CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

Methods: We used CMS Transformed Medicaid Statistical Information System (T-MSIS) data to identify a cohort of Medicaid enrollees with chronic hepatitis C. We defined enrollees with chronic hepatitis C as persons with an HCV RNA code (CPT 87520, 87521, or 87522) index date during 2016 to 2020, with an ICD-10 chronic hepatitis C code (B18.2) ≥1 day after the index date. Persons aged 18-64 years enrolled in Medicaid for at least 12 months after their index date and not dually enrolled in Medicare were included. We estimated the prevalence of comorbidities documented within 12 months of the index date: HIV, chlamydia, syphilis, mental health disorders, substance use disorders, and drug overdose. Due to two distinct age-based chronic hepatitis C distributions, we stratified results by age group (18-44 and 45-64) using bivariate log-binomial regression to generate prevalence ratios (PR). Results: Among Medicaid enrollees from 2016 to 2020, 498,497 persons met the inclusion criteria for chronic hepatitis C. A higher percentage (53%) of those aged 18-44 (n=229,820) were female compared to (39%) of those aged 45-64 (n=268, 677). In unadjusted models, enrollees aged 18-44 were less likely to have an HIV diagnosis (PR=0.49, 95% CI: 0.48, 0.51) compared to older enrollees. In contrast, younger enrollees were more likely to be diagnosed with a comorbidity than those aged 45-64, including chlamydia (PR=5.41, 95% CI: 4.83, 6.05), drug overdose (PR=1.78, 95% CI: 1.74, 1.81), and mental health disorder (PR=1.65, 95% CI: 1.65, 1.66). Conclusions: We found that STIs, drug overdose, and mental health disorders are common among persons with chronic hepatitis C enrolled in Medicaid and observed distinct patterns by age group. The higher prevalence of comorbidities, excluding HIV, among the younger cohort may indicate a need for targeted services to support hepatitis C treatment and care, as well as linkage for mental health disorder treatment, substance use treatment, and other infectious disease prevention services.

Methods: A model of HCV transmission among PWID was calibrated in a Bayesian framework using data from Haiphong, mainly RDS surveys. The model included current and former injectors. A status quo (SQ) scenario modelled historical interventions, with no future HCV treatment. Future scenarios modelled the additional impact of providing from 2025-2030 HCV-testing and linkage-to-treatment in OAT and ART centres, and/or HCV testing and treatment in annual survey interventions of 1400 people with history of IDU, like DRIVE-C. We estimated the incremental cost-effectiveness ratio (ICER) per disability adjusted life-year (DALY) averted for the future scenarios compared to SQ over a 30-year time horizon (2025-2054; 3% annual discount rate). Results: In the SQ, HCV incidence among injectors decreased from 7.0 (95% credibility interval 2.8-13.7) per 100 person-years (/100pyrs) in 2016, fitting well against validation data, to 4.6/100pyrs (1.6-9.1) in 2023 and 4.5/100pyrs (1.6-9.0) in 2030. For the future scenario with RDS surveys and HCV-testing and linkage-to-treatment in OAT and ART centres, HCV incidence decreases to 2.1/100pyrs (0.6-4.7) by 2030, or 2.8/100pyrs (0.9-5.7) with just annual RDS surveys. The mean ICER was €658/DALY averted for the scenario with HCV testing and treatment in both annual RDS surveys and in OAT and ART centres, whilst it was €762/DALY for annual RDS surveys with HCV testing and treatment; both cost-effective at a willingness-to-pay threshold of €2,334/DALY averted (50% of Vietnam’s 2023 GDP per capita). Conclusions: Using RDS surveys and/or other care settings to scale-up HCV testing and treatment are cost-effective strategies to reduce HCV incidence among PWID in Vietnam. CC-Genotype (IFNL4) in HCV/HIV Coinfection: Cellular Exhaustion but Balanced Inflammatory Profile Sonia Arca De Lafuente 1 , Violeta Lara-Aguilar 1 , Manuel Llamas-Adan 1 , Sergio Grande García 1 , Cristina Gonzalez-Diaz 1 , Andrés Deza de la Casa 1 , Luz Martín Carbonero 2 , Pablo Ryan 3 , Ignacio de los Santos 4 , Mariano Matarranz 3 , Amanda Fernández Rodríguez 1 , Verónica Briz 1 1 Instituto de Salud Carlos III, Madrid, Spain, 2 Hospital Universitario La Paz, Madrid, Spain, 3 Hospital Universitario Infanta Leonor, Madrid, Spain, 4 Hospital Universitario de La Princesa, Madrid, Spain Background: CC genotype of the rs12979860 polymorphism on the lambda 4 interferon (IFNL4) gene has been related to spontaneous resolution of Hepatitis C virus (HCV) infection. The role of CC genotype in those who develop chronic HCV infection is still unknown, particularly notable during Human Immunodeficiency Virus (HIV) coinfection. To study its role in HCV/HIV coinfection, immunological characterization of rs12979860 genotypes (CC vs CT/ TT) has been conducted. Methods: Observational study in 118 people with HIV (PWH): 45 with HCV-chronic infection (CHC); 38 who spontaneously clarified HCV (SC); and 35 controls (HIV). rs12979860 was genotyped by real time PCR, expression of surface markers was evaluated in CD4+ and CD8+ memory T cells by flow cytometry, oxidative stress markers were quantified by ELISA, and 45 immune plasma markers by Luminex. Differences among genotypes were evaluated by generalized linear model (GLM), or generalized additive model for location, scale, and shape (GAMLSS), adjusted for the most significant variables and corrected by FDR. Results: CC-carriers presented a higher frequency of SC (47.54%), as expected. Significant differences among rs12979860 genotypes in the cellular immune profile were mainly observed within CHC group. In this group, CC-carriers showed higher levels of cellular immune exhaustion in CD8+T cells, specifically middle activation (CD25) in total effector memory (EM), EM1 and EM4 subpopulations; late activation (CD38) in EM and TEMRA; and senescence (PD1/ CD57) in EM, EM2, EM3 and TEMRA (pE2). Opposite, their resting CD8+T cells significantly decreased, including EM and TEMRA (total and pE2) ( Fig.1a ). Within SC group, CC-carriers showed significantly reduced senescence levels only in CD8+ TEMRA subpopulations. As for plasmatic markers, all CC-carriers showed a general increase in cytokines IL-2, IL-4, IL-10, IL-13 and IL-15. Also, among CHC, CC-carriers had higher levels of IL-1beta, IL-6, IL-17A, IL-27, IL-31, TNF-α, IL-1RA and GM-CSF, while oxidative stress slightly decreased ( Fig.1b ). No significant differences were found in HIV group. Conclusions: The favourable rs12979860-CC genotype is associated with increased levels of exhausted CD8+T cells among the PWH with chronic HCV infection, that may be masked during clinical monitoring by the general altered levels of soluble immune markers. CD8+T cell exhaustion relates to tumorigenesis, indicating that CC carriage is unfavourable along HCV/HIV coinfection and should be considered during clinical management.

Poster Abstracts

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Cost-Effectiveness of Interventions to Reduce HCV Among People Who Inject Drugs in Haiphong, Vietnam Adam Trickey 1 , Pham Minh Khue 2 , Nicolas Nagot 3 , Nguyen Thanh Binh 2 , Vu Hai Vinh 4 , Tran Thi Hong 2 , Catherine Quillet 3 , Roselyne Vallo 3 , Khuat Thi Hai Oanh 5 , Duong Thi Huong 2 , Todd Pollack 6 , Vo Thi Tuyet Nhung 7 , Don Des Jarlais 8 , Didier Laureillard 3 , Peter Vickerman 1 1 University of Bristol, Bristol, UK, 2 Hai Phong University, Hai Phong, Vietnam, 3 Université de Montpellier, Montpellier, France, 4 Viet Tiep Hospital, Hai Phong, Vietnam, 5 Supporting Community Development Initiatives, Hanoi, Vietnam, 6 Beth Israel Deaconess Medical Center, Boston, MA, USA, 7 The Partnership for Health Advancement in Vietnam - Beth Israel Deaconess Medical Center, Ho Chi Minh City, Vietnam, 8 New York University, New York City, NY, USA Background: In Vietnam, including Haiphong, many hepatitis C virus (HCV) infections occur among people who inject drugs (PWID). In 2016, there were an estimated 10,000 people with a history of injecting drug use (IDU) in Haiphong. Multiple respondent-driven sampling (RDS) surveys tested for HCV among PWID in Haiphong, and a survey intervention (ANRS 12380 DRIVE-C) provided HCV testing and treatment; treating 979 current and former injectors in 2019. HCV testing and linkage-to-treatment in centres providing opiate agonist treatment (OAT) or antiretroviral therapy (ART) was provided in 2021/22 (831 treated), but no other HCV treatment has been available. We aimed to model the impact and cost-effectiveness of providing HCV testing and treatment to PWID through RDS surveys and/or OAT and ART centres in Haiphong.

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