CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

antibody detected or detectable antibody but no detectable RNA). Groups were characterized by demographic variables and comorbid conditions as defined by Elixhauser ICD-9 codes. Comorbid conditions associated with HCV infection were analyzed though multivariate logistic regression using a stepwise approach. Results: In the DH system, 28,849 individuals were tested for HCV, of whom 2,018 (7%) had evidence of current HCV infection. In the KP system, 81, 419 individuals were tested for HCV; 1,644 (2%) had evidence of HCV infection. Among tested individuals in both systems, HCV-infected individuals were older and more often Black and male. Cirrhosis, liver cancer, HIV, renal disease, cardiovascular disease, mental illness, alcohol abuse, tobacco use, illicit drug use and death were significantly more common among HCV-infected individuals (see Table). Diabetes was more common among HCV-infected individuals in the KP system only; COPD was more common among HCV-infected individuals in the DH system only. In multivariate logistic regression analyses, the adjusted odds ratios for cirrhosis, mental illness and liver cancer were statistically significant for HCV-infected individuals while renal disease, cardiovascular disease and death were not significantly associated with HCV infection. Conclusion: Among individuals tested for HCV in these two large, integrated health care systems, HCV infection was common. While several comorbid conditions were more frequently observed among HCV-infected individuals, multivariate analysis showed significant associations for cirrhosis, liver cancer and mental illness, suggesting the high prevalence of many comorbid conditions among HCV-infected individuals may be more associated with socio-demographic characteristics, substance abuse and other comorbid conditions than with HCV infection directly.

Poster and Themed Discussion Abstracts

529 CAUSE & PREDICTORS OF MORTALITY IN AN HIV/HEPATITIS-C–COINFECTED COHORT IN SCOTLAND Rebecca Metcalfe 1 , Gordon Proctor 2 , Joe Schofield 3 , Emma Thomson 2

1 Brownlee Cntr for Infectious Diseases, NHS Greater Glasgow and Clyde, Glasgow, UK, 2 Univ of Glasgow, Glasgow, UK, 3 Pub Hlth Protection Unit, NHS Greater Glasgow and Clyde, Glasgow, UK Background: Cohort studies report the prevalence of HIV/hepatitis C (HCV) co-infection to range from 2.4% to 14% across the world and it is recognised that this group are associated with an increased all-cause and liver-related mortality when compared to HIV and HCV mono-infected patients. A few studies have reported on common causes of death in HIV/HCV co-infection but the results are conflicting. We sought to determine the common causes of mortality in our Scottish co-infected cohort and compare the characteristics of this group to the co-infected patients who remain in care, to determine predictive factors to all cause mortality. Methods: A retrospective cohort review of all patients co-infected with HIV and HCV was carried out, covering a 15 year period. Hospital medical records, coroner records and national registry records were reviewed to collect data on those patients who had died. Data was complied on cause of death, HIV and liver related markers and compared with data of co-infected patients who have not died and statistical analysis performed. Results: Over 15 years, there were 45 deaths in the HIV/HCV cohort, with a total follow-up time of 540 years and an all-cause mortality rate of 7.78/100 person years. Figure 1 shows the number and primary cause of death recorded for this cohort. Of the drug related deaths, a prescribed opiate substitute (methadone) was a contributor in 93%. Factors that were found to be significant predictors of all cause mortality were low CD4 count, high HIV viral load and even in patients not recorded as having had a liver-related death, lower albumin, higher bilirubin levels* and prolonged INR. *when atazanavir use was excluded Conclusion: In this study we found that drug related causes were the most common cause of death (31%) in HIV/hepatitis C co-infected patients. Other infections were responsible in 16% and liver-related deaths and HIV/AIDs were responsible for only 11%. We found that liver biochemistry markers can be used to determine risk of all-cause mortality in HIV/HCV co-infected patients and this suggests that liver dysfunction may adversely impact on the likelihood of overdose (even when not recorded as a contributor to death). The majority of drug related deaths were due to a prescribed opiate substitute which raises concerns about opiate prescribing in those with HIV/HCV co-infection.

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