CROI 2017 Review: Hepatitis C Coinfection

Transcription

1 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 This presentation is intended for educational use only, and does not in any way constitute medical consultation or advice related to any specific patient.

2 Outline Incidence of HCV among MSM Modeling HIV-HCV epidemiology in the DAA era Glecaprevir/pibrentsavir (G/P) interactions with ART

3 Incidence of HCV among MSM Abstract 134 Antoine Chaillon, Natasha Martin, et al, UCSD

4 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.

5 Retrospective cohort study Population: Methods - HIV+ MSM at Owen Clinic (UCSD) - For primary infection: baseline negative HCV Ab and at least one follow-up test (Ab or RNA) by 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 Source: Antoine Chaillon, Natasha Martin et al. Abstract 134. CROI 2017, Seattle, WA.

6 Baseline Characteristics N Baseline Characteristics 2,395 HIV+ MSM with baseline negative HCV Ab Median age 38 (range 31-45) Ethnicity Median follow-up 68% white 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% Source: Antoine Chaillon, Natasha Martin et al. Abstract 134. CROI 2017, Seattle, WA.

7 Results Overall: 149 incident HCV infections (1.185/100 PY) Risk Group Events PY Incidence (per 100 PY) None 21 4, IRR (per 100 PY) Meth only 86 5, ( ) IDU only ( ) Meth + IDU ( ) P valule <0.001 <0.001 < individuals with SVR; 3 reinfections (2.89/100 PY) Source: Antoine Chaillon, Natasha Martin et al. Abstract 134. CROI 2017, Seattle, WA.

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

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

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

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

12 Modeling HIV-HCV Epidemiology in the DAA Era Abstract 135 Virlogeu V et al. France.

13 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 , 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 Seattle, WA.

14 Results 5.5% 0.55% Source: Virlogeu V et al. Abstract 135. CROI Seattle, WA.

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

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

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

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

19 Glecaprevir (G)/Pibrentsavir (P) Interactions with ART Abstract413 Kosloski MP et al.

20 Background

21 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

22 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 Seattle, WA.

23 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