CROI 2019 Abstract eBook

Abstract eBook

Oral Abstracts

Oral Abstracts

85 FALL IN HCV INCIDENCE IN HIV+ MSM IN LONDON FOLLOWING WIDER ACCESS TO DAA THERAPY Lucy J. Garvey 1 , Colette J. Smith 2 , Christof Stingone 3 , Indrajit Ghosh 4 , Alison Rodger 2 , Lakshmi Jain 4 , Chandni Sood 1 , Tabitha Mahungu 3 , Carolyn Freeman 1 , Subathira Dakshina 4 , Filippo Ferro 3 , Laura Waters 4 , Ashley Brown 1 , Graham S. Cooke 5 , Sanjay Bhagani 3 1 Imperial College Healthcare NHS Trust, London, UK, 2 University College London, London, UK, 3 Royal Free Hospital, London, UK, 4 Mortimer Market Centre, London, UK, 5 Imperial College London, London, UK Background: Modelling of the London HCV epidemic in HIV+MSM suggested early access to DAA treatment plus risk-behaviour modification may reduce incidence. With high rates of linkage to care and treatment access, micro- elimination of HCV within HIV+MSMmay be realistic, ahead of 2030 WHO targets. Data from European cohorts have shown a reduction in HCV incidence amongst HIV+MSM. We examine the effect of HCV treatment access (in the pre- and post-DAA era) and risk-behaviour modification upon incidence of HCV first and re-infections in HIV+MSM in three large London clinics. Methods: A retrospective cohort study was conducted at 3 London HIV clinics (Royal Free and St Mary’s Hospitals, Mortimer Market) between July 2013 and June 2018. During each 6-month period the following data were collected [1] number of first acute HCV diagnoses [2] number of subsequent acute HCV diagnoses (re-infections) [3] denominator of HIV+MSM under active follow up [4] number of PEG IFN/RBV or DAA-based HCV treatments for acute/early HCV (<12m since diagnosis) [5] number of PEG IFN/RBV or DAA-based HCV therapies for chronic HCV (>12m since diagnosis). Incidence rates (acute HCV diagnoses/ HIV+MSM 1000 PYFU) and re-infection rates (re-infections/all incident infections x 100) were calculated for each time-period. Results: 293 acute HCV infections were identified (246 first infections and 47 re-infections). DAA treatment became widely available in late 2015. All centres adopted risk-reduction behaviour intervention with counselling/psychology. Incidence of first HCV episode peaked at 17.72/1000 HIV+MSM PYFU [95%CI 12.81–22.64] in 2015. Rates fell to 4.64 [95%CI 2.53–7.78] by 2018. Re-infection rates increased from 9% to 16% during the study period. Supervised early HCV treatments (<12m of diagnosis) increased from 22% to 61% between 2013 and 2018. Supervised chronic HCV/HIV treatment rates increased from 2.8/month in pre-DAA era to 15.6/month in post-DAA era. Time from diagnosis to starting any HCV treatment reduced from average of 40.9 months (2013) to 3.1 months (2018). Conclusion: There has been a 74% reduction in incidence of first HCV infection and 62% reduction of overall HCV incidence in HIV+MSM since the epidemic peak of 2015 which coincides with wider access to DAA-based therapy across London. However re-infection rates remain high and maybe increasing. Further interventions to reduce ongoing transmission including access to treatment for reinfection are likely needed if micro-elimination is to be achieved.

86 HCV REINFECTION AMONG HIV-INFECTED MSM IN NEW YORK CITY Jesse R. Carollo 1 , Stephanie H. Factor 1 , Gabriela Rodriguez-Caprio 1 , Asa Radix 2 , Stephen M. Dillon 3 , Rona Vail 2 , Krisczar J. Bungay 3 , Robert Chavez 4 , José Lares-Guia 5 , Daniel S. Fierer 1 , for the New York Acute Hepatitis C Surveillance Network 1 Icahn School of Medicine at Mt Sinai, New York, NY, USA, 2 Callen–Lorde Community Health Center, New York, NY, USA, 3 GothamMedical Group, New York, NY, USA, 4 AIDS Healthcare Foundation, New York, NY, USA, 5 Office of José Lares-Guia, MD, New York, NY, USA Background: High HCV re-infection rates of 3-15% have been reported after IFN treatment in HIV-infected MSM in Europe. There are no data on HCV re- infection from similar cohorts in the United States, or among those cured with all-oral direct-acting antiviral (DAA) therapy. Methods: We assessed all HIV-infected MSM from our cohort in New York City (NYC) for clearance of HCV. Clearance was defined as SVR 12 if by treatment; or undetectable HCV VL for ≥12 weeks if by spontaneous clearance (SC). Re-infection was defined as new HCV viremia after clearance. Clinical onset of re-infection was defined as the date of the 1st-noted ALT elevation or HCV viremia. Observation time was defined as the period between 12 weeks after completion of therapy or SC, and either the clinical onset of HCV re-infection or the last undetectable HCV VL in those not re-infected. Results: We identified 267 HIV-infected MSMwith documented clearance of primary HCV infection and ≥4 weeks follow-up. Median age was 45; 170 (64%) were white, 40 (15%) black, 55 (21%) Hispanic; genotypes (n=258) were 1a in 206 (80%), 1b in 23 (9%), and other in 29 (11%). Median CD4 count was 579 cells/uL; median HIV VL was <50 copies/mL. We found 44 re-infections among 38 (14%) men, onset between 2006 to 2018, a median of 1.5 (IQR 0.8,2.9; range 0.3-11.4) years after clearance; genotypes (n=41) were 1a in 31 (76%), 1b in 3 (7%), and other in 7 (17%). Including the re-infections, follow-up was available for a total of 300 episodes of HCV clearance, with a median follow-up time of 1.8 (IQR 0.8,3.3; range 0.1-11.4) years, and a total of 734 person-years (PY). The overall re-infection rate was 5.7/100PY (95% CI 4.2,7.7), with no significant difference among the 112 (37%), 160 (53%), or 28 (9%) infections cleared with IFN, DAA, or SC, respectively (p=0.52, Fisher exact). Further, time to re-infection did not differ among the groups (p=0.82, log-rank test) (Figure). Conclusion: The high HCV re-infection rate in our large cohort of HIV- infected MSM in NYC was independent of whether clearance was by IFN or DAA treatments, or by SC, and comparable to Europe rates. Most re-infections occurred within the first 2 years, but infections continued to occur for more than 11 years after clearance. These data suggest that long-term surveillance is warranted for all HIV-infected MSM after clearance of HCV infection. Further, strategies to reduce HCV re-infections are needed to meet the goal of eliminating HCV in these men who are at significant risk for HCV infection.

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CROI 2019