CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

1 Bonn University Hospital, Bonn, Germany, 2 Chelsea and Westminster Hospital, London, UK, 3 Center for Infectiology, Berlin, Germany, 4 Infektiologikum, Frankfurt, Germany, 5 Cologne University Hospital, Cologne, Germany, 6 Charité Universitätsmedizin, Berlin, Germany, 7 Hospital Clinic of Barcelona, Barcelona, Spain, 8 Klinikum rechts der Isar, Munich, Germany, 9 Royal Free Hospital, London, UK, 10 Rigshospitalet, Copenhagen, Denmark, 11 Medical University of Vienna, Vienna, Austria, 12 Center for HIV and Hepatogastroenterology, Düsseldorf, Germany Background: Several trials have shown high sustained viral response (SVR) rates with shortened direct acting antivirals (DAA) containing therapy in acute hepatitis C (AHC) coinfection. In addition, data frommodelling and real life cohorts have shown a reduced AHC incidence with early DAA therapy. However, with no DAA currently being licensed for the treatment of AHC and with the high drug prices low DAA treatment uptake poses the biggest obstacle to HCV micro- elimination in a high-risk population. Here we evaluate rates of DAA treatment initiation of AHC coinfection in a large European cohort. Methods: The PROBE-C study is an observational cohort on AHC in HIV coinfection. Between 2007 and 2017 465 AHC episodes were documented in HIV-infected patients with at least 12 months of follow-up from Austria, Denmark, France, Germany, Great Britain and Spain. Fisher’s exact, chi-square and Mann-Whitney U test were used for statistical analysis. Results: 457/465 (98%) patients were male, median age was 41 years (IQR 38-46). Main risk groups for HCV transmission were MSM (98.9%) and injecting drug use (IDU) (1.1%). 78.3% of patients were infected with HCV genotype (GT) 1, 2.6%with GT3 and 18.6%with GT4. Median baseline HCV-RNA was 230,000 IU/mL (135,000-474,432), median CD4+ T cell count 574 cells/µL (547-604). 92% of all patients received cART, 91% had baseline suppressed HIV-RNA (<200 copies/mL). Median maximum ALT was 445 U/l (402-522). In 324/465 (70%) HCV treatment was initiated. In 277/324 (85%) treatment was interferon (IFN)-containing, in 47/324 (15%) DAA-based. Median time from AHC diagnosis to treatment initiation was 11 weeks (10-13). 241 of 277 (87%) AHC patients receiving INF were treated within 24 weeks of AHC diagnosis, only 8 of 47 (17%) AHC patients receiving DAA were treated within 24 weeks of AHC diagnosis. Overall rates of treatment uptake within 24 weeks of diagnosis dropped from 75% in 2007 to 14% in 2017 (table 1). Conclusion: IFN-containing therapy was no longer used for treatment of AHC coinfection in our pan-European cohort after 2015. Although available and recommended by guidelines during the acute phase, DAA-based therapy was mostly deferred to the early chronic phase of HCV infection. With more patients being viremic now than in the interferon-era drug labels need to be urgently amended to allow usage of DAA during the acute phase to limit HCV transmission in high-risk populations.

1 Kirby Institute, Sydney, NSW, Australia, 2 Taylor Square Private Clinic, Sydney, NSW, Australia, 3 East Sydney Doctors, Darlinghurst, NSW, Australia, 4 Holdsworth House Medical Practice, Sydney, NSW, Australia, 5 Burnet Institute, Melbourne, VIC, Australia, 6 Royal Adelaide Hospital, Adelaide, SA, Australia, 7 Kirketon Road Clinic, Sydney, NSW, Australia Background: Given unrestricted access to direct-acting antiviral (DAA) therapies fromMarch 2016 in Australia, HCV elimination should be achievable among people living with HIV (PLWH). Increasing HCV risk behavior and HCV reinfection, however, have the potential to compromise HCV elimination. Methods: The Control and Elimination of HCV from HIV-infected individuals within Australia (CEASE-D) is an ongoing observational cohort study. HIV/HCV (antibody positive) co-infected individuals (≥18 years) were enrolled from 14 primary and tertiary clinics in Australia. Participants completed a questionnaire at enrolment (July 2014-March 2017) and first follow-up visit (June 2017-May 2018). We compared participants’ clinical and behavioural features at enrolment and follow-up. Reinfection incidence was calculated with follow-up censored May 2018. Results: Of 402 HIV/HCV antibody-positive participants (mean age 49 years, gay and bisexual male (GBM) 80%, cirrhosis 13%), 288 (72%) had detectable HCV RNA at enrolment. Injecting drug use (IDU) ever was reported by 79%. Current IDU (within six months) was reported by 36% at enrolment and 35% at follow up, predominantly amphetamines (30% for both). Among people reporting more recent IDU (within one month), 33% reported ≥weekly injecting and 11% reported needle/syringe sharing at enrolment, compared with 33% ≥weekly injecting and 13% needle/syringe sharing at follow up. Among GBM, 53% reported condom-less anal intercourse (CLAI) with one or more casual male partners (CMP) and 34% reported group sex at enrolment, compared to 40% CLAI with CMP and 25% group sex at follow-up (p=0.002 and p=0.020 respectively). HCV treatment uptake among those with detectable HCV RNA was 7% in 2014, 10% in 2015, 80% in 2016, and 35% in 2017, and was accompanied by a substantial decline in the proportion with detectable HCV RNA, from 79% in 2014 to 8% in 2018. Reinfection was reported in five participants through follow-up (incidence 0.81 per 100 person years, 95% CI 0.34-1.94), all of whom identified as GBM. Conclusion: A substantial reduction in HCV viraemic prevalence was observed among PLWH in Australia following unrestricted DAA access. There was no evidence of increasing HCV risk behavior with injecting risk remaining stable and some reduction in sexual risk behaviour. HCV elimination should be achievable among PLWH in the near future. 578 CARE FACILITATION FOR HIV/HCV COINFECTED INCREASES MOVEMENT ON THE HCV CARE CASCADE Lisa R. Metsch 1 , Daniel J. Feaster 2 , Carmen L. Masson 3 , David C. Perlman 4 , Lauren Gooden 1 , TimMatheson 5 , Susan Tross 6 , C. Mindy Nelson 2 , Felipe A. Muñoz 7 , Raul Mandler 8 , Gregory M. Lucas 9 , Meg Sullivan 10 , Mamta K. Jain 11 , Petra Jacobs 8 , Carlos del Rio 12 1 Columbia University Medical Center, New York, NY, USA, 2 University of Miami, Miami, FL, USA, 3 University of California San Francisco, San Francisco, CA, USA, 4 Icahn School of Medicine at Mt Sinai, New York, NY, USA, 5 San Francisco Department of Public Health, San Francisco, CA, USA, 6 New York State Psychiatric Institute, New York, NY, USA, 7 Emmes Corporation, Rockville, MD, USA, 8 National Institute on Drug Abuse, Rockville, MD, USA, 9 Johns Hopkins University School of Medicine, Baltimore, MD, USA, 10 Boston Medical Center, Boston, MA, USA, 11 University of Texas Southwestern, Dallas, TX, USA, 12 Emory University, Atlanta, GA, USA Background: HIV-HCV co-infection increases morbidity and mortality more than infection with either virus alone. CTN-0064 examined the efficacy of an HCV care-facilitation (CF) intervention on progression along the HCV care cascade. Methods: HIV-infected substance-using participants previously enrolled in CTN-0049 from 8 sites (Miami, FL, New York, NY, Atlanta, GA, Baltimore, MD, Boston, MA, Philadelphia, PA, Chicago, IL, and Dallas, TX) were enrolled from Feb 2016 to Jan 2017. After informed consent, participants were HCV tested and, if positive, were randomized to either treatment as usual (TAU) or CF. Individuals randomized to CF received up to 12 in-person 30-minute sessions. CF included motivational encouragement to receive HCV viral load results and engage in ongoing HCV care and strengths-based case-management to provide support in HIV/HCV care engagement and adherence. The outcome was number of steps achieved along 8 steps of the HIV/HCV care cascade over 12 months: receiving HCV viral load results, HIV primary care engagement, initiating ART, having an

Poster Abstracts

577 HCV REINFECTION RISK FOLLOWING DAA THERAPY IN PEOPLE LIVING WITH HIV IN AUSTRALIA Samira Hosseini Hooshyar 1 , Marianne Martinello 1 , Sofia Bartlett 1 , Robert Finlayson 2 , David Baker 3 , Mark Bloch 4 , Joseph S. Doyle 5 , David Shaw 6 , Phillip Read 7 , Jasmine Yee 1 , Lanni Lin 1 , Tanya Applegate 1 , Margaret Hellard 5 , Gregory J. Dore 1 , Gail Matthews 1

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