CROI 2017 Abstract e-Book

Abstract eBook

Oral Abstracts

136 UNRESTRICTED DAA ACCESS IN THE NETHERLANDS: RAPID THERAPY UPTAKE IN HIV+HCV+ PATIENTS Anne Boerekamps 1 , Astrid Newsum 2 , Colette Smit 3 , Peter Reiss 4 , Clemens Richter 5 , Marc van der Valk 6 , Joop Arends 7 , Kees Brinkman 8 , Bart Rijnders 1 , for the Netherlands ATHENA HIV Observational Cohort and the NVHB-SHM HepatitisWorking Group 1 Erasmus Univ Med Cntr, Rotterdam, Netherlands, 2 Pub Hlth Service of Amsterdam and Academic Med Cntr, Amsterdam, Netherlands, 3 Stichting HIV Monitoring, Amsterdam, Netherlands, 4 Stichting HIV Monitoring and Academic Med Cntr, Amsterdam, Netherlands, 5 Rijnstate Hosp, Arnhem, Netherlands, 6 Academic Med Cntr, Amsterdam, Netherlands, 7 Univ Med Cntr Utrecht, Utrecht, Netherlands, 8 OLVG, Amsterdam, Netherlands Background: Direct acting antiviral (DAA) therapy is a short, safe and effective treatment for chronic hepatitis C virus (HCV). Its high costs led to restricted reimbursement in most countries. Since 11/2015, DAAs can be prescribed to all HIV-HCV co-infected patients in the Netherlands, regardless of the fibrosis stage. We evaluated the impact of unrestricted DAA availability on HCV treatment uptake in HIV-HCV co-infected patients. Methods: The ATHENA cohort collects nationwide data through an opt-out system from 98% of all HIV infected patients in care since 1998, and can provide an overview of HCV treatment uptake and impact over time in this population. Data were collected up until the database lock of 05/2016, i.e. 6 months after unrestricted DAA availability. Patients were included if they ever had 1 positive HCV RNA test, were classified as having a chronic or acute HCV infection, did not spontaneously clear HCV and were still in care (at least 1 clinical visit after 06/01/2015). The presence of severe chronic liver disease (clinical, radiographic or endoscopic signs of severe liver disease, whether or not combined with a histology or FibroScan® result), treatment characteristics and sustained virological response (SVR) were analyzed. When patients were treated more than once, only the most recent treatment and its outcome was included in the analysis. Results: Of the 22,042 HIV infected patients in the database, 1812 with HCV co-infection were included, of whom 1420 were still in care. Of the 392 patients not retained in care, 63 were lost to follow up, 269 had died and 60 had moved abroad. Of the 1420 still in care, 613 (43%) completed treatment with (PEG)-IFN +/- BOC/TVR, 413 (29%) completed treatment with DAAs, 94 (7%) had not yet completed DAA therapy and 300 (21%) remained untreated (figure). At the time of analysis, 65% (923/1420) of HCV-HIV co-infected patients had either been cured of HCV (n=829) or were completing DAA treatment (n=94). Notably, a high uptake was observed for patients without severe chronic liver disease: only 6 months after unlimited DAA availability, 33% (246/736) of those were cured with DAAs (n=192) or still on DAAs (n=54). The overall SVR after completing DAA treatment was 98% (404/413; 95%CI 96-99%). Conclusion: Unlimited DAA availability resulted in a rapid treatment uptake among HIV-HCV co-infected patients without severe liver disease in only 6 months. Altogether, 65% of Dutch HIV-HCV co-infected patients are cured or expected to be cured in the near future.

Oral Abstracts

137LB SUBSTANTIAL DECLINE IN ACUTE HCV INFECTIONS AMONG DUTCH HIV+MSM AFTER DAA ROLL OUT Anne Boerekamps 1 , Guido van den Berk 2 , Fanny Lauw 3 , Eliane Leyten 4 , Joop Arends 5 , Marjo Kasteren 6 , Mark Claassen 7 , Charles Boucher 1 , Bart Rijnders 1 , for the Dutch Acute HCV in HIV (DAHHS) Study Group 1 Erasmus Univ Med Cntr, Rotterdam, Netherlands, 2 OLVG, Amsterdam, Netherlands, 3 Slotervaart MC, Amsterdam, Netherlands, 4 MC Haaglanden, The Hague, Netherlands, 5 Univ Medl Cntr Utrecht, Utrecht, Netherlands, 6 St. Elizabeth Ziekenhuis, Tilburg, Netherlands, 7 Rijnstate Hosp, Arnhem, Netherlands Background: The incidence of acute HCV (AHCV) among Dutch HIV+MSM has been high for >10yrs. Recent modeling studies predict that prompt treatment with direct acting antivirals (DAA) may decrease this incidence substantially (CROI2016 A536) but confirmation from real-life data is awaited. In 11/2014 all oral DAA therapy became available for F3-4 fibrosis and from 09/2015 for F0-2 as well, resulting in rapid DAA uptake in Dutch HIV+MSMwith chronic HCV with already 65% cured or on DAA therapy 6 months after unrestricted DAA availability (CROI 2017 Boerekamps et al). Also, in 2014 (in DAHHS1 study NCT01912495) as well as in 2016 (in ongoing DAHHS2 study NCT02600325) patients with AHCV were offered immediate therapy in DAHHS centers across the Netherlands. We hypothesized that this rapid treatment uptake will result in a lower incidence of AHCV among HIV+MSM. Methods: AHCV was defined as HCV-RNA positivity, preceded by a negative HCV-RNA or HCV-IgG within 12 months. When stored plasma could not be retested, a normal ALT preceding the first positive HCV-RNA test together with a negative IgG any time in the past or a positive HCV-RNA and a simultaneous negative IgG was also considered diagnostic for AHCV. The incidence of AHCV was calculated by dividing the cases by the patient years of follow-up (PYFU). Data were available from 18 HIV treatment centers, geographically

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CROI 2017