CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

558 SYNDEMIC OF VIRAL COINFECTIONS AND INCIDENT END-STAGE RENAL DISEASE

Dahn Jeong 1 , Carmine Rossi 1 , Stanley Wong 2 , Zahid A. Butt 2 , Geoff W. McKee 2 , Jason Wong 2 , Amanda Yu 2 , Mawuena Binka 2 , Maria Alvarez 2 , Prince Adu 2 , Mel Krajden 2 , Naveed Z. Janjua 1 1 University of British Columbia, Vancouver, BC, Canada, 2 BC Centre for Disease Control, Vancouver, BC, Canada Background: Advances in infection care and treatment have improved the life expectancy of persons living with HIV. Consequently, persons living with HIV are aging with increased risk of chronic conditions such as liver and cardiovascular diseases, lung cancer, neurocognitive impairment and chronic kidney disease (CKD). Syndemic viral infections are associated with increased risk of CKD and end-stage renal disease (ESRD). However, population-level estimates of the impact of syndemic co-infections are lacking. This study assessed the effect of HBV, HCV and HIV co-infections on incident ESRD in a large population-based cohort. Methods: The British Columbia (BC) Hepatitis Testers Cohort includes ~1.7 million individuals tested for HCV or HIV, or reported as a case of HBV, HCV, or HIV in BC, and is linked with various administrative healthcare data. ESRD was defined through ICD-9/10 codes. Individuals tested for all three infections since 1990 were followed from the date of their last test until the earliest of 1) incident ESRD, 2) death or 3) 12/31/2015. Fine and Gray competing risk models with adjustment for age, sex, ethnicity, alcohol and injection substance use, social/material deprivation, and history of diabetes and hypertension were used to estimate sub- distributional hazard ratios (HRs) and 95% confidence intervals (CIs) for incident ESRD. Further stratified analysis was performed accounting for diabetes. Results: Of 524,186 individuals tested, we observed 3,762 incident ESRD events (0.7%) and 24,714 deaths (4.7%) during a median follow-up of 4.1 years. The highest ESRD incidence rate (per 1,000 person-years) was observed in persons with triple HBV/HCV/HIV infection (26.7) followed by HCV/HIV (10.2), HBV/HIV (10.0), HBV/HCV co-infection (5.8), and HIV (3.8), HCV (3.0) and HBV mono- infection (1.8) (Figure). In multivariable analysis, relative to those with no chronic infections, those with triple infection had the highest relative hazard for ESRD (HR 34, 95% CI: 29-41). When stratified by diabetes status, triple infection still had the highest relative hazard for ESRD (HRs 16, 95% CI: 5-28 and 38, 95% CI: 31-46) for both persons with diabetes and those without, respectively. Conclusion: Persons living with HIV/HBV/HCV triple infection were at highest risk of ESRD. Management of these syndemic conditions, particularly through HBV, HCV and/or HIV treatment could reduce the risk of ESRD among people with co-infections.

557 HEPATITIS C COINFECTION AND EXTRAHEPATIC CANCER INCIDENCE AMONG PEOPLE WITH HIV Sarah J. Willis 1 , H. Nina Kim 2 , Chad J. Achenbach 3 , Edward R. Cachay 4 , Katerina A. Christopoulos 5 , Heidi M. Crane 2 , Ricardo A. Franco 6 , Christopher B. Hurt 7 , Mari M. Kitahata 2 , Richard D. Moore 8 , Michael J. Silverberg 9 , Phyllis Tien 5 , Daniel Westreich 7 , Julia L. Marcus 1 1 Harvard Medical School, Boston, MA, USA, 2 University of Washington, Seattle, WA, USA, 3 Northwestern University, Chicago, IL, USA, 4 University of California San Diego, San Diego, CA, USA, 5 University of California San Francisco, San Francisco, CA, USA, 6 University of Alabama at Birmingham, Birmingham, AL, USA, 7 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 8 Johns Hopkins University School of Medicine, Baltimore, MD, USA, 9 Kaiser Permanente Division of Research, Oakland, CA, USA Background: Hepatitis C virus (HCV) coinfection may contribute to the elevated risk of cancers among people with HIV infection through increased inflammation or immune activation. Although HCV coinfection is a known risk factor for liver cancer, HCV may also be associated with an increased risk of extrahepatic cancers among people with HIV infection. However, few studies have explored the risk of extrahepatic cancers among people with HIV/HCV coinfection or the potential impact of HCV treatment using direct-acting antiviral agents (DAAs). Methods: Our study population included adults in HIV care at a CNICS site in the U.S. during 1995-2018, excluding those with previous cancer diagnoses and those without HCV testing. We defined HCV infection by positive HCV antibody or detectable HCV RNA level up to baseline (i.e., 180 days after enrollment). Patients were followed from baseline until cancer diagnosis, death, or last HIV care visit. We used Cox regression to estimate hazard ratios (HRs) for extrahepatic cancer incidence among patients with HIV/HCV coinfection compared with those with HIV monoinfection. We used standardized morbidity ratio weights to compare extrahepatic cancer incidence among patients with HIV/HCV coinfection with the incidence we would have observed under a hypothetical scenario in which all patients with HIV/HCV coinfection were successfully treated with DAAs at baseline. To explore potential misclassification of HCV status, we conducted a sensitivity analysis classifying those who only had a positive HCV antibody as missing HCV status. Results: Of the 21,310 adults in our analyses, 3823 (18%) were coinfected with HCV. Incidence rates of any extrahepatic cancer among patients with HIV/ HCV coinfection and HIV monoinfection were 643 and 572 cases per 100,000 person-years, respectively, with a crude HR of 1.13 (99% CI: 0.89, 1.43; Table). In crude analyses, patients with HIV/HCV coinfection were at elevated risk of cancer of the kidney and lung, and of inflammation-related cancers (defined in Table footnote), compared with patients with HIV monoinfection. In weighted analyses (Table), patients with HIV/HCV coinfection remained at elevated risk of kidney cancer (HR 3.43, 99% CI: 1.06, 11.06). Results were similar when classifying those with only positive HCV antibody as missing HCV status. Conclusion: Extrahepatic cancers driven by immune dysfunction, specifically kidney cancer, may be prevented by HCV-curative DAA therapies among patients with HIV/HCV coinfection.

Poster Abstracts

CROI 2020 200