CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

Results: Eleven infections were identified; the country-wide prevalence of HCV viremia was 1.1% among adults ≥ 40 years of age and 5.3% among those with HIV infection. All successfully genotyped cases were due to genotype 4 infection. We identified a cluster of cases in one province, Kasai Occidental, all of which failed initial genotyping attempts. To explore this finding, we are performing additional sampling of adults in this region and employing alternate sequencing approaches. Conclusion: HCV is common among adults in the DRC and disproportionately affects those living with HIV. Based on recent DRC population estimates, 100,000 to 200,000 adults older than 40 years of age may have active infection and be eligible for treatment. Additionally, there appears to be a cluster of HCV cases in one region with undetermined genotype. Previous sequence analysis of HCV samples obtained from this region of the DRC led to the identification of a novel and rare Genotype 7 strain of HCV. Phylogenetic analyses of these cases may provide further insight into the diversity and evolution of HCV in sub-Saharan Africa. Finally, DBS-based HCV testing represents a useful tool for defining the burden of HCV viremia and can be easily incorporated into population-based surveys. 523 LOW HCV PREVALENCE AMONG HIV+ INDIVIDUALS IN SUB-SAHARAN AFRICA Anne Loarec 1 , Lucas Molfino 2 , Kizito Walter 3 , Winnie Muyindike 4 , Valentina Carnimeo 1 , Isabelle Andrieux-Meyer 5 , Suna Balkan 6 , Yvonne Nzomukunda 3 , David Maman 7 , Juliet Mwanga-Amumpaire 8 1 MSF, Epicentre, Paris, France, 2 MSF, Maputo, Mozambique, 3 MSF, Nairobi, Kenya, 4 Mbarara Univ of Sci and Tech, Mbarara, Uganda, 5 MSF, Geneva, Switzerland, 6 MSF, Paris, France, 7 Epicentre, Cape Town, South Africa, 8 MSF, Epicentre, Mbarara, Uganda Background: Data on the burden of hepatitis C virus (HCV) in sub-Saharan Africa among HIV patients are critically needed. We present the results of the screening activities among HIV positive cohorts at 5 sites that are supported by MSF in 4 countries in Eastern and Southern Africa, namely Mbarara in Uganda, Kibera and Homa Bay both in Kenya, Maputo in Mozambique, and Chiradzulu in Malawi. Methods: We included all HIV-positive adults screened between 2014 and 2016 for HCV antibodies at the 5 MSF-supported sites. For each site, a specific screening strategy was implemented in collaboration with the relevant Ministry of Health, according to the context and target population. The screening was done using a single test: OraQuick HCV Rapid Antibody Test (OraSure Technologies, Bethlehem, USA), followed by a viral load (RT-PCR) for confirmation of active infection. Results: In Mbarara, Uganda, 18 (0.24%) out of 7,500 HIV patients, were tested positive with HCV serology test. In Kibera, Kenya, out of 4,500 patients screened, 10 (0.22%) were tested positive for HCV. In Maputo, Mozambique, the proportion was higher: 30 (1.15%) patients out of 2,600. In this latter site, the screening strategy targeted patients with advanced stage of disease or those belonging to a high-risk group, such as intravenous drug users. In Chiradzulu, Malawi, 385 HIV-positive patients were screened and only 2 (0.52%) tested positive for HCV. In Homa Bay, Kenya, out of 351 HIV-positive in-patients screened, one patient (0.28%) was tested positive. The proportion of patients with a positive HCV serology and a confirmed active infection (PCR-positive) varied across sites. A total of 5 (29%) patients out of 17 and 2 (20%) out of 10 were confirmed to have an active HCV infection in Uganda and Kenya, respectively. This proportion was higher in Mozambique where 26 (86%) out of 30 patients were confirmed to have active infection. Conclusion: In 4 sub-Saharan countries, HCV prevalence among HIV positive people was low, between 0.05 and 1%. This is lower than found in previous estimates. HCV infection in the broader HIV-infected population does not seem to be a major public health issue in these settings. Nevertheless, data on specific high-risk groups such as intravenous drug users are still lacking. Our results underscore the need to target screening for HCV infection among high-risk groups.

Poster and Themed Discussion Abstracts

524 EFFECT OF OST AND PSYCHOTHERAPY ON HIV RISK AMONG HCV INFECTED INDIVIDUALS Zahid A. Butt 1 , Nabin Shrestha 1 , Naveed Z. Janjua 2 , for the BC-HTCTeam 1 Univ of British Columbia, Vancouver, British Columbia, Canada, 2 BC Cntr for Disease Control, Vancouver, British Columbia, Canada

Background: Hepatitis C Virus (HCV) and HIV infections co-occur in certain population groups because of shared risk factors. Limited data on time to HIV infection among HCV infected individuals is available. Understanding differences in HIV incidence among these individuals can help inform strategies to prevent HIV infection. We estimated the time to HIV diagnosis among HCV infected individuals and evaluated factors that could affect HIV infection risk. Methods: The British Columbia Hepatitis Testers Cohort (BC-HTC) includes all BC residents (~1.5 million) tested for HCV or HIV from 1990 to 2013 and links medical visits, hospitalizations, cancers, prescriptions and deaths. All HCV positive and HIV negative individuals were followed for a positive HIV test to estimate adjusted hazard ratios (aHR) for factors associated with HIV infection using Cox proportional hazards regression. Results: Of 36,163 individuals who were HCV positive and HIV negative at cohort entry, 2255 (6.2%) acquired HIV over 266,010 years of follow-up for an overall incidence rate of 8.5/1000PY (person years). The HIV incidence rate among HCV seroconverters was 10.7/1000PY versus 8.2/1000PY among those with prevalent HCV infection at diagnosis. Overall median [IQR] time to HIV infection was 3.36 [4.96] years, shorter for seroconverters than prevalent HCV infections (2.78 vs 3.52, p =0.003). In Cox regression, people who injected drugs (PWID) (aHR: 1.42, 95% CI: 1.29-1.57), those with Hepatitis B Virus (HBV) infection (aHR: 1.37, 95% CI: 1.19-1.58), men who have sex with men (MSM) (aHR: 5.91, 95% CI: 4.21- 8.29), and urban residence (aHR: 1.40, 95% CI: 1.19-1.65) were associated with higher risk of HIV infection after adjusting for number of HIV tests. Opioid Substitution Therapy (OST) (aHR: 0.39, 95% CI: 0.33-0.45) and psychiatric counseling (aHR: 0.48, 95% CI: 0.44-0.54) were associated with lower risk of HIV infection. Conclusion: Injection drug use, HBV coinfection, MSM, and urban residence increased the risk of HIV; while engagement in OST and mental health counseling reduced the risk of HIV infection among HCV infected individuals. *The BC-HTC team: Gesink D, Gilbert M, J Wong, M Kuo, A Yu, Alvarez M, Chong M, H Samji, J Buxton, Roth D, Consolacion T, Murti M, Ogilvie G, Balshaw R, M Tyndall, M Krajden

CROI 2017 219