CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

group (p<0. 00001). As compared to the treated group, the untreated group had 11. 5% patients with active cancer, for which they were receiving therapy (p=. 024), 78% patients with alcohol and/or drug abuse issues (p<0. 00001) and 5% patients with end-stage renal disease (ESRD), on hemodialysis (p=0. 000018). 46% of patients had Medicaid while 23% had no health care coverage. About 40 patients were lost to follow up. Poor HIV control with active drug abuse was the most common reason for withholding DAA therapy accounting for up to 60 % of untreated patients. Active cancer requiring therapy (10%), loss to follow up (10%) and ESRD (5%) were the other major reasons for not receiving therapy. Other reasons included patient non-compliance (3%), intolerable side effects (2%), patient refusal (2%) (Figure 1). In the rest, the reason for non-therapy could not be ascertained. At our center, all patients, irrespective of insurance status received DAA. Conclusion: 53% patients did not receive DAA though health insurance is not a barrier at our center. Poor HIV control and active drug use remain the predominant reasons for not receiving DAA therapy in HCV-HIV co-infected patients. Active cancer and loss of follow up were other major barriers. Thus, control of HIV and its consequent sequelae like cancers and nephropathy remains the biggest challenge in 574 PROGRESS TOWARDS HCV MICRO-ELIMINATION IN AN URBAN HIV- INFECTED COHORT Oluwaseun Falade-Nwulia 1 , Catherine Sutcliffe 2 , Shruti H. Mehta 2 , Juhi Moon 1 , Geetanjali Chander 1 , Jeanne C. Keruly 1 , Jennifer Katzianer 1 , Richard D. Moore 1 , Mark Sulkowski 1 1 Johns Hopkins University, Baltimore, MD, USA, 2 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA Background: Direct-acting antivirals (DAA) lead to high rates of Hepatitis C (HCV) cure. Bolstered by the results of DAA treatment, the World health Organization has called for HCV elimination by 2030. Given this task, HCV mirco- elimination has gained burgeoning support, and people with HIV have been identified as a population in which micro-elimination may be feasible. Here, we describe the HCV care continuum and progress towards HCV elimination in an urban HIV clinic population. Methods: We examined progress through the HCV care continuum among patients infected with HIV/HCV receiving HIV care in an HIV clinic at Johns Hopkins Hospital in Baltimore, MD. Individuals were eligible for inclusion in the study if they had HIV visits in at least 2 consecutive years between January 1, 2013 and December 31, 2016 and had a detectable HCV RNA. Patients were followed through March 31, 2018 for referral to HCV care, HCV treatment initiation and cure (undetectable HCV RNA 12 weeks post-treatment). Multivariable logistic regression was used to identify demographic and clinical characteristics associated with HCV treatment initiation. Results: Among 594 HIV/HCV coinfected individuals, the median age was 57 years (interquartile range (IQR) 52-61), 89%were black, 67%male, 51% had a psychiatric history, 73% had a history of injection drug use and 34% reported heroin and/or cocaine use in the preceding 3 months. The median CD4 count was 462 (IQR 295-673) cells/mm3; most (79%) were on antiretroviral therapy (ART), had HIV RNA <400 copies/ml (75%) and were infected with HCV genotype 1 (96%). The majority were insured by Medicaid (51%). Assessing the HCV care continuum in these 594 coinfected patients, 547 (92%) were referred for care, 517 (87%) were evaluated for treatment, 457 (77%) were prescribed treatment, 426 (72%) initiated treatment, and 381 (64%) had achieved HCV cure as of March 31, 2018. In multivariable analyses, >F2 liver fibrosis (odds ratio [OR], 3.12, 95% confidence interval [CI], 1.40-6.96) was positively associated with HCV treatment initiation. Conversely, being on ART with an HIV RNA >400 (OR, 0.22 (95% CI 0.13-0.35) and ≥50%missed HIV care visits (OR, 0.33; 95% CI, 0.17- 0.62 compared to no missed visits) were independently negatively associated with HCV treatment initiation. Recent illicit drug use was not associated with treatment initiation.

575 NETWORK-BASED RECRUITMENT FOR HEPATITIS C THERAPY AMONG PEOPLE WHO INJECT DRUGS Oluwaseun Falade-Nwulia 1 , Shruti H. Mehta 2 , Kathleen Ward 1 , Stephanie Katz 1 , Geetanjali Chander 1 , Sean McCormick 1 , Carl A. Latkin 2 , Mark Sulkowski 1 1 Johns Hopkins University, Baltimore, MD, USA, 2 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA Background: HCV treatment models based on an individual’s drug use network have the potential to accelerate HCV elimination through increased rates of treatment uptake and reduced rates of reinfection among injection partners. Data to support the feasibility of this approach is limited. Methods: Persons who reported recent (within < 1 year of enrollment) injection drug use were iteratively recruited from an urban infectious diseases clinic. We conducted detailed egocentric network inventories in which participants enumerated all network members including injection partners. These Egos (initial person recruited) received a brief intervention which included provision of information about HCV and its treatment and were instructed to recruit members of their injection network for HCV/HIV testing and, if positive, linkage to care. Egos received $10 for each listed member who presented for evaluation. Multivariable logistic regression analysis was conducted using generalized estimating equations (GEE) to assess for factors associated with the successful recruitment of ≥ one drug using network member. Results: Between January and August 2018, 67 PWID with active injection drug use and HCV (with or without prior treatment) completed egocentric network surveys with the following characteristics: Median age, 54 years (interquartile range (IQR) 45-58); male, 72%; Black, 81%; homeless, 50%; unemployed, 87%; mean income, $735/month; prior incarceration (median time incarcerated, 4 years), 97%. In this group 26 (38%) had been previously HCV treated of which 12(18%) reported previous HCV cure. Egos reported injecting heroin (40%) and cocaine + heroin (37%), and 42%≥ daily injection in the last 30 days. PWID reported a median of 7 (IQR 5-10) network members of which a median of 3 (IQR 1-5) were injection partners. Mean network density (proportion of ego’s network members that are connected controlling for network size) was 0.6. Of the 67 Egos, 27 recruited ≥ 1 drug using network member (range 1-5). In multivariate analysis, Egos were more likely to successfully recruit if they had been treated for HCV (Odds ratio (OR) 4.1, 95% Confidence Interval (CI) 1.1-16.1), were injecting at least daily (0R 3.4, 95% CI 0.9-11.7) and reported a dense network (OR 9.0, 95% CI 1.0-74.2). Conclusion: HCV treated PWID may be particularly effective at recruiting their drug using network members for HCV testing and linkage to care. Further work is needed to systematically assess network recruitment methods for HCV treatment 576 CAN’T BUY ME LOVE? OBSTACLES TO MICRO-ELIMINATION OF ACUTE HCV COINFECTION IN EUROPE Christoph Boesecke 1 , Mark Nelson 2 , Patrick Ingiliz 3 , Thomas Lutz 4 , Stefan H. Scholten 5 , Christiane Cordes 6 , Maria Martínez-Rebollar 7 , Christoph D. Spinner 8 , Michael Rausch 6 , Sanjay Bhagani 9 , Lars Peters 10 , Thomas Reiberger 11 , Stefan Mauss 12 , Jürgen K. Rockstroh 1 , for the PROBE-C study group

Poster Abstracts

Conclusion: Oral DAAs alone are not sufficient to achieve HCV micro- elimination. Improved engagement in HIV care is critical to this goal.

CROI 2019 216