the incidence and risk factors associated with HBV among HIV infected adults in Rakai, Uganda. Methods: We screened stored sera from 944 HIV infected adults enrolled in the Rakai Community Cohort Study between September 2003 to March 2015 for evidence of HBV exposure using the anti-HBc marker. Serum from participants who tested anti-HBc negative (506) at the baseline round was tested over 3-7 consecutive survey rounds for either anti-HBc or anti-HBs sero-conversion. The time of HBV incidence was defined as the median date between the last anti-Hbc or HBsAg negative sample and the first positive anti-HBs or HBsAg serum sample. All ART treatment regimens included lamivudine (3TC) or emtricitabine (FTC). Exact poisson incidence methods were used to estimate the incidence of HBV with 95% confidence intervals while the Cox proportional regression methods were used to estimate adjusted hazard ratios of ART use and other confounders. Results: Forty six infections occurred (12 positive for both HBsAg and anti-HBc, 5 for HBsAg only and 29 for anti-HBc only) over 3,346.4 person years, incidence 1.37/100 person years. HBV incidence was significantly lower with ART use: 0.67 /100 person years with ART use and 2.58/100 person years in absence of ART (p<0.001), and significantly decreased with age: 3.54 /100 pys if aged 15-29 years, 1.5/100 pys if aged 30-39 years and 0.48/100 pys if aged 40-50 years (p<0.001). The adjusted hazard ratios of HBV Incidence significantly differed by ART use: non ART use versus ART use, aHR=0.33(95% CI=0.2-0.6), and by age: 40-50 years versus 15-29 years, aHR=5.65(95% CI=2.1-15.1; 40-50 years versus 30-39 years, aHR=2.71(95%CI=1.1-). There was no statistical significant differences by gender, occupation, marital status or number of sex partners or baseline CD4 count. Conclusions: Conclusion: Ongoing HBV transmission demonstrated by this study represents a potential opportunity for vaccine preventive strategies. The protective effect of 3TC/FTC adds to the existing benefit of scaling up ART globally. 564 Long-Term Changes in Liver Fibrosis in HIV and HIV/HBV Infected Nigerians on ART Jennifer L. Grant 1 ; Oche Agbaji 2 ; Muazu Muhammad 2 ; Placid Ugoagwu 2 ; McHenry Stephen 3 ; ChloeThio 4 ; Agaba Patricia 2 ; Robert Murphy 5 ; Claudia Hawkins 1 1 Northwestern Univ, Chicago, IL, USA; 2 Jos Univ Teaching Hosp, Jos, Nigeria; 3 AIDS Prevention Initiative in Nigeria, Ltd, Jos, Nigeria; 4 Johns Hopkins Univ, Baltimore, MD, USA; 5 Northwestern Univ, Feinberg Sch of Med, Chicago, IL, USA Background: There are limited longitudinal data on changes in liver fibrosis by transient elastography (TE) in HIV/HBV co-infected patients on HBV active antiretroviral therapy (ART) in sub-Saharan Africa. Correlations with HBV DNA levels have also not been performed. Methods: This is a prospective analysis of ART-naïve, HIV and HIV/HBV co-infected adults (>18) at Jos University Teaching Hospital (JUTH), Nigeria, HIV Care and Treatment Center who underwent paired liver stiffness measurement (LSM) by TE at baseline and 36 months after ART initiation. All patients received the combination of either AZT or TDF + 3TC or FTC + NNRTI; 94% of HIV/HBV patients received both TDF + FTC. Cutoffs for Metavir scores were 5.9kPa (F2, moderate fibrosis), 7.6 kPa (F3, advanced fibrosis), and 9.4kPa (F4, cirrhosis). Multivariate (MV) regression models were constructed to identify factors associated with LSM decline, defined as >1 unit decrease in fibrosis stage from baseline, in all patients and HIV/HBV patients alone. Results: 99 HIV and 74 HIV/HBV co-infected ART-naïve patients (Table 1) underwent TE between July 2011 and February 2012 and again following ART initiation between July 2014 and February 2015. After a mean interval of 26.1 (± 10.6) months on ART, a significant decrease in mean LSM occurred in HIV (-0.2kPa, p<0.01) and HIV/HBV patients (-1.9kPa, p<0.01). A similar proportion of HIV and HIV/HBV patients had a decline in fibrosis ≥1 stage [15/22 (68%) vs. 28/42 (65%); p=0.81]. 55 (59%) and 48 (65%) of HIV and HIV/HBV

Poster Abstracts

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CROI 2016