CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

552 DIRECT-ACTING ANTIVIRALS IMPROVE ACCESS TO CARE AND CURE FOR PATIENTS WITH HIV-HCV Lauren F. Collins , Austin Chan, Jiayin Zheng, Shein-Chung Chow, Julius M. Wilder, Andrew J. Muir, Susanna Naggie Duke Univ, Durham, NC, USA

Background: Prior to the approval of direct-acting antivirals (DAA), uptake of curative hepatitis C virus (HCV) treatment was low, particularly for HIV/HCV co-infected patients. DAA offers >95% sustained virologic response (SVR) for the vast majority of HCV-infected patients, regardless of HIV-1 infection. Although safety and efficacy of HCV therapies have improved, challenges have emerged including high rates of insurance denials and drug interactions between antiretrovirals (ARV) and DAA. Methods: Using the Duke Enterprise Data Unified Content Explorer, we identified all HIV/HCV co-infected and HCV mono-infected patients engaged (at least one appointment in the system during the study period) in the healthcare system from 2011-2015, reflecting the DAA era. Prescriptions for DAA were queried to determine the treatment numbers. Demographic and clinical data were extracted by database and supplemented by manual record review. We describe the proportion of patients receiving DAA therapy per year of the study. Comparisons among cohorts employed the Fisher’s exact test, the chi-square test, and Student’s t-test as appropriate. Results: We identified 9,960 patients with HCV mono-infection and 715 with HIV/HCV co-infection seen at least annually. The description of the HCV mono-infected versus HIV-HCV co-infected patients is as follows: for gender, 60.9% and 69.9% of patients were male; for race, 38.4% and 71.7%were black; 30.6% and 23.9% had cirrhosis; 10.2% and 18.6% had hepatitis B virus co-infection. During the study period, 323/9960 (3.2%) patients with HCV mono-infection were prescribed an interferon-based regimen, compared to 22/715 (2.9%) of HIV/HCV co-infected patients (Figure 1). Comparatively, 970/9960 (9.7%) of HCV mono-infected versus 125/715 (17.4%) of HIV/HCV co-infected patients were prescribed interferon-free DAA regimens (p<0.0001). Patients with HIV/HCV achieved high SVR 12 weeks after therapy completion, with rates of 9/22 (40.9%) compared to 123/125 (98.4%) in the DAA-interferon versus DAA-only era, respectively (p<0.0001). ARV regimens were switched in 21 of 125 (17%) HIV-HCV co-infected patients prior to initiation of DAA. Conclusion: The introduction of DAA therapy has significantly improved access to HCV treatment and SVR is high in HIV/HCV co-infected patients. Meanwhile <20% of all HCV- infected patients at Duke have received therapy. More studies are needed to understand the barriers to access and how these barriers can be addressed.

Poster and Themed Discussion Abstracts

553 DIRECT ACTING ANTIVIRAL UPTAKE DISPARITIES IN HIV/HCV–COINFECTED POPULATIONS Sahar Saeed 1 , Erin C. Strumpf 1 , Sharon Walmsley 2 , Curtis Cooper 3 , Brian Conway 4 , Valerie-Martel Laferriere 5 , Neora Pick 6 , Alexander Wong 7 , Marina Klein 8 , for the Canadian Co- Infection Cohort Study 1 McGill Univ, Montreal , Canada, 2 Univ of Toronto, Toronto, Ontario, Canada, 3 Ottawa General Rsr Inst, Ottawa, Ontario, Canada, 4 Vancouver Infectious Diseases Cntr, Vancouver, Canada, 5 Cntr Hosp de l’Univ de Montréal, Montreal, Canada, 6 Oak Tree Clinic, Vancouver, Canada, 7 Regina Qu’Appelle Hlth Region, Regina, Canada, 8 McGill Univ Hlth Cntr Rsr Inst, Montreal, Ontario, Canada Background: Direct acting antivirals (DAAs) have revolutionized hepatitis C (HCV) treatment with nearly 100% cure rates even in real-world studies, giving hope that HCV can be eliminated. Historically, HCV treatment initiation rates have been low, particularly among people who inject drugs (PWID) an important group to target if the goal is to reduce incident HCV infections. In a publically funded health care setting, we investigated DAA treatment uptake disparities among HIV-HCV co-infected subpopulations. Methods: The Canadian Co-Infection Cohort Study prospectively follows 1625 HIV/HCV co-infected participants from 19 centers, representing approximately a quarter of the total Canadian co-infected population in care. Among HCV RNA+ participants, we determined the incidence of HCV treatment initiation per year and stratified by different risk profiles (Aboriginals, women, PWID and men who have sex with men (MSM)). Multivariate Cox models were used to estimate adjusted hazard ratios (aHR) for DAA initiation accounting for age, sex, Aboriginal status, active (within 6 months) and past PWID, MSM, alcohol use, advanced fibrosis, HCV genotype, undetectable HIV RNA, province and income (a priori predictors of treatment initiation). Results: Overall, HCV treatment initiations rose more than five times between 2013 and 2015, from 8 (95% CI: 5-11) to 46 (95% CI: 39-55) per 100 person-years. After stratifying initiation, by risk profiles, uptake was markedly lower among Aboriginals, women and active PWID (Figure 1). Among 854 HCV RNA+ participants, 195 initiated DAAs [128=ledipasvir/sofosbuvir (SOF); 28=SOF/ribavirin; 19=SOF/simeprevir; 13=SOF/ribavirin/interferon; 7=other all-oral regimens]. After adjustment (aHR, 95% CI), Aboriginals (0.56, 0.34-0.94), active PWID (0.54, 0.36-0.84) remained less likely to initiate HCV treatment. Women and past PWID tended to have lower treatment rates (0.80, 0.55, 1.15) and (0.73, 0.53, 1.02). Conversely, MSMwere more likely to initiate DAAs (1.89, 1.41- 2.46). SVR rates were high in all sub-groups regardless of uptake: 100% in women and Aboriginals, 95% in active PWID and 91% in MSM compared to 93% for the cohort overall. Conclusion: Treatment uptake has increased dramatically with the availability of all oral DAAs, but marginalized populations are still failing to access treatment. Barriers to treating these subgroups, who can obtain high SVR rates, need to be addressed if DAAs are to impact HCV incidence and the overall burden of chronic liver disease.

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