CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

Conclusion: Our data in HIV co-infected HCV+ LT recipients show a high rate of organ rejection. While the HCV genotype has been associated with rejection, we identify here additional host and donor genetic markers that may potentially increase the risk of organ rejection and which may help clinical management and organ allocation in liver transplantation in the HIV/HCV co-infected population.

Poster and Themed Discussion Abstracts

542LB HCC DEVELOPMENT IN HCV PATIENTS AFTER DAA: THE EXPERIENCE OF THE SCOLTA PROJECT Barbara Menzaghi 1 , Carlo Magni 2 , Laura A. Nicolini 3 , Giovanni Cenderello 4 , Vito Fiore 5 , Maria Gussio 6 , Roberto Gulminetti 7 , Francesca Vichi 8 , Paolo Bonfanti 9 1 Busto Arsizio Hosp, Busto Arsizio, Italy, 2 ASST Fatebenefratelli, Milan, Italy, 3 Univ of Genova, Genova, Italy, 4 Galliera Hosp, Genoa, Italy, 5 Unit of Infectious Diseases, Sassari, Italy, 6 Garibaldi Hosp, Catania, Italy, 7 IRCCS Policlinico San Matteo Fndn Univ of Pavia, Pavia, Italy, 8 S. Maria Annunziata Hosp, Milan, Italy, 9 A. Manzoni Hospital, Lecco, Italy Background: Interferon (IFN)-free direct antiviral agents (DAAs) effectively eradicate hepatitis C virus (HCV) and rapidly improve liver residual functions. Recent data have suggested that hepatocellular carcinoma (HCC) risk increases during and after DAAs treatment, in HCV-infected patients with advanced liver disease, but no strong evidence exists. Methods: The SCOLTA (Surveillance Cohort Long-Term Toxicity of Antiretrovirals/Antivirals)-HCV project is an observational, prospective, multicenter cohort study enrolling patients, either HCV mono- or HIV/HCV co-infected, who started DAA treatment. For HCV treatment and HCC surveillance, patients were followed according to Italian guidelines. Results: Overall 1,154 pts were included in this study. Males were 69.2%; median age was 56.2 years. HIV/HCV co-infected were 392 (34.0%). Twenty-nine (2.5%) patients had a history of HCC (24, 3.2%, with HCV and 5, 1.3%, with HCV/HIV). At the time of this analysis, median follow-up from initiation of DAA therapy was 16.7 months (IQR 12.7-19.4). Twenty-seven patients developed HCC, as a first diagnosis in 21 cases and recurrence in 6; the incidence rate/100 patient-years was 1.44 (95% CI 0.92-2.16) and 16.61 (95% CI 6.73- 34.55) respectively. HCC was diagnosed during DAA treatment in 10 patients (8 new diagnoses and 2 recurrences). All recurrences occurred in HCV mono-infected patients (5 with SVR 12 and 1 with relapse). Among 21 subjects with first HCC diagnosis, 4 were co-infected with HIV: the rate ratio in comparison with HCV mono-infected patients was 0.43 (95% CI 0.13-1.22, p=0.12). In a multivariate Cox model including age, sex, Metavir, HIV co-infection, HCV genotype, and outcome at 12 weeks, age (HR 1.06, 95% CI 1.01-1.12, by 1 year) and Metavir F4 (HR 4.70, 95% CI 1.08-20.44 as compared to F0-F3) were significantly associated to HCC. Conclusion: In untreated historical controls, HCC incidence rate ranged between 1 and 3/100 patient-years. Our findings indicate that, in cirrhotic patients, the incidence rate of HCC during the first 16 months following initiation of DAA therapy is not different from that expected in untreated patients. 543 HEPATITIS C CASCADE OF CARE IN NON-BIRTH COHORT PATIENTS WITHIN A LARGE HEALTH SYSTEM Background: Comprising 75% of all hepatitis C virus (HCV) infected persons in the US, the Birth Cohort (BC) (b. 1945-1965) has been the primary focus in many linkage to care efforts. However, rising HCV incidence in populations born outside of the BC (non-BC), suggest a need to refocus linkage efforts. The Centers for Disease Control and Prevention (CDC) reported that persons aged 30 and younger from nonurban areas compose the majority of acute HCV cases, identifying injection drug use as the main risk factor. This study examines a system- wide HCV cascade of care model for non- BC (HCoC). Methods: With Gilead FOCUS funding, antibody positive (HCV Ab +) persons were identified across MedStar Health. A retrospective chart review of HCV Ab+ non-BC individuals was conducted. Results: Between 7/1/2015 and 6/30/2016, 11,874 patients were screened, 60% (n=7,133) in the BC, 40% (n=4,741) comprised the non- BC, with 3% (n=320) testing HCV Ab+. Within the non-BC, 1.6% (n=78) tested HCV Ab +; mean age below the BC was 38.5 +/- 9.5 years and above the BC was 74.5 +/- 2.6 years, and 54% (42/78) were white males. Regarding the HCoC, 87.2% (68/78) of HCV Ab+ persons received clinical orders for HCV RNA tests, 92.6% (63/68) were completed, and 52.4% (33/63) were HCV RNA positive (HCV RNA+). Of this group, 90.9% (30/33) were referred to a specialist, with 50% (15/30) attending a specialist appointment. Of those seen by specialist, 26.7% (8/30) completed hepatocellular carcinoma (HCC) screening, 43.4% (13/30) completed liver staging. Of those HCV RNA+, 18.2% (6/33) received a prescription for HCV, 33% (4/6) started treatment, and 6% (2/33) have completed treatment. Chinyere Ukaegbu 1 , Alexander Geboy 1 , Whitney Nichols 1 , Amanda E. Smart 2 , Stephen Fernandez 3 , Peter Basch 1 , Dawn Fishbein 1 1 MedStar Hlth Rsr Inst, Washington, DC, USA, 2 Georgetown Univ, Washington, DC, USA, 3 MedStar Hlth Rsr Inst, Hyattsville, MD, USA

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