CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

Methods: Public Health - Seattle & King County collaborated with three community health centers, three large multi-clinic health care systems (private, public and capitated), and a HCV patient education and advocacy group. Patients seen at least once in the last year at a partner clinical site were included. In order to increase screening of patients born between 1945-65, electronic medical record prompts and reports were created, as well as lower cost interventions such as birthday card reminders and posters. Case management linked patients to care. Primary care providers received education and training through class-room didactics, an online customized curriculum, specialty clinic shadowing and through a telemedicine program, Project ECHO. Results: At baseline, 18% of all birth cohort patients in partner primary care clinics had documentation of HCV testing; this proportion increased to 54% by 2018. Of the 75479 patients screened at 87 clinics, 2147 (3%) were newly HCV antibody positive. Among 10240 patients previously or prospectively screened and with active HCV infection (RNA+), the majority were male (65%) and white (71%); 602 (6%) were HIV infected. The number of patients staged for liver disease (either by genotype or a fibrosis test) increased by 307% and those treated increased by 1239% (Fig 1). Of those treated, 6%were still undergoing treatment, 62% achieved a sustained viral response, 4% did not and 28% had not returned for 12 week lab testing. Conclusion: Using a combination of EMR-based healthcare system interventions, active linkage-to-care, and educational and training strategies, we were able to markedly improve HCV screening and treatment, resulting in a tripling in the number of patients screened and >tenfold increase of those treated. Treatment failure was rare, although a significant proportion of patients did not receive definitive testing for cure. The interventions are sustainable, scalable and foundational to the broader goal of HCV elimination.

68M); 30 HD (12F, 18M); 30 HIV positive subjects known HCV uninfected (18F, 12M) pts. In the group of HIV-/HCV+ and HIV+/HCV+ no statistically significant differences in HCV-RNA level, fibrosis and year living with HCV were observed. The results of OraQuick in the 4 groups are showed in table 1. In all the study population a sensivity of 53% (95% CI, 45%–60%) and specificity of 100% was found. The positive predictive value (PPV) was 1 (95% CI 0.96-1), while the negative predictive value (NPV) was 0.43 (95% CI 0.35-0.52). Analyzing the 4 subgroups of pts interestingly in the HCV+/HIV+ group the OraQuick test showed a sensitivity of 6% (95% CI, 2%–13%) and specificity of 100%. In HIV+/HCV+ pts the PPV was 1 (95% CI, 0.48-1), while the NPV was 0.28 (95% CI 0.19-0.37). Conversely in the HCV+ group, the OraQuick test showed a sensitivity and specificity of 100%. The PPV was 1 (95% CI 0.96-1) and NPV was 1 (95% CI 0.88-1). No associations were found between false positive results and CD4 count, HCV-RNA, liver fibrosis, DAA use, sex. Conclusion: In the context of HCV eradication goal the development of easy and quick tests may offer relevant opportunities to facilitate HCV screening. However, in our study the OralQuick test performance is strongly impaired in the HIV-infected people showing a very low sensitivity thus it should be discouraged in known HIV pts where serology can not be replaced.

Poster Abstracts

585 UTILITY OF HCV CORE ANTIGEN FOR THE DIAGNOSIS OF ACUTE HCV IN HIGH-RISK INDIVIDUALS Subathira Dakshina 1 , Diane Reid 1 , Ania Richardson 1 , Chantal Oxenham 1 , Nina Vora 1 , Richard Gilson 2 , Eleni Nastouli 3 , Laura Waters 1 , Sanjay Bhagani 4 , Indrajit Ghosh 1 1 Mortimer Market Centre, London, UK, 2 University College London, London, UK, 3 University College London Hospitals NHS Trust, London, UK, 4 Royal Free Hospital, London, UK Background: To achieve micro-elimination of HCV in high-risk groups, early detection of acute HCV is important in order to link individuals into care/ treatment and harm-reduction programmes. Current guidelines suggest regular anti-HCV screening with additional HCV-RNA for high-risk individuals with unexplained elevated serum aminotransferases. HCV core antigen (HCV- cAg) offers an alternative to HCV-RNA testing to confirm HCV viraemia. We describe the use of HCV-cAg testing for early diagnosis of acute HCV in high-risk individuals attending for sexual health screening (SHS) at a large central London Sexual Health/HIV clinic. Methods: Architect HCV-cAg testing (Abbott Diagnostics) was introduced in 5/2015 replacing anti-HCV to screen all high-risk patients attending for a SHS. High-risk HIV+ patients were offered 3-6 monthly screening in addition to routine 6-monthly HIV-monitoring blood tests (inclusive of liver function tests). All HCV-cAg positive samples were tested for HCV-RNA. We reviewed all acute HCV diagnoses screened with HCV-cAg from 5/2015–5/2018. Data were collected on patient demographics, HIV status, HCV reinfection, HCV genotype, anti-HCV and seroconversion, transmission risk factors and serum ALT. Results: 76 acute HCV infections were diagnosed; all men, 98.7%MSM, 80% Caucasian, median age 44.5 years, majority (64/76, 84%) HIV co-infected. 9 (12%) were HCV re-infections; 8/9 HIV co-infected. 73/76 (96%) were diagnosed with a positive HCV-cAg test; 3/76 (4%) had negative HCV-cAg but were HCV RNA+ (all 3 had raised ALT >300 at diagnosis). Median ALT at HCV diagnosis was 138 IU/l (IQR 67-360). 11 (15%) had ALT <50 IU/l at time of first HCV-cAg+. All were HCV RNA+. Median time to peak ALT was 36 days (IQR 6.5-66.5) from first HCV-cAg+. 41/67 (61%) had anti-HCV testing at HCV diagnosis; 18 (44%) were anti-HCV+; 15/23 seroconverted a median 37 days (IQR 21-64) later. Table 1 summarises risk-factors and HCV characteristics. If acute HCV diagnosis was dependent on anti-HCV seroconversion and HCV-RNA testing with raised ALT, 34 (45%) patients may have been missed at the visit diagnosis was made.

584 LOW PERFORMANCE OF THE ORAQUICK HCV RAPID ANTIBODY TEST IN HIV/HCV-INFECTED PEOPLE Serena Vita, Irene Pozzetto, Raffaella Marocco , Ilenia Mastrini, Laura Fondaco, Blerta Kertusha, Valdo Rossi, Pasquale Dolce, Tiziana Tieghi, Claudio M. Mastroianni, Miriam Lichtner Sapienza University of Rome, Rome, Italy Background: There is a global need to expand hepatitis C virus (HCV) diagnostic testing and saliva sampling may provide an easier access to HCV screening test. An estimated 2.3 million people living with HIV are coinfected with HCV globally. Despite this high numbers, the performance of HCV rapid test has not been extensively studied in HIV population. Methods: We enrolled consecutive patients (pts) attending the Outpatient Infectious Disease Clinic of S. M. Goretti in Latina from Oct 2017 to Jan 2018 and 30 healthy donors (HD) with a known plasma test for HCV and HIV. We performed the OraQuick HCV Rapid Antibody Test (OraSure Techn, Inc.). We collected anagraphical, clinical and laboratory data. The OraQuick HCV Rapid Antibody Test was used according to kit instruction. Statistical analysis was performed using Kruskall-Wallis, Mann-Whitney and 2 test. The 95% confidence interval (CI) was estimated for sensitivity, specificity, and positive and negative predictive values. Results: A total of 227 persons were recruited into the study: 83 pts with known HCV infection (30F, 43M); 84 with known HIV/HCV coinfection (16F,

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