CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

Conclusion: Our study, conducted just before HAV outbreak among MSM in Tokyo, showed that age and year of HIV diagnosis were the most relevant factors in the prevalence of anti-HAV. It is partly because there have hardly been HAV outbreak among younger people in Japan. IgG-HA antibody was present in 16.9% of the study population, which is far below the 60-70% immunity threshold necessary to prevent sustained transmission, suggesting that an extensive HAV vaccination program particularly for younger people is urgently needed.

7.97 (IQR 3.47-9.56). Non responders had significantly a lower T CD4/CD8 cells ratio than responders in univariate and multivariate analyses (p<0.05). Conclusion: A low immune response rate was observed after a single injection of HAV vaccine among HIV-positive patients. A Low T CD4/CD8 cells ratio was a risk factor of non response. In a context of vaccine shortage, a serologic control of response to HAV vaccination should be recommended in this population to ensure their protection. 621 LOSS OF HEPATITIS A VIRUS SEROPROTECTION IN PERSONS LIVING WITH HIV Rishi Chanderraj , Mark Cichocki, Tejal Gandhi, James Riddell University of Michigan, Ann Arbor, MI, USA Background: The Michigan hepatitis A virus (HAV) outbreak, which began in August 2016, persists today with 895 cases. A possible emerging issue has been identified during an ongoing outbreak of HAV in Michigan: loss of HAV seroprotection among patients co-infected with HIV. Immune responses to most vaccines are known to be impaired in HIV patients. Retrospective analyses of HIV infected patients who received HAV vaccination has shown that 90% of HIV patients remained seropositive at 3 years and 85% 6–10 years. No data exist on whether this decay is clinically meaningful. During the Michigan Hepatitis A outbreak, 26 outbreak cases were co-infected with HIV and HAV. 4 patients had received pre-exposure HepA vaccination, and 2 cases had positive HAV antibody test results upon entry into care for HIV without history of vaccination. These early findings are concerning for loss of seroprotection in persons living with HIV who may be susceptible and at risk of acquiring HAV infection. Here we describe a cohort of patients who have lost seroprotection against HAV at the University of Michigan HIV clinic. Methods: The HIV Clinic at the University of Michigan began repeating HAV Ab screening for those patients who have not not been performed during the previous 5 years. We collected baseline demographics for those patients who seroreverted from a positive to negative HAV total Antibody. Results: The Mean age at Time of Vaccination for seroreverters was 40 ± 5 years old. The proportion of patients with an undetectable viral load at the time of initial vaccination was 0.50. The mean viral load at the time of vaccination was 27,500 ± 7,382. All seroreverters had an undetectable viral load at the time of serorevertion. The Proportion of Seroreverters with history of AIDS defining Illness was 0.5. The mean time to repeat Serology was 11.37 ± 2.28 yrs. Conclusion: Patients living with HIV previously vaccinated against HAV may be susceptible and at risk of acquiring HAV infection. Repeat screening HAV total Antibody can indentify those patients susceptible to HAV infection who would benefit from repeat vaccination. 622 HBV REVACCINATION AMONG HIV-POSITIVE MSM RECEIVING HAART: A RANDOMIZED CLINICAL TRIAL Yi-Chia Huang 1 , Wen-Chun Liu 2 , Yi-Ching Su 2 , Hsin-Yun Sun 2 , Sui-Yuan Chang 2 , Chien-Ching Hung 2 1 National Taiwan University Hospital, Hsinchu City, Taiwan, 2 National Taiwan University Hospital, Taipei, Taiwan Background: The universal neonatal vaccination program against hepatitis B virus (HBV) in Taiwan has significantly reduced the HBV seroprevalence in general population and HIV-positive individuals. Optimal strategy of revaccination remains unknown among HIV-positive men who have sex with men (MSM) whose immunity against HBV have waned after neonatal vaccination. In this randomized controlled trial, we aimed to investigate the efficacy of HBV revaccination with standard- (20-μg) or double-dose (40-μg) of HBV vaccine among HIV-positive MSM. Methods: HIV-positive MSM who were born after 1 July, 1986, have been receiving antiretroviral therapy, and tested negative for HBsAg and anti-HBc with anti-HBs titer <10 mIU/ml were eligible for revaccination. Subjects who were aged <20 years, allergic to the vaccine (Engerix-B®), and receiving chemotherapy, steroids, and immunosuppressants within 30 days prior to screening were excluded. Participants were randomized to receive standard- or double-dose HBV vaccine (1:1 ratio with the block size of 4 after stratification by CD4 count). HBV vaccine was administered at weeks 0, 4, and 24. Adverse events were recorded for 7 days after each injection and serological responses were assessed at weeks 4, 24, and 28. Results: From September 2017 to August 2018, 67 HIV-positive MSM were enrolled with 35 in standard-dose arm and 32 in double-dose arm (Table). The serological response after revaccination was 93.3% for the standard-dose group

Poster Abstracts

620 LOW IMMUNE RESPONSE RATE OF HIV-POSITIVE PATIENTS TO SINGLE INJECTION OF HAV VACCINE Lucie Noel 1 , Marc-Antoine Valantin 1 , Marc Wirden 1 , Sophie Sayon 1 , Christine Blanc 1 , Roland Tubiana 1 , Christine Katlama 2 , Anne-Geneviève Marcelin 2 , Vincent Calvez 2 , Eve Todesco 1 1 Assistance Publique – Hôpitaux de Paris, Paris, France, 2 Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France Background: During the year 2017, a hepatitis A (HAV) outbreak occurred among men having sex with men (MSM) in France. Concomitantly, a shortage of HAV vaccines has led to the national recommendations of a single injection of HAV vaccine. Nevertheless, HIV-positive patients’ vaccine response can be inferior to general population. This study aimed to evaluate the immune response of HIV-1 positive MSM patients to a single injection of HAV vaccine in this context. Methods: We enrolled in this observational single center study all HIV-1 positive patients who had been vaccinated by a single injection of HAV vaccine in 2017. HAV serology was performed on a serum sample before and >30 days after the vaccine injection, using the routine system Architect® (Abbott) by chemiluminescent microparticulate immunoassays. Response to vaccine was defined by a ratio (signal of the sample/signal of the threshold value) ≥2. To compare responders and non-responders’ characteristics, Student (continuous variables) or Chi 2 (categories) tests for univariate and logistic regression for multivariate statistical analyses were performed. Results: In 2017, 73 patients mainly MSM (93.2%) with a median age of 49.4 years (IQR 36.0-57.1) received a single injection of HAV vaccine. HIV-1 viral load was ≤20 copies/mL in 83,6 % of the cases (93,2%≤50 copies/mL). Patients were diagnosed for HIV since 14.9 years in median (IQR 7.4-27.6) and 16,4% of themwere classified in the CDC stage C. Median CD4 and nadir CD4 cell counts were 658 (IQR 465-838) and 270/mm3 (IQR 93-381), respectively. Median ratio of T CD4/CD8 cells was 0,9 (IQR 0,56-1,21). One patient had already a positive HAV serology before the vaccine injection. The rate of immune response was 59.7% (n=43/72) after a median time of 106 days (IQR 68-171) between the vaccine injection and the collection of sample. The median response ratio was

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