CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

698

Prevalence and Risk Factors for Hepatitis C Viremia in People With HIV in the US During the DAA Era Jimmy Ma 1 , Robin M. Nance 1 , Edward Cachay 2 , Stephanie A. Ruderman 1 , Lydia N. Drumright 1 , Rob Fredericksen 1 , Oluwaseun Falade-Nwulia 3 , Geetanjali Chander 1 , Christopher Hurt 4 , George A. Yendewa 5 , April Pettit 6 , Richard D. Moore 3 , Mari Kitahata 1 , H. Nina Kim 1 , for the Center for AIDS Research Network of Integrated Clinical Systems 1 University of Washington, Seattle, WA, USA, 2 University of California San Diego, La Jolla, CA, USA, 3 The Johns Hopkins University, Baltimore, MD, USA, 4 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 5 Case Western Reserve University, Cleveland, OH, USA, 6 Vanderbilt University, Nashville, TN, USA Background: Characterizing the burden and understanding the vulnerabilities and risks for active hepatitis C virus (HCV) infection in the direct-acting antiviral (DAA) era among PWH will provide key information on current progress and guide efforts toward HCV micro-elimination. We evaluated the prevalence of HCV viremia among PWH in clinical care in the US during the DAA era and examined risk factors for HCV viremia from 2018-22. Methods: Using a serial cross-sectional design, we examined all adult PWH in clinical care at 9 sites in the CFAR Network of Integrated Clinical Systems (CNICS) cohort with ≥1 encounter in 2011-13 (pre-interferon free DAA era, number of participants=22445), 2014-17 (early DAA era, N=25161), or 2018-22 (current DAA era, N=25314). We defined HCV viremia as a positive HCV RNA or genotype. Prevalence of HCV viremia was determined for each time period, using the most recent available lab results, and by demographic group (age, gender, race/ ethnicity). We administered validated survey instruments to measure current substance use (AUDIT-C, alcohol; ASSIST, other drugs) and depressive symptom severity (PHQ-9). FIB-4 score was calculated using the age and closest lab values on or before a participant's HCV lab test. We used adjusted relative risk regression (Poisson) to evaluate risk factors for HCV viremia in 2018-22. Results: Among PWH in care, the overall prevalence of HCV viremia was 8.7% in 2011-13, 10.5% in 2014-17, and 4.8% in 2018-22. Disparities in the prevalence of HCV viremia across groups defined by age, gender, and race/ethnicity were smaller in 2018-22 than earlier time periods (overall range across all 3 demographic groups by time period: 3.0-13.0% [2011-13]; 3.5-14.4% [2014-17]; 3.2-5.6% [2018-22]). In adjusted relative risk regression, identifying as female (RR 1.33, 95% CI 1.13-1.56), FIB-4 (RR 1.67 per unit, 95% CI 1.59-1.76), depressive symptom severity (RR 1.18 per 5 units on PHQ-9, 95% CI 1.08-1.30), and current use of methamphetamine (RR 2.76, 95% CI 2.06-3.68) or illicit opioids (RR 2.22, 95% CI 1.58-3.12) (P<0.001 for each factor) were associated with higher likelihood of HCV viremia in 2018-22. Conclusion: The prevalence of HCV viremia during the DAA era in this US-based national cohort of PWH improved over time and across demographic subgroups but remains elevated. Our findings underscore the importance of prioritizing substance use and mental health treatment in PWH to achieve HCV elimination goals.

699

Elimination of HCV Among People With HIV in Australia Joanne Carson 1 , Marianne Martinello 1 , Samira Hosseini-Hooshyar 1 , Phillip Read 2 , David A. Baker 3 , Jeffrey Post 4 , Robert Finlayson 5 , Mark Bloch 6 , Joseph Doyle 7 , David Shaw 8 , Margaret Hellard 7 , Ecaterina Filep 1 , Gregory Dore 9 , Gail Matthews 1 1 University of New South Wales, Sydney, Australia, 2 Kirketon Road Centre, Sydney, Australia, 3 East Sydney Doctors, Sydney, Australia, 4 The Albion Centre, Sydney, Australia, 5 Taylor Square Private Clinic, Sydney, Australia, 6 Holdsworth House Medical Practice, Sydney, Australia, 7 Burnet Institute, Melbourne, Australia, 8 Royal Adelaide Hospital, Sydney, Australia, 9 St Vincent's Hospital Sydney, Sydney, Australia Background: An estimated 2000-2500 people were living with HIV/HCV coinfection in Australia prior to availability of HCV direct-acting antivirals (DAAs). Rapid DAA scale-up occurred from 2016 following unrestricted DAA access for adults. The aim of this analysis was to evaluate progress towards HCV elimination among people with HIV in Australia. Methods: The CEASE prospective cohort study enrolled people with HIV and anti-HCV antibodies, irrespective of HCV RNA status, from 11 primary and tertiary clinics. Enrolment (ENR; 2014-2016), Follow-Up 1 (FU1; 2017-2018) and Follow-Up 2 (FU2; 2021-2023) visits were undertaken. Biobehavioural data were collected at each visit and clinical data extracted from medical records. Participants with at least 2 study visits were included in analysis and proportion with HCV RNA calculated. Death and HCV reinfection incidence rates were calculated per 100 person-years (PY). Cox regression was used to assess associated factors. Results: Of 314 participants (median age 49-years, 97% male [89% gay or bisexual], 13% cirrhosis, 80% history of injecting drug use [IDU], 42% current IDU [past month]) data were available for 295 at FU1 and 266 at FU2 (220/266 HCV RNA available). Of those with detectable HCV RNA at ENR (n=224), 210 received HCV treatment, 204 had documented cure, and 189 had post-cure visit. The proportion with detectable HCV RNA declined from 71% (ENR), to 7% (FU1), to 1% (FU2). Fourteen participants had HCV reinfection (13/14 retreated). HCV reinfection rate was 1.5/100 PY (95%CI 0.91, 2.60; median FU 5.6 years); decreasing from 2.7/100 PY (ENR-FU1) to 0.60/100 PY (FU1-FU2). Current IDU (adjusted hazard ratio [AHR] 3.72 95%CI 1.29, 10.72) increased reinfection risk. In the overall study population, 29 died. Death rate was 2.1/100 PY (95%CI 1.46, 3.01; median FU 4.7 years), stable over time. Median age at death was 56-years (range 29-68). Leading causes of death were chronic comorbidities (24%), cancer (21%), sepsis (14%), and drug overdose or suicide (7%). Older age (AHR 1.06 per year 95%CI 1.01, 1.11) and liver cirrhosis (AHR 2.46 95%CI 1.10, 5.52) increased death risk. Current IDU did not increase death risk, although younger age (<35 years) at injecting initiation did (AHR 3.56; 1.06, 12.00). Conclusion: HCV prevalence among people with HIV in Australia has declined substantially following rapid DAA scale-up, however surveillance, for HCV (re) infection and associated morbidity and mortality, remains important. Community Pop-Up Clinic: Cascade of Care and HCV Treatment of Vancouver’s Inner-City PWID Population Brian Conway , Saina Beitari, Shawn Sharma, Rossitta Yung, Shana Yi Vancouver Infectious Diseases Center, Vancouver, Canada Background: Several strategies have been proposed to identify HCV-infected inner-city residents, engage them in care, provide them with antiviral therapy, establish conditions to maximize treatment completion and cure achievement. Elimination of HCV infection as a public health concern by the end of this decade will require a concerted effort in all target populations, including vulnerable inner-city populations, many of whom are actively using drugs and are facing other issues more challenging that HCV infection: housing and financial insecurity, untreated mental illness, and active untreated addiction. Methods: We have evaluated a novel approach of Community Pop-Up Clinics and its ability to promote access to care, uptake of HCV therapy and its outcome, with additional analyses of HCV reinfection events and opioid-related mortality. We hypothesized that by implementing this CPC program, we will optimize engagement in care of vulnerable inner-city populations, increase successful uptake of HCV therapy and reduce reinfection events and mortality. Results: From January 2021 – August 2023 (32 months), we conducted 112 CPCs and evaluated 1968 individuals. 620 individuals (31.5%) were found to carry HCV antibodies. Of 620 individuals we identified as carrying HCV antibodies, 474 individuals (76.5%) were found to be viremic. HCV engagement has been secured in 387 cases (81.6%). 326 (84.2%) individuals have started treatment and 60 are in the pre-treatment phase, and 1 had died of an overdose

Poster Abstracts

700

CROI 2024 204