CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

late presentation for HIV and poor immune recovery significantly impair HBV seroconversion rates in HBV/HIV coinfected patients. 628 ABSENCE OF HBV REACTIVATION IN HIV/HCV/HBCAB COINFECTED PATIENTS TREATED WITH DAA Maddalena Cerrone , Francesca Ferretti, Ryan Whyte, Mimie Chirwa, Mark Nelson Chelsea and Westminster NHS Foundation Trust, London, UK Background: HBV reactivation during HCV direct-antiviral agents (DAA) therapy has been described in individuals with positive hepatitis B (HB) core antibodies (anti-HBc) in the absence of HB surface antigen (sAg) prior to HCV treatment. This is the consequence of the disinhibition of HBV replication following HCV eradication. Despite some antiretroviral agents (ART) are effective on both HIV and HBV, little data of HBV reactivation exist in people living with HIV treated for HCV with DAA. Methods: In order to determine the prevalence of occult HBV reactivation we retrospectively enrolled ART-treated HIV/HCV co-infected individuals who completed DAA interferon-free regimens between April 2015 and August 2018 in a large centre in London. Demographic characteristics, HBV markers, antiretroviral treatment, ART switch to prevent HBV (adding tenofovir disoproxil fumarate, TDF or tenofovir alafenamide, TAF plus emtricitabine, FTC) and addition of HBV prophylaxis (entecavir, ETV) prior to start DAA were collected. Subjects were followed up with alanine aminotransferase (ALT) at two to four weekly intervals during treatment and at week 4, 12, 24 and 48 after the end of treatment. HBV reactivation was defined as ALT elevation of 2 or more times above the upper limit of normal (ULN) in combination with molecular HBV reactivation. Results: 274 HIV-infected subjects were treated for HCV with DAA. At baseline, 87/274 (32%) were HBs-Ag negative/anti-HBc positive, 6/274 (2%) were HBsAg positive and 141/274 (51%) were anti-HBs positive/anti-HBc negative. Results of anti-HBc positive subjects are shown in Table 1. Of all 87 HBsAg negative/ anti-HBc positive subjects at risk of HBV reactivation, 85/87 (98%) received at least one anti-HBV active agent as a part of ART for at least 3 months before baseline. Six/87 (7%) commenced prophylaxis with ETV as receiving either only lamivudine (3TC) (5/6) or no anti-HBV ART (1/6). Four/87 had deranged ALT during DAA therapy or at following visits but no molecular HBV reactivation. All HBsAg positive subjects were on TDF/FTC and did not meet study criteria of HBV reactivation. Conclusion: Almost one-third of our HIV/HCV cohort was HBcAb positive prior to DAA initiation. The absence of HBV reactivations in our cohort where 98% of anti-HBc positive subjects were on an at least one HBV-active drug prior to DAA initiation suggests that this is an effective strategy to prevent it. However, further studies are warranted to assess the role of anti-HBV prophylaxis during DAA treatment.

627 HIV LATE PRESENTATION AND ITS IMPACT ON HBV SEROCONVERSION IN HBV/HIV Christoph Boesecke 1 , Christian Hoffmann 2 , Stefan Mauss 3 , Thomas Lutz 4 , Patrick Ingiliz 5 , Christoph D. Spinner 6 , Stefan H. Scholten 7 , Florian Berger 3 , Stephan Schneeweiss 7 , Fabian Busch 1 , Clara Lehmann 7 , Gerd Fätkenheuer 7 , Jürgen K. Rockstroh 1 , for the DZIF HBV HIV Cohort 1 Bonn University Hospital, Bonn, Germany, 2 ICH Study Center, Hamburg, Germany, 3 Center for HIV and Hepatogastroenterology, Düsseldorf, Germany, 4 Infektiologikum, Frankfurt, Germany, 5 Center for Infectiology, Berlin, Germany, 6 Klinikum rechts der Isar, Munich, Germany, 7 Cologne University Hospital, Cologne, Germany Background: Several cohorts have shown that successful long-term tenofovir (TDF)-containing combination antiretroviral therapy (cART) leads to HBsAg loss in 5-15% of HBV HIV coinfected patients. However, data on determinants of HBsAg loss in this setting remain sparse. Here we evaluate factors associated with HBV seroconversion under HBV active ART in a large German multi-center cohort with a median follow-up of at least 10 years. Methods: Non-interventional retrospective cohort of 7 German HIV care centres assessing rates of HBV seroconversion defined as HBsAg loss in 359 HBV/ HIV coinfected patients under HBV active (TDF or tenofovir alafenamide (TAF) containing) cART. Fisher’s exact, chi-square and Mann-Whitney U test were used for statistical analysis. Results: In total, 359 patients were included. 90% patients were male, median age was 41 years (IQR 41-43). 83%were of Caucasian, 14% of African and 3% of Asian descent. Main routes of HIV transmission were MSM (74%), origin from high prevalence country (9%) and heterosexual intercourse (9%). CDC stage at HIV diagnosis was C3 in 13% followed by A2 (12%), CD4 nadir 251/ul (211-296). 61%were ART-naïve when TDF or TAF containing cART was initiated (baseline). Median CD4 cell count at baseline was 359/ul (321-404). 59%were HBeAg positive at baseline. 90%were HBV-DNA positive (limit of detection <10 IU/ml) at baseline. 73% received TDF/FTC, 18% TDF/3TC and 3% TAF/FTC at baseline. 53%were switched to TAF during follow-up. 44% received a boosted protease inhibitor, 41% NNRTI and 10% an integrase inhibitor. Median follow-up was 11 years (10-12), median CD4 gain was 188/ul (130-229). Overall, HBsAg loss occurred in 66/359 (18.4%) patients. Median time to HBsAg loss was 41 months (33-60). There was no correlation between HBsAg loss and gender (p=0.551), age (p=0.307), country of origin (p=0.269), CD4 cell count (p=0.639), CD4 nadir (p=0.364), HBeAg (p=0.712), ART class (p=0.818), or switch to TAF (p=0.267). However, patients with stage CDC C (p≤0.001), lower CD4 gain (p=0.043) and not receiving TDF/FTC (p=0.008) were less likely to lose HBsAg. Conclusion: While long-term TDF-containing cART leads to higher rates of HBsAg loss when compared to published data for HBV monoinfected subjects,

Poster Abstracts

CROI 2019 238