CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

crack or speed (87% vs 64%, p<0.001), current IDU (54% vs 16%, p<0.001), current non-IDU (67% vs 50%, p=0.001), or history of incarceration (74% vs 53%, p<0.001). Among the HCV Ab+, 73% had HCV RNA testing and 38%were HCV RNA+ (Figure). Fifty-nine of the HCV Ab+ underwent LSM: 27 (46%) and 16 (27%) had significant and advanced fibrosis, respectively. Fibrosis prevalence was similarly high regardless of HCV RNA status. The majority of the HCV RNA+ had health insurance (91%) and a primary care provider (PCP) (68%). Among the 44 HCV RNA+, 25 were referred to further HCV care, including 8 who were referred to an HCV provider on the van, 4 of whom have started HCV treatment on the van. Conclusion: HCV screening on a mobile van in a large urban center demonstrated a high prevalence of HCV Ab+ (36%) among high-risk groups, with one-fourth having advanced fibrosis. Despite the majority having insurance and a PCP, 38% of the HCV Ab+ had active HCV viremia. This underscores the need for heightened efforts to improve HCV treatment access to high-risk groups and has motivated a program offering HCV treatment on the mobile unit.

PLWH in need of DAA are not fully engaged in HIV care, DAA treatment outside conventional healths system is needed to achieve HCV micro-elimination

571 REAL-WORLD EFFECTIVENESS OF GLECAPREVIR/PIBRENTASVIR FOR HEPATITIS C VIRUS INFECTION Lourdes Domínguez-Domínguez 1 , Juan Berenguer 2 , Ángela Gil-Martín 3 , Diego Rincón 2 , Antonio Olveira 4 , Inmaculada Fernández 1 , Beatriz Álvarez 5 , Laura Benitez 6 , Ignacio Santos 7 , José Barrio Antoranz 8 , Elvira Poves 9 , Juan E. Losa 10 , Inma Jarrin 11 , María J. Calvo 3 , Juan González-García 4 , for the RUA-VCH Study Group 1 Hospital Universitario 12 de Octubre, Madrid, Spain, 2 Hospital General Universitario Gregorio Marañón, Madrid, Spain, 3 Subdireccion General de Farmacia, Madrid, Spain, 4 La Paz University Hospital, Madrid, Spain, 5 Fundacion Jimenez Diaz, Madrid, Spain, 6 Hospital Puerta de Hierro, Madrid, Spain, 7 Hospital Universitario de La Princesa, Madrid, Spain, 8 Hospital Universitario Infanta Leonor, Madrid, Spain, 9 Hospital Universitario Príncipe de Asturias, Madrid, Spain, 10 Hospital Universitario Fundación Alcorcón, Alcorcón, Spain, 11 Institute de Salud Carlos III, Majadahonda, Spain Background: Glecaprevir and pibrentasvir (GLE/PIB) are direct-acting antiviral agents (DAAs) with pan-genotypic activity and a high barrier to resistance. We evaluated the effectiveness and safety of GLE/PIB in a large prospective registry HCV-infected individuals with/without coinfection by HIV and receiving DAAs for HCV infection. Methods: RUA-VHC (Madrid Registry of Use of DAA for HCV) is a prospective registry of HCV-monoinfected (MoP) and HIV/HCV-coinfected (CoP) individuals receiving all-oral DAAs in hospitals of the Madrid Regional Health Service. RUA-VHC was created in November 2014 (Hepatology 2017; 66:344). For this study, we selected patients with chronic hepatitis C who had received once- daily treatment with 3 tablets of the fixed-dose combination of GLE/PIB (total dose: 300 mg/120 mg) and were scheduled to finish treatment on or before01/ February/2019. Retreatment after all-oral DAA therapy was excluded. We assessed sustained virologic response at 12 wk by intention-to-treat (ITT) and by a modified intention-to-treat approach (m-ITT), in which non-virological failures for reasons other than discontinuation of treatment secondary to adverse events or death were not considered in the analysis. Results: A total of 1,183 patients (1,078 MoP/105 CoP) met the inclusion criteria. Treatment duration was 8 weeks in 1,063 patients (964 MoP/99 CoP), 12 weeks in 115 patients (109 MoP/6 CoP), and 16 weeks in 5 MoP. Median age was 54 years, 51.7%were men, 9.4% had been treated previously with interferon- based anti-HCV therapies, and 7.0% had cirrhosis. Genotype distribution was as follows: G1, 70.7%; G3, 10.6%; G4, 10.2%; G2, 3.5%; Other/mixed/unknown genotypes accounted for 4.8%. Patient characteristics and treatment results overall and by treatment duration and the presence/absence of HIV coinfection are shown in the Table. Sustained virologic response rates were 97.7% (95% CI, 96.7%-98.5%) by ITT and 99.0% (95% CI, 98.2%-99.5%) by m-ITT analysis. The presence of HIV or liver cirrhosis, and genotype distribution did not influence treatment response. Conclusion: In this large prospective real-life cohort of patients with hepatitis C, treatment with GLE/PIB led to SVR rates of almost 98%. Treatment with GLE/PIB was highly efficacious across all genotypes and in the presence of HIV infection or liver cirrhosis.

Poster Abstracts

570 PROGRESS AND REAL-LIFE CHALLENGES FOR HCV ELIMINATION IN PEOPLE LIVING WITH HIV Edward R. Cachay 1 , Francesca Torriani 1 , Lucas Hill 1 , Craig Ballard 1 , Abigail Aquino 1 , Huifang Qin 1 , Sonia Jain 1 , Natasha Martin 1 , W. C. Mathews 1 1 University of California San Diego, La Jolla, CA, USA Background: The state of California has provided unrestricted access to direct- acting antivirals (DAA) since January 2018 for people living with HIV (PLWH). We aim to assess the impact of the hepatitis C virus (HCV) treatment uptake among PLWH on HCV population viremia and identify health-system areas for improvement to achieve HCV elimination. Methods: Retrospective cohort of PLWH with active HCV infection (detectable HCV viral load) under care at UC San Diego between 2014 and June 2019. We describe the annual proportion of PLWH with active HCV who started DAA therapy and the resulting cumulative population level of HCV viremia. Our cohort was then divided into early DAA (2014-2017) and unrestricted DAA (2018-2019) era groups. We compared the difference of proportion in health system landmarks of HCV treatment referral, HCV care uptake, staged/retained/ prescribed DAA therapy, DAA treatment initiation, and HCV cure between the two groups. Results: Following DAA approval, of 3,111 PLWH in care, 493 (15.9%) had HCV Ab positive and 263 (53.4%) of whom had active HCV viremia. The proportion of viremic patients starting DAA therapy increased from 13.5% in 2014 to 41% in 2017. After the first year of unrestricted DAA access, HCV treatment uptake increased to 54.9% and then dropped to 32% in 2019. The overall HCV population viremia among those with HCV Ab positive decreased from 53.4% in 2014 to 12.5% in 2019 (figure, panel A). In comparison to the early DAA era, following unrestricted DAA access, the proportion of patients who did not initiate therapy after establishing HCV care decreased from 22% to 14%. During the early DAA era and after establishing HCV care, the main reason for not initiating DAA was lack of insurance approval. In contrast, all PLWH who did not start DAA in the DAA unrestricted era were due failure to pick up their approved DAA or lost to follow-up. Despite DAA unrestricted access in 2018, there was almost a 2-fold increase in the proportion of PLWH not linked to HCV care (figure, panel B). Among those patients with active viremia, the number of patients engaged in their HIV care decreased from 95% in 2014 to 63% after one year of unrestricted DAA access. Conclusion: HCV linkage and HCV retention in care have emerged as main challenges among PLWH for HCV treatment uptake. As many of the remaining

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