CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

may contribute to this progression. This study aims to characterize the lipidomic profiles linked to MASLD in HIV/HCV-coinfected patients with advanced fibrosis or cirrhosis at 1 and 6 years (yrs) after DAA-induced SVR. Methods: Fifty-two HIV/HCV-coinfected patients with advanced fibrosis or cirrhosis who achieved SVR following DAA therapy were included. Untargeted lipidomic profiling was performed on plasma samples collected at 1 yr (n=52) and 6 yrs (n=29) post-SVR using liquid chromatography-mass spectrometry. The primary outcome was MASLD, defined by a Hepatic Steatosis Index ≥36 and the presence of at least one adult cardiometabolic risk factor. Statistical analyses included orthogonal partial least squares discriminant analysis (oPLS-DA) and generalized linear models (GLM), with corrections for multiple comparisons. Results: MASLD prevalence was 28.9% at 1 yr and 44.8% at 6 yrs post SVR. oPLS-DA models showed that lipid profiles successfully differentiated patients based on MASLD status, identifying 225 plasma lipids at 1 yr and 167 at 6 yrs, with a variable importance in projection (VIP) score ≥1. Adjusted GLMs confirmed significant associations between MASLD and 116 lipids at 1 yr and 49 at 6 yrs. At 1 yr, over 75% of significant lipids were glycerophospholipids (GP), with increased phosphatidylcholines (PC) and phosphatidylethanolamines (PE) and decreased lysophosphatidylcholines (LPC) and lysophosphatidylethanolamines (LPE) in MASLD patients. By 6 yrs, LPC remained the most abundant differential lipid within the GP category. Additionally, LPE, lysophosphatidylinositols, and fatty acids decreased, while triglycerides significantly increased at 6 yrs. Conclusions: MASLD was common during follow-up in this cohort, with lipidomic profiles indicating significant changes over time. Increases in PCs and triglycerides, alongside decreases in LPCs and LPEs, suggest ongoing metabolic disturbances that may contribute to liver disease progression despite SVR. These findings highlight the potential role of lipid dysregulation in the pathogenesis of post-SVR liver disease, emphasizing the need for long-term metabolic and liver health monitoring in HIV/HCV-coinfected patients with advanced fibrosis or cirrhosis.

year of follow-up in SEN-B, a prospective general population cohort of pwHBV in urban Senegal. Methods: We analyzed all treatment-naïve pwHBV with negative HIV antibodies from the SEN-B cohort. We compared liver stiffness measurement (LSM)-based AVT eligibility (LSM-E) and AST to Platelet Ratio Index (APRI)- based eligibility (APRI-E) between WHO 2024 and WHO 2015 guidelines at time of enrollment. Furthermore, we assessed the proportion of pwHBV who were ineligible at enrolment but who became eligible during the first year of follow up under WHO 2024 criteria. The proportion of participants eligible under different guidelines were compared using McNemar's chi-squared test. Results: Of 748 treatment-naïve SEN-B participants, 396 (52.9%) were men, 734 (98.1%) had a negative HBe antigen test, and the median age was 31years (IQR: 25–38). At enrollment, LSM-E was 6.3% for WHO 2015 and 34.8% for WHO 2024 criteria (p<0.001), whereas APRI-E was 5.1% for WHO 2015 and 29.8% for WHO 2024 criteria (p<0.001, Figure 1). Whereas with WHO 2015 guidelines only 2.6% of pwHBV were eligible for AVT due to liver cirrhosis (LSM >12.5 kPa), this proportion increased to 11.1% with the new WHO 2024 cut-off (LSM >7 kPa). Using APRI-based criteria, eligibility rose from 0.8% under WHO 2015 (APRI >2) to 4.5% under WHO 2024 (APRI >0.5). With the WHO 2024 guidelines, 64 (8.6%) pwHBV became newly eligible based on family history of hepatocellular carcinoma, and 61 (8.1%) on comorbidities, including 3 (0.4%) due hepatitis delta virus infection, 18 (2.4%) due to diabetes, and 40 (5.3%) due to liver steatosis. Among 535 participants ineligible for AVT at enrolment, 52 (9.7%) additional pwHBV became eligible based on LSM-E under WHO 2024 guidelines during the first year of clinical follow-up. Conclusions: Treatment eligibility increased under WHO 2024 guidelines compared to WHO 2015 but remained well below the projected 50%. Monitoring AVT eligibility during the first year of follow-up should be planned for those who are ineligible the first time. Continuum of Hepatitis B Surface Antigen Expression Among PWID and MSM Living With HIV in India Talia A. Loeb 1 , Mihili Gunaratne 1 , Hussain Syed Iqbal 2 , Mark Anderson 3 , A. K. Srikrishnan 2 , Allison M. McFall 1 , Gregory M. Lucas 4 , Mary Rodgers 3 , Muniratnam S. Kumar 2 , David Thomas 4 , Ashwin Balagopal 4 , Shruti H. Mehta 1 , Sunil S. Solomon 4 , Gavin Cloherty 3 , Chloe Thio 4 1 The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 2 YR Gaitonde Center for AIDS Research and Education, Chennai, India, 3 Abbott Laboratories, Abbott Park, IL, USA, 4 The Johns Hopkins University School of Medicine, Baltimore, MD, USA Background: Functional hepatitis B virus (HBV) cure is defined by clearance of HBV surface antigen (HBsAg) from blood and occurs more often in people with HIV and HBV (PWHHB) taking tenofovir-based antiretroviral therapy (ART) than people with HBV mono-infection on tenofovir. This suggests that HBsAg “clearance” is not binary but occurs across a continuum of immunological control that is reduced by HIV and restored by ART. Methods: We tested stored baseline plasma specimens from a cohort of 2314 people who inject drugs (PWID) and men who have sex with men (MSM) living with HIV enrolled as part of a cluster-randomized trial. Specimens were tested for HBV biomarkers using the ARCHITECT platform including core antibody (anti HBc) and surface antibody (anti-HBs) and HBV DNA (Abbott RealTi m e HBV viral load). HBsAg was measured using the ARCHITECT HBsAg Next Qualitative assay, which at a signal-to-cutoff (S/Co) of 1 has a sensitivity of 0.005 IU/ml (compared to ~0.05 IU/ml in most commercially available assays). We examined the association of HBsAg above (S/Co >10) and below (S/Co 1-10) the threshold with detection of anti-HBs and HBV DNA. Multivariable logistic regression identified correlates of detectable HBV DNA. Results: Overall, 257 participants of 2198 tested had a positive anti-HBc and an HBsAg Next S/Co ≥1, of whom median age was 31 years; 28% were initiated on ART (for a median of 137 days), and 16% had undetectable HIV RNA (<150 c/mL). Median CD4+ T cell count was 379 cells/µl. 34% (n=87) had an HBsAg Next S/Co 1-10 and may have been classified as negative by most commercially-available HBsAg assays. 73/87 (84%) had HBV DNA results available; 37% (n=27) had detectable HBV DNA (Figure). Prevalence of anti-HBs in those with S/Co 1-10 was 23% vs 5% in those with S/Co of ≥10 (p<0.001). In the group with S/Co 1-10, compared to undetectable HBV DNA, those with detectable DNA had higher S/Co values for anti-HBc (aOR 1.57, 95% CI 1.26-1.95) and were less likely to be on ART at baseline (aOR 0.10, 95% CI 0.02-0.64). There was no association with anti-HBs or CD4+ T cell count.

Poster Abstracts

768

767

Changes in Antiviral Treatment Eligibility With the New WHO 2024 Guidelines in Senegal Bruce Shinga S. Wembulua 1 , Judicaël Malick Tine 1 , Ndeye Fatou Ngom 1 , Ousseynou Ndiaye 2 , Melissa Sandrine Pandi 2 , Messan Akotia 2 , Moussa Seydi 1 , Gilles Wandeler 3 , Adrià Ramírez Mena 3 1 Centre Hospitalier Universitaire de Fann, Dakar, Senegal, 2 Institute for Health Research, Epidemiological Surveillance and Training, Dakar, Senegal, 3 Bern University Hospital, Bern, Switzerland Background: The updated Word Health Organization (WHO) 2024 guidelines are expected to significantly increase the proportion of people living with HBV (pwHBV) eligible for antiviral treatment (AVT) compared to the WHO 2015 guidelines. We compared AVT eligibility under both guidelines at enrollment and assessed the proportion of pwHBV who became eligible during the first

CROI 2025 226