CROI 2020 Abstract eBook

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Poster Abstracts

controllers). It is unknown whether persistent controllers have superior capacity to spontaneously clear HCV coinfection compared to transient controllers. Methods: HIV-controllers with available data for antibodies to HCV (anti-HCV) were recruited (n=744). Factors associated with HIV spontaneous control in relation to HCV coinfection were analyzed in persistent and transient HIV- controllers with anti-HCV positive (n=202 and n=138, respectively) in comparison with 1700 anti-HCV positive non HIV-controllers. In addition, the factors related to the loss and time to lose HIV-controller status were explored (n=744). Results: A higher frequency of HCV spontaneous clearance was found in persistent HIV-controllers (25.5%) compared to non-controllers (10.2%). After adjusting for potential confounders as sex, age, HIV transmission risk, CD4+ T-cell nadir and time of follow up, HCV clearance was independently associated with persistent HIV spontaneous control (p=0.002; OR (95% CI)= 2.573 (1.428-4.633), but not with transient spontaneous control (p=0.119; 1.589 (0.888-2.845). Furthermore, persistent HIV-controllers were more likely to spontaneously clear the HCV in comparison with transient controllers (p=0.027; 2.650 (1.119-6.276). Finally, no loss or a delayed time to lose HIV-controller status was independently associated with HCV spontaneous clearance (p= 0.010; 1.990 (1.177-3.364). Conclusion: This study shows an association between spontaneous persistent HIV-control and HCV spontaneous clearance. Our results support common mechanisms involved in spontaneous persistent HIV control and HCV clearance. These results suggest persistent but not transient HIV-controllers as a good model of functional HIV cure. 593 HPTN 078: HIGH INCIDENCE OF HEPATITIS C VIRUS INFECTIONS AMONG MSM Risha Irvin 1 , Jowanna Malone 1 , Theresa Gamble 2 , James Hughes 3 , Jason Farley 1 , Kenneth H. Mayer 4 , Carlos del Rio 5 , D. Scott Batey 6 , Michael Murphy 1 , Oliver Laeyendecker 1 , Batsirai M. Mabvakure 1 , Robert H. Remien 7 , Chris Beyrer 1 , Chloe Thio 1 , for the HPTN 078 Research Team 1 Johns Hopkins University, Baltimore, MD, USA, 2 FHI 360, Durham, NC, USA, 3 University of Washington, Seattle, WA, USA, 4 Harvard Medical School, Boston, MA, USA, 5 Emory University, Atlanta, GA, USA, 6 University of Alabama at Birmingham, Birmingham, AL, USA, 7 Columbia University, New York, NY, USA Background: Annual hepatitis C virus (HCV) testing is recommended in HIV- infected (HIV+) men who have sex with men (MSM) due to sexual transmission risk. While there is no HCV testing guideline for HIV-uninfected MSM, incident HCV infections have been noted. More data on incident HCV infection in MSM are needed. Methods: HPTN 078 assessed the efficacy of an integrated strategy to achieve HIV viral suppression; MSM were screened using respondent driven sampling and direct recruitment to identify HIV+MSMwho were not in care in Atlanta, Birmingham, Baltimore and Boston. At screening, demographic and behavioral questionnaires were completed, along with HIV and HCV testing. To identify subjects with recent HCV infection, HCV antibody (Ab) and RNA+ samples were tested using a modified Green Cross antibody avidity assay. Incidence rate was calculated using the Assay-Based Incidence Estimation Model. Phylogenetic analysis was used to assess clustering. Univariable logistic regression was used to evaluate associations with recent HCV infection. Results: This study included 1041 HCV Ab- MSM and 96 HCV Ab+/HCV RNA+ MSM who were tested for recent infection. Of the 96, 16 had a recent infection (12 HIV+), so further analyses were restricted to these 16 plus the 1041 HCV Ab- MSM. Of these 1057 men, median age 38 years, 70% Black, 83% insured, 38% employed, and 69% HIV+ (Table 1). The overall HCV incidence rate was 5.0/100 person-years (PYs) (95% confidence intervals [CI]: 2.0-8.0/100 PYs), with rates of 5.5/100 PYs (1.8-9.2/100 PYs) in HIV+MSM and 4.0/100 PYs (-0.4-8.5/100 PYs) in HIV-uninfected MSM (P=0.38). The median lifetime number of male sexual partners was 16 (interquartile range [IQR]: 6, 50) in HCV Ab- MSM and 100 (19, 150) in MSM with recent HCV (P<0.01). The proportion of men who had substance use counseling was significantly greater in those with recent HCV compared to those who were HCV Ab- (44% vs. 16%, P<0.01). These associations were similar in the HIV+ group. Recent infections were mainly genotype 1; 3 genotype 3; none clustered together. Conclusion: Although recent HCV infection was more common in HIV+ than in HIV-uninfected MSM, it was higher in both groups than in other studies. This suggests that HCV risk counseling should be considered in both HIV+ and HIV-uninfected MSM, particularly in those with a high number of lifetime sexual

partners and substance use. Integrating HCV prevention into substance use counseling should be explored.

594 SEX, NOT DRUG USE, IS DRIVING HCV REINFECTION AMONG HIV- INFECTED MSM IN NEW YORK CITY

Stephanie H. Factor 1 , Jesse R. Carollo 1 , Gabriela Rodriguez-Caprio 1 , Asa Radix 2 , Stephen M. Dillon 3 , Rona Vail 2 , Krisczar J. Bungay 3 , Robert Chavez 4 , José Lares- Guia 5 , Daniel S. Fierer 1 , for the New York Acute Hepatitis C Surveillance Network 1 Icahn School of Medicine at Mt Sinai, New York, NY, USA, 2 Callen–Lorde Community Health Center, New York, NY, USA, 3 GothamMedical Group, New York, NY, USA, 4 AIDS Healthcare Foundation, New York, NY, USA, 5 Office of José Lares-Guia, MD, New York, NY, USA Background: HCV reinfection rates are high among HIV-infected MSM in Western European cities as well as in New York City (NYC). We have previously shown that the two behavioral risk factors for primary HCV infection in NYC were receipt of semen into the rectumwith receptive anal intercourse (semen in rectum), and sex with use of crystal methamphetamine (sex on CM). Behavioral risk factors for HCV reinfection in this population, however, have not been studied. Methods: We performed a prospective cohort study in NYC to determine the behavioral risk factors for reinfection after primary HCV among HIV-infected MSM. Reinfection was defined as new HCV viremia after successful therapy (SVR 12) or spontaneous clearance (SC). Clinical visits for surveillance for reinfection were performed between Jan 2006 and Dec 2018, starting at the end of therapy, or the first undetectable VL for SC. Participants were queried about engagement in the two previously demonstrated risk factors for primary HCV in NYC, semen in rectum and sex on CM, and, additionally, about injection use of CM. Cox proportional hazards models analyses with these three behaviors as time- dependent variables, adjusted for age, race, ethnicity, and year of HCV clearance, were used to identify the behavioral risk factors for 1st HCV reinfection. Results: Among our full cohort of 305 men with cleared HCV, 37 had 1st reinfections (rate 4.4/100 PY). We had adequate behavioral data from 244 (80%) men, of whom 29 (78% of 37) had 1st reinfections (rate 4.5/100 PY). Median age was 44 years, 21%were black, 78%white, and 20% Latino, which mirrored the full cohort, as did HIV and HCV parameters. Over 647 PY (median 2.13 [IQR 0.78, 3.66]) there were 1,286 visits (median 4 [IQR 2, 6] per participant). While all three risk factors were significantly associated with 1st HCV reinfection in univariable Cox proportional hazards models (Table, 1st column), in the multivariable Cox proportional hazards model, only semen in rectumwas significantly associated with 1st HCV reinfection (HR=3.96 [95% CI 1.43, 10.96], p=0.008) (Table, 2nd column). Conclusion: Sex, with receipt of semen into the rectum, rather than drug (methamphetamine) use, was the behavior driving HCV reinfection in HIV- infected MSM. Taken together with previous research demonstrating HCV in semen, and as condom use has not been successful as an HCV prevention strategy, our results suggest the need for novel interventions to prevent seminal HCV from causing trans-rectal HCV infection.

Poster Abstracts

CROI 2020 214