CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

infected with HIV. 92% of participants were treatment naïve, 58% had genotype 1 infection, 96% received a sofosbuvir-based regimen, and 19% had a fibrosis score ≥F3. Overall, 22/26 (85%) participants achieved a sustained virologic response (SVR12). Three participants discontinued therapy, one due to adverse effects, one due to insurance lapse, and one due to incarceration. Two participants who achieved end of treatment response had return of viremia shortly after treatment discontinuation (both with unique genotypes that were not adequately covered by treatment regimen). Conclusion: On-site HCV treatment with DAAs of people currently injecting drugs at a needle syringe program is effective, and can achieve high rates of SVR12. Needle syringe program provide a convenient and safe venue to engage HCV infected individuals who are continuing to inject. The rates of re-infection in this population, and the impact of HCV treatment at a needle syringe program on high risk behavior and community wide transmission (cure-as-prevention) need further investigation.

Poster and Themed Discussion Abstracts

555 HIGH EFFICACY OF IFN-FREE ANTI-HCV REGIMENS FOR INDIVIDUALS ON OPIATE AGONIST THERAPY

Juan Macías 1 , Luis E. Morano-Amado 2 , Francisca Cuenca-Lopez 3 , Miriam Serrano 4 , Karin Neukam 1 , Francisco Téllez 5 , Manuel Márquez 6 , Dolores Merino 7 , Juan A. Pineda 1 1 Hosp Univ de Valme, Sevilla, Spain, 2 Hosp Univ Alvaro Cunqueiro, Vigo, Spain, 3 Hosp Univ Reina Sofia, Cordoba, Spain, 4 Hosp Univ de Gran Canaria Dr Negrín, Las Palmas, Gran Canaria, 5 Hosp de La Línea, La Línea de la Concepción, Spain, 6 Hosp Virgen de la Victoria, Málaga, Spain, 7 Complejo Hospario Univ de Huelva, Huelva, Spain Background: A large proportion of individuals with HCV infection have been persons who inject drugs (PWID). PWID on opiate agonist therapy (OAT) may frequently use illicit drugs and relapse on injecting drug use. Due to these, clinicians may be reluctant to start anti-HCV therapy in PWID on OAT concerned about adherence and potential lower rates of sustained viral response (SVR). However, there is few data on SVR to direct antiviral agents against HCV (DAA) in patients on OAT. Because of these, we compared the rates of SVR to IFN-free DAA combinations among individuals with and without OAT in real life conditions of use. Methods: The HEPAVIR-THERAPY cohort, recruiting HIV/HCV-coinfected patients (NCT02057003), and the GEHEP-MONO cohort (NCT02333292), including HCV-monoinfected individuals, are ongoing prospective multicenter cohorts of patients receiving DAA in clinical practice. We compared SVR 4 weeks after treatment (SVR4) among persons who never injected drugs (PWNID), PWID without OAT and PWID on OAT. Analyses were carried out by intention-to-treat. Results: 914 patients started IFN-free DAA combinations, 370 (40%) PWNID, 443 (49%) PWID without OAT and 101 (11%) PWID on OAT. SVR4 rates were 354 (96%) for PWNID, 397 (90%) for PWID without OAT and 90 (89%) for PWID on OAT (p=0.002). Rates of relapse were: PWNID, 8 (2,2%); PWID without OAT, 21 (4,7%); PWID on OAT, 2 (2%) (p=0,092). Interruptions due to adverse events were: PWNID, 2 (0,5%); PWID without OAT, 3 (0,7%); PWID on OAT, 2 (2%) (p=0,324). Rates of voluntary drop-out were: PWNID, 3 (0,8%); PWID without OAT, 14 (3,2%); PWID on OAT, 4 (4%) (p=0,042). SVR4 rates for individuals without HIV infection were: PWNID 281/289 (97%), PWID without OAT 87/94 (93%) and PWID on OAT 30/34 (88%) (p=0,018). SVR4 rates for HIV-coinfected individuals were: PWNID 73/81(90%), PWID without OAT 310/349 (89%) and PWID on OAT 60/67 (90%) (p=0,938). Multivariate analysis adjusted by HIV, cirrhosis, HCV genotype and baseline HCV RNA showed that PWID without OAT [PWNID as reference, adjusted OR (AOR) 0,58, 95% confidence interval (95%CI): 0,28-1,2, p=0,147] and PWID on OAT [PWNID as reference, adjusted OR (AOR) 0,53, 95% confidence interval (95%CI): 0,21-1,4, p=0,193] were not independently associated with SVR4. Conclusion: HCV-infected PWID on OAT achieve high SVR4 rates with IFN-free DAA. Because of this real life efficacy, HCV infection treatment should not be deferred among PWID due to ongoing OAT. 556 SVR12 FOR PATIENTS WITH BEHAVIORAL HEALTH CONDITIONS TREATED FOR HEPATITIS C IN FQHCS Background: Patients with chronic hepatitis C receiving primary care at federally-qualified health centers (FQHCs) often have co-occurring behavioral health conditions, including mental health, substance use and chronic pain diagnoses, which make providers reluctant to offer hepatitis C treatment. Despite increased access to hepatitis C direct-acting antivirals at FQHCs, few studies look at the characteristics and treatment outcomes for such patients. We aim to evaluate outcomes for patients with mental health, substance use and chronic pain diagnoses treated for hepatitis C by primary care providers (PCPs) in non-academic, non-specialist, community health center settings serving a low-income urban population. Methods: We collected diagnosis, treatment and lab data from the medical records of patients treated for hepatitis C by PCPs at four FQHCs from January 2015 to July 2016. Patients with depression, anxiety, psychotic or organic brain disorders were considered to have a mental health diagnosis. Patients with illicit drug or excessive alcohol use were considered to have a substance use disorder. Medication regimens were determined by PCPs according to guidelines and obtained through usual processes. No study drugs or additional behavioral health staff were provided. Sophy S. Wong , Megan Crowley, Jan Diamond Alameda Hlth Consortium, San Leandro, CA, USA

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