CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

(EIA) from 2007 to 2015 were included. Outcomes of all cases were categorized as confirmed HCV (RNA+), retained in care (≥ 2 RNA test or 1 genotype test post EIA+ test), initiated treatment (≥ 1 genotype test post RNA+ test), and sustained virologic response (RNA- test ≥ 12 weeks after a positive RNA test). The proportion of cases achieving each step in the cascade was calculated as a conditional proportion. Chi-square was used to test for differences in achieving each step in the cascade by gender, age, birth cohort, risk history, region of residence, and viral load. Wilcoxon Rank Sumwas used to test for differences in time from an antibody test (EIA) to a confirmatory test (RNA). Results: In Massachusetts, 63% (n=39,919/63,657) of reported EIA+ cases received an RNA test. Of cases identified with confirmed HCV infection (n=32,095), 80%were retained in care, 50% initiated treatment, and 3% could be documented through surveillance to have sustained virologic response (Figure 1). Differences in achieving each step in the care cascade were observed for all case characteristics. A higher proportion of cases with history of injection drug use (42%) and Boston area residence (31%) were retained in care (p<0.0001). Baby boomers reported a shorter median time to an RNA after an EIA (28 days) than young adults (65 days) (p<0.0001). Conclusion: While only 50% of EIA+ cases reported to the Massachusetts surveillance system had a positive HCV RNA test reported, 80% of those that did so were retained in care and 50% had a genotype test reported. Documentation of sustained virologic response was extremely low (3%) and differences by case characteristics were observed across all stages of care. The higher retention in care among certain groups may reflect the success of targeted linkage to care efforts. Improved surveillance capture of negative HCV RNA test results will likely support detection of treatment response as antiviral treatment becomes more common.

of ongoing therapy (including a 12 week follow-up period) and sustained virologic response (SVR), and SVR alone. SVR was measured 12 weeks after stopping treatment or later (reinfections were thus captured and taken as failing SVR). In addition, multivariable logistic regression models were performed to identify factors associated with DAA use. Results: Among 5613 patients, HCV antibody test was not performed in 249 (4.4%) and 1195 (21.3%) had a postive antibody test, of whom 1178 (98.6%) were HCV-RNA tested and 934 (78.2%) were ever HCV-RNA positive (Figure). HCV genotype was known for 821 (87.9%), 520 (55.7%) showed genotype 1 and 218 (23.4%) genotype 3. Among the 806 individuals that remained HCV-RNA positive, 487 (60.4%) individuals initiated HCV treatment, 261 (53.6%) received DAAs without interferon and 226 (46.4%) interferon based regimens. The composite endpoint of ongoing therapy and SVR occurred in 433 (53.7%) patients and 378 (46.9%) achieved SVR. Significant differences between HIV clinics, according to providing DAAs directly or not were found for all treatment related stages of the continuum of care. The proportion of those starting treatment ranged from 76.2% in clinics providing DAAs without referral to 55.8% for clinics who have to refer patients to hepatologists. DAA use was strongly associated with clinics providing DAAs (OR 3.36; 2.16 – 5.24) to a lesser extent with younger age (OR 0.68; 0.46 – 1.01) compared to being 50 years of age or older, but was not associated with transmission category, sex, origin and HCV genotype. Conclusion: Austria is “en route” to eliminate HCV from HIV/HCV coinfected individuals. To improve and hasten this process a “no matter who provides HCV therapy” strategy is warranted.

Poster Abstracts

597 THE HCV DIAGNOSIS AND TREATMENT UPTAKE AMONG PATIENTS IN HIV CARE Daniel Radwan 1 , Oluwaseun Falade-Nwulia 1 , Ryan Westergaard 2 , W. C. Mathews 3 , Edward R. Cachay 3 , Judith Aberg 4 , Richard D. Moore 1 , Kelly Gebo 1 1 Johns Hopkins University, Baltimore, MD, USA, 2 University of Wisconsin, Madison, WI, USA, 3 University of California San Diego, San Diego, CA, USA, 4 Mt Sinai School of Medicine, New York, NY, USA Background: Despite the high prevalence of HIV/HCV coinfection and the availability of safe, effective direct acting antiviral (DAA) drugs, the prevalence of HCV testing, treatment, and sustained virologic response (SVR) among people with HIV (PWH) is unknown. The objective of this study is to establish an HCV testing and treatment cascade among patients in HIV care. Methods: We examined rates of HCV testing, HCV coinfection, DAA prescription, and SVR between 2013-15 among adult patients enrolled and followed at 12 sites in the HIV Research Network (HIVRN). Multivariate logistic regression, adjusting for care site, was performed to identify demographic and clinical characteristics associated with the outcomes. Results: Among 28,821 PWH – with a median age of 47 (IQR 37-54), 68.2% non-white; 48.5%MSM, 11.2% IDU; 13.5% CD4<200, 76.5% on ART, 72.9% HIV-1 RNA <200; and 60.7%Medicaid and/or Medicare, 16.0% private insurance – 22,425 (77.8%) were tested for HCV while in HIV care. After adjustment for other factors, Black race, IDU (AOR 3.40 95% CI (2.99, 3.86)), CD4<200 (AOR 1.34, (1.21, 1.49)) and having HIV-1 RNA >200 (AOR 1.43, (1.31, 1.56)) were associated

596 THE HEPATITIS C CONTINUUM OF CARE AMONG HIV INFECTED INDIVIDUALS IN AUSTRIA

Michaela Rappold 1 , Armin Rieger 2 , Martin Gisinger 1 , Mario Sarcletti 1 , Brigitte Schmied 3 , Maria Geit 4 , Alexander Zoufaly 5 , Bernhard Haas 6 , Ninon Taylor 7 , Manfred Kanatschnig 8 , Laura Simula 1 , Sara Krüger 1 , Bruno Ledergerber 9 , Robert Zangerle 1 1 Medical University of Innsbruck, Innsbruck, Austria, 2 Medical University of Vienna, Vienna, Austria, 3 Otto-Wagner Hospital, Vienna, Austria, 4 Kepler University Hospital Linz, Linz, Austria, 5 Kaiser Franz Josef Spital, Vienna, Austria, 6 General Hospital Graz South-West, Graz, Austria, 7 Paracelsus Medical University, Salzburg, Austria, 8 General Hospital Klagenfurt, Klagenfurt, Austria, 9 University Hospital Zurich, Zurich, Switzerland Background: In Austria, prescription of direct antiviral agents (DAAs) is restricted almost exclusively to hepatologists. However, 3 of 8 HIV clinics are allowed to prescribe DAAs directly without referring their HIV/HCV coinfected patients. The aim of this study was to evaluate whether this restriction negatively impacts on the HCV continuum of care. Methods: We analyzed data from patients of the Austrian HIV cohort study from January 2014 to August 2017. Stages of the continuum included anti-HCV positive, HCV-RNA tested, ever HCV-RNA positive, remaining HCV-RNA positive without therapy, treatment (latest, if measured more than once), the composite

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