croi 2017 review: hepatitis c coinfectiondepts.washington.edu/nwaetc/presentations/uploads/... ·...

This presentation is intended for educational use only, and does not in any way constitute medical consultation or advice

related to any specific patient.

Mountain West AIDS Education and Training Center

This presentation is intended for educational use only, and does not in any way constitute medical consultation or advice

related to any specific patient.

Mountain West AIDS Education and Training Center

CROI 2017 Review: Hepatitis C Coinfection

Brian R. Wood, MD

Assistant Professor of Medicine

Medical Director, Mountain West AETC ECHO Telehealth

February 23, 2017

Outline

• Incidence of HCV among MSM 2000-2015

• Modeling HIV-HCV epidemiology in the DAA era

• Glecaprevir/pibrentsavir (G/P) interactions with ART

Incidence of HCV among MSM 2000-2015

Abstract 134

Antoine Chaillon, Natasha Martin, et al, UCSD

Background

• Background: increasing reports of acute HCV among HIV+

MSM in Europe and Australia; limited data from US

- Systematic review: pooled incidence of new HCV infection in

HIV+ MSM: 0.5/100 person-years (PY)

• Aims:

- Determine primary HCV incidence among HIV+ MSM, and

- HCV reinfection incidence among those successfully treated

Source: Antoine Chaillon, Natasha Martin et al. Abstract 134. CROI 2017, Seattle, WA.

Methods

• Retrospective cohort study

• Population:

- HIV+ MSM at Owen Clinic (UCSD)

- For primary infection: baseline negative HCV Ab 2000-2015 and at least one follow-up test (Ab or RNA) by 2015

- For reinfection: 24-week SVR between 2006 and 2014, at least one follow-up test before 2016

• Outcomes:

- Incident infection (new +HCV Ab or RNA) for primary infection and recurrence of +RNA for reinfection


Baseline Characteristics

Baseline Characteristics

N 2,395 HIV+ MSM with baseline

negative HCV Ab

Median age 38 (range 31-45)

Ethnicity 68% white

Median follow-up 4.4 years

Drug use (self report) No drug use: 32.2%

Meth only: 42.3%

IDU only: 0.3%

Meth + IDU: 5.3%

Unknown: 20%


Results

• Overall: 149 incident HCV infections (1.185/100 PY)

• 43 individuals with SVR; 3 reinfections (2.89/100 PY)


Risk

Group

Events PY Incidence

(per 100 PY)

IRR

(per 100 PY)

P valule

None 21 4,424 0.475 1

Meth only 86 5,991 1.436 3.024 (1.860-

5.132)

<0.001

IDU only 2 32 6.296 13.167 (1.497-

53.965)

<0.001

Meth + IDU 17 739 2.301 4.896

(2.401-9.644)

<0.001

Results


Conclusions

• High and increasing HCV incidence, especially in MSM with history of meth or IDU use

• Also elevated HCV reinfection risk

• Need behavioral risk reduction strategies & routine screening:

- Baseline testing, then yearly Ab, q3-6 mo LFT’s, repeat testing if elevation in AST/ALT or 3 mo after last IDU use or STI; consider RNA

• Limitations

- Lack of detailed behavioral history and few in IDU only group

- Reinfection analysis from IFN era with small N


Modeling HIV-HCV Epidemiology in the DAA Era

Abstract 135

Virlogeu V et al. France.

Background and Methods

• Goal: model changing HIV-HCV epidemiology in DAA era

and predict potential change in prevalence over time

• Based on HCV prevalence and incidence data from 2012-

2016, along with SVR rates

• Risk groups: IDU, MSM (low-risk and high-risk),

heterosexual, other risk

• Based on data from cohort in France; ≈130,000 HIV+

patients in care

Source: Virlogeu V et al. Abstract 135. CROI 2017. Seattle, WA.

Results


5.5%

0.55%

Results


Conclusions and Limitations

• The oral DAA era offers potential to drastically reduce HCV

prevalence within 10 years, but need improved access to

treatment for chronic infection and ideally acute infection

• Limitations: didn’t consider mixing between risk groups,

HCV transmission between HIV- and HIV+ patients, didn’t

account for international migration


Conclusions

• Achieving HCV eradication in HIV-infected persons is

possible and will require:

- Behavioral risk reduction for high-risk MSM

- Regular screening in MSM

- Regular HCV RNA testing in cured patients

- Maintain DAA treatment coverage >30%

- Study HCV transmission from HIV- to HIV+ persons

- Target undiagnosed patients for engagement in care


Glecaprevir (G)/Pibrentsavir (P) Interactions with ART

Abstract413

Kosloski MP et al.

Background

Background

• Clinical trials to date (generally 8-12 weeks of tx):

- ENDURANCE-1: GT1, no cirrhosis, tx-naïve or exp, with co-infection

- ENDURANCE-3: GT3, no cirrhosis, tx-naïve

- SURVEYOR-2 (Part 3): GT3 with prior tx exp and/or cirrhosis

- SURVEYOR-2 (Part 4): GT2,4,5,6, no cirrhosis, tx-naïve or exp

- EXPEDITION-IV: GT1-6 with renal failure (stage 4-5 kidney disease)

- Granted breakthrough designation by FDA; expected approval

summer 2017

Interactions with ART

• Prior data: G/P ok with RAL or RPV

• Current Phase 1 study: intensive PK interactions between

G/P and E/C/F/TAF or ABC/3TC/DTG

- 24 healthy subjects given G/P + E/C/F/TAF

- 24 healthy subjects given G/P + ABC/3TC/DTG

• Some subtle interactions (i.e. increased G/P levels and E/C

levels with co-administration)

• *But overall no dose adjustment needed with E/C/F/TAF or

ABC/3TC/DTG

Source: Kosloski MP et al. Abstract 413. CROI 2017. Seattle, WA.

Summary

• Risk of HCV infection and reinfection is elevated in HIV+

MSM, especially those who use meth or injection drugs

• Hepatitis C treatment is prevention and part of the strategy

towards eradication; must be combined with behavioral

interventions, screening, and other tools

• Need improved access to treatment and hopefully coming

new drug combinations allow access for those who

currently have barriers

croi 2017 review: hepatitis c coinfectiondepts.washington.edu/nwaetc/presentations/uploads/... ·...

Documents