CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

702

High Completion and Cure Rates With a Decentralized, Integrated HCV Treatment Approach in Vietnam Nhan T. Do 1 , Nhung T. Vo 2 , Huong T. Phan 1 , Dung A. Tran 1 , Thuy T. Pham 3 , Chieu V. Vu 4 , Linh An T. Tong 4 , Hang T. Duong 4 , Duy T. Nguyen 4 , Mai T. Pham 2 , Lisa A. Cosimi 5 , Todd Pollack 2 1 Vietnam Administration for HIV/AIDS Control, Hanoi, Vietnam, 2 Beth Israel Deaconess Medical Center, Boston, MA, USA, 3 Beth Israel Deaconess Medical Center, Hanoi, Vietnam, 4 The Global Fund, Hanoi, Vietnam, 5 Brigham and Women's Hospital, Boston, MA, USA Background: WHO recommends a simplified service delivery approach to the treatment of chronic hepatitis C (HCV) infection including decentralization to the primary care level and integration into existing services. In 2021, with support from the Global Fund, the Vietnam Administration for HIV/AIDS Control within the Ministry of Health scaled up HCV treatment at public HIV and methadone clinics in 36 provinces. Methods: Patients with HCV viremic infection with and without liver fibrosis or cirrhosis were eligible for HCV treatment through the National program. Patients were treated with sofosbuvir/daclatasvir for 12 or 24 weeks following the Vietnam national guidelines. Program data were collected and stored in the Ministry of Health database. We assessed HCV treatment outcomes at national, provincial and district levels. The primary endpoints were treatment completion and sustained virologic response 12 weeks after treatment completion (SVR12). Multivariate logistic regression analysis was used to find factors associated with SVR12. Results: Data were available for 15,196 individuals treated for HCV between May 2021 and June 2023 at HIV clinics (71.3%) or methadone sites (28.4%). The mean age was 42.3 years, 14344 (94.4%) were male, and 8696 (57.2%) had a history of injection drug use. Individuals were treated at the district [13767 (90.6%)], provincial [1167 (7.7%)], and national levels [211 (1.4%)]. Overall, only 271 (1.8%) discontinued treatment due to lost-to-follow-up [171 (63.1%)], change to private treatment [40 (14.8%)], drug stock-out [21 (7.7%)], side effects [12 (4.4%)] or death [27 (10.0%)]. Of the 7663 (51%) with an HCV RNA test 12 weeks or more after completing therapy, 7169 (93.8%) achieved an SVR12. When stratified by level of care, SVR12 rates were 98.9%, 95.9%, and 93.5% at the national, provincial, and district levels respectively. On multivariate analysis, factors independently associated with SVR12 included age > 40, identified as neither MSM or PWID, DTG-based antiretroviral regimen, and presence of liver cirrhosis (Table). Conclusion: Decentralized treatment of HCV infection integrated into HIV and addiction care was highly effective in Vietnam with high rates of treatment completion and SVR12. Ensuring the continued availability of medications and testing reagents as well as financing mechanisms will further strengthen and sustain this program. High Rate of Hepatitis C Incidence in Vietnamese MSM Living With HIV Donn J Colby 1 , Minh T. Nguyen 2 , Lan A. Do 1 , Tam C. Le 3 , Huu T. Tran 3 , Binh Q. Luong 4 , Phuong K. Doan 5 , Khang Q. Do 6 , Hung Van 4 , An Bao 3 1 Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam, 2 Hoan My Sai Gon Hospital, Ho Chi Minh City, Vietnam, 3 Center for Applied Research on Men and Community Health, Ho Chi Minh City, Vietnam, 4 US Centers for Disease Control and Prevention Ho Chi Minh City, Ho Chi Minh City, Vietnam, 5 US Centers for Disease Control and Prevention Can Tho, Cần Thơ, Vietnam, 6 Galant Clinic, Ho Chi Minh City, Vietnam Background: Men who have sex with men (MSM) living with HIV have higher rates of hepatitis C virus (HCV) infection than MSM without HIV infection in North America and Europe. Studies have shown similarly high rates of HCV incidence among MSM living with HIV in large Asian cities, including Bangkok, Taipei, Hong Kong, and Tokyo. There are limited data on HCV incidence among MSM in Vietnam. Methods: MSM and transgender women (TGW) were recruited at two antiretroviral therapy clinics for people living with HIV in Ho Chi Minh City and Can Tho, Vietnam. Participants provided informed consent at the first visit and had a second visit after 12 months. At each visit, participants competed a questionnaire on risk behaviors (sexual behavior and substance use) and had

in the pre-treatment phase. The median time from CPC attendance to HCV treatment initiation was 6 weeks. Of 326, 302 have completed treatment, 18 are currently on treatment and 1 died of an overdose during treatment. Of 302 subjects who have completed treatment, 286 are confirmed as cured (SVR 12), 16 are awaiting SVR 4, 2 documented virologic relapse and 1 documented to be reinfected, a rate of 0.31/100 person-years. 3 patients withdrew from the treatment. By mITT, the cure rate is 286/288 (99.3%). Overall, in this vulnerable population with 6-7 opioid overdose deaths/day, we only documented 2 overdose deaths over 326 PY of overall follow-up. Conclusion: Taken together, the data we present validates the development of multidisciplinary programs such as ours aimed at treating HCV in vulnerable inner-city populations that must be engaged in care for HCV elimination to become a reality. This report also documents additional societal benefits, e.g. lower overdose death, that could be achieved from such a program. Nationwide HCV Elimination Program and the Status of Microelimination in People With HIV in Taiwan Guan-Jhou Chen 1 , Hsin-Yun Sun 2 , Kuan-Yin Lin 2 , Chien-Ching Hung 2 1 National Taiwan University College of Medicine, Taipei, Taiwan, 2 National Taiwan University Hospital, Taipei, Taiwan Background: Evidence from Western countries suggests that nationwide hepatitis C virus (HCV) elimination programs, typically coupled with the expansion of HCV testing and direct-acting antiviral (DAA) treatments, could mitigate new HCV infections among people with HIV (PWH). However, real world data from Asia-Pacific region remained scarce, and the impact of HCV testing and DAA treatment program on HCV reinfection is less addressed. Methods: Since 2018, Taiwan has initiated a nation-led HCV elimination program aiming to achieve the WHO 2030 targets by 2025. The restrictions on access to reimbursed DAA treatment were lifted and, by the end of 2021, >130,000 courses of DAA had been prescribed. In this study, PWH who were followed at a university hospital were included and the data of anti-HCV antibodies and HCV RNA and the information on DAA treatment were collected prospectively. High-risk PWH (defined as those who had had previous HCV viremia, sexually transmitted infections or unexplained elevation of liver aminotransferases within 6 months) tested for HCV viremia every 3-6 months. The prevalence, incidence and the reinfection rate after successful DAA treatment were estimated every calendar year from 2011 to 2022. Results: In total, 4465 PWH were included, including 321 PWH who had received successful DAA treatment since 2018 and were followed for HCV reinfections. Since 2018, the prevalence of HCV viremia has started to decline significantly; as of 2022, the prevalence of HCV viremia had reduced by 80.6% (95% confidence interval [CI], 72.2-86.8) when compared to the epidemiological peak in 2018 (Figure). The rate of new HCV acquisition peaked in 2019, with an incidence rate of 25.94 per 1000 person-years of follow-up (PYFU; 95% CI, 20.44-32.47), which had declined by 71.7% (95% CI, 53.2-86.3%) by the end of 2022, to 7.34 per 1000 PYFU (95% CI, 4.61-11.13). However, the incidence of HCV reinfection peaked later in 2020 at 84.03 per 1000 PYFU (95% CI, 50.58-131.8) and remained high in 2022, with an incidence of 49.30 per 1000 PYFU (95% CI, 26.71-83.82). Compared to the 2020 peak, the rate of HCV reinfection in 2022 showed only a modest reduction by 41.3% (95% CI, -30.4% to 74.4%). Conclusion: The ongoing HCV elimination program has resulted in significant reduction of HCV prevalence and incidence among PWH in Taiwan. However, the incidence of HCV reinfection remained high in the DAA era.

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Poster Abstracts

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CROI 2024 205