CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

Methods: Polymerase sequences (NS5b) were obtained by Sanger Sequencing (SS) from acute HCV infections, defined as a positive serology and/or a positive viral load < 12 months. Maximum likelihood phylogenies were estimated using FastTree 2.1 under a GTR+CAT model of nucleotide substitution with SH-like tests. More than 400 sequences from Pitié-Salpêtrière hospital HCV patients were used as reference for comparison. Clades with a branch support ≥80% and intra-clade genetic distances <0.03 nucleotide substitution per sites were considered as transmission chains. Results: Sequencing of 80 acute HCV infections diagnosed during the period 2014-2016 from a neighborhood of center of Paris (« le Marais ») was performed. Patients were infected with HCV genotype 1a (50%), 4d (40%), 3a (7.5%) and 2k (2.5%) and 92.5% of themwere coinfected with HIV. At least 81% (n=65) were MSM (15 with unknown sexual orientation). This was a recontamination for 20 patients. Twenty-two transmission chains were identified, including 53 acute Hepatitis C (of which 14 recontaminations) divided in 6 pairs of 2 patients and 14 clusters from 3 to 8 patients. Seven transmission chains were composed by only acute HCV whereas thirteen were mixed acute/chronic. Conclusion: A high incidence of acute HCV infection has been found in HIV MSM patients in Paris and many of these HCV patients were part of a transmission chain. These results highlight the necessity of frequent HCV testing even after a successfull treatment. In this context of clustering, treatment strategies must be rethought and transmitted drug resistance mutations should be monitored in the future. 521 SYSTEMATIC HCV-RNA SCREEN IN HIV+ MSM REVEALS HIGH NUMBERS OF POTENTIAL TRANSMITTERS Dominique L. Braun 1 , Roger Kouyos 1 , Benjamin H. Hampel 1 , Christina Grube 1 , Huldrych F. Günthard 1 , Jürg Böni 2 , Jan S. Fehr 1 , for the Swiss HIV Cohort Study 1 Univ Hosp Zurich, Zurich, Switzerland, 2 Univ of Zurich, Zurich, Switzerland Background: The prevalence of sexually transmitted incident hepatitis C virus (HCV) infections among HIV-positive men who have sex with men (MSM) has increased worldwide, including an epidemic in Switzerland in MSM. The Swiss HCVree Trial (ClinicalTrials.gov NCT02785666) aims to implement a targeted HCV-RNA based assessment of the prevalence of replicating HCV infections in HIV-positive MSM participating in the Swiss HIV Cohort Study (SHCS), and thereafter to treat all HCV-RNA positive MSM with newest anti-HCV direct acting agents. Here we report on preliminary data from the screening period. Methods: Between October 1st 2015 and May 31th 2016 we offered a systematic, intensified HCV-RNA polymerase chain reaction (PCR) based screening to all MSM participating in the SHCS, which is estimated to represent 75% of all HIV-infected MSM living in Switzerland. Participants were screened at least once at the occasion of their regular clinical HIV visit. Liver transaminases were measured simultaneously, considering >50 U/l as above the upper limit of normal. HCV-RNA testing was done centralized at a single lab using the Abbott RealTime HCV assay with a limit of detection of 12 IU/ml. Results: Overall, 3’792 individuals are recorded as MSM in the SHCS database, of themwe screened 3’620 (95%) by HCV-RNA PCR. Hundred-seventy-eight (4.9%) out of these 3’620 MSM harbored a replicating HCV infection (Figure 1). Mean age of MSM was 49 years and 94% had suppressed HIV viremia, without differences between replicating and non-replicating HCV. Genotype (GT) 1 was the most prevalent GT (72%), followed by GT 4 (22%), GT 3 (5%), and GT 2 (1%). Of the 178 MSM with replicating HCV, 32 individuals (18%) had an incident HCV infection, without prior positive HCV test (e.g, HCV antibodies, HCV-RNA) recorded in the SHCS database. Eight of the MSM with an incident HCV (25%) presented with normal liver enzymes during the screening period. Conclusion: We identified a high number of replicating HCV infections among HIV positive MSM participating in the SHCS, resulting in 5% prevalence in this population. A substantial proportion of MSM with replicating HCV presented with non-elevated liver enzymes. Thus, an intensified HCV-RNA based screening strategy among sexually active HIV-coinfected MSM is worth to detect potentially transmitters, and to offer universal treatment with DAAs in order to end the epidemic and to achieve a reduction of disease burden on a population level.

Poster and Themed Discussion Abstracts

522 HCV IN DEMOCRATIC REPUBLIC OF THE CONGO: THE 2013–2014 DEMOGRAPHIC AND HEALTH SURVEY

Gavin Cloherty 1 , Vera Holzmayer 1 , Jacques Pepin 2 , Eric H. Frost 2 , Michael Fried 3 , Anto Tshefu 4 , Franck Fwamba 5 , Jérémie Muwanga 5 , Steven R. Meshnick 3 , Jonathan Parr 3 1 Abbott Labs, Abbott Park, IL, USA, 2 Univ of Sherbrooke, Sherbrooke, Quebec, Canada, 3 Univ of North Carolina at Chapel Hill, Chapel Hill, NC,USA, 4 Univ of Kinshasa, Kinshasa, Democratic Republic of the Congo, 5 Natl AIDS Control Prog (PNLS), Kinshasa, Democratic Republic of the Congo Background: The burden of HCV in sub-Saharan Africa has been poorly studied, despite estimates indicating that the region harbors some of the highest viral hepatitis rates in the world. The 2013-2014 Demographic and Health Survey (DHS) of the Democratic Republic of the Congo (DRC) offered a unique opportunity to delineate the extent and characteristics of HCV infection in the country. Because the DHS is a nationally representative survey, we could estimate the national burden of infection in the DRC. Methods: We extracted RNA from a subset of dried blood spots (DBS) collected during the DHS, including 1,009 adults at least 40 years of age, and performed high-throughput HCV viremia testing using the Abbott m2000 instrument (Abbott Molecular, Des Plaines, IL). The Abbott platform reliably identifies HCV RNA extracted from a 6mm punch from DBS prepared using 50uL of whole blood obtained from subjects with viral loads of at least 1,000 IU/mL and allows for high-throughput screening. HCV-positive samples underwent targeted sequencing for genotyping and phylogenetic analyses.

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