CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

76 (20%) were treatment-experienced. The overall SVR4 rate was 97.6% (95% CI 95.5, 98.9). SVR12 by mITT was 98.2% (95% CI 96.1,99.3); SVR12 by per-protocol was similar. SVR4 rate remained high across key subgroups including blacks and those with high baseline HCV VL, FIB-4 >3.25 or prior HCV treatment. However, there was a trend toward lower SVR rates with treatment duration <8 weeks (90%, 95% CI 55.5, 99.9) and pre-treatment HIV VL >40 copies/ml (92.6%, 95% CI 75.7, 99.1). Among the 9 patients who did not achieve SVR, 1 had on-treatment breakthrough and 8 had virologic relapse. Conclusion: SVR rates among HIV/HCV patients in routine clinical care appear to be comparable to that reported in clinical trials and high across subgroups traditionally considered difficult-to-treat.

Poster Abstracts

610 DAA TREATMENT RESPONSE AMONG HIV/HCV-COINFECTED PATIENTS IN THE CNICS COHORT H. Nina Kim 1 , Robin M. Nance 1 , Benigno Rodriguez 2 , Kenneth H. Mayer 3 , Richard D. Moore 4 , Edward R. Cachay 5 , W. C. Mathews 5 , Elvin Geng 6 , Joseph J. Eron 7 , Ricardo A. Franco 8 , Michael Saag 8 , Mari Kitahata 1 1 University of Washington, Seattle, WA, USA, 2 Case Western Reserve University, Cleveland, OH, USA, 3 Fenway Health, Boston, MA, USA, 4 Johns Hopkins University, Baltimore, MD, USA, 5 University of California San Diego, San Diego, CA, USA, 6 University of California San Francisco, San Francisco, CA, USA, 7 University of North Carolina Chapel Hill, Chapel Hill, NC, USA, 8 University of Alabama at Birmingham, Birmingham, AL, USA Background: Patients with HIV and chronic hepatitis C (HCV) coinfection have had high sustained virologic response (SVR) rates to direct-acting antiviral (DAA) therapy in clinical trials, and are no longer considered a treatment-refractory population. Yet these trials were nearly all open-label studies with strict eligibility criteria. We provide real-world SVR rates to DAA therapy in a large, diverse population of HIV/HCV patients across seven sites in the CNICS network. Methods: We identified patients who started an interferon-free DAA combination (regimens outlined below) any time after respective FDA approval date through March 2017 and had post-treatment HCV viral level (VL) measured. SVR4 was defined as an undetectable HCV RNA ≥4 weeks post-treatment and SVR12, ≥12 weeks post-treatment. We calculated SVR4 rates and 95% confidence intervals (CI) using a modified intent-to-treat analysis (mITT), SVR12 rates by mITT and SVR12 per-protocol (excluding individuals with early treatment cessation). We evaluated SVR4 across key subgroups: age ≥50, female, black, genotype, ledipasvir-sofosbuvir (LDV-SOF), cirrhosis (FIB-4 >3.25), treatment experience (prior peginterferon/ribavirin), antiretroviral therapy (ART) status, HCV and HIV VL, and CD4 counts (measured pre- treatment) and <8-week duration. Results: Among 373 HIV/HCV patients who underwent DAA therapy, 80% were men, 32%white, 59% black, with median age of 56. Median CD4 cell count was 549 cells/mm 3 and 90%were on ART. DAA regimens included: LDV-SOF (84.2%), simeprevir/sofosbuvir (8.6%), sofosbuvir/daclatasvir (3.2%), paritaprevir-ritonavir-ombitasvir/dasabuvir (2.1%), elbasvir-grazoprevir (1.1%) and sofosbuvir-velpatasvir (0.8%). Of these, 22 (6%) were also on ribavirin and

611 REDUCTIONS IN HEALTHCARE SERVICE USAGE FOLLOWING DIRECT ACTING ANTIVIRAL THERAPY Sahar Saeed 1 , Erica E. Moodie 1 , Mark Hull 2 , Sharon Walmsley 3 , Curtis Cooper 4 , Alexander Wong 5 , Michael John Gill 6 , Valerie Martel-Laferriere 7 , Erin C. Strumpf 1 , Marina Klein 8 1 McGill University, Montreal, QC, Canada, 2 St. Paul’s Hospital, Vancouver, BC, Canada, 3 Toronto General Hospital, Toronto, ON, Canada, 4 Ottawa General Research Institute, Ottawa, ON, Canada, 5 Regina Qu’Appelle Health Region, Regina, SK, Canada, 6 Southern Alberta Clinic, Calgary, AB, Canada, 7 Centre de Research du Centre Hospitalier de l’Université de Montreal, Montreal, QC, Canada, 8 McGill University Health Centre, Glen site, Montreal, QC, Canada Background: High costs of direct acting antivirals (DAAs) have limited treatment access worldwide. Empirical evidence on the cost benefits of DAAs in real world populations would support wider treatment access. We investigated the impact of all oral-DAA therapy on healthcare services utilization (HCSU) among HIV-Hepatitis C (HCV) coinfected individuals in Canada. Methods: The Canadian Co-Infection Cohort Study prospectively follows 1785 HIV-HCV co-infected participants from 18 centres. Data on sociodemographic, clinical, HCSU and prescriptions are collected biannually through self- administered questionnaires. We used a segmented multivariate negative binomial mixed model to evaluate the impact of DAAs on annual HCSU rates. HCSU was defined as out-patient visits (including number of visits to walk-in, general/HIV practitioners and specialist) and in-patient visits (emergency room and hospitalization). Out-patient visits, pre-treatment were truncated 6-months prior to initiation to account for changes in HCSU in preparation of initiating DAAs. Follow-up time post-DAA treatment included visits following ascertainment of treatment response (>12 weeks post-DAA treatment). Multivariate models included time updated CD4 cell count, HIV viral load, injection drug use and fixed confounders; age, sex, fibrosis and psychiatric diagnoses. Results: Between 2014-2016, 318 participants initiated oral DAAs, 200 completed at least 1 visit before and after DAA treatment (total of 1868 visits) with a mean of 3.2 years (SD 2.6) pre- and 0.7 years (SD 0.5) post-DAA follow up time. 70% of DAA regimens consisted of ledipasvir/sofosbuvir. Median age at DAA initiation was 52 (IQR 48, 56), 76%were male, 90% had HIV viral load

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