CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

Miami, New York City, Philadelphia, San Francisco, San Juan, and Washington DC. We examined prevalence of acute (anti-HCV non-reactive/RNA detected) and chronic (anti-HCV reactive/RNA detected) HCV infection and HIV/HCV co- infection. We obtained adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) to assess characteristics associated with current HCV infection (RNA detected vs. not detected) and HIV/HCV co-infection (vs. no HIV/HCV co-infection). Results: Overall, 62.4% (3239/5,190) had a reactive anti-HCV result, 44.2% (1678/3795) had HCV RNA detected, and 4.0% (153/3,779) had HIV/HCV co- infection. Of those with both antibody and RNA test results, 3.9% (149/3795) had acute and 40.3% (1529/3795) had chronic HCV infection. Acute infection was highest among PWID who were male (4.3%), ages 25-34 (4.2%), black (4.5%), HIV-positive (4.6%), injecting ≤5 years (4.3%), injected >1 time/day (4.2%), injected heroin most often (4.3%), and were fromMiami (17.6%) or Philadelphia (5.3%). Current HCV infection was higher among PWID who were male (aPR 1.2, 95% CI 1.1-1.3), white (aPR 1.3, 95% CI 1.1-1.5), injecting >5 years (aPR 1.5, 95% CI 1.2-1.8), injected >1 time/day (aPR 1.5, 95% CI 1.3-1.7), and shared syringes (aPR 1.2, 95% CI 1.1-1.3) or injection equipment (aPR 1.3, 95% CI 1.1-1.4) in the past year. HIV/HCV co-infection was higher among participants who were transgender (aPR 6.3, 95% CI 2.8-14.5), injecting >5 years (aPR 2.1, 95% CI 1.3-3.1), injected speedball (heroin and cocaine injected together) (aPR 2.1, 95% CI 1.4-3.0) or stimulants (aPR 1.8, 95% CI 1.1-2.9) most often (vs. heroin), and were fromMiami (aPR 2.3, 95% CI 1.3-3.9). Conclusion: Acute and chronic HCV prevalence was high among a sample of U.S. urban PWID. Nearly one in two PWID had current HCV infection and one in 25 had HIV/HCV co-infection in our sample. HCV and HIV elimination efforts should focus on providing treatment and reducing risk behaviors among PWID to prevent further transmission. 603 HEPATITIS B VIRUS VACCINATION IN A CURRENT-ERA HIV CLINIC Meagan Deming 1 , Shyam Kottilil 1 1 University of Maryland, Baltimore, MD, USA Background: Hepatitis B virus (HBV) infections remain a global health issue with complications including liver cirrhosis and hepatocellular carcinoma. Individuals co-infected with Human Immunodeficiency Virus (HIV) and HBV have increased liver-related morbidity and mortality compared to those with HBV mono-infection. Vaccination is a potent intervention to prevent HBV infection, but certain critical populations including people living with HIV are less likely to achieve seroprotection after vaccination. Seroprotection (antibody to hepatitis B surface antigen titer ≥10 IU/mL) was historically poor, with trial rates ranging from 34 to 88% and improving with immunologic reconstitution and viral suppression. We hypothesized that the seroprotection rates (SPR) in a clinic population of Veterans would reflect the improving immunologic status of the cohort. Methods: We reviewed the HBV serologies and vaccination records of Veterans with HIV engaged in care at the Baltimore Veterans Affairs Infectious Disease Clinic over the past 20 years to assess the ultimate seroprotection status of the cohort. Results: The overall seroprotection status is in line with previous data, with 79% of clinic patients showing serologic response to vaccination. Of the patients who remain nonimmune, 43% (89 of 207) have been vaccinated without seroprotection. Importantly, over half the clinic population is HBV core antibody positive, reinforcing the overlapping risk factors for HIV and HBV acquisition. In the two decades surveyed, the percentage of virally suppressed patients improved from 22.5% of 507 in 2000 to 50.7% of 554 in 2009 and to 86.6% of 261 in 2019. The median CD4 count improved from 394 (IQR 212-593) in 2000 to 532 (IQR 342-772) in 2010, and to 630 (IQR 417-833) in 2019. Despite the improved immunologic status of this cohort, the SPR after 2009 showed no significant improvement compared to the prior decade: 56.7% compared to 57.0%. The apparently static response rates may reflect the aging of the cohort (median age increased from 50 to 57) and declining renal function (from 39% of patients with glomerular filtration rate >=90 to 16%). Response rates in the second decade may further reflect intrinsic immunologic anergy seen in re-vaccination attempts of prior non-responders. Conclusion: Despite lower than anticipated SPR, consistent vaccination standards have contributed to seroprotection for a majority of the cohort, and revaccination of nonresponders with CpG-adjuvanted HBV vaccine is ongoing.

604 IMMUNIZATION RESPONSE IN INFANTS BORN TO HBsAg+ HBeAg+ MOTHERS RECEIVING TDF Gonzague Jourdain 1 , Patrinee Traisathit 2 , Nicolas Salvadori 2 , Nantawan Wangsaeng 2 , Woottichai Khamduang 2 , Nicole Ngo-Giang-Huong 1 , for the iTAP Study Group 1 French National Research Institute for Sustainable Development, Marseilles, France, 2 Chiang Mai University, Chiang Mai, Thailand Background: It is unknown whether maternal antiviral prophylaxis could affect the response to vaccine in infants receiving hepatitis B (HB) immune globulin (HBIg) born to mothers infected with HB virus (HBV). We analyzed the infant immunization response in a randomized clinical trial in Thailand (iTAP-1, NCT01745822). Methods: iTAP-1 was an RCT assessing TDF prophylaxis (vs placebo) in HBsAg+ HBeAg+ women from 28 weeks’ pregnancy to 2 months postpartum. All infants received HBIg and HB vaccine (monovalent at birth and 1 month, as part of a multivalent vaccine at 2, 4 and 6 months). Antibody titers were measured using the Monolisa Anti-HBs Plus kit Blood at visits scheduled at 1, 2, 4, 6, 9 and 12 months. All infants were included in this analysis, except 3 (placebo group) confirmed HBV infected. Comparisons were made using the Wilcoxon rank sum test. Results: 315 infants (162 TDF, 153 placebo) participated in the analysis: 166 male and 149 female. At birth, median (IQR) weight was 3.0 kg (2.8-3.4) and length 50.3 cm (49.0-52.0). Median (95% CI) anti-HBs geometric concentrations at 1, 2, 4, 6, 9 and 12 month visits were: 123 IU/L (115-132), 71 (66-77), 268 (228-315), 556 (477-648), 595 (512-691), 294 (253-342), respectively (see Figure: anti-HBs geometric concentrations according to actual age at assessment). All infants had anti-HBs titers > 10 IU/L at all visits, except 4 of 311 (1.3%) at 1 month, 3 of 303 (1.0%) at 2 months, and 1 of 274 at 12 months. At 6 months and thereafter, there were no significant differences in anti-HBs titers between treatment arm (TDF versus placebo), according to maternal bodyweight before delivery, gestational age at delivery, birth weight, sex, infant length, or response. HBIg masked the response until 2 months, then titers increased until 9 months (3 months after last vaccine administration). Immunization was effective in >99% of the infants aged 4 to 12 months, a higher percentage than in most 'real world' cohorts where the birth dose is followed by 2 or 3 doses. The difference may be related to the different vaccine schedules or implementation issues in real world. durations from birth to vaccine birth dose or to HBIg administration. Conclusion: Maternal antiviral prophylaxis had no effect on the infant

Poster Abstracts

605 EFFECTIVENESS OF THE NOVEL ADJUVANTED HEPATITIS B VACCINE AMONG HIV AND HCV PATIENTS Brooke Kimball 1 , Katy Garrett 1 1 Maine Medical Center, Portland, ME, USA Background: People living with HIV or chronic hepatitis C virus (HCV) have diminished immune responses to hepatitis B virus (HBV) vaccination. The

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