CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

(11/15), found were from previously identified injecting partnerships while four additional genetic links were found with individuals outside of the partnership. Taken together, over half (56%) of new infections occurred outside the a priori injecting dyad as the virus sequence from the new infections were no more similar to the HCV sequence isolated from the corresponding index case than to a randomly chosen sequence. Conclusion: Reconstruction of genetic transmission networks illustrate that only 44% of new HCV infections within the partnerships enrolled in the UFO cohort likely stemmed from direct transmission from their index partners. These results highlight the degree of difficulty in pinpointing the source of HCV transmission among PWID and demonstrate the importance and complementarity of partner naming and genetic surveillance for characterizing HCV transmission networks in an effort to guide public health interventions for disrupting transmission among communities. 585 HCV RNA AND ANTIGEN DETECTION FOR DIAGNOSIS OF ACUTE HEPATITIS C AMONG MSM ON PrEP Julien Gras 1 , Nadia Mahjoub 1 , Isabelle Charreau 2 , Laurent Cotte 3 , Cécile Tremblay 4 , Julie Chas 5 , François Raffi 6 , Eric Cua 7 , Brigitte Guillon 2 , Nicolas Guigue 1 , Marie-Laure Chaix Baudier 1 , Laurence Meyer 2 , Jean-Michel Molina 1 , Constance Delaugerre 1 1 Hôpital Saint-Louis, Paris, France, 2 INSERM, Le Kremlin-Bicetre, France, 3 CHU de Lyon, Lyon, France, 4 Université de Montréal, Montreal, QC, Canada, 5 Tenon Hospital, Paris, France, 6 CHU Hôtel-Dieu, Nantes, France, 7 CHU de Nice, Nice, France Background: High incidence of HCV infection has been reported among high risk MSM. Current guidelines recommend that these individuals should be screened at least once a year with ALT and anti-HCV antibodies. Our aimwas to assess the sensitivity of the different tests for early diagnosis of acute hepatitis C in high risk MSM. Methods: In the ANRS IPERGAY PrEP trial among high risk MSM, a 3rd generation (3thG) antibody immunoassay (EIA ARCHITECT HCV Ab®, Abbott) was used for HCV diagnosis at screening and if ALT (performed every 2-months) ≥ 2.5 times the upper limit of normal. In patients with a positive EIA, we used stored sera to perform the following tests at the date of diagnosis and at previous visits (until HCV RNA was negative): antibodies (EIA 3thG ARCHITECT Anti-HCV, Abbott), rapid tests for detection of HCV antibodies (OraQuick® and Toyo®), plasma HCV RNA (AmpliPrep/COBAS® TaqMan® HCV Test, Roche and Xpert® HCV Viral Load, Cepheid), and the antigen immunoassay (EIA ARCHITECT HCV Ag®, Abbott). We evaluated the sensitivity of each test, including ALT, for the diagnosis of acute hepatitis C. HCV subtype was determined for each patient. Results: FromMarch 5, 2012 to June 30, 2016, among 428 enrolled participants , 14 were diagnosed with HCV infection including one co-infected with HIV, with a median follow-up of 2.1 years (IQR: 1.5-2.8). One case was diagnosed at enrollment and 13 during follow-up, leading to an HCV incidence of 1.40 per 100 person-years (95%CI: 0.74-2.39). Phylogenetic analysis identified HCV genotype 1 in 6 patients (43%), type 3 in 1 (7%) and type 4 in the remaining 7 (50%). Stored sera were available in all 14 cases at diagnosis. At previous visit, which occurred within a median of 2 months earlier (IQR: 1.5-2), stored sera were available for most patients for EIA 3thG, HCV RNA Roche and ALT (Table). On the visit before the first positive HCV-antibodies, among 12 patients who were tested with both HCV RNA (Roche) and ALT, 7 had an HCV RNA detectable and no increased ALT (p=0.008 McNemar’s test). Conclusion: The HCV antigen immunoassay and plasma HCV RNA test were positive within a median of 2 months before the detection of antibodies and ALT elevation, when patients were asymptomatic. These tests should be used in high risk MSM for early diagnosis of acute HCV infection and prevention of transmission.

586 ESTIMATING HIV, HCV AND HSV-2 INCIDENCE FROM EMERGENCY DEPARTMENT SEROSURVEYS Oliver Laeyendecker 1 , Simon E. Spencer 2 , Louise Dyson 2 , Yu-Hsiang Hsieh 3 , Eshan U. Patel 3 , Richard Rothman 3 , Gabor Kelen 3 , Thomas C. Quinn 1 , T. Deirdre Hollingsworth 2 1 NIAID, Baltimore, MD, USA, 2 University of Warwick, Coventry, UK, 3 The Johns Hopkins University, Baltimore, MD, USA Background: Historically, the Johns Hopkins Hospital Emergency Depart (JHH ED) has conducted serial identity-unlinked sero-surveys to monitor the HIV epidemic among the marginalized inner-city populations of Baltimore, Maryland. These surveys demonstrated a high burden of HSV-2, HIV and HCV, particularly among African Americans. We sought to determine temporal changes in incidence for these three viral infections in this population using age-based prevalence models. Methods: A novel differential equation model was fitted to the survey rounds of 2003, 2007 and 2013 using Markov chain Monte Carlo methods. Those survey rounds contained 1,490, 2,298 and 2,972 black individuals aged 18 to 90. We jointly modelled incidence of infection and coinfection with HIV, HCV and HSV-2 within age/gender cohorts. This model was fitted to observed prevalence within a non-parametric Bayesian framework, allowing us to infer incidence rates that vary smoothly with time and age. Incidence (and 95% credible intervals) were estimated for all viral infections using ten five-year intervals from birth cohorts from≤1947 to ≥1988. Results: There was no change in HCV incidence in women between the ≤1947 cohort and the 1963-1967 cohort. HCV incidence decreased between women in the 1963-1967 cohort and the ≥1988 cohort from 1.7% (0.2, 3.4) to 0.6% (0.0, 1.6). HIV incidence in women similarly decreased from 1.3% (0.1, 2.8) in the 1973-1977 cohort to 0.6% (0.0-1.8) in the ≥1988 cohort. HSV-2 incidence was higher for women in younger birth cohorts increasing from 2.5% (0.4, 4.9) in the ≤1947 cohort to 3.4% (1.2, 5.7) in the ≥1988 cohort. For men, HCV incidence did not change between the ≤1947 cohort to 1958-1962 cohort. HCV incidence decreased in men from 1.7% (0.2, 3.4) in the 1958-1962 cohort to 0.68% (0.0, 1.9) in the ≥1988 cohort. Among men, HIV incidence was stable at 1.1% (0.6, 1.7) as was HSV-2 incidence (2.0%, 1.1-3.1). The greatest burden of multiple infections were seen in the birth cohorts from 1948 to 1972. Conclusion: The incidence of HCV among black women and men attending the JHH ED has substantially decreased among younger age cohorts. Additionally, the incidence of HIV has also decreased among women but not among men. These changes reflect a decreasing burden of disease in younger cohorts, rather than a reduction in incidence across the whole population. HSV-2 incidence remains high for men and women showing a continued burden and risk for sexually transmitted infections. 587 ESTIMATING HIV AND HCV INCIDENCE AMONG PERSONS WHO INJECT DRUGS IN INDIA Denali Boon 1 , Sunil S. Solomon 2 , Aylur K. Srikrishnan 3 , Allison M. McFall 2 , Pachamuthu Balakrishnan 3 , Syed Iqbal 3 , Gregory M. Lucas 2 , Oliver Laeyendecker 1 , Thomas C. Quinn 1 , Shruti H. Mehta 2 1 NIAID, Baltimore, MD, USA, 2 The Johns Hopkins University, Baltimore, MD, USA, 3 YR Gaitonde Center for AIDS Research and Education, Chennai, India

Poster Abstracts

CROI 2018 215