436. Effectiveness of DAA Regimens in Genotype 1 HIV/HCV Coinfected Patients: An Analysis of the VA National Clinical Case Registry
Session: Poster Abstract Session: Hepatitis C
Thursday, October 27, 2016
Room: Poster Hall
Background: SVR rates are similar in HIV-negative and -positive HCV individuals in clinical trials. There are limited real-world data. We examined the effectiveness of ledipasvir/sofosbuvir±ribavirin (LS±RBV) and ombitasvir/ paritaprevir/ritonavir+dasabuvir (OPrD)±RBV in HIV/HCV genotype 1 (GT1) veterans initiating HCV therapy.

Methods: Observational, intent-to-treat cohort analysis using the Veterans Affairs’ Clinical Case Registry to identify HIV/HCV GT1 veterans initiating 12 weeks of LS±RBV or OPrD±RBV by 30 Sept 2015 with end of treatment (EOT) by 15 Jan 2016 and ≤91 days drug supply. Data were available through 30 Apr 2016. SVR required RNA below the limit of quantification >10 weeks after EOT. Multivariate models of SVR included age, race, body mass index (BMI), proton pump inhibitor (PPI) use, prior HCV treatment, subtype, and cirrhosis.

Results:

In total, 996 GT1 HIV/HCV veterans initiated therapy; 757 LS, 138 LS+RBV, 28 OPrD, and 73 OPrD+RBV. The mean age was 60.8 years, 98.5% were male, 67.0% were black, 22.6% had cirrhosis; 97.8% had HIV viral loads <200 copies/ml and 17.9% were on PPIs. Patients receiving LS+RBV were more likely to have cirrhosis (45.7%). Mean creatinine change (mg/dL) among patients receiving LS and tenofovir (TDF) without a protease inhibitor (PI) (n=372), LS and PI/TDF (n=100) and LS with no TDF (n=423) were 0.19±0.2, 0.18±0.25, and 0.22±0.86, respectively (p=0.7). Overall SVR was 90.9% (823/905) including 92.1% (631/685) for LS, 86.3% (113/131) for LS+RBV, 88.9% (24/27) for OPrD and 88.7% (55/62) for OPrD+RBV. SVR was 85.9% (176/205) in those with cirrhosis and 92.4% (647/700) in those without (p=0.006). SVR did not differ between blacks (90.5% [546/603]) and all others (91.8% [279/304]) overall, or among those on LS regimens who received PPIs (89.7% [131/146]) and those who did not (91.5% [613/670]). Cirrhosis was predictive of SVR in multivariate analysis (OR 0.47, 95% CI 0.28-0.78, p=0.003).

Conclusion: GT1 HIV/HCV patients had high SVR rates; black race and PPI use were not associated with lower SVR, overall and on LS regimens, respectively. Cirrhosis was associated with significantly reduced odds of SVR. Renal function did not worsen on LS regimens with TDF.

Debika Bhattacharya, MD, MSc1, Pamela Belperio, PharmD2, Troy Shahoumian, MPH, PhD2, Timothy Loomis, PhD2, Matthew Bidwell Goetz, MD1,3, Larry Mole, PharmD2 and Lisa Backus, MD, PhD2,4, (1)Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, (2)Population Health Service, Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA, (3)David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, (4)Department of Medicine, Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA

Disclosures:

D. Bhattacharya, Bristol-Myers Squibb Company: Investigator , Research support
AbbVie Inc.: Investigator , Research support
Merck & Co., Inc.: Investigator , Research support

P. Belperio, None

T. Shahoumian, None

T. Loomis, None

M. Bidwell Goetz, None

L. Mole, None

L. Backus, None

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