CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

Methods: A prospective, multicenter cohort study, including HCV/HIV co-infected LT patients who received IFN-free treatment for recurrent hepatitis C with two or more DAAs (patients receiving DAAs with IFN or Sofosbuvir (SOF) plus ribavirine (RBV) were excluded). For comparison, we included a matched cohort of HCV mono-infected patients who received similar treatment for recurrent HCV. Only patients reaching a follow-up of at least 12 weeks after the end of treatment were analyzed. Results: Among patients with post-LT HCV recurrence in the FIPSE cohort, 39/228 (17%) of HIV+ and 118/693 (17%) of HCV mono-infected patients received IFN-free regimens containing at least 2 DAAs +/- RBV after a median (IQR) of 42 (16-72) months after LT. No differences in demographics and pre- or peri-transplant characteristics were observed. For HIV-infected individuals, median (IQR) CD4 T-cell count was 367 (200-465) cells/µL. All patients received antiretroviral treatment (ART) and 33 (85%) had a plasma HIV-RNA <50 copies/mL; 19 (48%) were receiving ART based on a non-boosted integrase inhibitor. SVR rates were high (95%) and similar in the HIV-infected and uninfected cohorts (Table). Of note, two failures in HIV+ patients were observed for genotype 4 (SVR 75% vs. 100% among other genotypes, p=0.038). No significant differences in SVR rates among genotypes were observed for HCV mono-infected individuals. Treatment was well tolerated. Only one patient in the mono-infected cohort died because treatment was started in the advanced decompensated cirrhosis stage. Conclusion: IFN-free regimens for post LT HCV recurrence in HIV infected individuals of our national cohort were highly effective and well tolerated, with results comparable to HCV mono-infected patients. Newer treatment options will probably improve efficacy for genotype 4 in co-infected LT recipients.

Poster and Themed Discussion Abstracts

541 RISK FACTORS OF ACUTE REJECTION AFTER LIVER TRANSPLANTATION IN HIV+/HCV+ PATIENTS

Christian Manzardo 1 , Sandra Silva Arrieta 2 , Antonio Rafecas 3 , Sandra Franco 2 , Santos del Campo 4 , Elisa Cordero 5 , Judith Peñafiel 1 , Antoni Rimola 1 , Christian Brander 2 , Jose M. Miro 1 1 Univ of Barcelona, Barcelona, Spain, 2 IrsiCaixa Inst for AIDS Rsr, Badalona, Spain, 3 L’Hosp de Llobregat, Spain, 4 Hosp Ramon y Cajal, Madrid, Spain, 5 Univ of Sevilla, Sevilla, Spain Background: HCV/HIV-infected liver transplant (LT) recipients have higher rates of acute rejection than recipients without HIV infection (38% vs. 20%; Miro et al. AJT. 2012; Terrault et al. Liver Transplant 2012). However, the causes of rejection have been poorly studied. The aimwas to investigate the contribution of clinical, virological and genetic patient and donor variables that may predict acute rejection in HCV/HIV-infected LT recipients. Methods: We studied 45 HIV/HCV co-infected patients that underwent LT between 2006-2012 in six referral centers across Spain (FIPSE cohort). For 33 of the 45 recipients, organ donor samples or at least some genetic information were available. Recipient and donor gender and age as well as patient’s pre- and post LT HCV viral loads, HCV genotype, CD4+ cell count, MELD score, immune suppressive treatment and donor-risk index were recorded. In addition, donor and recipient genetic markers were determined, including HLA-A, -B and DR, genotype and IL28B single nucleotide polymorphisms (SNPs: rs12979860, rs8099917 and ss469415590) Results: Out of the 45 patients more than a quarter (n=12, 27%) had a histology-proven episode of acute rejection within the first year after transplant. Median (IQR) time between LT and acute rejection was 2.5 (1.6; 6) weeks. Independent risk factors for an acute rejection were infection with HCV genotype 1 (GT1 vs. non-GT1 p=0.015) and mismatches in the HLA class I and II loci. In particular, a complete mismatch across HLA-A, -B and -DR was associated with organ rejection (p=0.001). This was driven by the HLA-A locus, where a complete mismatch resulted in acute rejection in 10 of 18 individuals (56%), whereas among subjects with at least 1 HLA-A match, rejection was observed in only 1 of 11 individuals (9%, p=0.021). Furthermore, patients receiving organs carrying the interferon-λ3 gene (IFNL3, also named IL28B) SNP rs12979860-CC allele (p=0.061) and the interferon-λ4 gene, ss469415590-TT alleles, (p=0.075) tended to suffer increased rates of organ rejection episodes.

CROI 2017 227