CROI 2015 Program and Abstracts

Abstract Listing

Poster Abstracts

reporting no THC use, weekly users reported more injection drug [28% vs 18% p=0.004] and alcohol use [60% vs 44% p=0.001]. In univariate analysis, log APRI [HR 10.35 (5.69- 18.84) p 〈 0.001], log HCV RNA [HR 1.3 (1.10-1.54) p=0.002] and log HIV RNA [HR 1.14 (1.02-1.29) p=0.03] at entry were associated with progression to severe fibrosis; higher CD4+ count [per 50 cells HR 0.96 (0.93-0.98) p 〈 0.0004] and ART use [HR 0.62 (0.38-1.01), p=0.05] were associated with lower fibrosis. Cumulative alcohol use [risk per 1 drink increase per week [HR 1.03 (1.02-1.04) p 〈 0.001] was associated with greater risk of progression. In multivariate analysis, entry APRI, HCV RNA, CD4+ count and cumulative alcohol use remained significant. Cumulative THC use was not independently associated with a greater risk of fibrosis progression [HR 1.00 (95% CI 0.996-1.003)] even in those with moderate fibrosis at entry [HR 1.00 (95% CI 0.995-1.005)]. Conclusions: In this large cohort of HCV/HIV co-infected women with prospectively collected cumulative alcohol and THC use, THC was not associated with liver fibrosis progression. Interestingly, alcohol use was strongly associated with THC use and independently associated with liver fibrosis, and may better predict fibrosis progression in HCV/ HIV co-infected women 640 HIV Infection Does Not Worsen Prognosis of Liver Transplantation for Hepatocellular Carcinoma Fernando H. Agüero 1 ; Alejandro Forner 2 ; Christian Manzardo 1 ; AndresValdivieso 3 ; Marino Blanes 4 ; Rafael Barcena 5 ; Antoni Rafecas 1 ; Lluis Castells 6 ; Antonio Rimola 1 ; Jose MMiro 1 1 University of Barcelona, Barcelona, Barcelona, Spain; 2 Hospital Clinic, IDIBAPS and El Centro de Investigación Biomédica en Red en el Área Temática de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain; 3 Hospital Universitario de Cruces, Bilbao, Spain, Bilbao, Spain; 4 Hospital Universitario La Fe, Valencia, Spain, Valencia, Spain; 5 Hospital Universitario Ramón y Cajal, Madrid, Spain, Madrid, Spain; 6 Hospital Universitari Vall d‘Hebrón, Barcelona, Spain, Barcelona, Spain Background: Small series of liver transplantation (LT) in HIV-infected patients with hepatocellular carcinoma (HCC) have been reported in recent years. However, data on recurrence of HCC and survival after LT are limited and controversial. The aim of this study was to assess the impact of HIV on clinical outcome in patients undergoing LT for HCC. Methods: Prospective cohort study of HIV-infected patients with HCC who received LT at 22 Spanish centres (FIPSE cohort) and were matched with non–HIV-infected LT recipients (1:3 ratio). The study started in 2002, and follow-up ended in July 2014. The matched criteria were age, gender, calendar year of LT, HCV or HBV coinfection, and HCC. The main outcomes were recurrence of HCC and survival. Patients with incidental HCC were excluded. Results: In total, 74 HIV-infected patients and 222 non–HIV-infected patients underwent LT for HCC. Most were men (86%) and had HCV infection (92%). HIV-infected patients were younger (47 vs 51 y) and the frequency of HCV replication at LT was lower (80% vs 90%) than in HIV-negative patients. At LT, median (IQR) CD4 cells/mm 3 was 347 (238-523) and most HIV-infected patients (96%) were on antiretroviral therapy. HIV plasma viral load was <50 copies/mL in 93%. No differences were seen between HIV-infected and non– HIV-infected recipients in the pathological characteristics of HCC in the explanted liver ( Table ). After a median of 46 (25-72) months of follow-up, recurrence was recorded in 12 (16%) HIV-infected patients and 32 (14%) HIV-negative patients, Recurrence at 1, 3, and 5 years (Kaplan-Meier estimates) for HIV-infected patients vs non–HIV-infected patients was 7% vs 5%, 17% vs 11%, and 20% vs 19%, respectively (p=0.876), with a similar rate of recurrence: 0.229 and 0.266 person-year, respectively. The incidence rate ratio was 0.86 (95% CI, 0.66-1.12). In the whole series, microscopic vascular invasion (HR, 3.79 95% CI, 1.67-8.57) was the only factor independently associated with recurrence of HCC. Survival at 1, 3, and 5 years for HIV-infected patients vs non–HIV-infected patients was 87% vs 89%, 78% vs 78%, and 69% vs 73% (p=0.905). HCV infection (HR, 8.85 95% CI, 1.23-63.64) and satellite nodules (HR, 1.92 95% CI, 1.13-3.24) were the variables independently associated with mortality.

Poster Abstracts

Conclusions: HIV-infection did not have any impact on recurrence of HCC or survival after LT. These results support the indication of LT in HIV-infected patients with HCC. 641 Rapid Progression to Cirrhosis and Death Among HCV-Infected Persons Who Inject Drugs in India Shruti H. Mehta 1 ; Suniti Solomon 2 ; Allison M. McFall 1 ; Aylur K. Srikrishnan 2 ; Pachamuthu Balakrishnan 2 ; Nandagopal P 2 ; David L.Thomas 1 ; Mark Sulkowski 1 ; Sunil S. Solomon 1 1 Johns Hopkins University, Baltimore, MD, US; 2 YR Gaitonde Centre for AIDS Research and Education, Chennai, India Background: The recent introduction of direct-acting antivirals for HCV have sparked hope for HCV treatment in resource-limited settings (RLS). Despite WHO recommending HCV therapy for all chronically infected persons, it is likely that initially, similar to the early years of ART, access to these therapies will be limited in RLS. Therefore, it is critical to identify HCV-infected persons most in need of therapy. Methods: A cohort of 809 persons who inject drugs (PWID) was recruited from 2/2012 – 9/2014 in Chennai, India, of whom 264 (34%) were chronically HCV-infected (HCV RNA positive). We characterized incidence of clinical outcomes (all cause-mortality and cirrhosis) among HCV-infected individuals with more than 1 follow-up visit (n=226). Cirrhosis was ascertained by elastography (Fibroscan) and all-cause mortality by verbal autopsy. Kaplan-Meier survival curves and Poisson regression were used to identify predictors. A subset was asked about barriers to accessing HCV treatment (n=57). Results: Median age of HCV-infected persons was 42; all were male, 53% had primary school education or less and median monthly income was ~$97 USD. 84 (32%) were HIV/ HCV co-infected. 51% had no fibrosis, 24%moderate fibrosis and 25% had severe fibrosis/cirrhosis at baseline. 57% had evidence of alcohol dependence by AUDIT. 27 died over

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CROI 2015