CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

related mortality in HIV/HCV co-infected and HCV mono-infected patients treated by DAA. Methods: Four HCV mono-infected participants from the ANRS CO22 HEPATHER cohort were matched on age and sex to each HIV/HCV co-infected participant from the ANRS CO13 HEPAVIH cohort. All participants were treated by DAA between March 2014 and December 2017. Cox proportional Hazards models adjusted on age, sex, duration since HCV diagnosis, HCV contamination routes, HCV genotype, cirrhosis status, tobacco and alcohol consumption were used. Results: 592 HIV/HCV co-infected and 2049 HCV mono-infected were included. Median age was 52.9 years [IQR: 49.6 ; 56.7] and 53.3 years [IQR: 49.6 ; 56.9]; 436 (73.6%) and 1498 (73.1%) were men; median duration since HCV diagnosis was 18.0 years [IQR: 12.4 ; 22.2] and 14.5 years [6.4 ; 20.8], and 159 (28.8%) and 793 (41.2%) were cirrhotic, respectively. Participants were predominantly treated by Sofosbuvir and Ledipasvir (48.8% and 34.5%, respectively) or Sofosbuvir and Daclatasvir (32.6% and 31.2%, respectively) and SVR was observed in 92.9% and 94.6% overall, respectively. After a median follow-up of 2.8 years, incidence of liver-related events was 12.4 per 1000 PY (95%CI: 7.7 ; 19.9) in HIV/ HCV co-infected and 13.4 per 1000PY (95%CI: 10.5 ; 17.0) in HCV mono-infected (p=0.78). Incidence of liver-related mortality was 5.6 per 1000 PY (95%CI: 2.8 ; 11.1) in HIV/HCV co-infected and 4.9 per 1000 PY (95%CI: 3.4 ; 7.1) in HCV mono-infected (p=0.76). Incidence of non-liver-related mortality was 12.5 per 1000 PY (95%CI: 7.9 ; 19.8) in HIV/HCV co-infected and 4.9 per 1000 PY (95%CI: 3.4 ; 7.1) in HCV mono-infected (p<0.01). After adjustment, HIV co-infection was not associated with a higher risk of liver-related events (HR=0.67 95%CI: 0.27 ; 1.67) or liver-related-mortality (HR=0.94 95%CI: 0.19 ; 4.67), but the risk of non-liver-related mortality (HR=2.67 95%CI: 0.97 ; 7.37) tended to be higher in HIV/HCV co-infected. Conclusion: After DAA treatment, SVR rates were not impacted by HIV co- infection, the risk of liver-related events and liver-related mortality were similar between HIV/HCV co-infected and HCV mono-infected but HIV co-infection tended to increase the risk of non-liver-related mortality.

1 ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy Background: Liver transplantation (LT) represents the best therapeutic option for end-stage liver disease (ESLD) and hepatocellular carcinoma (HCC). In recent years, LT in HIV+ recipients showed similar survival rates compared to HIV-, even though the risks of rejection and infection seem higher. Direct-acting agents (DAAs) are widely available in Italy from 2015: few data are available on their impact on mortality in this special population. Aims of this study: evaluate the rate of overall survival and HCC recurrence; define the causes of death; describe the impact of DAAs on mortality. Methods: All subjects with HCV/HBV infection who underwent LT for ESLD or HCC from 2012 were retrospectively evaluated. Descriptive statistics and non- parametric tests (Chi-square and Mann-Whitney U, as appropriate) were used; KM probability curves were calculated. Results: 278 individuals, mainly men (83.1%), with a median age of 57 (IQR 52-63) years were included; 30 (10.8%) were HIV+. HCC was the indication for LT in 65.8% of cases. HIV+ subjects were younger (53 vs 58 years, p<0.00001), more commonly HCV+ after Sustained Virologic Response (43% vs 21%, p=0.0199) and infected by HCV genotype 1a (40% vs 14.1%, p=0.0073). HIV+ subjects transplanted for ESLD showed a worse Child class (11 vs 10, p=0.0308) and a higher MELD score at the limit of significance (23 vs 17, p=0.0836), while no difference was observed for those transplanted for HCC. BCLC stage, alfa-fetoprotein level, portal vein thrombosis and previous bridging treatments were similar in the two groups. The overall survival after a median follow up of 42 months was 80.6%with no difference among HIV+ and HIV- (Figure 1). Mortality after DAAs availability dropped from 27% (before 2015) to 9% (since 2016, p=0.0003), with similar trajectories in both groups. In HIV+ patients HCC relapse was significantly more common (26% vs 9%, p=0.0141) and with extra-hepatic involvement (17% vs 5%, p=0.0107). Although the main reason of death was HCC recurrence in HIV+ (40%) and liver-related issues in HIV- (29%), such difference was not statistically significant, as highlighted also by similar infection-related mortality (20% vs 16%, p=0.9265). Conclusion: Over a follow up of more than 6 years, HIV+ subjects showed survival rates comparable to what observed in HIV- LT recipients with a significant decrease in mortality after DAA availability. Even if HCC recurrence was more common in HIV+, the causes of death were similar in the two groups with no distinctive role for infective complications.

Poster Abstracts

578 HIV COINFECTION AND RISK OF MORBIDITY AND MORTALITY IN HCV PATIENTS TREATED BY DAA Mathieu Chalouni 1 , Stanislas Pol 2 , Philippe Sogni 3 , Hélène Fontaine 2 , Karine Lacombe 4 , Jean-Marc Lacombe 5 , Laure Esterle 6 , Camille Gilbert 6 , Céline Dorival 5 , Dominique Salmon 2 , Carrat Fabrice 5 , Linda Wittkop 6 , for the ANRS CO22 HEPATHER cohort and ANRS CO13 HEPAVIH cohort Study Groups 1 INSERM, Bordeaux, France, 2 Assistance Publique – Hôpitaux de Paris, Paris, France, 3 Paris Descartes University, Paris, France, 4 Saint-Antoine Hospital, Paris, France, 5 Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France, 6 University of Bordeaux, Bordeaux, France Background: HIV co-infection leads to increased mortality, liver disease progression and extra-hepatic manifestations in HCV-infected patients. DAA lead to high SVR rates and decrease the risk of disease progression. We compared risks of liver-related events, liver-related mortality and non-liver-

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