CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

of all-cause mortality and development of HCC were similar for HBV-infected PWH with and those without HDV infection. Conclusion: PWH with chronic HBV infection remain at risk for HDV superinfection, and HDV infection is associated with liver-related death in the era of tenofovir-containing ART.

how stable liver fibrosis stages measured by transient elastography remain over time, and how frequent monitoring should be performed. We assessed changes in liver fibrosis stage in pwHBV from a prospective cohort in Dakar, Senegal. Methods: We included all HBsAg-positive individuals enrolled in SEN-B from 2019 to 2023, and who had not received antiviral treatment. Liver stiffness was evaluated 6-monthly using transient elastography and was categorized as normal (<7.0 kPa; equivalent to Metavir stage F0-1), significant fibrosis (7.1-11.0 kPa; Metavir F2-3), or cirrhosis (>11.0 kPa; Metavir F4). We evaluated fibrosis progression (F0-1 to F2-3 or F4, or F2-3 to F4) at 12 (+/- 6) months of follow-up. We used multivariable logistic regression to explore potential risk factors of fibrosis progression, including sex, age, body mass index (BMI), ALT and HBV DNA levels, HBeAg, HDV co-infection and alcohol consumption. Results: Of 689 treatement-naïve individuals with HBV infection, 130 (18.9%) initiated antiviral treatment before the second liver stiffness measurement and were excluded. Of 556 participants analyzed, 51.1% were men, the median age was 31 years (Interquartile range [IQR] 25-39), 29.3% had a BMI ≥25 kg/ m 2 , 23.6% had HBV DNA>2,000 IU/mL and 5.2% had ALT>40 IU. Significant fibrosis was present in 25 (4.5%) individuals at baseline and in 36 (6.5%) at 12 months. Overall, 4.5% (25/556) of participants experienced liver fibrosis progression during follow-up, of whom 24 (96.0%) had F0-1 fibrosis stage at inclusion. In multivariable analyses, male sex (adjusted odds ratio 2.77, 95% confidence interval 1.05-7.33) was the only characteristic associated with fibrosis progression. Conclusion: SEN-B is one of the largest prospective cohorts of people with HBV with longitudinal data on liver fibrosis in sub-Saharan Africa. Five percent of individuals ineligible for antiviral therapy experienced a progression of liver fibrosis stage during the first year of follow-up and this outcome was more likely in men than women. Long-term data is urgently needed to understand the determinants of liver fibrosis changes in Africa in order to inform monitoring strategies. Prevalence and Incidence of Hepatitis B Among People Living With HIV in 4 Sub-Saharan Countries Josphat Kosgei 1 , Nicole Dear 2 , Hannah Kibuuka 3 , John Owuoth 4 , Jonah Maswai 1 , Valentine Sing'oei 4 , Emmanuel Bahemana 5 , Victor Anyebe 6 , Debika Bhattacharya 7 , Georg Lauer 7 , Arthur Kim 7 , Trevor A. Crowell 8 , Neha Shah 9 , Julie Ake 9 , for the AFRICOS Study Group 1 HJF Medical Research International, Kericho, Kenya, 2 US Military HIV Research Program, Bethesda, MD, USA, 3 Makerere University, Kampala, Uganda, 4 HJF Medical Research International, Kisumu, Kenya, 5 HJF Medical Research International, Mbeya, United Republic of Tanzania, 6 Walter Reed Army Institute of Research, Silver Springs, MD, USA, 7 University of California Los Angeles, Los Angeles, CA, USA, 8 Henry M Jackson Foundation, Bethesda, MD, USA, 9 US Military HIV Research Program, Silver Spring, MD, USA Background: Chronic hepatitis B is increasing despite it being a vaccine preventable disease. Africa remains among the regions with the highest number of hepatitis B surface antigen (HBsAg) positive individuals with many studies suggesting HBV transmission occurring predominantly in childhood. To better understand the burden of hepatitis B infection in Sub-Saharan Africa, we assessed the prevalence and incidence of hepatitis B in a prospective cohort study in four African countries. Methods: The African Cohort Study (AFRICOS) is an ongoing observational cohort that started in 2013. The study enrolls participants from PEPFAR supported HIV clinical sites across five programs (South Rift Valley, Kenya; Kisumu West, Kenya; Kayunga, Uganda; Mbeya, Tanzania; and Abuja & Lagos, Nigeria) in four countries. People with HIV are enrolled and followed through twice-yearly visits for up to 15 years. Hepatitis B screening is performed at enrollment and annually with HBsAg test, with positive tests confirmed with HBsAg ELISA. Hepatitis B incidence rates and 95% confidence intervals (CIs) were estimated, using a Poisson distribution, as the number of new hepatitis B diagnoses per 1000 person-years (PY) of follow-up. Results: As of June 2023, 3368 people living with HIV were enrolled, 57.9% being females, with a median age of 41.4 years. At enrollment, 216 participants (6.4%) had a reactive HBsAg result for HBV. Nigeria had the highest prevalence at 14.0% followed by Kisumu West (9.1%), with South Rift Valley having the lowest prevalence at 1.6%. There was a significant difference in prevalence between male and female participants (8.3% v 5.0%, p<0.001). There were 63 incident cases for an incidence rate of 4.4/1000 PY (95% CI: 3.5 – 5.7). The median age for the incident cases was 42.7 years (IQR: 36.4-48.9). Kisumu West had the highest incidence rate (9.2/1000PY, 95% CI: 6.20-14.31) followed by

726

Risk of Liver-Related Events in Individuals With HBV/HIV Coinfection With and Without HDV Laura E. Telep 1 , Grace M Chee 1 , Amanda W. Singer 1 , Anand P. Chokkalingam 1 , David L. Wyles 2 1 Gilead Sciences, Inc, Foster City, CA, USA, 2 Denver Health Medical Center, Denver, CO, USA Background: Up to 10% of individuals with human immunodeficiency virus (HIV) are coinfected with hepatitis B virus (HBV). Limited data are available describing the natural history of triple infection with HBV/HIV/hepatitis delta virus (HDV). This study examines baseline liver health, HDV prevalence, and the risk of liver-related events in individuals in United States (US) administrative claims data with HBV/HIV with or without HDV. Methods: A retrospective cohort study was conducted in the HealthVerity dataset which includes US medical and pharmacy claims, electronic medical records, and hospital data from years 2015 –2022 for > 100 million individuals. Those included were ≥ 18 years at cohort entry with one inpatient or two outpatient international classification of disease (ICD-9/10-CM) codes at least 30 days apart for each type of viral infection. Cohort entry was the date of the last infection among HBV, HIV, and HDV. All included patients had continuous insurance enrollment for 365 days prior and at least one day after cohort entry. We used Cox proportional hazard methods to estimate risk of liver-related events in individuals with vs. without HDV. Prevalence of HDV was assessed using any single HDV claim in any enrollment period. Results: Of the 12,292 patients with HBV/HIV coinfection, we identified 608 patients with HDV and 11,177 with no evidence of HDV. At baseline, individuals with HDV were more likely to have claims for compensated (13.3 vs. 8.4%) and decompensated (10.2 vs. 6.0%) cirrhosis, HCC (1.6 vs. 1.1%), and liver transplant (1.0 vs. 0.3%). Among individuals with no evidence of these conditions at baseline, the risk of developing cirrhosis was 1.20 (0.85 – 1.69) for HDV vs. no HDV and among those with compensated cirrhosis at baseline, the risk of decompensation, HCC, or liver transplant was 1.72 (0.99 – 3.00). A sensitivity analysis excluding individuals with HCV at baseline yielded similar results. HDV prevalence was 6.8% vs. 7.4% (p < 0.01) and the prevalence of injection drug use among individuals with HDV was 12.8% vs. 27.7% (p < 0.01) in the HBV and HBV/HIV cohorts respectively. Conclusion: HDV infection is associated with poor liver health at baseline and increased risk of liver-related events in individuals with HBV/HIV coinfection. HDV and HDV/PWID prevalence was significantly higher among patients with HBV/HIV co-infection than in the general HBV population in this dataset. The figure, table, or graphic for this abstract has been removed. Changes in Liver Fibrosis Stage Among People Living With Untreated Hepatitis B in Senegal Adrià Ramírez Mena 1 , Bruce Wembulua Shinga 2 , Aboubakar S. Badiane 2 , Kiné Ndiaye 3 , Judicaël Tine 2 , Alassane Ndiaye 3 , Maguett Fall 2 , Hubert Akotia 4 , Melissa S. Pandi 4 , Daye Ka 2 , Louise Fortes 5 , Ousseynou Ndiaye 4 , Ndeye Fatou Ngom 3 , Moussa Seydi 2 , Gilles Wandeler 1 , for SEN-B 1 University Hospital of Bern, Bern, Switzerland, 2 Centre Hospitalier Universitaire de Fann, Dakar, Senegal, 3 Centre de Traitement Ambulatoire de Fann, Dakar, Senegal, 4 Centre Régional de Recherche et de Formation à la Prise en Charge Clinique de Fann, Dakar, Senegal, 5 Centre Hospitalier National de Hôpital Dalal Jamm, Dakar, Senegal Background: Hepatitis B virus (HBV) infection is the most important cause of liver cirrhosis and cancer in West Africa. Although close to 80% of persons with HBV (pwHBV) are ineligible for antiviral therapy at presentation, it is unclear

Poster Abstracts

728

727

CROI 2024 214