CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

and 94.1% the double-dose group (p>0.999). The proportions of serological response (anti-HBs ≥10 mIU/ml) and high-titer responses (anti-HBs >100 mIU/ ml) at weeks 4, 24, and 28 were not statistically significant between the two arms. All participants with baseline anti-HBs titer higher ≥1 mIU/ml achieved high-titer response after revaccination, regardless of the assigned regimen. In multivariate analysis, double-dose revaccination (adjusted odds ratio [aOR], 6.2; 95% CI, 1.6-24.8) and baseline anti-HBs titer ≥ 1mIU/ml (aOR, 12.5; 95% CI, 3.1-49.7) were associated with high-titer responses after the first dose of revaccination. Conclusion: Revaccination with standard- or double-dose HBV vaccine results in similarly high serological response rates among HIV-positive patients receiving HAART. Patients with baseline anti-HBs titer ≥1 mIU/ml and undergoing double-dose vaccination achieved high-titer responses after after the first dose of HBV revaccination.

prevalent in North America and Europe. Q129 accounted for 3 of 7 mutations in India, D144 for 4 of 18 mutations in Africa, and M133 for 4 of 15 mutations in South and Central America. Conclusion: While the sample size is large, our approach relied on sequences that were previously uploaded to GenBank. Non-random, convenience sampling was often conducted, and many countries have no data available, thus highlighting the need for systematic and unbiased surveillance of vaccine escape mutations in more countries. Nonetheless, the prevalence of polymorphisms at sites associated with vaccine escape is high and may compromise efforts to control HBV infection. 624 HEPATITIS B CURE IN HIV PATIENTS IS MORE LIKELY IN HISPANICS AND THOSE WITH AIDS Mamta K. Jain 1 , Paul Parisot 1 , Gabriella Go 2 , Trung T. Vu 3 , Karen J. Vigil 2 , Barbara S. Taylor 3 1 University of Texas Southwestern, Dallas, TX, USA, 2 University of Texas at Houston, Houston, TX, USA, 3 University of Texas at San Antonio, San Antonio, TX, USA Background: Nucleoside analogues are thought to resolve chronic hepatitis B virus (HBV) very infrequently in most settings, especially in HIV. We examined a longitudinal cohort of HIV/HBV on combined ART (cART) to determine clinical predictors of HBV cure. Methods: We retrospectively abstracted data of HIV and HBsAg+ patients obtaining care from 2005 -2018. Those without chronic HBV were excluded. Baseline characteristics obtained included demographics, insurance, HIV risk factors, CD4 cell count, HBV DNA, HIV RNA, Hepatitis B eAg, and liver function tests (LFT). Those who achieved HBsAg loss during follow-up were compared to those who did not. Predictors of HBsAg loss were examined using logistic regression analysis. Results: Among 365 with HIV and HBsAg+ co-infection, 303 had sufficient data to classify as chronic HBV (87%were male, 58% Black, 24%White, and 14% Hispanic, 59%were HBeAg+). At baseline, median CD4 was 234 cells/ mL, 45% had AIDS, and median log HIV RNA among those non-suppressed (ns) was 4.88 copies/mL, 22% had suppressed HIV RNA. First measured HBV DNA was suppressed in 28%, median log HBV DNA was 6.98 copies/mL among ns patients. Among those who suppressed HBV DNA, median time to suppression was 8.87 months. Among the 38 (12.54%) with HBsAg loss, differences were seen by race, baseline CD4 count, proportion with AIDS, HBeAg+, and time to HBV DNA suppression (see Table 1). Compared to Whites, Hispanics were more likely to have HBsAg loss (AOR 4.27, 95% CI 1.20, 15.18, p=0.03) and those with AIDS (AOR 3.57, 95% CI 1.50, 8.54, p=0.004). Every month without HBV DNA suppression decreased likelihood of HBsAg loss (AOR 0.97, 95% CI: 0.95, 0.99, p=0.03). Median change in CD4 count [cells/mL (IQR)] was higher in those HBsAg loss vs. not [204(98, 436) vs. 106 (-12, 265), p=0.004]. No differences were seen with regard to LFTs, gender, insurance, HIV risk factor, age, or HIV RNA.

Poster Abstracts

623 THE GLOBAL DISTRIBUTION OF HEPATITIS B VIRUS VACCINE ESCAPE MUTATIONS Mahad T. Raheel 1 , Wonderful T. Choga 2 , Jason T. Blackard 1 1 University of Cincinnati, Cincinnati, OH, USA, 2 Botswana Harvard AIDS Institute Partnership, Gabarone, Botswana Background: Hepatitis B virus (HBV) infects over 250 million people and is the leading cause of hepatitis and hepatocellular carcinoma worldwide. Vaccination is effective at preventing infection, although vaccination rates are not optimal, and mutations within the ‘a’ determinant region of the HBV surface antigen (HBsAg) are associated with vaccine escape. The emergence of escape mutants raises concern of HBV infection in previously vaccinated individuals, particularly in the developing world where such mutations may be relatively common. Methods: We evaluated the frequency, genotype, and global distribution of known escape mutations in 4,244 unique full-length HBV genomes from genotypes A to I. The ‘a’ determinant of the Surface gene (amino acids 124 to 147) was extracted using AliView and inspected for polymorphisms at previously identified vaccine escape mutations including T116, P120, T126, Q129, M133, P134, K141, P142, D144, or G145. Sequences were also evaluated in Geno2Pheno to confirm the genotype and the presence of polymorphisms. Results: 268 (6.3%) sequences from 36 countries contained a polymorphism at a vaccine escape site. In genotype A, the most common mutation occurred at M133. In genotype B, Q129 and M133 occurred 45 and 51 times, respectively, accounting for 94% of mutations. Mutations at G145 were most frequent in genotype C, while P120 was most common in genotype D. Amongst all genotypes, mutations at M133 were the most common and accounted for 29.5% of escape mutations. Mutations at T116, P120, F134, K141, and P142 occurred across geographically diverse locations, whereas mutations at Q129, M133, D144, and G145 were concentrated in East Asia. The most prevalent mutation in the Middle East and North Africa was at position P120, whereas M133 was most

Conclusion: HBsAg loss occurred in a surprisingly high percentage (12.54%) of HIV+ patients, more frequently in Hispanics and in those with AIDS. Longer time to HBV DNA suppression was associated with decreased likelihood to HBsAg loss. We hypothesize that HBV immune restoration is associated with HBsAg loss as a higher change in CD4 count occurred in those with HBsAg loss. Chronic hepatitis B can resolve in those with HIV, especially among those with AIDS, if effective HBV active cART is initiated leading to increase in CD4 and effective HBV viral suppression.

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