CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

Methods: The GEHEP-002 multicentric cohort (ClinicalTrials.gov ID: NCT02785835) recruits HCC cases diagnosed in HIV-infected patients from 32 centers from Spain. The Barcelona-Clinic Liver Cancer (BCLC) staging systemwas used for HCC staging and treatment allocation. The proportion of patients receiving less effective therapy against HCC as indicated by BCLC stage at diagnosis and the evolution of this proportion over time was analyzed. Results: 317 HCC cases from the GEHEP-002 cohort were included in this study. The distribution of patients according to BCLC stage at diagnosis were: Stage 0= 6 (2%); Stage A: 115 (36.3%); Stage B: 26 (8.2%); Stage C: 111 (35%) and Stage D: 59 (18.5%). Eighty-four (32.5%) out of 258 patients who were potentially candidates to therapy did not received therapy or received treatment less effective as indicated by BCLC (Table 1). The proportion of patients receiving no/less effective therapy varied according to the BCLC stage. Thus, it was 25%, 34.6% and 43% in patients at BCLC stage 0/A, B and C, respectively (p<0.0001) (Table 1). Forty-one (43.6%) out of 94 cases diagnosed prior to 2010 and potentially candidates to HCC treatment received no/less effective therapy than recommended, while this occurred in 45 (27.4%) out of 164 cases diagnosed from 2010 (p=0.03). Conversely, the proportion of HCC cases diagnosed at stage 0/A increased in the second period (36 out of 128 [28%] vs. 85 out of 190 [45%]; p < 0.001). Conclusion: A high proportion of HIV-infected patients diagnosed of HCC did not receive therapy or receive less effective treatment as recommended by its BCLC stage. This situation becomes more frequent as HCC diagnosis is made in a more advanced stage. However, the access to therapy has improved in the recent years, probably as a consequence of the increase in the proportion of HCC cases that are diagnosed in earlier stages.

Poster and Themed Discussion Abstracts

539 PREDICTORS OF HEPATOCELLULAR CARCINOMA IN HIV/HCV COINFECTED PATIENTS WITH CIRRHOSIS Aaron P. Thrift , Kathryn E. Royse, Christine Hartman, Jennifer R. Kramer, Elizabeth Chiao Baylor Coll of Med, Houston, TX

Background: Cirrhosis is the most important risk factor for hepatocellular carcinoma (HCC) in patients with HIV/HCV co-infection. However, even among patients with cirrhosis, HCC risk is not uniform. Indeed, most HIV/HCV co-infected patients with cirrhosis do not progress to HCC. We sought to determine risk factors for progression from cirrhosis to HCC in HIV/HCV co-infected patients. Methods: We used the Veterans Affairs HIV and HCV Clinical Case Registries and identified HIV/HCV co-infected patients that were diagnosed with cirrhosis (defined by ICD-9-CM codes [571.5, 571.6, and 571.2] or an aspartate aminotransferase to platelet ratio index >2) from 1999-2010. We excluded female veterans (due to small numbers; <2%), as well as patients lacking HCV RNA, follow-up CD4 count or HIV viral load information, and patients diagnosed with cirrhosis within 90 days of HIV diagnosis. The outcome was incident HCC as indicated by ICD-9-CM (155.0 without 155.1). Patients were censored at death, date of last health care encounter or 12/31/2010. We examined associations with age at HIV diagnosis, race/ethnicity, HCV genotype, and HIV-related (combination anti-retroviral therapy era of diagnosis, CD4 cell count, percent time with undetectable HIV viral load, and use of highly active anti-retroviral therapy [HAART]), clinical (ALT and Deyo without AIDS) and behavioral factors (alcohol use, smoking, hard-drug use). Cox proportional hazards analysis was used to estimate Hazard ratios (HR) and 95% confidence intervals (CI) for associations with HCC. Results: We included 2689 patients; the majority were aged >40y, African American, most recent CD4 count>200, and HCV genotype 1 or 4. Over a median follow-up of 5.0 (SD, 3.4) years, 88 patients (3.3%) developed HCC. In univariate analysis, HCC incidence varied by age at HIV diagnosis, race/ethnicity, ever HAART, alcohol use, and hard-drug use (all p<.10). Older age at HIV diagnosis (>50 vs. <40y; HR=2.19; 95%CI 1.02-4.70), Hispanic ethnicity (vs. non-Hispanic white; HR=2.46; 95%CI 1.05-5.76), and HCV genotype 1/4 (vs. HCV genotype 2/3; HR=1.95; 95%CI 1.06-3.57) were associated with higher risk of HCC in the multivariable model. Percent undetectable HIV viral load and CD4 count <200 (nadir or most recent) were not associated with HCC. Conclusion: HCC is common in HIV/HCV co-infected patients with cirrhosis (3.3%) and risk varies by age, ethnicity and HCV genotype. If confirmed in other populations, these findings may lead to enhanced HCC prevention and surveillance efforts. 540 IFN-FREE THERAPY IS EFFECTIVE AND SAFE FOR HCV RECURRENCE IN LT HCV/HIV COINFECTION Christian Manzardo 1 , Maria Carlota Londoño 1 , Ana Moreno 2 , Lluis Castells 3 , Victoria Aguilera 4 , Jose R. Fernandez 5 , Jorge Calvo-Pulido 6 , Judith Peñafiel 1 , Antoni Rimola 1 , Jose M. Miro 1 1 Univ of Barcelona, Barcelona, Spain, 2 Hosp Ramon y Cajal, Madrid, Spain, 3 Hosp Univ Vall d‘Hebron, Barcelona, Spain, 4 Hosp Univ La Fe, Valencia, Spain, 5 Hosp Univ de Cruces, Barkaldo, Spain, 6 Hosp 12 de Octubre, Madrid, Spain Background: Interferon (IFN)-based therapy against hepatitis C virus (HCV) recurrence after liver transplantation (LT) has poor effectiveness and tolerability both in HCV- mono-infected (≈30% of sustained virological response [SVR]) and HIV-HCV co-infected LT recipients (≈20% of SVR). Only small case series have reported on the use of direct antiviral agents (DAAs) in LT HCV/HIV co-infected recipients. The aim of this study is to report the effectiveness and safety of IFN-free regimens in a nationwide cohort of HIV HCV co-infected individuals having undergone LT.

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