CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

Conclusion: DAA adherence < 95% and basal CD4+ count < 200/μL predict lower SVR. On the other hand, data sugest MSM transmission is also a risk factor for failure, but it could be due to higher rate of HCV reinfection. Larger number of MSM patients would be needed to confirm this latter finding. 609 PREDICTORS OF LACK OF HEPATITIS C ERADICATION USING DIRECT- ACTING ANTIVIRALS Edward R. Cachay 1 , Alvaro Mena 2 , Laura Benitez 3 , Ivana Maida 4 , Carmen de Mendoza Fernández 3 , Angeles Castro 2 , Elena Dore 4 , Craig Ballard 1 , Vincent Soriano 5 , W. C. Mathews 1 1 University of California San Diego, San Diego, CA, USA, 2 University Hospital of La Coruña, La Coruña, Spain, 3 Puerta de Hierro Research Institute and University Hospital, Madrid, Spain, 4 University of Sassari, Sassari, Italy, 5 La Paz University Hospital, Madrid, Spain Background: The high efficacy of direct-acting antivirals (DAA) makes eradication of hepatitis C (HCV) an achievable goal for nearly all in need. Identification of factors involved in the lack of sustained viral response (SVR) following DAA treatment among patients living with HIV (PLWH) is paramount for global HCV eradication efforts. Methods: Retrospective cohort analysis of PLWH treated for HCV in standard of care in 3 countries from January 2014 to January 2017. Bivariate analyses followed by logistic regression were used to identify factors associated with lack of SVR. Potential predictors included demographics; HIV regimen, CD4, and viral load; HCV-genotype(GT), prior treatment history, and DAA used; fibrosis stage, cirrhosis, and prior liver decompensation; Charlson comorbidity index; active alcohol, any illicit drug use, intravenous drug use (IDU), unstable housing and active psychiatric illness. Results: A total of 450 PLWH were treated with different DAA regimens. Median age 52 years, CD4+ 457/mm 3 , undetectable HIV viral load 86%. Most patients were male (76.4%), white (67%), heterosexual with IDU history (67.6%) and HCV treatment naïve (70.6%). The HCV GT distribution was GT1a (47.1%), GT1b (20.9%), GT4 (13.4%), GT3 (11%), GT1 untypeable (4.9%) and GT2 (2.7%). One-third of patients (n=151) were cirrhotics of whom 25% (n=38) had prior liver decompensation. The prevalence of current alcohol, drug use, unstable housing and active psychiatric illness at DAA initiation was 31.8% (n=141), 30.9% (n= 139, [26 were IDU]), 5.8% (n=26) and 24.2% (n=109), respectively. Overall 415 patients (92.2%) achieved SVR (GT1: 91.5%, GT2: 91.7%, GT3: 94%, GT4: 95%), including 91.4% of cirrhotics and 86.8% of those with prior liver decompensation. Of the 35 failures, 23 were HCV relapses, 9 were lost to follow- up, 2 discontinued DAA due to side effects, and 1 stopped DAA due to a severe comorbidity. In bivariate analysis(Table), active psychiatric illness (p<.0001) and illicit drug use (p=0.006) were associated with lack of SVR. In logistic regression analysis of effects of both drug use and psychiatric illness, only active psychiatric illness was associated with lack of SVR [OR: 2.7, CI; 1.2-5.8, P=0.01]. There was no interaction between drug use and active psychiatric illness. Conclusion: In this multinational DAA cohort of PLWH, active psychiatric illness was independently associated with lack of SVR to DAA. The role of drug adherence and/or drug interactions should be further explored in this population.

including age, sex, liver stiffness, G1 subtype, HCV-RNA, HIV, and treatment duration showed the factors associated with treatment failure to be male sex (adjusted odds ratio [aOR] 2.37; 95%CI 1.24-4.52; P=.01) and HIV infection (aOR 2.16; 95% CI 1.76-4.87; P=.01). Similar findings were observed when we restricted the analysis to patients with HCV-RNA < 6 million IU/mL. Conclusion: The results of this large prospective real-world study analyzing treatment outcomes for LDV/SOF against HCV G1 in treatment-naïve noncirrhotic patients suggest that HIV infection is a predictor of treatment failure in patients with chronic hepatitis C. Some characteristics of CoP, such as low nadir CD4+ count and prior clinical AIDS, which are indicative of immunosuppression, may explain these results and require further analysis.

Poster Abstracts

608 PREDICTIVE FACTORS OF INTERFERON-FREE THERAPY FAILURE IN HIV/ HCV COINFECTION Lourdes Domínguez-Domínguez 1 , Maria Lagarde 1 , Otilia Bisbal 1 , Mariano Matarranz 1 , Carlos Lumbreras 1 , Asunción Hernando 2 , Rafael Rubio 1 , Federico Pulido 1 1 Hospital Universitario 12 de Octubre, Madrid, Spain, 2 Universidad Europea de Madrid, Madrid, Spain Background: Many cohorts show effectiveness of all-oral direct acting antivirals (DAA) for HCV therapy > 90%. Few studies focus on predictive factors of failure in HIV coinfected patients. Methods: HIV/HCV patients included in the cohort “VIH-DOC” were eligible if treated with DAA between 9th January 2015 and 31st August 2016. Sustained virological response (SVR) was analyzed 24 weeks after the end of therapy in the intention to treat population. SVR proportions were compared by the Fisher exact test in different subgroups depending on age, gender, transmission mechanism, associated diseases (mellitus diabetes, alcohol consumption, HBV coinfection, cirrhosis -defined by either liver stiffness ≥14.6kPa or clinical evidence-, estimated glomerular filtration rate impairment, and symptomatic or asymptomatic cryoglobulinemia), and factors related to the HCV (basal viral load, genotype, IL28B polymorphism CC vs. non-CC, previous interferon based therapy and DAA estimated adherence) and to the HIV (basal viral load and basal CD4+ cells count). Binary logistic regression was used for multivariate analysis which included clinically relevant variables (cirrhosis, response to previous interferon therapy and IL28B polymorphism) and factors with a Fisher exact test p value <0.15. Results: DAA were prescribed to 423 patients. Mean age was 50.1 years old. Men were 74.4% of patiens. Main transmission mechanismwas drug injection (84.9%). Men who had sex with men (MSM) accounted for 4.5% of cases. SVR was confirmed in 393 (92.9%, 95%CI:90.0-95.2). No difference was shown when comparing SVR in cirrhosis vs. non-cirrhosis (Dif% 1.9 [95%CI:(-3.1) - 8.3], p=0.540); nor in subgroups defined by gender, age and other associated diseases. Patients with DAA adherence <95% had lower SVR (Dif% 10.3 [95%CI:3.5-19.6], p=0.003); as well as those with basal CD4+ count <200/ μL (Dif% 14.7 [95%CI:4.1-31.0], p=0.006). After logistic regression, both DAA adherence and basal CD4+ count remained with a role on SVR (OR 3.9 [95%CI:1.8-8.8, p=0.001] and 5.2 [95%CI:1.9-13.9, p=0.001], respectively). Moreover, MSM had 4.2 [95%CI:1.1-16.1, p=0.039] times less probability of SVR achievement. Model’s Nagelkerke R square was 0.13.

CROI 2018 224