CROI 2020 Abstract eBook

Abstract eBook

Oral Abstracts

federal, state, and local partners. Response interventions supported diagnosis, treatment, and prevention (including expansion of preexposure prophylaxis and syringe services); many activities are now being expanded in other counties statewide. Cluster and outbreak response requires increased coordination and creativity to improve service delivery to vulnerable communities.

1 New York State Department of Health, Albany, NY, USA, 2 University at Albany, Albany, NY, USA Background: Hepatitis C virus (HCV) infections in New York State (NYS) have been rising among young adults due to increased injection drug use. In 2018 in NYS (excluding NYC), 61% of new female cases were in women of child bearing age (15-44 yrs old). Increased HCV infections in this age group are concerning as 6% of HCV RNA-positive pregnant women will transmit HCV to their baby. To plan effective public health actions, accurate HCV prevalence rates among pregnant women are needed; however, many HCV infections go undiagnosed and unreported. Babies passively acquire maternal IgG antibodies. Therefore, testing newborn blood for HCV antibodies can reveal mom’s serostatus. Our goal was to perform a large-scale HCV serosurvey of pregnant women in NYS by testing newborn dried blood spots (DBS) using a high-throughput, low-cost Luminex HCV immunoassay. Methods: All DBS submitted to NYS’s newborn screening program over 6 wks were sampled by punching a 3mm circle into microplates. Aggregate data on birth weight, gestational age and mother’s county of residence were recorded, and samples were blinded. A generic patient code was included to identify duplicate samples. HCV antigen-coupled beads were used to test eluted blood for HCV antibodies using a low-cost (<$0.80/well) Luminex-based immunoassay in 384-well plates. Repeated median fluorescence intensity (MFI) >1000 was considered HCV antibody reactive. Results: Of the 29,323 DBS sampled, 25,571 (87%) were from unique babies born to mothers residing in NYS. Of these, 18,581 (73%) were tested. 148 DBS were HCV antibody reactive, for an overall NYS seroprevalence of 0.8%. Multiple DBS collected on different days were tested from 1409 individuals, 31 with repeat HCV reactive results, 1376 with repeat non-reactive results and 2 with discordant results close to the MFI cutoff. Premature birth (26%) and low birth weight (26%) were twice as common in babies born to HCV seropositive mothers than seronegative mothers (p<0.001). HCV seroprevalence in Central (2.1%) and Western/Finger Lakes (1.5%) regions, where multiple counties are designated rural, was 3-4 times higher than the rest of NYS and similar to high rates observed in other U.S. rural regions. For the year, we estimate that ~1800 babies will be born to HCV antibody positive women in NYS. Conclusion: Newborn DBS testing using a Luminex-based immunoassay is an effective way to assess HCV burden among pregnant women.

Oral Abstracts

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HCV TRANSMISSION AMONG MSM: EXTERNAL INTRODUCTIONS COULD COMPLICATE MICRO-ELIMINATION Jelle Koopsen 1 , Edyth Parker 1 , Colin Russell 1 , Thijs J.Van De Laar 2 , Elske Hoornenborg 3 , Marc Van Der Valk 1 , Janke Schinkel 1 1 Academic Medical Center, Amsterdam, Netherlands, 2 OLVG, Amsterdam, Netherlands, 3 Public Health Service Amsterdam, Amsterdam, Netherlands Background: Elimination of HCV has become a target with the introduction of highly effective direct antiviral agents (DAAs). In the Netherlands, new HCV infections including frequent reinfections almost exclusively occur in MSM. It is unclear whether unrestricted access and high uptake of DAAs is sufficient to eliminate HCV in high-risk populations such as MSM. This study presents historic trends and current dynamics of HCV among MSM in Amsterdam based on sequence data collected between 1994 and 2019. Methods: HVR1 sequences of 232 primary HCV infections and 56 reinfections were obtained from 244 MSM in care in Amsterdam. Maximum-likelihood phylogenies were constructed for each HCV genotype separately, and time-scaled phylogenies were constructed using a Bayesian coalescent approach. Transmission clusters were determined by Phydelity, which utilizes a statistically-principled and phylogeny-informed framework. The proportion of unclustered sequences over time was calculated using year-specific transmission trees inferred from sequences up to that year. Results: For subtype 1a (n=191) we found 19 transmission pairs and 12 transmission clusters ranging from 3 to 8 sequences. Transmission clusters of subtypes 2b (n=18) and 3a (n=17) were introduced more recently than clusters of subtypes 1a and 4d (n=62). For subtype 1a and 4d, clusters were introduced between 1998 and 2011, whereas for subtype 2b and 3a this was between 2009- 2012. The estimated transmission rate (based on genetic diversity) increased around the year 2000 and plateaued 10-15 years later for subtypes 1a and 4d. The proportion of unclustered sequences of subtype 1a, the most prevalent subtype in this population, increased from approximately 40% before 2014 to about 75% in more recent years. Conclusion: The proportion of unclustered sequences has increased among HCV infections in recent years. The most likely explanation for this is that transmission of local strains has declined as a result of intense treatment efforts whereas external (possibly international) introductions of HCV into the MSM population in Amsterdam has increased. Frequent international transmission events will complicate national micro-elimination efforts and therefore international collaboration combined with international scale-up of treatment of all diagnosed HCV infections (including reinfections) is important.

126 HEPATOCELLULAR CARCINOMA RISK AMONG PERSONS WITH HIV IN NORTH AMERICA, 1996-2015 Jing Sun 1 , Keri N. Althoff 1 , H.Nina Kim 2 , Mari M. Kitahata 2 , Chad J. Achenbach 3 , Gypsyamber D'Souza 1 , Marina Klein 4 , Bryan Lau 1 , Joseph Lim 5 , Vincent Lo Re 6 , Julia L. Marcus 7 , Angel M. Mayor 8 , Michael J. Silverberg 9 , Gregory D. Kirk 1 , for the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) of IeDEA 1 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 2 University of Washington, Seattle, WA, USA, 3 Northwestern University, Chicago, IL, USA, 4 McGill University, Montreal, QC, Canada, 5 Yale University, New Haven, CT, USA, 6 University of Pennsylvania, Philadelphia, PA, USA, 7 Harvard University, Cambridge, MA, USA, 8 Universidad Central del Caribe, Bayamon, Puerto Rico, 9 Kaiser Permanente, Oakland, CA, USA Background: People living with HIV (PWH) are often co-infected with HBV and HCV, leading to increased risk of hepatocellular carcinoma (HCC). HCC risk may have changed in the current era of potent combination antiretroviral therapy (ART). We assessed temporal trends in HCC among PWH, comparing HCC rates by viral hepatitis infection status, risk populations, and HIV disease severity in the North America AIDS Cohort Collaboration on Research and Design (NA-ACCORD).

125 NEWBORN TESTING REVEALS HIGH HCV SEROPREVALENCE IN PREGNANT WOMEN FROM NEW YORK STATE

Linda M. Styer 1 , Erica Miller 2 , Jean Rock 1 , Lea Krein 1 , Monica Martin 1 , Dhanushki Samaranayake 1 , Shu-Yin Leung 1 , Michele Caggana 1 , Colleen Flanigan 1 , Monica Parker 1

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CROI 2020