2149. A Cohort of Spanish Coinfected HIV/HVC Prisoners Treated with Direct Acting Antiviral Agents (DAAs).
Session: Poster Abstract Session: HIV/HCV Coinfection and Liver Disease
Saturday, October 29, 2016
Room: Poster Hall
Posters
  • Slide1.PNG (3.9 MB)
  • Background: High curative therapies with DAAs should greatly enhance HCV treatment in prison because prevention benefits, so several guidelines recommend prioritize to inmates regardless of fibrosis stage. In Spain, the prevalence of HCV infection in prisoners achieved 20% in 2014, 26.8% of them were co-infected with HIV. Treating HIV/HCV patients can be a challenge due to their special complexity. At our knowledge, few data have been published about DAAs treatment on HIV/HCV inmates. Our aim was to describe the preliminary outcome of a cohort of Spanish co-infected prisoners treated with DAAs.

    Methods: Prospective data collection of HIV/HCV patients treated with DAAs in a Penitentiary Unit of a Hospital (Access to therapy was limited to available drugs, so we had to prioritize by liver function, fibrosis and extra-hepatic disease)

    Results: Since February 2015, 47 (12.7% females) co-infected with undetectable HIV viral load started treatment with DAAs (32 naïve and 15 IFN-RBV pre-treated). Mean age was 45.7 years (range 30-57). A big proportion (75.6%) were cirrhotic, 26/36 with > 20 kPa FibroScan, 2 have already suffered liver decompensation and 7 (14.8%) had esophageal varices. Genotype distribution was: 21 GT1a (44.7%), 5 GT1b (10.6%) 1 GT2 (2%), 13 GT3 (27.6%), 7 GT4 (14.9%). Proposed length of treatment was 12 weeks for 33 patients (70.2%) and 24 weeks for 14. All of them received SOF, 33/47 with LED in a STR (70%), 12 with SMV (25.5%) and only one with DTV. RBV was added in 39 (83%)

    On May 13, 2016: 38/47 patients had completed treatment without significant AE, but 2/38 dead after end of treatment (1 acute portal thrombosis and 1 no determined sudden dead). VR rate at the end was 100%, SVR12 was 93.9 % (31/33). Two failures were detected with SOF+LED+RBV (one g1a and one g1b). Only one abandoned in 6th week, no more gave up the clinical follow up despite prison release. After SVR24, a patient presented another acute portal thrombosis.

    Pending SVR12 results will be updated at Congress.

    Conclusion: Co-infected inmates show a high level of adherence and good tolerance to DAAs, achieving high cure HCV rates, but access to treatment can be too late for some of them. Public health should eliminate the barriers to access to treat HIV/HCV in prison setting.

    Paloma Gijón, MD/PhD1, Ana Álvarez-Uría, MD1, Elena Reigadas, Pharm/PhD1, Teresa Aldámiz, MD/PhD1, Oihane Aldecoa-Otarola, MD1 and Francisco Fernandez-González, MD/PhD2, (1)Microbiology, Hospital Gregorio Marañón, Madrid, Spain, (2)Penitentiary Unit, Hospital Gregorio Marañón, Madrid, Spain

    Disclosures:

    P. Gijón, None

    A. Álvarez-Uría, None

    E. Reigadas, None

    T. Aldámiz, None

    O. Aldecoa-Otarola, None

    F. Fernandez-González, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.