CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

calculated from the date of SVR documentation until the first subsequent positive HCV RNA or the last negative HCV RNA. Clinical onset of re-infection was defined as the date of the first noted HCV RNA. Person-time incidence rates [95% C.I.] per 100 years-at-risk (PYFU) were estimated using the Poisson distribution Results: There were 204 PLWH with documented SVR. Their median age was 52 years (95% CI: 50-53.4), 83.3%were male, and 21.6%were non-white. HCV genotypes distribution were 1a in 139 (68.1%), 1b in 20 (9.8%), 3 in 27 (13.2%) and other in 18 (8.8%). The median CD4 count in cells/uL was 503 (95% CI: 464-562) and 188 (92.2%) had undetectable HIV viral load. HCV risk factors were MSM in 54.9%, of which 40.2% also had a history of intravenous drug use (IVDU), and IVDU as the only risk factor in 39.2%. Six men acquired a new HCV infection over 321.7 PYFU. The HCV reinfection incidence rate overall was 1.87 and in MSM non-IVDU 3.54 per 100 PYFU. The median time from end-of- DAA-treatment to reinfection was 54 weeks (range 7-95.4 weeks). Of the six reinfected patients, three had a change in genotype and one had cirrhosis with documented SVR a year after finishing DAA before his reinfection. The table shows reinfection rates by HCV risk category, gender, ethnicity, and age. There were no reinfections among females. Five reinfected patients were-treated successfully, with one pending retreatment with DAA Conclusion: The overall reinfection rate in San Diego among PLWH in the DAA era is low, and is highest among MSM but comparable to previously observed in the interferon era. This result may help guide future interventions to prevent HCV reinfection in PLWH at risk in San Diego

595 HCV REINFECTION AMONG HIV PATIENTS AFTER DAA THERAPY IN THE COUNTRY OF GEORGIA Nikoloz Chkhartishvili 1 , Pati Gabunia 1 , Akaki Abutidze 1 , Giorgi Korkotashvili 1 , Otar Chokoshvili 1 , Natia Dvali 1 , Lali Sharvadze 1 , Tengiz Tsertsvadze 1 1 Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia Background: In 2015, in partnership with US CDC and Gilead Sciences, Georgia launched national hepatitis C elimination program. All HCV patients, including HIV co-infected persons, have free access to direct acting antivirals (DAA). We report rates of HCV re-infection among HIV-infected persons in real-life settings. Methods: Analysis included HIV patients treated with DAAs during 2015-2017 and who achieved sustained virologic response (SVR), defined as undetectable HCV RNA after 12 weeks after completing treatment. Patients were followed until August 2019. Risk-based approach was used to screen for HCV re-infection, which included history of injection drug use (IDU), high risk sexual behavior, recent history of invasive procedures and elevated liver enzymes. Reinfection was defined as detectable HCV RNA after confirmed SVR. Results: During the study period 420 patients achieved SVR and 274 (65%) were screened for HCV reinfection. Among 274 persosns tested for HCV reinfection the median age was 46 (IQR: 40-51) years, 242 (88.3%) were men and 201 (73.4%) had history of IDU. HCV genotypes included: 103 (37.6%) genotype 1, 84 (30.7%) genotype 3, 83 (30.3%) genotype 2 and 4 (1.5%) genotype 4. With regard to DAA regimens, 142 (51.8%) were treated with ledipasvir/sofosbuvir ± ribavirin, 58 (21.2%) – with sofosbuvir/ribavirin and 74 (27.0%) – with sofosbuvir/ribavirin + pegilated interferon. Patients were followed for median 1.8 (IQR: 1.1-2.5) years contributing to 507 person-years (PY) of follow-up. In total, 12 (4.4%) persons had HCV re-infection with an overall incidence of 2.4 per 100 PY. All reinfected patients were men with history of IDU. The median time to reinfection was 1.5 (IQR: 0.9-2.2) years. Genotype switch was documented in 7 (58.3%) cases. Rate of reinfection among persons with history of IDU was 3.3/100 PY. Among 201 persons with history of IDU only 32 (15.9%) were engaged in opioid substitution treatment (OST). Reinfection rate among persons on OST was 1.5/100 PY (1 reinfection) vs. 3.7/100 PY (11 reinfections) among those not receiving OST. No statistically significant differences were observed in rates of reinfection by baseline HCV genotype and treatment regimen. Conclusion: HIV positive IDUs are at high risk for HCV reinfection following successful DAA therapy. Greater engagement in OST programs are required to prevent reinfections and achieve elimination targets. 596 HCV REINFECTION AFTER DAA TREATMENT AMONG PEOPLE LIVING WITH HIV IN SAN DIEGO Lucas Hill 1 , Natasha Martin 1 , Sonia Jain 1 , Francesca Torriani 1 , Xiaoying Sun 1 , Huifang Qin 1 , Craig Ballard 1 , W. C. Mathews 1 , Edward R. Cachay 1 1 University of California San Diego, La Jolla, CA, USA Background: Previously, we reported the HCV reinfection rate in San Diego from 2000 to 2014 among HIV-infected men who have sex with men (MSM) during the interferon era was 2.89/100 PYFU. Herein, we report the HCV re-infection rates in all groups of people living with HIV (PLWH) treated with interferon-free direct-acting antivirals (DAA) in San Diego, California Methods: Retrospective cohort analysis of adult PLWH treated with DAA at the University of California, San Diego between 2014 and April 2019. PLWH with documented sustained virologic response (SVR), and at least one subsequent HCV RNA measurement before September 2019 were included. HCV re-infection was defined as new HCV viremia after documented SVR. Follow up time was

Poster Abstracts

597 HCV INCIDENCE AMONG HIV-INFECTED MSM IN FRANCE: RESULTS FROM THE FHDH-ANRS CO4 COHORT Mathieu Castry 1 , Anthony Cousien 1 , Jonathan Bellet 1 , Karen Champenois 1 , Gilles Pialoux 2 , Yazdan Yazdanpanah 3 , Dominique Costagliola 1 , Sophie Grabar 1 , Sylvie Deuffic-Burban 1 1 INSERM, Paris, France, 2 Tenon Hospital, Paris, France, 3 AP–HP, Hôpital Bichat- Claude Bernard, Paris, France Background: Despite the availability of highly effective directly acting antivirals (DAAs), sexual transmission of hepatitis C virus (HCV) in men who have sex with men (MSM) is still ongoing, associated with high-risk sexual behaviors. The objective of this study was to estimate the incidence of primary HCV infection among HIV-positive MSM in France in the post-DAA era. Methods: We used data from a large French hospital cohort of HIV-positive individuals (FHDH-ANRS CO4) prospectively collected between 2014 and 2017. HCV infection rates were calculated using person-time methods, among HIV- positive MSM with a negative anti-HCV test at cohort entry and subsequent HCV tests. HCV negative status was assigned to individuals never testing HCV positive throughout follow-up, discontinued on December 31th 2017. Incident HCV infection was based on any positive HCV test (RNA and/or antibodies) during follow-up; the date of HCV infection was the midpoint between the last negative and first positive test. Individuals were considered lost to follow-up if they had no clinical visit for 18 months; follow-up was ceased 6 months after last clinical visit. Results: A total of 15,692 HIV-positive MSM were included. Their median age was 45 years (interquartile range (IQR): 35-52). The median number of HCV serology tests during follow-up for each individual was 3 (IQR: 2-4), with a median testing interval of 1.25 years (IQR: 0.85-1.93) between two tests. Overall, 330 incident HCV infections occurred over 45,866 person-years

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