CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

598 RISK FACTORS AND PATTERNS OF HCV TRANSMISSION IN MEN WHO HAVE SEX WITH MEN IN ENGLAND Daniel Bradshaw 1 , Tetyana Vasylyeva 2 , Chris Davis 3 , Oliver Pybus 2 , Julien Theze 2 , Emma Thomson 3 , Marianne Martinello 4 , Gail Matthews 4 , Ruth Burholt 5 , Yvonne Gilleece 5 , Graham S. Cooke 6 , Emma E. Page 7 , Laura Waters 8 , Mark Nelson 6 1 Public Health England, London, UK, 2 University of Oxford, Oxford, UK, 3 University of Glasgow, Glasgow, UK, 4 University of New South Wales, Darlinghurst, NSW, Australia, 5 Brighton & Sussex University Hospitals NHS Trust, Brighton, UK, 6 Imperial College London, London, UK, 7 Leeds Teaching Hospitals NHS Trust, Leeds, UK, 8 Mortimer Market Centre, London, UK Background: We sought to characterise risk factors and patterns of HCV transmission in a cohort of men who have sex with men (MSM) in England. Methods: MSM with recently-acquired HCV (AHCV) (n=40) were prospectively recruited from 01/2017-08/2017 (‘clinic cohort’). Clinical data and risk behaviours were identified by notes review and questionnaires. Blood was obtained for HCV whole genome sequencing. Phylogenetic analyses for genotype (GT) 1a were performed, including MSM from the clinic cohort (n=18) and 2 other AHCV cohorts, TARGET3D (n=24) and CHAT (n=10), to identify transmission clusters. Results: Sixteen (40.0%) men were HIV-. (See Table.) HIV- vs HIV+men were significantly (sig.) younger (34, IQR 29-43 vs 44, 36-50 years, respectively). Most HCV infections were GT1a (13, 81.3% HIV- vs 14, 58.3% HIV+men); GT4 was sig. less frequent in HIV- (n=1, 6.3%) vs HIV+men (n=9, 37.5%). Most (22, 91.7%) HIV+MSMwere aviraemic on antiretrovirals; most (13, 81.3%) HIV-MSM had taken HIV PrEP in the last year. Seven HIV-(43.8%) vs 11 HIV+(45.8%) men had a history of injection drug use (IDU), methamphetamine being used most often (11/18, 61.1%); 15(93.8%) HIV- vs 19(79.2%) HIV+men reported non-injected drug use in the last year. HIV- men had sig. more partners (36, IQR 16-50 vs 16, 4-16); reporting of group sex (14, 87.5% vs 17, 70.8%), condomless anal sex (16, 100.0% vs 21, 87.5%) and fisting (12, 75.0% vs 13, 54.2%) in the last year was not sig. different for HIV- vs HIV+men, respectively. The preferred way of meeting partners was via phone apps (13, 81.3% HIV- vs 21, 87.5% HIV+men), with one app used by 26/29 (89.7%) respondees. For the question, ‘howmany partners in the past 12 months did you think had HIV?’, a majority thought ‘some’, ‘most’ or ‘all’ partners had HIV (13, 81.3% HIV- vs 20, 83.3% HIV+ recruits); fewmen thought ‘some’, ‘most’ or ‘all’ partners had HCV (4, 25.0% HIV- vs 3, 12.5% HIV+ recruits). For 52 GT1a sequences, 47(90.4%) clustered with ≥1 other sequence. There were 7 clusters of 2-27 men; 6 clusters contained HIV- and HIV+MSM and 1 cluster only HIV+MSM. One mixed HIV-/HIV+ cluster was likely part of a larger cluster first described for HIV+MSM in 2007. Conclusion: PrEP-using MSM are at risk of HCV, with similar behaviours to HIV+MSM. Younger age and greater partner number for HIV-MSM raise the possibility of a rapid HCV epidemic, with transmissions likely bridging from HIV+ populations. Fewmen demonstrated HCV awareness and risk reduction strategies should be expanded.

1 HIV–NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand, 2 Armed Forces Research Institute of Medical Sciences in Bangkok, Bangkok, Thailand, 3 Kirby Institute, Sydney, NSW, Australia, 4 Chulalongkorn University, Bangkok, Thailand, 5 Thai Red Cross AIDS Research Center, Bangkok, Thailand Background: Sexual transmission of hepatitis C viral infections (HCV) has been reported among men who have sex with men (MSM) living with HIV frommajor cities of the world, although less frequently from the Asia-Pacific region. We investigated the incidence of HCV among HIV-positive MSM taking antiretroviral therapy (ART) in a long-term clinical cohort in Bangkok, Thailand. Methods: MSM with negative baseline anti-HCV antibody tests were identified in the Thai HIV-NAT 006 cohort from October 1996 to July 2018. HCV incidence among MSM was defined by two positive anti-HCV antibody tests and confirmed by detectable HCV RNA level. HCV genotyping was done using the Linear Array Hepatitis C Virus Genotyping Test. Recent syphilis infection was defined as a reactive RPR within 6 months of HCV seroconversion. Results: A total of 464 MSMwith median (IQR) baseline age of 38 (32-46) years and baseline median CD4 count of 303 (180-466) cells/mm³ were included in the study. Participants had been treated with ART for a median of 7.5 (5.7-12.5) years. Of 464 MSM, 29 incident cases were identified during 2885 person-years (PYS) of follow-up. The crude incidence rate of HCV surged from 0.37 per 100 person-years of follow-up (PYS) before 2014 to 2.21 per 100 PYFU in 2014-2018. At the time of HCV seroconversion, most participants (82%) had suppressed HIV viremia and the median CD4 count was 581 (479-792) cells/mm³. Of the HCV incident cases, (81%, N=13/16) had genotype 1a and 27.6% had hepatitis B co-infection (HBsAg positive). In multivariate analysis, age < 35 years (HR, 3.31, 95% CI, 1.42-7.71, p=0.005) and recent syphilis infection (HR, 3.84, 95% CI, 1.78-8.26, p=0.001) were strongly associated with incident HCV among Thai MSM living with HIV. Among 29 incident cases, three participants reported injecting methamphetamines use from collected behavioral risk assessment questionnaire. Spontaneous clearance was observed in 1 case. 4 participants (14%) were treated for HCV and all achieved SVR at week 12. Conclusion: A recent surge in HCV incidence is noted among MSM receiving chronic HIV care in Bangkok, Thailand. In the era of effective direct acting agents (DAAs) and “Undetectable=Untransmissible”, sexually transmitted infections, including hepatitis C and syphilis, need to be routinely screened and treated in HIV+MSM to prevent further transmission to both HIV-positive-and HIV-negative partners, particularly among resource-limited settings where the access to DAAs are still low.

Poster Abstracts

599 SURGE IN HEPATITIS C INCIDENCE ASSOCIATED WITH SYPHILIS INFECTION AMONG THAI MSM Win Min Han 1 , Tanakorn Apornpong 1 , Stephen J. Kerr 1 , Sasiwimol Ubolyam 1 , Sivaporn Gatechompol 1 , Tanyaporn Wansom 2 , Gail Matthews 3 , Pisit Tangkijvanich 4 , Kiat Ruxrungtham 4 , Praphan Phanunphak 5 , Anchalee Avihingsanon 1

600 HCV-GT1A SPATIOTEMPORAL DISTRIBUTION, EPIDEMIC HISTORY, AND NS5A RESISTANCE IN SPAIN Claudia Palladino 1 , Ifeanyi J. Ezeonwumelu 1 , Pedro Borrego 1 , Irene Mate- Cano 2 , Paula Martínez-Román 2 , Sonia Arca-Lafuente 2 , Salvador Resino 2 , Nuno Taveira 1 , Verónica Briz 2 , for the Multidisciplinary Group of viral coinfection HIV/ Hepatitis (COVIHEP)

CROI 2019 226