CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

590 HCV INCIDENCE IN HIV-INFECTED AND IN PrEP-USING MSM Laurent Cotte 1 , Eric Cua 2 , Jacques Reynes 3 , François Raffi 4 , David Rey 5 , Pierre Delobel 6 , Amandine Gagneux-Brunon 7 , Christine Jacomet 8 , Romain Palich 9 , Hélène Laroche 10 , André Cabié 11 , Bruno Hoen 12 , Christian Chidiac 1 , Pierre Pradat 1 1 Hospices Civils de Lyon, Lyon, France, 2 CHU de Nice, Nice, France, 3 CHU de Montpellier, Montpellier, France, 4 CHU de Nantes, Nantes, France, 5 Hôpitaux Universitaires de Strasbourg, Strasbourg, France, 6 CHU de Toulouse, Toulouse, France, 7 CHU de Saint Etienne, Saint Etienne, France, 8 CHU de Clermont-Ferrand, Clermont-Ferrand, France, 9 AP–HP, Paris, France, 10 Assistance Publique–Hopitaux Marseille, Marseille, France, 11 CHU Fort de France, Fort de France, Martinique, 12 CHU de Guadeloupe, Pointe à Pitre, France Background: Despite a high level of engagement in care, priority access to DAAs and high HCV treatment uptake, acute HCV incidence still appears on the rise in HIV+MSM in France. Acute HCV have been reported in HIV negative PrEP users, but there are currently no data regarding the incidence in this population. We assessed the incidence of acute HCV in PrEP users MSM and in HIV+MSM enrolled in a large French cohort. Methods: The DatAIDS cohort covers about 25% of French HIV+ patients in care. HIV+, HCV-negative MSM with serological follow-up in 2016 and HIV-negative, HCV-negative MSM PrEP users enrolled from January 2016 to May 2017 in 13 of the 15 cohort sites were analyzed to assess the incidence of a first acute HCV. The incidence of HCV reinfection was determined in patients having cured a previous one. Since PrEP recruitment was highly heterogeneous between sites, a sub-analysis was conducted based on the 5 sites with the highest number of PrEP patients. Results: Among 13,825 HIV+MSM followed in 2016, HCV serological status was available in 13,051 (94.4%). 666 patients were already HCV+ when entering the study (prevalence 5.1%) and serological follow-up was available in 2016 for 4,151 HCV-negative patients. Virological follow-up was available for 440 patients who had cured a previous infection. 59 acute HCV infections occurred in 2016 (42 first infections, 17 reinfections). Incidence of first HCV infection, reinfection and overall acute HCV was respectively 1.01, 3.77 and 1.28 / 100PY. 930 HIV-negative subjects were enrolled for PrEP. HCV serology was available in all patients and serological follow-up was available for 916 (972 PY). 17 patients were already HCV-infected when entering the study (prevalence 1.8%), of whom 14 were cured and 3 had an active HCV infection. 12 acute HCV infections occurred during follow-up (12 first infections, 2 reinfections). Incidence of first HCV infection and overall acute HCV was respectively 1.03 and 1.24/100PY. In a sub-analysis restricted to 5 sites contributing to 90% of PrEP patients and 44% of HIV+MSM, the overall incidence of acute HCV infection was 1.38 and 1.52 / 100PY in HIV+ and HIV-negative MSM, respectively. Conclusion: Incidence of a first HCV infection and of all acute HCV infections in HIV+MSM and in HIV-negative MSM PrEP users was similar in France in 2016- 2017. HIV+ and HIV-negative MSM PrEP users probably share similar at-risk practices for HCV and should be similarly targeted for preventive interventions. 591 HCV INCIDENCE IS STILL INCREASING IN FRENCH HIV-INFECTED MSM Laurent Cotte 1 , Thomas Huleux 2 , François Raffi 3 , Pierre Delobel 4 , Jacques Reynes 5 , Pascal Puglièse 6 , David Rey 7 , Firouze Bani-Sadr 8 , Isabelle Poizot- Martin 9 , André Cabié 10 , Antoine Chéret 11 , Claudine Duvivier 11 , Marc-Antoine Valantin 11 , Pierre Pradat 1 1 Hospices Civils de Lyon, Lyon, France, 2 Centre Hospitalier de Tourcoing, Tourcoing, France, 3 CHU de Nantes, Nantes, France, 4 CHU de Toulouse, Toulouse, France, 5 CHU de Montpellier, Montpellier, France, 6 CHU de Nice, Nice, France, 7 Hôpitaux Universitaires de Strasbourg, Strasbourg, France, 8 CHU de Reims, Reims, France, 9 Assistance Publique–Hopitaux Marseille, Marseille, France, 10 CHU Fort de France, Fort de France, Martinique, 11 AP–HP, Paris, France Background: High HCV treatment uptake combined with very effective direct- acting antiviral (DAA)-based regimens recently resulted in a dramatic decline in active HCV infection in French HIV-infected patients in all risk groups except MSM. Recent data suggested that wide access to DAA in the Netherlands led to a 51% decline in acute HCV between 2014 and 2016. However, this decrease was observed for genotype 1 only, and not for genotype 4 (Rijnders et al, abstract # 137LB, CROI 2017). We assessed the yearly incidence of acute HCV infection in HIV-infected patients enrolled in a large French cohort from 2012 to 2016. Methods: The DatAIDS cohort covers about 25% of HIV-infected patients in care in France. HCV negative patients with serological follow-up between 2012 and 2016 were enrolled and the incidence of first acute HCV infection

was determined yearly. For patients who had cured a previous infection, the incidence of HCV reinfection was also determined yearly. Results: Among 40,714 HIV-patients followed between 2012 and 2016, HCV status was available in 38,217 (94%). 5,559 patients (15%) were already HCV infected at the time of the study. HCV treatment uptake was 43% among patients with a detectable HCV-RNA in 2016. By the end of 2016, 82% of all patients had cured HCV, either spontaneously or following treatment. Among 21,518 HCV negative patients with serological follow-up between 2012 and 2016 (63,447 PY), 218 first HCV infections occurred. Similarly, among 3,392 patients who had cured a previous infection (10,595 PY), 74 reinfections occurred. The yearly HCV incidences for MSM and for patients with other HIV-risk factors are reported in the following table. Conclusion: Despite a high HCV treatment uptake and cure rate, the incidence of acute HCV infection regularly increased in French MSM between 2012 and 2016. The incidence of reinfection fluctuated but remained constantly higher than the incidence of first infection, suggesting that a subgroup of patients pursued high-risk practices following a first infection. The incidence in patients with other HIV-risk factors including IVDUs also increased during the period but remained considerably lower than in MSM.

Poster Abstracts

592 LOW PREVALENCE OF HEPATITIS C VIRUS AMONG NYC MSM INITIATING PrEP AND PEP, 2016-2017 Tarek Mikati , Kelly Jamison, Christine M. Borges, Demetre C. Daskalakis New York City Department of Health and Mental Hygiene, Long Island City, NY, USA Background: There is some evidence that hepatitis C virus (HCV) may be sexually transmitted among HIV-positive men who have sex with men (MSM). There have been recent reports of elevated HCV prevalence among HIV- negative MSM initiating HIV pre-exposure prophylaxis (PrEP). The aim of this analysis was to determine HCV prevalence among HIV-negative MSM initiating HIV post-exposure prophylaxis (PEP) or PrEP at New York City (NYC) Sexual Health Clinics (SHC). The HCV prevalence among MSM attending sexual health clinics in the United States has not been recently reported. Methods: NYC SHC began providing PEP and PrEP to patients at increased risk of HIV infection in September 2016. At the time of medication initiation, HCV serology (HCV Ab) with reflex HCV RNA PCR is obtained per New York State PrEP/PEP Guidelines. Using electronic medical record data from the PrEP/PEP initiation visit, we examined HCV testing, demographics, incident sexually transmitted infections, and reported sexual behavior and recent recreational drug use. Patients who tested positive for HCV antibody were matched against the NYC HCV surveillance registry to determine if they were newly diagnosed. Results: From September 2016-August 2017, 1142 HIV-negative MSM initiated PEP (N=760) or PrEP (N=382) in NYCSHCs; HCV Ab testing was performed for 99.7% (1139/1142). Among patients tested for HCV Ab, median age was 28 years (IQR 25-33); 26% (290/1139) were black non-Hispanic and 30% (345/1139) were Hispanic. Patients reported a median of 3 sex partners in past three months (IQR 2- 6); 25%were diagnosed with chlamydia, gonorrhea, and / or early syphilis at the time of PrEP/PEP initiation. In the three months prior to the visit, 4% (45/1139) of patients reported methamphetamine, gamma- hydroxybutyrate (GHB), or injection drug use (IDU). Three patients (0.26%, 95% CI: 0.1-0.8 %) tested positive for HCV Ab; one reported IDU. The patient with an IDU history was a previously diagnosed chronically infected HCV case with

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