CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

current HBV vaccine has a positive response rate upwards of 85% in the general population, but that same vaccine series only provides immunity for 20-70% of people living with HIV and 40-60% for the HCV population, emphasizing the need for advancement. A novel, adjuvanted HBV vaccine, HepB-CpG, demonstrated improved immune response (>90%) in non-HIV and non-HCV cohorts. Yet, the effectiveness in HIV and HCV patients in unknown. This study evaluated the immune response to HepB-CpG among HIV and HCV patients at an outpatient virology clinic. Methods: We evaluated HIV and HCV patients who received at least one dose of HepB-CpG beginning October 1, 2018. HBV vaccination and serology were performed in conjunction with routine clinical appointments. An HBV surface antibody ≥10 mIU/ml was considered a positive immune response. Population characteristics and overall effectiveness were evaluated using descriptive statistics and represented as n(%) or median(IQR) as appropriate. Results: Among 130 individuals, 41 (32%) were living with HIV and 89 (68%) with HCV. Most were white (110, 85%) and non-diabetic (112, 86%). The median age was 53 (38-61). Viral load was <20 copies/mL in 26 (63%) HIV patients at the time of first vaccination, and the majority had CD4 counts greater than 500. Two- thirds of HIV patients had received at least one full HBV vaccine series previously, whereas the same was true for only one-third of HCV patients. Of the 11 HIV patients tested for immunity after series completion, 82% had a positive HBV antibody. Interestingly, an additional 6 patients became immune after just one dose, bringing the total positive response rate to 88%. HCV patients responded similarly, with 78% immune after completing the series and an additional 3 patients immune after one dose. No patients reported adverse events. Conclusion: Our analysis shows an overall immune response to HepB-CpG of 84%, which is considerably higher than historical data using the non- adjuvanted vaccine. As part of a robust immunization program to protect HIV and HCV patients, HepB-CpG should be considered as an assuring alternative to the traditional HBV vaccination series. 606 TIMING OF ANTI-HBs ANTIBODIES DECAY IN VACCINATED PLWH/A: A LONG-LASTING RESPONSE Alice Tomio 1 , Julien Lupo 1 , Myriam Blanc 1 1 CHU de Grenoble, Grenoble, France Background: It is widely recommended to immunize people living with HIV/ AIDS (PLWH/A) against hepatitis B virus. A regular monitoring of anti-HBs antibody titers is generally performed during the following year to assess the need for vaccine boost, but the timing of the decay of these antibodies is poorly known. We analyzed the waning over time of anti-HBV seroprotection in PLWH/A in our center. Methods: We included all PLWH/A with at least 2 measurements of anti-HBs antibodies between the years 2001 and 2018; subjects positive for anti-HBc antibody or HBs antigen were excluded. We analysed the variation for each pair of successive measurements, excluding the pairs where the first measure was under 10 mUI/mL, or if an HBV vaccination was realized between the two dates, or if the rise between 2 dates was over 100 mUI/mL (as this may reflect an uncharted vaccination). Results: We analyzed 887 couples of successive titrations in 372 patients. The delay between the 2 measurements was <10 months for 23.9%, 10-14 months for 43.6%, between 15-27 months for 18.3%, and >27 months for 14.2%. The mean and the median decrease of the anti-HBs titer were 2.6±10 mUI/ ml and 0.29 [interquartiles 25-75: -0.02; 1.9] mUI/ml per month, respectively. This decay represents 0.7±3% (mean) or 0.6% (median) [interquartiles 25-75: 0.1; 1.8] per month of the initial titer. There was no statistically significant association between the slope of antibody decay and the nadir of CD4 T cells, the age at the first antibody titer, gender, or CMV serostatus. The absolute value of monthly decay was positively correlated with the initial antibody titer (rho=0.198, p<0.0001), but not the relative value. In a Kaplan-Meier analysis of the 130 patients with anti-HBs titer above 100 mUI/mL (median of follow-up: 43 months), the median time to a titer under 100 mUI/mL was 102 months;

in particular, it was 56 months for those with an initial ani-HBs antibody titer between 100 and 500 mUI/mL, and was not reached for those over 500 (figure). Conclusion: The rate of decrease of the anti-HBs antibody titer in PLWH/A suggests that measurements do not need to be performed more than every 3 to 4 years, and even longer periods for those over 500 mUI/mL.

607 HIGH INCIDENCE OF HBV INFECTION IN HIV-COINFECTED PATIENTS ACCESSING ART CARE Nokukhanya Msomi 1 , Kogieleum Naidoo 2 , Nonhlanhla Yende-Zuma 2 , Kerusha Govender 1 , Nesri Padayatchi 2 , Jeome Singh 3 , Salim S.Abdool Karim 2 , Quarraisha Abdool Karim 2 , Koleka Mlisana 4 1 University of KwaZulu-Natal, Durban, South Africa, 2 CAPRISA, Durban, South Africa, 3 University of Toronto, Toronto, ON, Canada, 4 National Health Laboratory Service, Johannesburg, South Africa Background: Hepatitis B virus (HBV), Human Immunodeficiency virus (HIV) and Tuberculosis (TB) are common infections in South Africa. HBV vaccination has been included in the country’s childhood immunization schedule since 1995; however, less is known of the current burden of HBV in adults. We utilized the opportunity of care provision or HIV-TB co-infected patients to determine the magnitude of, and the relationship between HIV and HBV, and identify risk factors for HBV infection in HIV infected patients with and without TB in urban and rural KwaZulu-Natal, South Africa. Methods: This retrospective cohort analysis was undertaken in 2018. In-care HIV infected patients were included in the analysis. Results from clinical records were analysed to determine the prevalence, incidence, persistence and factors associated with HBV infection in HIV infected patients with or without TB co-infection. Results: A total of 4292 HIV infected patients with a mean age of 35 (SD: 8.8 years) were included. The baseline prevalence of HBV was 8.5% (363/4292) [95% confidence interval (CI): 7.7 to 9.3] and 9.4% (95%CI: 8.6% to 10.3 %) at end of follow-up. The HBV incidence rate was 2.1/100 person-years (p-y). Being male was associated with a two-fold higher risk (HR 2.11; 95% CI: 1.14 -3.92) of incident HBV infection while severe immunosuppression was associated with a two-fold higher risk of persistent infection (adjusted risk ratio 2.54; 95% CI 1.06- 6.14; p=0.004). Active TB at enrolment was associated with a two-fold higher risk of incident HBV infection (aHR 2.38; 95% CI: 0.77 to 7.35). Conclusion: The provision of HIV care and treatment in high HBV burden settings provide a missed opportunity for HBV screening, immunization and care provision. 608 CHARACTERIZING HBV INFECTION AMONG PERSONS LIVING WITH HIV IN CARE IN URBAN SENEGAL Adrià Ramírez Mena 1 , Judicaël M. Tine 2 , Ousseynou Ndiaye 2 , Louise Fortes 2 , Ka Daye 2 , Ndeye Fatou Gnom 2 , Fall Fatou 3 , Moussa Seydi 2 , Gilles Wandeler 4 1 University of Bern, Bern, Switzerland, 2 CHU de Fann, Dakar, Senegal, 3 Hopital Principal de Dakar, Dakar, Senegal, 4 University Hospital of Bern, Bern, Switzerland Background: Chronic hepatitis B virus (HBV) infection affects 10% of the general population and is the leading cause of liver cirrhosis and cancer in West Africa. Despite current recommendations, HBV infection is generally not tested for in clinical routine in the region. We investigated the HBV infection status of HIV-infected individuals in care at an outpatient clinic in Dakar, Senegal, and determined the proportion of HIV/HBV-coinfected individuals with viral replication despite antiretroviral therapy (ART). Methods: We tested all HIV-infected individuals presenting for routine clinical care between March and July 2019 for the presence of HBsAg using a one-step lateral flow assay rapid test (NovaTest®). All individuals with a positive result underwent an HIV viral load (VL) and HBV VL (COBAS/ TaqMan® HBV/HIV Test) measurement. Liver stiffness measurements (LSM) were conducted by a single investigator, using transient elastography. We compared the main characteristics between individuals previously tested for HBV and the others using Chi-square and Mann-Whitney tests. We determined the proportion of

Poster Abstracts

CROI 2020 219