CROI 2015 Program and Abstracts

Abstract Listing

Poster Abstracts

Methods: We analyzed all coinfected HIV/HCV patients in the MASTER cohort in order to estimate the incidence of CKD, DM and CVD. Patients were divided into 2 groups: SVR and non-SVR (naïve or non-responder to anti-HCV treatment). CKD and DM were defined as eGFR and fasting glucose plasma levels <60 mL/min/1.73 m 2 and >126 mg/dL in 2 consecutive time points, respectively. All major CVD, including coronary heart disease, cerebrovascular disease, chronic heart failure and peripheral vascular disease were evaluated. Cirrhosis was defined by a FIB-4 score >3.25. Kaplan-Meier curves and Cox regression analyses were used. Results: Data of 5407 patients were analysed (75.86%male, 64.79% IVDU, GT1 28.37%, cirrhosis 12.21%). Overall, the incidence of CKD, DM, CVD and death were 3.97 (95% confidence interval [CI]:3.46-4.53), 8.09 (95%CI:7.34-8.90), 4.32 (95%CI:3.79-4.91), 8.24 (95%CI:7.50-9.04) per 1000 person years of follow-up (PYFU). In the Cox regression analysis, SVR was not associated with a lower risk of CKD (relative hazard [RH]:1.16;95%CI:0.8-1.69), DM (RH 0.96;95%CI:0.71-1.29), CVD (RH 0.88;95%CI:0.58-1.32) and death (RH 0.98;95%CI:0.76-1.28) compared to non-SVR group. Moreover, no differences were observed in patients who received more cycles of anti-HCV treatment. Cirrhosis was significantly associated with the risk of CKD (RH 1.62;95%CI:1.15-2.28), DM (RH 2.66;95%CI:2.12-3.34), CVD (RH 1.5;95%CI:1.06-2.12) and death (RH 5.5;95%:4.45-6.8). Conclusions: Our results suggest that the achievement of an SVR after anti-HCV treatment in patients coinfected with HIV/HCV does not reduce liver-related extrahepatic complications and mortality . However, people with cirrhosis have an increased risk of CKD, DM, CVD and death. Thus, coinfected patients should early be treated to prevent the progression of liver fibrosis. 656 Impact of SVR on Liver Decompensation and Hepatic Fibrosis Markers in HIV/HCV JanetTate 1 ; E. JohnWherry 2 ; Jay R. Kostman 2 ; Debika Bhattacharya 4 ; Guadalupe Garcia-Tsao 5 ; Cynthia Gibert 6 ; Joseph K. Lim 5 ; David Rimland 3 ; Amy Justice 1 ; Vincent Lo Re 2 Veterans Aging Cohort Study ProjectTeam 1 VA Connecticute Health System, West Haven, CT, US; 2 Univeristy of Pennsylvania, Philadelphia, PA, US; 3 Atlanta VA Healthcare System, Atlanta, GA, US; 4 VA Greater Los Angeles, Los Angeles, CA, US; 5 Yale University School of Medicine, New Haven, CT, US; 6 Washington DC VA Medical Center, Washington, DC, US Background: It remains unclear if rates of hepatic decompensation (HD) and changes in liver fibrosis differ between HIV/hepatitis C virus (HCV)-coinfected and HCV-monoinfected patients after sustained virologic response (SVR) to HCV therapy. We evaluated the risk of HD and changes in liver fibrosis after SVR in HCV-treated coinfected and monoinfected patients. Methods: We performed a cohort study of HCV genotype 1, 2, and 3 patients (393 antiretroviral-treated coinfected; 12,598 monoinfected) prescribed pegylated interferon and ribavirin between 2002 and 2011 in the national Veterans Affairs health system. SVR was defined as persistently undetectable HCV RNA beginning 12 weeks after treatment end date. HD was defined by ascites, spontaneous bacterial peritonitis, and variceal bleed diagnoses. FIB4, a non-invasive measure of hepatic fibrosis, was calculated from 1 year before start of treatment (baseline) through end of follow-up. We used proportional hazards models to estimate the hazard ratio (HR) of incident HD associated with SVR, by HIV and advanced fibrosis/cirrhosis status (FIB4 >3.25). Generalized estimating equation models estimated change in FIB4 by time, SVR, and HIV status. Results: SVR was associated with a reduced rate of HD in coinfected (3.3 vs. 21.3/1000 pyears; HR, 0.16 [95% CI 0.04-0.70]) and monoinfected (1.4 vs. 8.1/1000 pyears; HR, 0.17; 95% CI, 0.11-0.27]) patients (Figure). Among those with pre-HCV therapy advanced fibrosis/cirrhosis, the risk of HD associated with SVR remained lower for both coinfected (0 vs. 135/1000 pyears) and monoinfected (7.4 vs. 29.4/1000 pyears; HR, 0.25; 95% CI, 0.13-0.47) patients. After SVR, mean FIB4 results were significantly lower and mean platelet counts significantly higher in both coinfected and monoinfected patients.

Poster Abstracts

Conclusions: SVR was associated with a similarly reduced risk of HD in coinfected as in monoinfected patients. After SVR, FIB4 decreased and platelet increases, regardless of HIV status. Future studies should evaluate changes in hepatic fibrosis after SVR with interferon-free direct-acting antiviral-based therapies in both HIV/HCV-coinfected and HCV- monoinfected patients. 657 Portal Pressure Changes After HCV Eradication in HIV/HCV+ Patients With Cirrhosis Matilde Sánchez-Conde; Leire Pérez-Latorre; Diego Rincón; Pilar Miralles; MaríaVega Catalina; Juan Carlos López; Rafael Bañares; Juan Berenguer Hospital General Universitario Gregorio Marañón, Madrid, Spain Background: In patients with compensated cirrhosis (CR), hepatic venous pressure gradient (HVPG) is the most accurate predictor of liver-related events (LRE). In cirrhotic patients receiving pharmacologic treatment for prevention of variceal rebleeding, a decrease in HVPG ≥ 20% or to ≤ 12 mm Hg is associated with a marked reduction in the long-term risk

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CROI 2015