CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

Conclusion: The overall incidence of an HCV reinfection in our large multicenter cohort remained low. However, patients with ongoing risk behaviour displayed an increased incidence for an HCV reinfection, in particular men who have sex with men. 613 PREVALENCE OF ACTIVE HEPATITIS B AMONG NEW YORK CITY MSM, 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: The CDC recommended regimen for HIV pre-exposure prophylaxis (PrEP) and post exposure prophylaxis (PEP) contain tenofovir DF (TDF)/ emtricitabine (FTC). Providing this medication to those infected with Hepatitis B virus (HBV) could theoretically lead to hepatitis flares and liver injury with TDF/FTC discontinuation. The prevalence of chronic active HBV infection in the United States (U.S.) is 1.1 % among foreign born and 0.14% among U.S. born. The aim of this analysis is to determine the prevalence of active HBV infection among men who have sex with men (MSM) initiating PrEP or PEP at New York City (NYC) sexual health clinics (SHC). Methods: Hepatitis B serologies are obtained from all patients who initiate PrEP and PEP at NYC SHC. Using electronic medical record data, we examined HBV serologies, demographics, and reported sexual behavior. Patients who tested positive for hepatitis B core antibody (anti-HBc) and hepatitis B surface antigen (HBsAg) were classified as actively infected while those who tested positive for Hepatitis B surface Antibody (anti-Hbs) and anti-HBc were considered naturally immune. Patients who tested positive only for anti-HBs were classified as vaccine induced immunity. All patients who tested positive for HBsAg were matched with NYC HBV surveillance registry to determine if they were newly diagnosed. Results: From September 2016 to August 2017, 1142 HIV negative MSM initiated PEP and PrEP that contained TFD/FTC. HBV serologies were obtained from 1139 (99.7%). Their median age was 28 years (IQR 25-33); 30%were Hispanic, 29%were White non- Hispanic (NH) 26%were Black NH, and 6%were Asian NH. More than one third were foreign born (37%; n=424). Prevalence of HBV vaccine induced immunity was 57% (657/1139) and HBV natural immunity was 5.6% (64/1139). Six patients (0.53%, 95% CI: 0.24- 1.2 %) were actively infected with HBV. Foreign-born patients were more likely to be infected with HBV than US-born (1.2%vs. 0.14%; p<0.03). Five were considered newly diagnosed per the NYC HBV registry. All six patients were offered active referrals to HBV providers; five patients accepted. Conclusion: Despite the high rate of HBV vaccine induced immunity of 57% among this MSM cohort, the prevalence of HBV active infection among US -born and foreign-born MSM initiating PEP and PrEP is similar to the national estimates Establishing access to HBV care through active referral systems to HBV providers is important, especially in clinics that provide PEP/PrEP to foreign- born MSM. 614 PREVALENCE AND PREDICTORS OF HEP B INFECTION AND HEP B/HIV CO-INFECTION, ZAMBIA 2016 Karampreet Sachathep 1 , Kumbutso Dzekedzeke 1 , Lloyd Mulenga 2 , Nchimunya Nkombo 3 , Webster Kasongo 4 , Andrea Low 1 , Suzue Saito 1 , Stanley Kamocha 5 , Kathy Hageman 5 , Gina Mulundu 6 , Eyasu Teshale 7 1 ICAP at Columbia University, New York, NY, USA, 2 Government of Zambia Ministry of Health, Lusaka, Zambia, 3 Central Statistical Office, Lusaka, Zambia, 4 Tropical Diseases Research Centre, Ndola, Zambia, 5 CDC Zambia, Lusaka, Zambia, 6 University Teaching Hospital, Lusaka, Zambia, 7 CDC, Atlanta, GA, USA Background: : Estimating the prevalence of hepatitis B virus (HBV) infection and HBV/HIV coinfection is important given successful scale up of Antiretroviral Therapy (ART) in Zambia and concerns about HBV treatment resistance of current treatment regimens recommended in Zambia. Methods: We used data from the 2016 Zambia Population-based HIV Impact Assessment (ZAMPHIA), a national household survey that includes rapid hepatitis B surface antigen (HBsAg) and HIV rapid tests in the home. Current HBV infection was defined by HBsAg+ results. We estimated the prevalence of HBV and HBV/HIV coinfection and conducted multivariate logistic regression to determine associated predictors using weighted data. Results: ZAMPHIA recruited 26,888 individuals aged 0-59 years. The national HBV prevalence was 5.6% (95% CI=5.2-6.0%,) for adults and 1.3% (Table 1) for children, which translates to an estimated 410,377 adults and 93,753 children (Table 1), nationally. Amongst those HBV+, 13.6%were found to be coinfected

<50 copies/mL, median CD4 count was 505 cells/mL (IQR 297, 710) and 27% had evidence of liver fibrosis. Sustained virologic response rates were 95%. Table 1 summarizes changes in HCSU rates pre- and post- DAA treatment. Out- and in-patient visits increased 17% and 6% respectively before DAA initiation. Post-DAA treatment, there was a 41% reduction in annual out-patient visits compared to pre-treatment rates (Incidence Rate Ratio (IRR) 0.59, 95% CI 0.31, 1.12) and a 21% reduction in annual in-patient visits (0.79, 0.58, 1.07). Conclusion: We found evidence of reductions in both in- and out- patient visits post DAA therapy in a real-world HIV-HCV coinfected population.

Poster Abstracts

612 HIGH INCIDENCE OF HCV REINFECTION IN MSM IN THE DAA ERA Patrick Ingiliz 1 , Malte Wehmeyer 2 , Stefan Christensen 3 , Thomas Lutz 4 , Knud Schewe 5 , Axel Baumgarten 1 , Dietrich Hueppe 6 , Karl-Georg Simon 7 , Jürgen K. Rockstroh 8 , Christoph Boesecke 8 , Stefan Mauss 9 1 Center for Infectiology, Berlin, Germany, 2 University Hospital Hamburg–Eppendorf, Hamburg, Germany, 3 CIM Infectious Diseases, Münster, Germany, 4 Infektiologikum, Frankfurt, Germany, 5 DAGNÄ eV, Berlin, Germany, 6 Gastroenterology Practice, Herne, Germany, 7 Gastroenterology Practice, Leverkusen, Germany, 8 Bonn University Hospital, Bonn, Germany, 9 Center for HIV and Hepatogastroenterology, Düsseldorf, Germany Background: Reinfection with the hepatitis C virus (HCV) has been described in patients with ongoing risk behaviour. Among men who have sex with men (MSM), users of intravenous (IDU) and non-intravenous drugs (mainly methamphetamine) for sexual enhancement (Chemsex) have been identified as a main risk group for HCV acquisition. The frequency of HCV reinfections after treatment with direct-acting antivirals (DAA) is not known. Here, we analysed the reinfection incidence rate in HCV mono-infected and HIV/HCV co-infected MSM or patients with IDU from the German hepatitis C cohort (GECCO). Methods: Until September 2017, 2364 DAA treatment courses of HIV/HCV co-infected and HCV mono-infected patients from 9 hepatitis centers have been included in the GECCO database since February 2014. All patients who completed HCV antiviral therapy were included in our current analysis. A reinfection was diagnosed in patients with a detectable HCV viral load who previously achieved a sustained virological response 12 weeks after the end of treatment, or with evidence for a genotype switch. Results: In total, 32/1960 patients (0.02%) had an HCV reinfection. The follow- up time for the entire cohort was 1141 person-years (median follow-up time 26 weeks per patient; range 4-205 weeks), indicating an HCV reinfection incidence of 2.8 per 100 person-years. All patients with an HCV reinfection were male, the mean age was 48 years (standard deviation 8.6 years), 3 (9.4%) suffered from liver cirrhosis, 26/32 (81.25%) had an HCV/HIV co-infection, 25 patients (78.1%) were MSM and 7 patients reported IDU (21.9%). Importantly, 8/25 (32%) MSM were occasional IDU. The median time from end of anti-HCV treatment to the diagnosis of the HCV reinfection was 53 weeks (range 2-115). A genotype switch occurred in 14/32 patients (44%). The reinfection rate in patients with IDU was 1.0% (7/710) during 390 person-years. Thus, the incidence of an HCV reinfection in patients with IDU was 1.8 per 100 person years. The reinfection rate in patients with MSM was 11.2% (25/223) during 175 person-years, indicating an incidence for an HCV reinfection of 14.3 per 100 person-years.

CROI 2018 226