CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

2) Liver stiffness prior to starting treatment≥ 9.5 kPa; 3) Had an available LS measurement at the time of SVR. SVR was considered as the baseline time- point. Overall accumulated incidence of liver complications was estimated, as well as complication-specific incidences. The median time (Q1-Q3) to the emergence of a hepatic event was assessed. Results: 1006 patients were included, 661 (61%) coinfected with VIH. 554 (55%) showed previous compensated cirrhosis. 994 (94%) patients had achieved SVR with interferon-free regimens. After SVR, 42% of individuals (426) showed liver stiffness values above 14 KPa. After a median follow-up time (Q1-Q3) of 37 (24-42) months, 47 (4.7%) patients developed liver complications: 19 (1.9%) HCC, 15 (1.5%) ascites, 9 (0.9%) portal hypertensive gastrointestinal bleeding (PHGB) and 4 (0.4%) hepatic encephalopathy. The distribution of liver complications during follow-up is displayed in figure 1. The median time to the emergence of hepatic events was: hepatic encephalopathy 10.2 (6.6-12.6) months, ascites 12.7 (4.6-25.9) months, HCC 16.9 (12.4-32.2) months and PHGB 26.5 (16.6-40.5) months. Conclusion: The vast majority of HCV-infected patients who develop liver complications after reaching SVR with DAA do it within two years after SVR time-point. Specifically, hepatic encephalopathy and ascites do not usually emerge after this period. Conversely, HCC and PHGB may occur in longer term, hence it is mandatory to identify patients at risk of developing these hepatic events to continue performing surveillance for them 582 LIVER STIFFNESS FOR PORTAL HYPERTENSIVE GASTROINTESTINAL BLEEDING AFTER HCV CURE Anaïs Corma-Gómez 1 , Juan Macías 1 , Francisco Téllez 2 , Luis Morano 3 , Mario Frías 4 , Rafael Granados 5 , Juan C. Alados 6 , Maria Paniagua-Garcia 7 , Francisco Vera 8 , Nicolás Merchante 1 , Rosario Palacios 9 , Ignacio Santos 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: Among patients with active HCV-infection, values of liver stiffness (LS)<21 kPa identify individuals without risk of developing portal hypertensive gastrointestinal bleeding (PHGB).Thus, this LS level has been incorporated to some management algorithm of HCV-infected patients,so that upper gastrointestinal endoscopy (UGE) is safely spared in those with LS<21 kPa.However, there is no information about its predictive value among HCV- infected patients after SVR.So, the aim of this study was to assess the predictive ability of LS for PHGB in HCV-infected patients with advanced fibrosis who attain SVR with DAA-based therapy. Methods: Multicentric prospective cohort study where HCV-monoinfected patients and HIV/HCV-coinfected patients were included if they met the following inclusion criteria: 1)Had achieved SVR with a DAA-based regimen; 2) Had LS values ≥9.5 kPa prior to treatment; 3)Had an available LS measurement at SVR time-point.Patients with PHGB episodes prior to SVR were excluded. Absolute frequencies and accumulated incidences of PHGB after SVR were calculated. Results: In this study,991 individuals were included. 647 (65%) were coinfected with HIV. 598 (60%) patients showed cirrhosis prior to treatment and specifically 360 (36%) had LS values ≥21 kPa. The corresponding figures at SVR were: 413 (42%) individuals with LS ≥14 kPa and 227 (23%) with LS ≥21 kPa. After a median follow-up time (Q1-Q3) of 37 (24-42) months, 9 [0.9% (0.5%-1.7%)] patients developed a first PHGB episode. The cummulative incidences of PGHB in the group of patients with LS ≥21 kPa and in patients with LS ≥14 kPa, after SVR, were respectively 4.0% (2.1%-7.4%) and 2.2% (1.2%-4.1%).133 (37%) individuals with LS ≥21 kPa prior to treatment had a value below this cut-off at the time of SVR. None out of the 764 patients who showed LS <21 kPa at SVR time-point presented a PHGB event. Hence, the negative predictive value of this LS cut-off for the emergence of a first PHGB episode after SVR was 100%. Conclusion: The predictive ability of the LS 21 kPa cut-off for a first PHGB episode evidenced in patients with HCV-active infection remains among

HCV-infected individuals who attain SVR with DAA-based therapy.These results suggest that stopping surveillance of esophagogastric varices in patients with LS<21 kPa at SVR is safe.At least 133 (37%) patients with LS≥21 kPa,in whom this parameter declines below to such a cut-off with SVR, may benefit from this decision. 583 TREATMENT WITH DIRECT-ACTING ANTIVIRALS REDUCES HEALTH CARE SERVICE UTILIZATION Sahar Saeed 1 , Erica E. Moodie 1 , Sharon Walmsley 2 , Curtis Cooper 3 , Michael John Gill 4 , Alexander Wong 5 , Valerie Martel-Laferriere 6 , Marie-Louise Vachon 7 , Marina Klein 8 , for the Canadian HIV-HCV Co-Infection Cohort Study 1 McGill University, Montreal, QC, Canada, 2 University Health Network, Toronto, ON, Canada, 3 University of Ottawa, Ottawa, ON, Canada, 4 Alberta Health Services, Calgary, AB, Canada, 5 Regina Qu’Appelle Health Region, Regina, SK, Canada, 6 Centre de Recherche du CHUM, Montreal, QC, Canada, 7 CHU de Québec-Université Laval, Quebec, QC, Canada, 8 Research Institute of McGill University Health Centre, Montreal, QC, Canada Background: Empirical evidence to support cost savings of direct-acting antivirals (DAAs) in real-world populations would support wider access. We investigated the impact of successful treatment of hepatitis C (HCV) with DAA therapy on healthcare services utilization (HCSU) among people living with HIV in Canada. Methods: We used data from the Canadian Co-Infection Cohort study that prospectively follows 1974 HIV-HCV coinfected participants from 18 centres. Data is collected through self-administrated questionnaires, chart review and blood testing biannually. Among people who initiated DAA and achieved a sustained virologic response (SVR) we used a segmented negative binomial mixed-effect models to evaluate the impact of SVR on HCSU. The model controlled for pre-treatment trends in HCSU, exposure time (offset) and time updated covariates: CD4 cell count, HIV RNA, active injection drug use, significant fibrosis (>F2) and fixed covariates: age and sex. We categorized HCSU as out-patient visits (walk-in, general (GP) or HIV practitioners, specialists); or in-patient visits (emergency room (ER) and hospitalizations). Observations were truncated 6-months before DAA initiation to account for changes in HCSU in preparation for initiating DAAs. Results: Between 2014-2018, 455 participants completed DAA therapy, of whom 424 achieved SVR. Median age at DAA initiation was 51 years (IQR 46, 56), 75%were male, 81% had HIV RNA <50 copies/mL; median CD4 was 520 cells/mL (IQR 331, 749) and 27% had liver fibrosis. A total of 2573 visits were divided as either pre-treatment (mean of 2.3 years (SD 1.2)) or post-SVR (mean 1.8 years (SD 0.9)). Overall, out-patient visits decreased from 12.6 visits/person- year (PY) before DAA initiation to 9.4 visits/PY post-SVR. Similarly, in-patient visits dropped from 2.8 visits/PY pre-treatment to 1.4 visits/PY post-SVR. Table 1 summarizes changes in HCSU by visit type. Before DAA initiation, annual rates of ER and specialist visits increased, hospitalizations and HIV visits were stable, while GP and walk-in-clinic visits decreased over time. Reductions in ER, hospitalizations and specialist visits were seen immediately after SVR and this effect persisted over time with annual reductions of 13%, 6% and 18% respectively, controlling for pre-treatment trends. Conclusion: We found evidence of immediate and sustained reductions of both in- and out-patient visits following SVR with DAA therapy in a real-world HIV-HCV co-infected population.

Poster Abstracts

584 HCV CURE IN HIV COINFECTION DAMPENS INFLAMMATION AND IMPROVES COGNITION Lynn Pulliam 1 , Linda Abadjian 2 , Alex Monto 1 , Bing Sun 2 1 University of California San Francisco, San Francisco, CA, USA, 2 San Francisco VA Medical Center, San Francisco, CA, USA Background: Chronic inflammation in HIV/HCV coinfection increases cognitive impairment. With new direct-acting antiviral therapies for HCV, sustained viral response (SVR) or cure is possible. Our objective was to determine if chronic

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