CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

S207R and S210R vs 205-225 for wt). Overall, this suggests an impaired HBsAg C-terminus stability in presence of these mutations. Conclusion: Gain of positively charged aa at specific HBsAg C-terminus positions tightly correlates with HCC, by affecting the folding of this domain in ER membrane. These mutations might affect HBsAg secretion and contribute to HBV-related carcinogenesis. Their detection may help identifying patients at higher HCC-risk that may deserves more intense liver evaluation. 624 SURVIVAL AFTER END-STAGE LIVER DISEASE IN ADULTS WITH HIV: DATA FROM THE NA-ACCORD Eve-Marie A. Benson 1 , Marina Klein 2 , Mari Kitahata 3 , Richard D. Moore 1 , Vincent Lo Re 4 , Michael A. Horberg 5 , Angel Mayor 6 , Michael J. Silverberg 7 , H. Nina Kim 3 , Joseph J. Eron 8 , Edward R. Cachay 9 , Mark Hull 10 , Stephen J. Gange 1 , Keri N. Althoff 1 1 Johns Hopkins University, Baltimore, MD, USA, 2 McGill University, Montreal, QC, Canada, 3 University of Washington, Seattle, WA, USA, 4 University of Pennsylvania, Philadelphia, PA, USA, 5 Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA, 6 Universidad Central del Caribe, Bayamon, Puerto Rico, 7 Kaiser Permanente Northern California, Oakland, CA, USA, 8 University of North Carolina Chapel Hill, Chapel Hill, NC, USA, 9 University of California San Diego, San Diego, CA, USA, 10 University of British Columbia, Vancouver, BC, Canada Background: Liver disease is a leading cause of death among persons with HIV. Our objective was to investigate whether survival after end-stage liver disease (ESLD) differs among adults with HIV according to the presence of HBV and HCV coinfection. Methods: Adults from 12 cohorts contributing data to the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) from 1 Jan 2000 to 31 Dec 2009 with validated ESLD diagnosis were included. Participants were followed from ESLD diagnosis until death, loss to follow up (defined as 1.5 years after last CD4 or HIV RNA measurement), or administratively censored at 5 years after diagnosis or 31 Dec 2009, whichever came first. Coinfection with HBV (positive HBV surface or e antigen or detectable HBV DNA) or HCV (positive HCV antibody test, detectable HCV RNA,or quantifiable HCV genotype), demographic characteristics, HIV transmission risk, CD4 count, detectable ( >400 copies/mL) HIV RNA, platelet count, antiretroviral therapy (ART), alcohol use and smoking at ESLD diagnosis, and calendar time (in two year intervals) were accounted for in multivariate pooled logistic regression models to estimate the hazard odds ratios (aHOR) of death. Kaplan Meier survival estimates were plotted overall and stratified by HBV and HCV coinfection. Triply infected adults were excluded from these analyses (n=27). Results: A total of 298 adults with validated ESLD diagnoses contributed 5921 person-months and 159 deaths (median time to death = 23 [17, 36] months); 35%were infected with HIV only, 16% had HBV coinfection, and 49% had HCV coinfection. Among participants, 84%were male and 49%were white. 45%were not on ART at ESLD diagnosis, 19%were on ART but had detectable HIV RNA, and 35%were on ART and had suppressed HIV RNA. In multivariate models, coinfection with HBV (aHOR=1.17 [0.70, 1.94]) and HCV (aHOR=1.45 [0.95, 2.22]) were associated with a higher risk of death compared with HIV monoinfection, as was smoking (aHOR=2.77 [1.39, 5.49]). After restricting to participants with HIV RNA ≤400 copies/mL at ESLD diagnosis and adjusting for confounders, the risk of death associated with HBV increased (aHOR=1.50 [0.62, 3.64]) but was unchanged with HCV (aHOR=1.45 [0.68, 3.14]). Conclusion: Although not statistically significant, the magnitude of the estimates of the risk of death suggest a trend towards a decreased survival among those with HBV or HCV coinfection at the time of ESLD diagnosis, even among those with controlled HIV RNA.

625 HAV EPIDEMICS AMONG MSM : HIGH PREVALENCE OF HIV INFECTED PATIENTS Veronique Lemee 1 , Anne-Marie Roque-Afonso 2 , Elodie Alessandri-Gradt 1 , Lina Mouna 2 , Laure Izquierdo 2 , Odile Goria 1 , Hélène Montialoux 1 , Valerie Delbos 1 , Thomas Mourez 1 , Jeremie Leporrier 1 , Jean-Christophe Plantier 1 , Ghassan Riachi 1 1 Rouen University Hospital, Rouen, France, 2 AP–HP, Paris, France Background: Transmission of HAV is mainly via fecal-oral route, including direct person-to-person contact. The population of men who have sex with men (MSM) whose sexual practices favors the fecal-oral transmission of the virus, is highly at risk of HAV infection. Since the summer of 2016, many European countries observed a growing number of hepatitis A infections among MSM. In December 2016, the European Center for Disease Control and Prevention (ECDC) reported the circulation of two strains of HAV genotype IA which resulted in the emergence of several epidemic foci in various European countries including the United Kingdom, Germany and the Netherlands. At the same date, we observed the first cases in Normandy, France, where the epidemic started in the country. Methods: Risk factors, behavioral and biological data (including viral co- infections) collected for each HAV+ patient hospitalised in the Rouen University Hospital were analysed. A phylogenetic analysis of the amplified HAV positive strains was operated by the French National Reference Center for HAV, and compared to the current European data. Results: From december 2016 to september 2017, 41 patients (Sex ratio M/ F=40/1) with confirmed HAV were described in the Seine-Maritime county. Among them 35 were admitted in our hospital. A majority of the patients (n=22; 62%) described themself as MSM. All of themwere infected with a genotype IA HAV strain VRD 521 2016, which is one of the epidemic strain that circulates in Europe since 2016 in the MSM community. Nine of these infected MSM (29%) were also infected with HIV and treated by HAART. Conclusion: Sexual transmission is becoming a major route of transmission of hepatitis A in countries where the infrastructures reduce the risk of fecal contamination through the environment. Sexual behaviours must be included systematically when questionning about the origin of HAV epidemics. Regarding the high number of HIV+ among patients hospitalized with HAV infection, systematic screening for HBV, HCV and HIV should be proposed. Vaccination and control of the seropositivity against HAV should be systematically proposed among HIV MSM. 626 ACUTE HEPATITIS A AMONG HIV-INFECTED THAI MSM IS LINKED TO MSM IN EUROPE AND TAIWAN Donn Colby 1 , Nawarat Posuwan 2 , Carlo Sacdalan 1 , Jintana Intasan 1 , Eugène Kroon 1 , Tanyaporn Wansom 3 , Nittaya Phanuphak 1 , Jintanat Ananworanich 4 , Merlin L. Robb 5 , Praphan Phanunphak 1 , Yong Poovorawan 2 1 Thai Red Cross AIDS Research Center, Bangkok, Thailand, 2 Chulalongkorn University, Bangkok, Thailand, 3 Armed Forces Research Institute of Medical Sciences in Bangkok, Bangkok, Thailand, 4 US Military HIV Research Program, Bethesda, MD, USA, 5 US Military HIV Research Program, Silver Spring, MD, USA Background: In 2016-17 outbreaks of acute Hepatitis A virus (HAV) infection were reported among men who have sex with men (MSM) in Taiwan, the

Poster Abstracts

CROI 2018 231