HCV reinfection in HCV/HIV coinfected patients treated for VHC in AIDS Center Prague

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Augustus Sparks
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1 HCV reinfection in HCV/HIV coinfected patients treated for VHC in AIDS Center Prague Viktor ASTER, MD, PhD Department of Infectious and Tropical Diseases, Hospital Bulovka, First Faculty of Medicine, Charles University in Prague, District Hospital Liberec.

2 Disclosure: I have nothing to disclose

3 Introduction HCV reinfection may follow both HCV cure and spontaneous clearance respectively 1),2) is more common in HIV coinfected population 3) and more common in HIV infected MSM 1),2 ) HIV-positive MSM with a prior HCV-infection should be tested every 3 to 6 months for reinfection, those who had achieved a reinfection every 3 months. (NEAT study group). 2) HCV reinfection (Australian cohort) 1),3) Incidence per 100 PYFU HCV monoinf. 0 HIV/HCV coinf. 12,3 606 p. HIV+ with SC or SVR (NEAT cohort) 2) reinfection 149 (24,6%) 70 p. with SC or SVR again 2nd reinfection 30 (43%) 1) Ingiliz P, 12-th International Workshop on Co-infection- HIV & Hepatitis, June 2016, Berlin, Germany 2) Ingiliz P, Martin TC, Rodger A, Stellbrink HJ, Mauss S, Boesecke C, Mandorfer M, Bottero J, Baumgarten A, BhaganiS, Lacombe K, Nelson M, Rockstroh JK, NEAT study group. HCV reinfection incidence and spontaneous clearance rates in HIV-positive men who have sex with men in Western Europe. J Hepatol Sep 17, 3) Martin T et al., EASL 2016

HIV/HCV coinfection: 10,9% prevalence anti-hcv+ 3) presumption: 150 living HIV/HCV coinfected persons (succesfully treated not calculated) HIV+ common population 10,9%

4 HIV and HCV infection in the Czech Republic (CZ) HIV in the Czech R.: 2836 persons HIV infected, 2480 living, 356 dying (13%) (Aug. 2016) 1 ) 0,026% prevalence HIV+ HCV in The Czech R.: Common population: 1,67% prevalence anti-hcv+ 2) 0,93% prevalence HCV RNA+ 2)? pers. living with HCV? HIV/HCV coinfection: 10,9% prevalence anti-hcv+ 3) presumption: 150 living HIV/HCV coinfected persons (succesfully treated not calculated) HIV+ common population 10,9% 1,67% 1) National institute of Health, ) Chlibek R, University of Defence, ) Aster V, Polakova A, Nemecek V, Maly M: September 2013, Snopkova S: June anti-hcv+ anti-hcv-

HIV+ patients treated for VHC in AIDS-Center Prague since 2003 till 2016: characteristics n=46 Pt Age Sex Acquisition GT Fibrosis SVR P/R DAA SVR DAA 1. 34 F HET 3a ND Y 2. 18 M HEM 1b ND Y 3.

5 HIV+ patients treated for VHC in AIDS-Center Prague since 2003 till 2016: characteristics n=46 Pt Age Sex Acquisition GT Fibrosis SVR P/R DAA SVR DAA F HET 3a ND Y M HEM 1b ND Y F IDU 1b ND Y F HET 1b ND Y M UK 3a 4 N SOF/DCV/RBV 12W Y M HEM 1a ND N F HET 3a ND N F HET 1a ND Y M MSM 3a2b 0-1 Y M MSM 3a 4 N F HET 3a 4 N M MSM 3a 0-1 Y F HET 1a/b ND Y M HET 3a 0-1 Y M MSM 1a/b ND Y M MSM 1a 0-1 N M MSM 1a/b 0-1 Y M MSM 1b ND Y M MSM 1b ND Y M HET 1a 2 N M UK 4a 0-1 N M UK 1a/b ND N M MSM 1a/b ND N M MSM 1a 4 N P/R/BOC Y M MSM 1a ND N M MSM 1a/b ND N M MSM 4 c/d 0-1 N M IDU 3a 2 N M MSM 4 c/d 2 N M MSM 4 c/d 4 N M MSM 4 c/d 0-1 Y F HET 1a 0-1 N M MSM ND ND Y/N M MSM 4 ND N M MSM 1 ND Y M MSM 4c/d 0-1 N M MSM 1a ND Y M MSM 1b 0-1 N M MSM Y M HET 3a 0-1 Y M MSM 1a ND Y M MSM 1a 1 Y M MSM 3a 0-1 Y M MSM 1a ND N M BIS 1a 3 NA LDV/SOF Y M HEM 1a 2.3 N LDV/SOF Y Age: 18-62, average: 39,5 Sex: male: 38 (82,6%), female: 8 (17,4%) Mode of HCV acquisition: MSM: 27 (58,7%), HET: 10 (21,7%), IDU: 2 (4,4%), HEM: 3 (6,5%), BIS: (2,2%), unknown: 3 (6,5%) GT: GT 1: 26 (56,5%) 1a/b: 7 (15,2%) 1a: 13 (28,3%) 1b: 6 (13,0%) GT 3: 11 (23,9%) GT 4: 7 (15,2%) Fibrosis stage: F 0-1 and 1: 15 (32,6%) F 2 and 2-3: 4 ( 8,7%) F3: 1 (2,2%) F4: 5 (10,9%) GT 1a; 13; 29% GT 1a/b; 7; 16% GT 1b; 6; 14% GT 4; 7; 16% Fibroscan not provided: 21 (45,7%) Pt s treated by PegIFN/RBV: 45 Pt s treated by DAA s: 4 (3 pt s of them were originally unsuccessfully treatet by P/R) 2 out of 46 pt treated for acute VHC GT 3; 11; 25%

HIV+ patients treated for VHC in AIDS-Center Prague since 2003 till 2016: results (retreatment of reinfection included) n=46 Pt GT Fibrosis SVR P/R DAA SVR DAA 1. 3a ND Y 2. 1b ND Y 3. 1b ND Y 4.

6 HIV+ patients treated for VHC in AIDS-Center Prague since 2003 till 2016: results (retreatment of reinfection included) n=46 Pt GT Fibrosis SVR P/R DAA SVR DAA 1. 3a ND Y 2. 1b ND Y 3. 1b ND Y 4. 1b ND Y 5. 3a 4 N SOF/DCV/RBV 12W Y 6. 1a ND N 7. 3a ND N 8. 1a ND Y 9. 3a2b 0-1 Y 10. 3a 4 N 11. 3a 4 N 12. 3a 0-1 Y 13. 1a/b ND Y 14. 3a 0-1 Y 15. 1a/b ND Y 16. 1a 0-1 N 17. 1a/b 0-1 Y 18. 1b ND Y 19. 1b ND Y 20. 1a 2 N 21. 4a 0-1 N 22. 1a/b ND N 23. 1a/b ND N 24. 1a 4 N P/R/BOC Y 25. 1a ND N 26. 1a/b ND N c/d 0-1 N 28. 3a 2 N c/d 2 N c/d 4 N c/d 0-1 Y 32. 1a 0-1 N 33. ND ND Y/N ND N ND Y 36. 4c/d 0-1 N 37. 1a ND Y 38. 1b 0-1 N Y 40. 3a 0-1 Y 41. 1a ND Y 42. 1a 1 Y 43. 3a 0-1 Y 44. 1a ND N 45. 1a 3 NA LDV/SOF Y 46. 1a 2.3 N LDV/SOF Y 25 (54,4%) out of 46 patients treated for VHC achieved SVR 45 pts were treated by PegIFN/RBV: 21 (46,7%) achieved SVR 4 pts were treated by DAA, all achieved SVR SOF/DCV/RBV: 1pt LDV/SOF: 2 pt s P/R/BOC: 1 pt SVR+; 25; 54% SVR+ SVR-; 21; 46% SVR-

HCV reinfections in HIV+ patients treated for VHC (first treatment) in AIDS-Center Prague since 2003 till 2016: n=46 Pt Sex Acq. GT SVR P/R 1. F HET 3a Y Time to reinf. 2. M HEM 1b Y 12Y ND Reinf.

7 HCV reinfections in HIV+ patients treated for VHC (first treatment) in AIDS-Center Prague since 2003 till 2016: n=46 Pt Sex Acq. GT SVR P/R 1. F HET 3a Y Time to reinf. 2. M HEM 1b Y 12Y ND Reinf. GT Tr. vir. after Th VHC 3. F IDU 1b Y 4. F HET 1b Y 5. F HET 1a Y 6. M MSM 3a2b Y 18M 1b 7. M MSM 3a Y 26M 4cd 8. F HET 1a/b Y 12M 1a/b 9. M HET 3a Y Y 5M after SVR M MSM 1a/b Y 11. M MSM 1a/b Y 36M 1a/b 12. M MSM 1b Y 13. M MSM 1b Y Y 18M after SVR M MSM 4 c/d Y 15. M MSM ND Y 34M M MSM 4 N? ETR 1a 17. M MSM 1 Y 18. M MSM 1a Y 19. M MSM 1 Y 20. M HET 3a Y 21. M MSM 1a Y 22. M MSM 1a Y 23. M MSM 3a Y 7 (30,4%) out of 23 pts successfully treated for VHC were HCV reinfected 5 out of 7 pts were MSM 3 pts were reinfected by another GT, 2 pts by the same GT Average time to reinfection was 38,6 M. Average time to reinfection in MSM was 22,8M None of the patients successfully treated by DAA s had HCV reinfection 2 pts had low transient viraemia after SVR

HCV reinfections in patients with HIV coinfection: results of treatment (AIDS Center Prague) HCV reinfection performed 7 (30,4%) out of 23 HIV/HCV coinfected pts successfully treated for VHC 7; 30%

8 HCV reinfections in patients with HIV coinfection: results of treatment (AIDS Center Prague) HCV reinfection performed 7 (30,4%) out of 23 HIV/HCV coinfected pts successfully treated for VHC 7; 30% 16; 70% HCV reinfected none reinfection 5 out of 7 HCV reinfected pts were treated for HCV infection by Peg-IFN/RBV. 3 pts achieved SVR+ Pt Sex Acq. Reinf GT Treatment of reinf. SVR M HEM ND ND ND 2. M MSM 1b P/R NO 3. M MSM 4cd P/R YES 4. F HET 1a/b P/R YES 5. M MSM 1a/b P/R YES 6. M MSM 4 P/R NO 7. M MSM 1a ND ND

9 Conclusions The prevalence of HIV infection is still relatively low in The Czech Republic IFN containing regimens are still most frequent options for HCV treatment HCV reinfection is not uncommon in HIV infected persons from AIDS-Center Prague, especially in MSM Patients with HCV spontaneous clearance were not calculated in our cohort Because of still limited access to IFN-free regimens in the Czech Republic, HCV reinfection may complicate availability of the HCV treatment.

May reduced use of barrier sex in on-cart supressed persons contribute to HCV reinfection rate?

10 Discussion and Questions Low, transient, once documented HCV viraemia after succesfull SVR: is it reinfection with spontaneous clearance? Can we prevent HCV reinfection in HIV+? May reduced use of barrier sex in on-cart supressed persons contribute to HCV reinfection rate? Lower use of barrier sex because of anti-hiv PREP use: possible cause of HCV infection increased risk? Anti-HCV PREP and PEP by DAAS: real future?

11 Acknowledgement All colleagues from AIDS-Center Prague: STANKOVA Marie, Department of Infectious and Tropical Diseases, Hospital Bulovka, First Faculty of Medicine, Charles University in Prague MACHALA Ladislav, Department of Infectious Diseases, Hospital Bulovka, Third Faculty of Medicine, Charles University in Prague ROZSYPAL Hanus, Department of Infectious and Tropical Diseases, Hospital Bulovka, First Faculty of Medicine, Charles University in Prague JILICH David, Department of Infectious and Tropical Diseases, Hospital Bulovka, First Faculty of Medicine, Charles University in Prague VESELY Dan, Department of Infectious and Tropical Diseases, Hospital Bulovka, First Faculty of Medicine, Charles University in Prague FLEISHANS Lukas, Department of Infectious and Tropical Diseases, Hospital Bulovka, First Faculty of Medicine, Charles University in Prague

HIV/Hepatitis co-infection situation in Czech and Slovak Republics

2nd Central and Eastern European Meeting on Viral Hepatitis and Co-Infection with HIV HIV/Hepatitis co-infection situation in Czech and Slovak Republics Viktor ASTER, MD, PhD Department of Infectious and