2233. Hepatitis C Eradication: Who is being left behind in the HIV population?
Session: Poster Abstract Session: HIV and Viral Hepatitis Co-Infection
Saturday, October 6, 2018
Room: S Poster Hall
Posters
  • IDSA Poster 2018 HCV Eradicate.pdf (480.2 kB)
  • Background: HCV treatment has increased since direct-acting antivirals became available. HIV clinics are scaling-up treatment to eradicate HCV. Little is known about HIV patients and access to HCV treatment.

    Methods: We retrospectively analyzed all HIV/HCV co-infected patients within our safety-net hospital system who received outpatient care in our HIV clinics from 11/1/2015-10/31/2017. Data was abstracted on demographics, insurance, HIV RNA, drug use, homelessness, and number of visits. No visits for >1 year was lost to care and missed visits was missing >1 primary care visit. We examined the association of these variables to risk of having a detectable HCV RNA (surrogate marker for HCV treatment) through multivariate logistic regression.

    Results: We identified 914 with HIV/HCV (72% Male, 55% Black, 35% Medicaid, 29% Medicare, 16% Ryan White, 13% homeless) of which 47% were heterosexual, 36% MSM, and 14% IDU. HIV was undetectable in 74%, 69% were between age 46-65, 17% had active alcohol use and 33% had drug use. HCV RNA was available for 868 and was detected in (57%). Whites and Hispanics compared to Blacks were less likely to have detectable HCV RNA. Detectable HCV RNA was more likely in those >50 years of age compared to <40 years, with detectable HIV viral load, >1 missed visit, and lost to care. 

    Conclusion: We found that those at risk for not being treated for HCV were Blacks, older patients and those not engaged in HIV care or not suppressed on HIV treatment. To achieve HCV eradication will require efforts to engage older patients, Blacks, those noncompliant with ART, and not engaged in HIV care.

    HCV virus detected (n= 497)

    HCV virus undetected

    (n=371)

    AOR (95%CI)

    Race/ethnicity

    Black

    311 (63)

    171 (46)

    Reference

    White

    126 (25)

    116 (31)

    0.54 (0.38, 0.77)***

    Hispanic

    56 (11)

    70 (19)

    0.55 (0.35, 0.86**

    Other

    4 (0.8)

    14 (4)

    0.25 (0.08, 0.81)**

    Age group

    <40

    56 (11)

    63 (17)

    Reference

    40-49

    84 (17)

    78 (21)

    1.35 (0.80, 2.25)

    50-59

    229 (46)

    146 (39)

    1.83 (1.14, 2.91)*

    >=60

    128 (60)

    84 (23)

    2.29 (1.35, 3.89)*

    HIV detected

    no

    341 ( 69)

    310 ( 84)

    Reference

    yes

    156 (31)

    61 ( 28)

    1.92 (1.33, 2.76) ***

    Lost to care

    no

    395 (79)

    336 (91)

    Reference

    yes

    102 (21)

    35 (9)

    2.17(1.39, 3.39)***

    Missed >1 visit

    No

    214 (43.1)

    229( 61.7)

    reference

    Yes

    283 (56.9)

    142 (38.3)

    1.77 (1.31, 2.39)***

    *** P<0.001 P <0.01 P<0.05

    Mamta K Jain, MD, MPH1,2, Claudia Chavez, B.S.3, Joanne Sanders, MS3 and Kranthi Vysyaraju, MS4, (1)Internal Medicine, Division of Infectious Diseases, University of Texas Southwestern Medical Center, Dallas, TX, (2)Parkland Health and Hospital System, Dallas, TX, (3)Clinical Sciences, UT Southwestern Medical Center, Dallas, TX, (4)UT Southwestern Medical Center, Dallas, TX

    Disclosures:

    M. K. Jain, Gilead Sciences: Grant Investigator , Grant recipient and Research support . Janssen: Investigator , Research support . GSK/ViiV: Investigator , Consulting fee and Research support . Merck: Investigator , Research support .

    C. Chavez, None

    J. Sanders, None

    K. Vysyaraju, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.