2231. Hepatitis C Viremia Post Direct Acting Therapy Did Not Correlate with Treatment Failure in HCV/HIV Co-Infected Patients
Session: Poster Abstract Session: HIV and HCV
Saturday, October 7, 2017
Room: Poster Hall CD
Background:

AASLD/IDSA guidelines recommend 12 weeks of ledipasvir/sofosbuvir for HCV genotype 1 infection treatment. HCV viral load (VL) is measured at baseline, week 4 of treatment, and at end of treatment (EOT). The aim of this study is to describe HCV/HIV patients who had post EOT viremia that did not correlate with treatment failure.

Methods:

We reviewed data of patients with HCV/HIV co-infections treated with ledipasvir/sofosbuvir and post EOT viremia. Viral load was detected using Roche Second-Generation Cobas AmpliPrep/Cobas TaqMan which has high sensitivity and specificity with no reported cross-reactivity.

Results:

Over the course of two years, we treated a total of 112 HCV/HIV co-infected patients. Four patients had EOT viremia (3.5%). During post-EOT HCV VL monitoring single episodes of HCV viremia (157-4511 IU/mL) were detected at 4-14 weeks post-EOT. All occurrences were preceded and followed by at least one undetectable HCV VL.

All patients reported excellent adherence to HCV therapy (pill count and patient report) except for one patient who missed two weeks of therapy. All patients had absolute CD4+ cell count >250 cells/mm3.

Table 1. Hepatitis C RNA Viral Load Monitoring

Baseline

HCV VL

(IU/mL)

Week 4

HCV VL

End of

Treatment

HCV VL

Post Treatment

HCV VL

(Weeks

after EOT)

Retest

Post Treatment

HCV VL

(Weeks

after EOT)

Patient #1

4’574,542

<15

Not detected

157 IU/mL

(week 14)

Not detected

(week 16)

Patient #2

5’916,672

<15

Not detected

978 IU/mL

(week 4)

Not detected

(week 12)

Patient #3

930,145

<15

Not detected

257 IU/mL

(week 28)

Not detected

(week 29)

Patient #4

6’415,450

Not detected

Not detected

4,511 IU/mL

(week 12)

Not detected

(week 16)

Conclusion:

Post-EOT HCV viremia should not be considered as HCV relapse or treatment failure. Furthermore, we recommend a repeat test in at least 4 weeks of detectable HCV VL to justify any future treatment decisions.

Mohanad Al Obaidi, MD, Infectious Disease, The University of Texas Health Science Center at Houston, Houston, TX, Karen J. Vigil, MD, The University of Texas Health Science Center at Houston, Houston, TX and Ben Barnett, MD, McGovern Medical School - The University of Texas Health Science Center, Houston, TX

Disclosures:

M. Al Obaidi, None

K. J. Vigil, None

B. Barnett, None

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