CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

Conclusion: HIV positive IDUs and MSM are at increased risk of re-infection following successful DAA therapy. Greater engagement in prevention interventions is required to prevent reinfections and achieve elimination targets. Hepatitis C Reinfection Among Men Who Have Sex With Men in an Acute HIV Cohort in Thailand Pathariya Promsena 1 , Ferron F. Ocampo 1 , Carlo P. Sacdalan 1 , Suteeraporn Pinyakorn 2 , Nisakorn Ratnaratorn 1 , Kultida Poltavee 1 , Nitiya Chomchey 1 , Somchai Sriplienchan 1 , Nittaya Phanuphak 3 , Sandhya Vasan 2 , Lydie Trautmann 2 , Donn J. Colby 2 , for SEARCH 010 /RV 254 1 SEARCH, Bangkok, Thailand, 2 US Military HIV Research Program, Silver Spring, MD, USA, 3 Institute of HIV Research and Innovation (IHRI), Bangkok, Thailand Background: The advent of direct-acting antivirals (DAAs) revolutionized the treatment of hepatitis C (HCV). However, HCV reinfections either after spontaneous clearance or sustained virologic response (SVR) pose a challenge in HCV elimination, particularly in high-risk populations. In this study, we determined the incidence and identified risk factors of HCV reinfection in a longitudinal early-treated acute HIV cohort in Thailand. Methods: SEARCH010/RV254 enrolls participants during acute HIV infection (Fiebig I-V) and initiates antiretroviral therapy (ART) within days of diagnosis. HCV antibody screening was performed at enrolment and then annually or if clinically indicated. HCV infection was confirmed with HCV ribonucleic acid (RNA). SVR was assessed at least 12 weeks after treatment completion. HCV RNA was monitored annually in all participants with HCV clearance (either spontaneous clearance or SVR). HCV reinfection was defined as positive HCV RNA after HCV clearance. Incidence of HCV reinfection with 95% confidence intervals (CI) per 100 person-years of follow-up (PYFU) was calculated using the exact method. Cox regression was used to identify risk factors for HCV reinfection. Results: Between May 2009 and August 2023, 127/724 (17.5%) participants were diagnosed with HCV infection. Data analysis included 91 participants who had spontaneously cleared (n=18) or achieved SVR after HCV treatment (n=73). Among these, 14 (15.4%) developed reinfection; five after spontaneous clearance and nine after SVR. All were men who have sex with men (MSM) with median age 34.0 (IQR 29.0-37.0) years. The median time to reinfection was 1.3 years (IQR 0.8-2.8). The overall HCV reinfection incidence density rate was 6.3 per 100 PYFU (95% CI, 3.7-10.6) over 222.8 PYFU. HCV reinfection incidence was higher in the spontaneous clearance group (9.4 per 100 PYFU, [95% CI, 3.9-22.6] than the SVR group (5.3 per 100 PYFU, [95% CI, 2.8-10.2], P=0.285). Although a high proportion of participants reported current illicit drug use (50.5%), current injection drug use (33.0%), condomless sex (37.4%), or had syphilis within the previous 6 months (26.4%), no significant associations between these risk factors and HCV reinfection were found in univariable analyses. Conclusion: In this early-treated AHI cohort of Thai MSM, there is a high incidence of HCV reinfection. Post-clearance follow-up with counseling and preventive strategies to reduce ongoing risk behavior are needed to reduce HCV reinfection. The figure, table, or graphic for this abstract has been removed. Re-Infection Following a Minimal Monitoring Approach for Treatment of Hepatitis C Virus Infection Win Min Han 1 , Sunil Suhas Solomon 2 , Laura Smeaton 3 , Sandra Wagner Cardoso 4 , Jiani Li 5 , P.C. Parvangada 5 , Mark Sulkowski 2 , Susanna Naggie 6 , Ross Martin 5 , Hongmei Mo 5 , Evguenia Maiorova 5 , David L. Wyles 7 1 HIV-NAT, Bangkok, Thailand, 2 The Johns Hopkins University School of Medicine, Baltimore, MD, USA, 3 Harvard TH Chan School of Public Health, Boston, MA, USA, 4 Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, Brazil, 5 Gilead Sciences, Inc, Foster City, CA, USA, 6 Duke University, Durham, NC, USA, 7 Denver Health Medical Center, Denver, CO, USA Background: MINMON (ACTG A5360) trial demonstrated that a minimal monitoring approach for HCV treatment with sofosbuvir-velpatasvir (SOF/ VEL) was safe and efficacious (sustained viral response [SVR]: 95%) in a diverse global population. In a phylogenetic analysis, we estimated HCV re-infection rates among participants with post-treatment HCV RNA >lower limit of quantification (LLoQ). Methods: HCV RNA evaluations were scheduled at weeks 0, 24 (SVR visit), 48 and 72 for MINMON participants. Samples with post-baseline HCV RNA >LLoQ and paired baseline samples underwent deep sequencing of NS5A and NS5B genes. Consensus sequences determined HCV genotype. FastTree generated phylogenetic trees; FigTree provided visualization. Participants

Background: The achievement of sustained viral response (SVR) is associated with a reduction in HR in most patients and therefore, with a lower risk of suffering hepatic events. However, in a non-negligible percentage (10-30%) of patients who achieve SVR, liver stiffness (LS) is not reduced, and the responsible factors are not yet known. The analysis of markers related to cellular aging could offer an answer to this question. Methods: Prospective study of parallel GEHEP and HEPAVIR cohorts at the Virgen de Valme University Hospital that met the following criteria: 1) SVR after 12 weeks with interferon-free direct-acting antivirals (DAA); 2) RH ≥ 9.5 kPa 3 months before DAA; 3) LS measurement and sample available on the SVR evaluation date. We will measure telomere length (RTL) and the levels of mitochondria, hsCRP, sCD163, sCD14, IL-6, Isoprostanate-8, CXCL10, CCL11, vWF, Vitamin D and CHI3L1, and we will analyze their association with the decrease or not of the LS at RVS. Results: A total of 175 patients were included. In 31 (18%) patients the LS did not decrease, going from a median (Q1-Q3) of 14.4 (10.3-27.7) kPa at the beginning of treatment to 21.3 (14.4-46.4) kPa in SVR. On the other hand, the group of 144 (82%) patients in whom LS decreased went from a median of 16.8 (11.9-28.6) kPa at the beginning of treatment to 11.5 (7.6.1-18.4) kPa in SVR. In the univariate analysis, the only variables that showed an association with the absence of LS decrease in SVR were RTL [8.06 (5.83, 11.09) vs 6.41 (4.78, 8.29) (p=0.011)], hsCRP [0.8 (0.35, 1.91) vs 1.55 (0.63, 4.24) (p=0.008)], and sCD163 [49.3 (39.8, 58.4) vs 45.2 (40, 47.9) (p=0.045)]. Factors such as HIV-coinfection, baseline HR, parenteral infection, HCV-3 genotype, HCV viral load, or the MELD and Child-Pugh A indices showed no association. In the multivariate analysis adjusted for sex, age, and hsCRP and sCD163 levels, greater RTL size was the only variable independently associated with the absence of LS decrease (OR 1.173; 95% CI (1.02-1.35); p = 0.025). Conclusion: Telomere length is independently associated with the absence of LS decrease in SVR. Greater cellular aging could be responsible, at least partially, for the absence of LS decrease in patients who achieve SVR. WITHDRAWN HCV Reinfection After DAA Therapy in People With HIV in the Country of Georgia Akaki Abutidze , Nikoloz Chkhartishvili, Lali Sharvadze, Pati Gabunia, Marine Mirziashvili, Alexi Abramishvili, Shorena Dvali, Tengiz Tsertsvadze Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia Background: Georgia ensured universal access to free direct acting antiviral (DAA) therapy for all HIV infected persons within the national hepatitis C elimination program. We aimed to assess the HCV reinfection rate after successful DAA treatment among HIV/HCV co-infected persons in Georgia in real-world settings. Methods: Study included HIV/HCV co-infected patients with confirmed sustained virologic response (SVR) documented between 2015 and 2021 and who remained alive as of June 30, 2023. Patients were followed until the first positive HCV RNA test post-SVR or the last HCV RNA negative test performed through June 30, 2023. Through 2019, patients were screened for HCV reinfection using risk-based approach (clinical and behavioral indications), while starting from 2020 national guidelines recommend annual HCV RNA screening. The date of reinfection was defined as a midpoint between the last negative and the first positive HCV RNA test result. Time to event approach was used to calculate the rates of reinfection per 100 person-years (PY) of follow-up. Results: During the study period 674 patients achieved SVR and 583 (86.5%) were screened for HCV reinfection. Among them, the median age was 48 (IQR: 43-54) years, 522 (89.5%) were men, 409 (70.2%) had been infected via injection drug use (IDU), 136 (23.3%) – via heterosexual contact and 34 (5.8%) – via male-to-male sex. Patients were followed for the median 4.4 (IQR: 2.9-5.9) years contributing to 2,549 PY of follow-up. In total, 54 (9.3%) persons had HCV reinfection with an overall incidence of 2.12 (95% CI: 1.59-2.76) per 100 PY. The rate of reinfection was significantly higher among men (2.35 per 100 PY, 95% CI: 1.76-3.77 per 100 PY) compared to women (0.34 per 100 PY, 95% CI: 0.01-1.91) (p=0.02). The rate of reinfection was 2.55 (95% CI: 1.86-3.46) per 100 PY among IDUs (46 reinfections), 4.72 (95% CI: 1.73-10.28) per 100 PY among MSM (6 reinfections) and 0.34 (95% CI: 0.04-1.22) per 100 PY among heterosexually infected persons (2 reinfections). Comparison of rates showed significant differences between IDU and heterosexually infected persons (p<0.0001), between MSM and heterosexually infected persons (p=0.001), but not between MSM and IDU (p=0.25).

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