CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

148/330 (45%) [44.0% HIV and 46.9% HIV/HBV co-infected] at Y6. At baseline, LSM scores were significantly higher in HIV/HBV vs. HIV-infected subjects [6.4 (4.2) kPa vs. 5.1 (1.58) kPa; p<0.01]. LSM declined significantly from baseline to Y3 and Y6 in both groups (p <0.01) {Fig 1.}, with a trend towards larger declines observed in HIV/HBV co-infected vs. HIV-infected subjects (-1.35 [3.53] kPa vs. -0.45 [2.28] kPa; p=0.17). In multivariate analyses, HIV/HBV co-infection [HR 2.0 (95%CI 1.20, 3.33); p=0.01] and higher LSM scores at baseline [HR 2.84 (1.14, 7.08); p=0.03] were significantly associated with >30% LSM decrease. There was no independent association between >30% LSM decrease and duration of ART or HIV immunologic and virologic status at baseline. Conclusion: Significant declines in LSM were observed in HIV/HBV co-infected and HIV-infected subjects in response to ART, highlighting the importance of early treatment initiation in both populations. LSM scores were low in HIV/HBV co-infected subjects, likely due to the relative inactive state of HBV infection (low baseline HBV DNA levels and low rates of HBeAg seropositivity) in this region.

estimated 10-year risk of death was 4.2 (95% CI:3.4-5.1) months in HBV- pts, 7.6 (5.9-9.2) in HBcAb+ and 14.1 (8.1-20.0) in HBsAg+ pts (log-rank p-value <0.0001). Compared to HBV- subjects, an increased risk of develop a FIB-4 >3,25 was shown in HBcAb+ (1.49,95%CI 1.03-2.15, p=0.035) and HBsAg+ subjects (2.62,95%CI 1.51-4,55, p<.001, Table). There was evidence that the difference in risk between HBcAb+ and HBV- was a lot larger in people currently not receiving a XTC/TDF-based ART (adjusted RR: 20.8 (95%: 2.94;147), interaction p-value =0.04). Conclusion: HBcAb+(HBsAg-)/HIV+ pts showed a significantly higher risk of progression to liver fibrosis compared to HBV- pts, especially in those not receiving anti-HBV drugs. These findings suggest that HBV resolved infection should be monitored as it is an indicator of faster hepatic disease evolution in HBV/HIV coinfected pts.

Poster Abstracts

608 IMPACT OF HIV ON THE SURVIVAL OF HEPATOCELLULAR CARCINOMA IN HCV-INFECTED PATIENTS Nicolás Merchante 1 , Miguel Rodríguez Fernández 1 , Blanca Figueruela López 1 , Francisco Rodríguez-Arrondo 2 , Boris Revollo 3 , Sofía Ibarra 4 , Esperanza Merino 5 , Maria J. Galindo 6 , Marta Montero 7 , Francisco Téllez 8 , Antonio Rivero-Juárez 9 , Miguel García-Deltoro 10 , Ignacio Santos 11 , Juan A. Pineda 1 , for the Grupo para el Estudio de las Hepatitis Víricas (GEHEP) 1 Hospital Universitario de Valme, Seville, Spain, 2 Hospital Donostia, San Sebastián, Spain, 3 Hospital Germans Trias i Pujol, Barcelona, Spain, 4 Hospital de Basurto, Basurto, Spain, 5 Hospital General Universitario de Alicante, Alicante, Spain, 6 Hospital Clinic of Valencia, Valencia, Spain, 7 Hospital Universitario y Politecnico La Fe, Valencia, Spain, 8 Hospital de Puerto Real, Puerto Real, Spain, 9 Hospital Universitario Reina Sofia, Cordoba, Spain, 10 Hospital General de Valencia, Valencia, Spain, 11 Hospital Universitario de La Princesa, Madrid, Spain Background: Previous studies have suggested that hepatocellular carcinoma (HCC) has a more aggressive presentation and a lower survival in HIV-infected patients. However, the differences in survival found in older studies may be due to a later diagnosis or to lower rates of treatment against HCC, and not to a specific negative impact of HIV infection. Objective: To assess the impact of HIV infection on the survival of HCC in HCV-infected patients. Methods: Multicenter cohort study (1999-2017). The GEHEP-002 cohort recruits all the HCC cases diagnosed in HIV-infected patients from 32 centers in Spain. For this study, 339 cases diagnosed in HIV/HCV-infected patients were selected. A control population of 118 HCC cases diagnosed in HCV-monoinfected patients during the study period at the Liver Unit from the Hospital de Valme was used. The survival after HCC diagnosis and its predictors, including HIV infection, were assessed. Results: HCC was diagnosed by surveillance, considered when all scheduled ultrasound had been performed at least within 1 year prior to HCC diagnosis, in 192 (57%) and 73 (62%) HIV+ and HIV- patients, respectively (p=0.3). In spite of similar rates of HCC diagnosis by screening, cases diagnosed in HIV/ HCV-coinfected patients were diagnosed at advanced stages. Barcelona-Clinic Liver-Cancer (BCLC) stage at diagnosis was: 0-A 133 (39.6%), B 28 (8.3%), C 118 (35.1%) and D 57 (17%) in HIV+ and 0-A 63 (53.4%), B 21 (17.8%), C 27 (22.9%) and D 7 (5.9%) in HIV- patients (p<0.001). 103 (77%) HIV/HCV-coinfected patients and 4 (70%) HCV-monoinfected patients diagnosed at BCLC stage 0-A underwent curative therapies (p=0.09). 334 (73.1%) patients died, 303 (91%) of them due to HCC. The probability of death at 1-year and 2-year was 53% and 65% in HIV+ and 35% and 57% in HIV- patients (p=0.13). In a Cox model adjusted by age, sex, alcohol consumption, HIV infection and previous SVR,

607 IMPACT OF HBCAB+ ON ADVANCED LIVER FIBROSIS DEVELOPMENT IN HIV-HBV INFECTED PATIENTS Vincenzo Malagnino 1 , Alessandro Cozzi-Lepri 2 , Loredana Sarmati 1 , Antonella Cingolani 3 , Carlotta Cerva 1 , Francesca Ceccherini Silberstein 1 , Alessandra Vergori 4 , Gianluca Cuomo 5 , Carlo Federico Perno 6 , Massimo Puoti 6 , Massimo Andreoni 1 , Antonella D’Arminio Monforte 6 , for the ICONA Foundation Study Group 1 University of Rome Tor Vergata, Rome, Italy, 2 University College London, London, UK, 3 Catholic University of the Sacred Heart, Rome, Italy, 4 IRCCS Lazzaro Spallanzani, Rome, Italy, 5 University of Modena and Reggio Emilia, Modena, Italy, 6 University of Milan, Milan, Italy Background: Coinfection with hepatitis B virus (HBV) and HIV is common, however there are few data on the influence of resolved HBV infection (i.e. HBcAb+/HBsAg- serology) on clinical progression of infection during antiretroviral therapy (ART). Methods: HIV+ patients (pts) enrolled from the ICONA Foundation Study Cohort were prospectively evaluated to investigate the influence of resolved HBV infection (HBcAb+) on the risk of occurrence of advanced liver fibrosis (defined as Fibrosis-4 score[FIB-4]>3.25). We included pts free from liver fibrosis (FIB-4 <3.25) at the date of their first available serology test (baseline). We distinguished 3 subgroups according to HBV serology at baseline: HBsAg+, HBsAg-/HBcAb+ (HBcAb+) and HBsAg-/HBcAb- (HBV-) pts. Standard survival analysis by means of Kaplan-Meier curves and Cox regression models with time- fixed covariates measured at baseline was performed. A Poisson regression was also performed to evaluate the same associations after stratifying for ART regimen currently used (grouped as XTC/TDF-based vs. not). Results: 2,528/8,880 pts (29%) HBcAb+ were identified: mainly males (75%) the majority having acquired HIV through sexual contacts (78%). With respect to HBV-, a significant higher proportion of HBcAb+ and HBsAg+ (12% and 14% vs. 9%, p<.001) pts had an AIDS event at baseline and a significant lower median number of CD4 cell nadir (315 and 330 vs 365, p<.001). Overall, 199 pts experienced a FIB-4 progression >3.25, among them 107/2528 HBcAb+ pts (4%), compared to 71/5907 HBV- (1%) and 21/445 HBsAg+ pts (5%). The

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