CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

579 EFFECT OF DAA REGIMENS ON MORTALITY IN HIV/HCV-COINFECTED PATIENTS WITH CIRRHOSIS Nicolás Merchante 1 , Francisco Téllez 2 , Angela Camacho-Espejo 3 , Dolores Merino 4 , Maria J. Rios-Villegas 5 , Marina Villalobos 6 , Mohamed Omar Mohamed Balgahata 7 , Carolina Freyre-Carrillo 2 , Antonio Rivero 3 , Miguel Raffo 4 , Maria Paniagua-Garcia 5 , Rosario Palacios 6 , Juan Macías 1 , Juan A. Pineda 1 , for the HEPAVIR-Cirrhosis Study Group 1 Hospital Universitario de Valme, Seville, Spain, 2 Hospital Universitario de Puerto Real, Cadiz, Spain, 3 Hospital Universitario Reina Sofia, Cordoba, Spain, 4 Complejo Hospitalario Universitario de Huelva, Huelva, Spain, 5 Hospital Universitario Virgen Macarena, Sevilla, Spain, 6 Hospital Virgen de la Victoria, Málaga, Spain, 7 Complejo Hospitalario de Jaén, Jaén, Spain Background: Our objective was to assess the impact of all-oral direct antiviral agents (DAA) regimens on mortality in HIV/HCV-coinfected patients with cirrhosis. Methods: 637 HIV/HCV-coinfected patients with cirrhosis prospectively recruited in the HEPAVIR-cirrhosis cohort from 2006 were followed-up until death or December 2018. The primary end-point was death of any cause and secondary end-point was liver-related death. The incidence rate (IR) (95% CI) of death of any cause in different groups were computed. Time-to-event analyses were performed to identify predictors of death. Results: After a median (Q1-Q3) follow-up of 72 (39-104) months, 131 (21%; 95% CI: 17-23) patients died, 59 (45%) of them due to liver-related complications. IR (95% CI) of death was 3.4 (2.8-4.1) per 100 person-years (PY). 480 (75%) patients achieved sustained virological response (SVR) during follow-up, 90 after interferon (IFN)-based regimens and 390 after all-oral DAA regimens. The median follow-up after all-oral DAA was 34 (23-41) months. 28 out of the 131 deaths and 8 out of the 59 liver-related deaths occurred after SVR. IR (95% CI) of death after SVR was 1.8 (1.2-2.7) per 100 PY versus 17.7 (14.6-21.5) per 100 PY in those not achieving SVR during follow-up (p<0.0001). When only patients with SVR were considered, the IR (95% CI) of death after SVR with all-oral DAA regimens was 2.1 (1.4-3.3) per 100 PY whereas it was 1.3 (0.5-2.8) per 100 PY in those achieving SVR with IFN-based regimens (p=0.27). The respective figures for liver-related death were 0.7 (0.3-1.5) and 0.2 (0.03-12.8) per 100 PY respectively (p=0.26). Figure 1 summarizes the trends in overall and liver-related mortality according to the changes of treatment strategies for hepatitis C in the cohort. Achieving SVR with an all-oral DAA regimen during follow-up was independently associated with a lower risk of death (adjusted hazard ratio 0.04; 95% CI: 0.02-0.07; p<0.0001). The type of regimen leading to SVR (all-oral DAA vs IFN-based) had no impact on the risk of liver-related death in a competing risk model adjusted by propensity score (adjusted sub-hazard ratio 1.91; 95% CI: 0.21-17.09; p=0.56). Conclusion: SVR with all-oral DAA regimens reduces the risk of death in HIV/ HCV-coinfected patients with cirrhosis. The sum of this effect to the high uptake and SVR rates of this therapy has led to a decline in the incidence of liver-related mortality in our cohort.

4 University of Bern, Bern, Switzerland, 5 St. Gallen Cantonal Hospital, St Gallen, Switzerland, 6 University Hospital Zurich, Zurich, Switzerland, 7 Swiss Federal Statistical Office, Neuchatel, Switzerland, 8 University Hospitals of Geneva, Geneva, Switzerland Background: Mortality rates and causes of death among persons with hepatitis C virus (HCV) infection are likely to change over time, with the introduction of direct-acting antiviral agents (DAA). However, the relatively slow progression of chronic hepatitis C may delay the emergence of such trends. To date, detailed analyses of cause-specific mortality among HCV-infected persons over time remain limited. Methods: We evaluated changes in causes of death among the Swiss Hepatitis C Cohort Study (SCCS) participants, from 2008 to 2016. We analysed risk factors for all-cause and cause-specific mortality, accounting for changes in treatment, fibrosis stage and use of injectable drugs over time. Mortality ascertainment was completed by linking lost-to-follow-up participants to the Swiss Federal Statistical Office (SFSO) death registry. Results: We included 4,700 SCCS participants, of whom 478 died between 2008 and 2016. Linkage to the SFSO death registry substantially improved the information on causes of death (from 42% of deaths with unknown cause before linkage to 10% after linkage). Leading causes of death were liver failure (crude death rate 4.4/1000 person-years), liver cancer (3.4/1000 p-yrs) and non-liver cancer (2.8/1000 p-yrs), with an increasing proportion of cancer-related deaths over time. Cause-specific analysis showed that persons with sustained virologic response (SVR) were less at risk for liver-related mortality. Conclusion: Although the expected decrease in mortality is not yet observed, causes of death among HCV-infected persons evolved over time. With the progressive widening of guidelines for DAA use, liver-related mortality is expected to decline in the future. Continued monitoring of cause-specific mortality will remain important to assess the long-term effect of DAA and to design effective interventions.

Poster Abstracts

581 KINETICS OF EMERGENCE OF LIVER COMPLICATIONS IN HCV-INFECTED PATIENTS AFTER SVR Anaïs Corma-Gómez 1 , Juan Macías 1 , Francisco Téllez 2 , Luis Morano 3 , Antonio Rivero-Juárez 4 , Rafael Granados 5 , Marta Santos 6 , Maria Paniagua-Garcia 7 , Francisco Vera 8 , Luis Miguel Real 1 , Jesus Santos 9 , Azucena Bautista 10 , Paloma Geijo 11 , Dolores Merino 12 , Juan A. Pineda 1 , for the RIS-HEP13 and GEHEP 011 Study Groups 1 Hospital Universitario de Valme, Seville, Spain, 2 Hospital Universitario de Puerto Real, Cadiz, Spain, 3 Hospital Universitario Alvaro Cunqueiro, Vigo, Spain, 4 Hospital Universitario Reina Sofia, Cordoba, Spain, 5 Hospital Universitario de Gran Canaria Dr Negrin, Las Palmas, Gran Canaria, 6 Hospital Universitario Jerez de la Frontera, Jerez de la Frontera, Spain, 7 Hospital Universitario Virgen Macarena, Sevilla, Spain, 8 Hospital General Universitario Santa Lucía, Cartagena, Spain, 9 Hospital Virgen de la Victoria, Málaga, Spain, 10 Hospital Universitario de La Princesa, Madrid, Spain, 11 Hospital Virgen de la Luz, Cuenca, Spain, 12 Hospital Juan Ramón Jiménez, Huelva, Spain Background: Despite achieving SVR with DAA-based regimens, a few HCV- infected patients still develop liver complications. Consequently, life-long surveillance for hepatic events, including hepatocellular carcinoma (HCC), is recommended among individuals with pre-treatment cirrhosis. However, there is little available evidence on the distribution over time of these liver complications’ appearing after SVR. Thus, the aim of this study was to describe the kinetics of liver complications appearance in HCV-infected patients, with advanced fibrosis, who attain SVR after DAA based therapy. Methods: Multicentric prospective cohort study, including HCV- and HIV/HCV- coinfected patients, who met: 1) Had achieved SVR with DAA-based therapy;

580 ALL-CAUSE MORTALITY AND CAUSES OF DEATH IN THE SWISS HEPATITIS C COHORT STUDY Maroussia Roelens 1 , Barbara Bertisch 1 , Darius Moradpour 2 , Andreas Cerny 3 , Nasser Semmo 4 , Patrick Schmid 5 , Beat Muellhaupt 6 , Christoph Junker 7 , Francesco Negro 8 , Olivia Keiser 1 1 University of Geneva, Geneva, Switzerland, 2 Lausanne University Hospital, Lausanne, Switzerland, 3 Epatocentro Ticino Foundation, Lugano, Switzerland,

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