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301. Risk of Virologic Failure with Antiretroviral Switches in HIV/HCV Co-infections

Abstract Background Direct-acting antivirals (DAA) and antiretroviral (ARV) medications pose treatment challenges in HIV/HCV co-infection. Management of contraindicated combinations varies across practices. ARV switches may increase the risk of HIV virologic and treatment failure, and has been reported to increase the risk of DAA treatment failure. This analysis assesses how switches in ARV regimen impacts treatment outcomes in HIV/HCV co-infection. Methods This retrospective cohort study includes patients 18 years and older with stable HIV/HCV co-infection (HIV RNA<50 for ≥6 months) who received DAA HCV therapy. Data were obtained using the Centers for AIDS Research Network of Integrated Clinical Systems. The “ARV switch” cohort is defined as patients undergoing a switch in ARV regimen within 6 months prior to DAA treatment. The “no ARV switch” cohort was defined as patients without a change in ARV during the same time period. The primary outcome is HIV treatment failure which is a composite endpoint including HIV virologic failure (defined as confirmed loss of HIV viral suppression), discontinuation/change of ARV regimen, progression to AIDS, or death. We compared baseline characteristics, the proportion of patients free of HIV treatment failure, free of HIV virologic failure, and that achieved sustained viral response (SVR) at 12 and 24 weeks after DAA treatment among ARV switch and no ARV switch groups. Results Of the 256 patients, 63/256 (25%) underwent an ARV switch (Table 1). At baseline, the most common regimen in the ARV switch group was protease inhibitor (PI)-based while for the no ARV switch group, it was an integrase strand transfer inhibitor (INSTI)-based regimen. HIV/HCV transmission risk factors, HCV genotype, and AST/ALT were similar among the two groups (Table 1). The proportion with HIV treatment and virologic failure, and the proportion achieving SVR12/24 were similar among the ARV switch and no ARV switch groups. Conclusion HIV treatment and virologic failure, and SVR12/24 were not different among patients who did or did not undergo a switch in their ARV regimen prior to DAA treatment. This suggests that switches in the ARV regimen for DAA treatment of HCV do not negatively impact HIV or HCV outcomes among patients with HIV/HCV Coinfection. Disclosures All authors: No reported disclosures.


Drug Use Characteristics and Hepatitis C Antibody Prevalence in Southern Illinois
Background. Hepatitis C virus (HCV) infection rates have increased among younger, rural persons nationally. We report on a preliminary sample of a study examining HCV acquisition risk factors among rural persons who inject drugs (PWID) or person who use opioids (PWUO) non-medically.
Methods. We used respondent-driven sampling (RDS) to recruit PWID/PWUO in southern, rural Illinois as part of a larger study on infectious disease rates among social networks of PWID and illicit opioid users. Participants were surveyed regarding drug and sexual risk behavior, healthcare access, stigma, and social networks, and underwent rapid screening for HCV (OraQuick Ò HCV Rapid Antibody Test) and other infections. Using R software, we generated descriptive statistics to characterize HCV prevalence.
Results. Between July 2018 and April 2019,135 current PWID/PWUO were recruited, screened, and surveyed (58.5% male; 82.2% white; mean age 40.1 years). HCV rapid tests detected antibodies (HCV+) among 53 of 112 screened (47.3%). HCV+ participants were more likely to be white (96.2% vs. 83.1%, P = 0.006) than HCV antibody negative (HCV-) participants and showed a bimodal age distribution with peaks in the 25-30 and 45-50 age ranges. Reported injection drug use and heroin use in the past 30 days was significantly more common among HCV+ participants (96.2% vs. 72.9%, P = 0.001, and 12.9 vs. 7.9 days, P = 0.024) While HCV+ participants less frequently used methamphetamine compared with HCV -participants, the use of that drug was still high in both groups (11.9 vs. 18.4 days of use in the past 30 days, P = 0.01). HCV+ participants reported fewer social network members than HCV-participants (2.2 vs. 3.0, P = 0.048).

Conclusion.
In this analysis of a preliminary sample, HCV exposure was high; with those positive for HCV antibody showing a bimodal age distribution, high frequency of multiple drug use, and smaller social network size compared with HCV negative counterparts. Upon RDS-based enrollment completion and pending analysis we will further examine HIV RNA status as well as the specific associations between network size and other risk factors that may inform disease screening and treatment interventions.
Disclosures. All authors: No reported disclosures. Background. Direct-acting antivirals (DAA) and antiretroviral (ARV) medications pose treatment challenges in HIV/HCV co-infection. Management of contraindicated combinations varies across practices. ARV switches may increase the risk of HIV virologic and treatment failure, and has been reported to increase the risk of DAA treatment failure. This analysis assesses how switches in ARV regimen impacts treatment outcomes in HIV/HCV co-infection.

Risk of Virologic Failure with Antiretroviral Switches in HIV/HCV Co-infections
Methods. This retrospective cohort study includes patients 18 years and older with stable HIV/HCV co-infection (HIV RNA<50 for ≥6 months) who received DAA HCV therapy. Data were obtained using the Centers for AIDS Research Network of Integrated Clinical Systems. The "ARV switch" cohort is defined as patients undergoing a switch in ARV regimen within 6 months prior to DAA treatment. The "no ARV switch" cohort was defined as patients without a change in ARV during the same time period. The primary outcome is HIV treatment failure which is a composite endpoint including HIV virologic failure (defined as confirmed loss of HIV viral suppression), discontinuation/change of ARV regimen, progression to AIDS, or death. We compared baseline characteristics, the proportion of patients free of HIV treatment failure, free of HIV virologic failure, and that achieved sustained viral response (SVR) at 12 and 24 weeks after DAA treatment among ARV switch and no ARV switch groups.
Results. Of the 256 patients, 63/256 (25%) underwent an ARV switch (Table  1). At baseline, the most common regimen in the ARV switch group was protease inhibitor (PI)-based while for the no ARV switch group, it was an integrase strand transfer inhibitor (INSTI)-based regimen. HIV/HCV transmission risk factors, HCV genotype, and AST/ALT were similar among the two groups (Table 1). The proportion with HIV treatment and virologic failure, and the proportion achieving SVR12/24 were similar among the ARV switch and no ARV switch groups.
Conclusion. HIV treatment and virologic failure, and SVR12/24 were not different among patients who did or did not undergo a switch in their ARV regimen prior to DAA treatment. This suggests that switches in the ARV regimen for DAA treatment of HCV do not negatively impact HIV or HCV outcomes among patients with HIV/ HCV Coinfection.

Disclosures. All authors:
No reported disclosures.