CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

receive it. We estimated DAA uptake among PWH with HCV coinfection in the NA-ACCORD to identify factors associated with DAA initiation. Methods: U.S. and Canadian PWH 18-years or older with untreated HCV in NA ACCORD clinical cohorts were followed from their latest date of: 1) detectable HCV viremia, 2) ART initiation, 3) enrollment date, or 4) 1/1/2014 until the first of: 1) DAA prescription (event), 2) clearance of HCV viremia (ineligible for DAA), 3) loss to follow-up, 4) death or 5) 12/31/2021. A competing risk approach estimated the cumulative incidence of DAA initiation while accounting for both death and HCV clearance. Cox proportional hazard models estimated crude and adjusted hazard ratios (aHR) and 95% confidence intervals to identify factors associated with DAA initiation including sex, age, HIV risk group, race/ethnicity, FIB-4 score, HBV coinfection, alcohol use, smoking status, HIV viral load and a history of AIDS, hypertension, diabetes, and chronic kidney disease. Results: Among 6,300 PWH with HCV, 3,672 initiated DAA. The 8-year cumulative incidence of DAA initiation was 65% [63%-66%]. Accounting for the competing risks of death and HCV clearance, 6% of eligible PWH did not initiate DAA ( Figure ). PWH reporting heterosexual (aHR=0.79 [0.68, 1.92]) or injection drug use (aHR=0.84 [0.75, 0.95] HIV risks initiated DAA at a lower rate compared with men who have sex with men. A reduced rate of DAA initiation was identified among non-Hispanic Black (aHR=0.83 [0.76, 0.90]) and Hispanic (aHR=0.88 [0.77, 1.00]) PWH compared with non-Hispanic white PWH. DAA initiation was significantly lower among PWH with at-risk alcohol use, smoking, detectable HIV viremia, and a history of AIDS. A higher FIB-4 score was associated with increased DAA initiation. Other assessed factors were not associated with differences in DAA initiation in multivariable models. Conclusions: Accounting for death and HCV clearance the treatment gap among PWH eligible for, and those initiating DAA has narrowed over time. We identified factors associated with disparities in DAA uptake including HIV risk, race/ethnicity, smoking, alcohol use and HIV viremia. Targeted approaches are needed to increase equity in DAA initiation by addressing these disparities to achieve the goal of HCV elimination among PWH.

between EOT and SVR visit, we performed HCV RNA testing on EOT samples (907/1245 with detectable RNA at SVR had EOT samples). Participants with EOT HCV RNA 90% medication possession) were reclassified as achieving SVR. Poisson regression was used to identify predictors of re-infection after SVR. Results: Median age of 1749 participants who achieved SVR was 30 yrs; 98% were cisgender men, 6% reported homelessness, and 41% reported injection in the 3 months before the SVR visit. There were 232 HCV re-infections between SVR and the first semi-annual visit (500 person-years [PY]) resulting in a overall re-infection rate of 46.4 per 100 PY, ranging from 23.3 to 73.6 per 100 PY across sites. Younger age, HIV co-infection, higher injection frequency, and needle sharing were associated with higher re-infection risk after SVR (p<0.01). Among 907 EOT samples, 412 had HCV RNA90% adherence increasing the SVR in the overall sample from 58% to 69%. Re-infection rate between EOT and SVR was 56.9 per 100 PY. From EOT to 12-months after SVR, re-infection rates declined over time (Figure). Conclusions: In this large trial in a resource-limited setting, comprised mostly of young actively injecting men, we observed an alarmingly high re-infection rate. Our findings suggest that in the most vulnerable, true SVR may be masked by high re-infection, even between EOT and SVR. Innovative harm reduction and treatment strategies are needed to sustain the impact of HCV treatment by minimizing re-infection.

Poster Abstracts

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Increasing HCV Prevalence Among People Who Inject Drugs in India Despite Improved Treatment Uptake Shruti H. Mehta 1 , Mihili Gunaratne 1 , A. K. Srikrishnan 2 , Ashwini Kedar 2 , Allison M. McFall 1 , Jiban J. Baishya 3 , Muniratnam S. Kumar 2 , Pradeep Amrose 2 , Boobalan Jayaseelan 2 , Gregory M. Lucas 3 , David Thomas 3 , Sunil S. Solomon 3 1 The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 2 YR Gaitonde Center for AIDS Research and Education, Chennai, India, 3 The Johns Hopkins University School of Medicine, Baltimore, MD, USA Background: HCV elimination targets for 2030 require that 90% of people with HCV (PWHCV) are diagnosed, and 80% of those diagnosed are treated, alongside measures to reduce primary infection and reinfection in groups like people who inject drugs (PWID) who bear a disproportionate burden. We characterize changes in HCV burden, awareness of HCV status, treatment uptake, and aviremia among PWID across 6 Indian cities over 12 years. Methods: We conducted 3 population-based surveys in each of 6 Indian cities using respondent-driven sampling (RDS) to recruit 750-1000 PWID/city/survey in 2012-2013, 2016-2017 and 2023-2024. In 2017, we scaled community-based integrated care centers in each city that delivered HIV and harm reduction services alongside rapid HCV antibody testing; HCV RNA testing and on-site treatment with direct-acting antivirals were integrated in 2021. In 2016, the government launched free HCV treatment in government centers. We characterize temporal trends in HCV prevalence, treatment uptake among diagnosed, and aviremia (no detectable HCV RNA at survey visit) among treated. Correlates of diagnosis and aviremia were explored. All analyses incorporated RDS-2 weights. Results: Across 3 periods, the median age was 28, 30 and 29 years with 91%, 91% and 99% reporting injection in the prior 6 months. 18%, 24% and 42% were living with HIV. HCV antibody prevalence increased from 40% to 56% to 82% with increases in all sites. Among those with current or prior chronic infection (detectable HCV RNA or self-reported treatment), the proportion

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High HCV Re-Infection Rates May Mask “True” Sustained Virologic Response in People Who Inject Drugs Sunil S. Solomon 1 , Jiban J. Baishya 1 , A. K. Srikrishnan 2 , Mihili Gunaratne 3 , Ashwini Kedar 2 , Pradeep Amrose 2 , Allison M. McFall 3 , Mark Sulkowski 1 , Boobalan Jayaseelan 2 , Gavin Cloherty 4 , Gregory M. Lucas 1 , David Thomas 1 , Shruti H. Mehta 3 1 The Johns Hopkins University School of Medicine, Baltimore, MD, USA, 2 YR Gaitonde Center for AIDS Research and Education, Chennai, India, 3 The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 4 Abbott Laboratories, Abbott Park, IL, USA Background: Eliminating HCV requires curing people and ensuring they remain free of re-infection. People who inject drugs (PWID) are particularly vulnerable to re-infection, but few re-infection estimates are available from resource limited settings. We evaluate HCV re-infection rates among PWID treated in community-based centers in 7 Indian cities. Methods: From 2021-2022, 3000 PWID ≥18 years with active HCV infection were enrolled in a randomized trial of HCV treatment support strategies. For all, treatment was delivered from community-based centers that provided HIV and harm reduction services including medication for opioid use disorder. 1749/2994 (58%) achieved sustained virologic response (SVR), defined as undetectable HCV RNA ≥12 weeks after end-of-treatment (EOT), and were followed semi-annually using HCV core antigen (ARCHITECT) to assess re-infection rate (number of re-infections/person-time at risk). Due to the potential for re-infection

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