CROI 2015 Program and Abstracts

Abstract Listing

Poster Abstracts

HCV treatment rates in HCV/HIV co-infected patients in active care in the Netherlands. The ATHENA observational cohort captures data from each patient with HIV linked to care in one of the designated Dutch HIV treatment centres, and thereby allows a comprehensive nationwide analysis. Methods: All HIV-infected patients seen in a HIV treatment centre are registered and monitored by the HIV Monitoring Foundation. We included data from all HIV/HCV co-infected patients who were linked to care between 1998 and 2014, excluding those with documented spontaneous HCV clearance. Patients were considered retained in care if they were alive and in care as of June 2014. HCV treatment included a combination of (pegylated) interferon alfa ((PEG)-IFN) with weight based ribavirin (RBV) or triple therapy of PEG- IFN+RBV with boceprevir or telaprevir. SVR was defined as a negative HCV RNA test result 24 weeks after treatment completion. Results: Out of a total of 1,515 patients linked to HIV care and diagnosed with HCV, 1,187(78%) patients were retained in care as of June 1, 2014. Of these 1,187 patients, 702(59%) had received treatment for HCV, and 651 of those had completed treatment and were in care for at least 24 weeks after the end of treatment with data available to calculate a SVR rate. SVR was achieved in 280 of these 651(43%) patients. Thus, of the 1,187 HCV/HIV co-infected patients who receive ongoing care in one of the Dutch HIV treatment centres, a total of 907(76%) remain in need of effective HCV therapy, 485 of whom are HCV treatment-naïeve and 422 not successfully treated.

Conclusions: Three quarter of all HCV/HIV-co-infected patients currently engaged in HIV care in the Netherlands remain in need of an effective curative treatment for HCV, of whom approximately equal proportions are HCV treatment-naïeve or -experienced. These data provide important information for estimating the need for highly effective all oral combination regimens of direct acting antivirals, access to which may not only prevent long-term hepatic complications, including hepatocellular carcinoma, but may also impact on the further spread of HCV. 660 Identifying and Prioritizing Hepatitis C Treatment for HIV-Hepatitis C Co-Infection Amanda D. Castel 1 ; Mariah M. Kalmin 1 ; Rachel Hart 2 ; Alan Greenberg 1 ; Henry Masur 3 DC Cohort Executive Committee 1 The Milken Institute School of Public Health at George Washington University, Washington, DC, US; 2 Cerner Corporation, Kansas City, MO, US; 3 National Institutes of Health (NIH), Bethesda, MD, US Background: Current guidelines for HCV management recommend that most patients should be treated. However, the drug cost for directly acting agents is substantial and the number of experienced healthcare providers in the U.S. is insufficient to treat all patients immediately. Thus, the guidelines suggest prioritization of treatment based on host factors including co-infections and degree of liver fibrosis. This analysis describes the prevalence and incidence of HCV, and risk factors for disease progression and transmission in incident HCV cases among a large urban cohort of HIV+ patients. Methods: Data from persons enrolled in the DC Cohort, a longitudinal observational cohort of HIV+ persons in care in Washington, DC were analyzed. Incident cases were defined based on ICD-9 codes indicative of HCV infection during study follow-up and considered to be a surrogate for active disease among this HIV-HCV co-infected population. Among participants with incident HCV diagnoses since enrollment, demographics, risk factors for HCV progression and transmission including co-morbid conditions, and relevant labs and treatments were collected. Fibrosis-4 (Fib-4) scores were calculated for untreated HCV infected persons. Descriptive analyses were conducted to describe risk factors for HCV transmission and disease morbidity. Results: Among 6,207 DC Cohort participants, 712 (12%) had a prior diagnosis of HCV documented at study enrollment. The 5,495 participants without HCV at study enrollment had a mean follow-up time of 27.2 months during which 213 (4%) incident cases of HCV were diagnosed. Only 7% of co-infected participants had received treatment for HCV; 64% received non-interferon based regimens. Among untreated participants, most had a high risk of HCV transmission: 27%were infected with HIV through MSM, 25% through IDU, and 2% through MSM/IDU. Among 199 co-infected untreated participants, in addition to HIV, 33% had multiple risk factors for HCV morbidity including Fib-4 scores >3.25 (17%), diagnoses of chronic liver disease/cirrhosis (9%), and hepatitis B infection (5%) (Table).

Poster Abstracts

412

CROI 2015