CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

601 THE PERFECT ICE STORM: THE MIX OF METH AND HIV SPREADS HEPATITIS C IN THAI MSM

classified with OUD; therefore, new strategies need consideration for reporting OUD, which will also increase HCV RF identification. These recommendations should be adopted as the natural next steps in global HCV elimination.

Donn J. Colby 1 , Siriporn Nonenoy 1 , Sataporn Waewklaihong 1 , Jitsupa Peelay 1 , Ratchadaporn Meksena 1 , Oranuch Nampaisarn 1 , Jitpisutt Ariyasirikul 1 , Piranun Hongchookiat 1 , Peeraporn Kaewon 1 , Pradit Chailit 1 , Sirichai Jarupittaya 1 , Nipat Teeratakulpisarn 1 , Reshmie Ramautarsing 1 , Praphan Phanuphak 1 , Nittaya Phanuphak 1 1 Thai Red Cross AIDS Research Center, Bangkok, Thailand Background: Recent oubreaks of hepatitis C infection (HCV) have been reported among men who have sex with men (MSM) in multiple countries. We report on factors associated with baseline HCV prevalence in a study of the use of amphetamine-type stimulants (ATS) in Bangkok, Thailand. Methods: MSM and transgender women (TW) who presented for routine HIV testing at the Thai Red Cross Anonymous Clinic (TRCAC) were recruited into a longitudinal study of ATS use. Recruitment was stratified to over-sample for HIV infection and ATS use within the previous 6 months. Baseline assessment included HIV serology, anti-HCV antibody, sexually transmitted infection (STI) screen (syphilis, gonorrhea, chlamydia), and a computer-assisted self interview covering sexual and substance use risk behavior. Results: Enrollment included 470 MSM (93.6%) and 32 TW (6.4%), of whom 161 (32%) were HIV-positive. Median age was 28 (IQR 24-35). Most (69%) had a bachelor degree or higher, and 95%were employed or in school. 94% reported ever having anal sex, 21% had group sex, and 54% of group sex events involved illicit drug use. Consistent condom use was only 38% for receptive and 41% for insertive anal sex. ATS use was reported by 131, most frequently crystal methamphetamine (METH) (n=122) followed by ecstasy (n=43) and oral amphetamines (n=18). HCV prevalence overall was 3.6%, and was associated with ATS use, HIV infection, or both (Figure, P<0.001). Over one-third (n=45) of METH users reported injecting the drug intravenously in the previous 6 months. However, only a minority (28%) of those with HCV reported injection drug use. STI were common: 16% had syphilis, 16% chlamydia, and 8% gonorrhea. On multivariable analysis, factors independently associated with HCV were HIV infection (OR 16.15; 95% CI 3.3-78.99), being mainly the receptive partner in anal sex (OR 4.3, 1.1-16.71), ever used METH (OR 9.13, 3.3-78.99), ever used oral amphetamine (OR 9.48, 1.63-55.03), and any STI (OR 5.98, 1.54-23.2). Conclusion: HCV infection is spreading rapidly among MSM with HIV in Bangkok, and is closely associated with the use of METH. Injection use of METH is also increasing rapidly in Thai MSM. However, most cases of HCV appear to be transmitted by anal sex, possibly potentiated by the presence of STIs and rough or prolonged sex in the context of illicit drug use. Harm reduction, and HCV treatment with direct-acting antivirals, are needed to address this newly emerging epidemic.

600 SYNDEMIC OF HCV, PRESCRIPTION OPIOID USE, AND PSYCHIATRIC ILLNESS: A NOVEL FRAMEWORK Adeel A. Butt 1 , for the ERCHIVES Study Team 1 Weill Cornell Medicine, New York, NY, USA Background: The concept of “syndemic” or synergistic epidemic, was coined by medical anthropologists to describe the clustering of two or more diseases within a population, and their biologic, social, cultural, economic and social interaction. While many definitions have been proposed, three core principles are 1) clustering of two or more conditions in a specific population; 2) their synergism in producing adverse outcomes; and 3) precipitation and propagation by large scale social, cultural, and economic forces. We propose that the confluence of hepatitis C virus (HCV) infection, prescription opioid use (POU), and psychiatric illness (PI) constitutes a syndemic with critical individual and societal consequences. Our objective was to define the epidemiology of SHOPS as a first step towards understanding its impact on individual and population outcomes. Methods: We used the ERCHIVES cohort to identify persons with each component of SHOPS individually and in all combinations. ERCHIVES includes all HCV diagnosed Veterans from 2001 onwards, who are identified based on a positive HCV antibody test and demographically matched HCV uninfected controls. HCV infection was defined based on a positive HCV antibody and at least one positive HCV RNA. POU was described as prescription of any approved opioid drug for >31 continuous days (to exclude short term use for surgical or dental procedures or after acute trauma). PI was defined by the presence of > 1 inpatient or > 2 outpatient ICD-9/10 codes for any of the following conditions: major or minor depression; bipolar disorder; schizophrenia; post-traumatic stress disorder. Treatment for each condition was determined by prescription of any approved pharmacotherapeutic agent for the condition. Results: Among 781,271 ERCHIVES participants between 2001-2018, 238,506 had chronic HCV only, 28,226 had POU only, and 99,681 had PI only. Other combinations of these conditions are listed in the figure. Overall, 205,473 had POU and 385,356 had PI. While 51.7% of those with HCV, 23.9%with POU and 84.2%with PI received any treatment for those conditions, only 17.8% of persons with all three syndemic components received treatment for all components. Conclusion: Co-occurrence of HCV, POU and PI is common, with treatment offered less frequently among those with multiple syndemic components. Next steps are to determine the clinical consequences of SHOPS and impact of treatment singly and in combination.

Poster Abstracts

602 HEPATITIS C VIRUS INFECTION AND COINFECTION WITH HIV AMONG PWID IN 10 US CITIES Johanna Chapin-Bardales 1 , Alice Asher 1 , Dita Broz 1 , Eyasu Teshale 1 , Tonya Hayden 1 , Carlos Blanco 2 , Senad Handanagic 1 , Cyprian Wejnert 1 , for the NHBS HCV Study Group 1 CDC, Atlanta, GA, USA, 2National Institute on Drug Abuse, Rockville, MD, USA Background: Understanding the burden of acute and chronic hepatitis C virus (HCV) infection and HIV/HCV co-infection among persons who inject drugs (PWID) is important for informing HIV and HCV elimination efforts. We measured HCV infection and HIV/HCV co-infection among PWID in 10 U.S. cities. Methods: In 2018 National HIV Behavioral Surveillance, PWID were recruited using respondent-driven sampling and offered a behavioral survey, HIV testing, and HCV antibody and RNA testing in Chicago, Dallas, Houston, Los Angeles,

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