studies

HEPATOLOGY, VOLUME 62, NUMBER 1 (SUPPL) AASLD ABSTRACTS 1095A
E (clinical illness, with anti-HEV IgM +ve) a year ago, when
their unit was affected by an outbreak (n=67), (B) other soldiers
in the unit who did not have symptomatic hepatitis (n=133),
and (C) soldiers in another unit located elsewhere in the city,
which was not affected by the outbreak (n=196). All sera were
tested for anti-HEV IgG using 3 commercial assays (Wantai
[W], China; DSI [D], Italy; and MP Biomedical [M], Singapore);
the manufacturers’ protocols were followed. Results: In
each group, assay W had the highest sensitivity (Table). After
excluding indeterminate results, which were most common with
assay M, the 3 assays showed positive concordant results in
55, 16 and 15 sera, and negative concordant results in 2, 75
and 133 sera, in groups A, B and C, respectively. Discordant
results were found in 10, 30 and 36 sera. Using positive results
in ≥2 assays as the criterion-standard, the sensitivity rates of
assays W, D and M were 100%, 100%, and 87%, respectively
in group A; 100%, 95% and 47% in group B; and 97%,
94% and 58% in group C. Similarly, using negative results
in ≥2 assays as the criterion-standard, the specificity rates of
assays W, D and M were 75%, 75%, and 100%, respectively
in group A; 96%, 99% and 95% in group B; and 92%, 100%
and 95% in group C. Overall assays W and D had good concordance
(97%, 95% and 91% in A, B and C). Conclusion: Of
the three assays, W and D had a higher sensitivity and high
degree of concordance with each other. In comparison, assay
M was less sensitive and had less concordance with the other
two assays. Also, assay M had more indeterminate test results.
These data indicate that assays W and D may be preferred
over assay M for anti-HEV seroprevalence studies.
Results with the three serological assays
Indet. = Indeterminate
Disclosures:
The following authors have nothing to disclose: Rakesh Aggarwal, Amit Goel,
Gurdeep Singh
1818
Hepatitis C Virus (HCV) Prevalence among People who
Inject Drugs (PWIDs) in Switzerland
Francesco Negro 1 , Philip Bruggmann 2 , Sarah Blach 3 , Pierre
Deltenre 4 , Jan Fehr 5 , Roger Kouyos 5 , Daniel Lavanchy 6 , Beat Mullhaupt
7 , Homie Razavi 3 , Patrick Schmid 8 , David Semela 9 , Martin
Stoeckle 10 , Andri Rauch 11 ; 1 Gastroenterology, Hepatology and
Clinical pathology, University Hospitals, Geneva-14, Switzerland;
2 ARUD Center for addiction medicine, Zurich, Switzerland; 3 Center
for Disease Analysis, Lousville, CO; 4 Gastroenterology and
hepatology, University Hospital, Lausanne, Switzerland; 5 Infectious
Diseases & Hospital Epidemiology, University Hospital, Zurich,
Switzerland; 6 Consultant, Denges, Switzerland; 7 Gastroenterology
and hepatology, University Hospital, Zurich, Switzerland;
8 Infectious diseases, Cantonal Hospital, St Gallen, Switzerland;
9 Gastroenterology, Cantonal Hospital, St. Gallen, Switzerland;
10 Infectious Diseases & Hospital Epidemiology, University Hospital,
Basel, Switzerland; 11 Infectious diseases, University Hospital,
Berne, Switzerland
Background - In Switzerland, HCV among PWIDs has been
decreasing due to active harm reduction efforts and an aging
population (average age – 44 yrs). Expert consensus and estimates
from the Swiss Federal Office of Public Health suggest
that there are between 8,000 and 12,000 active PWIDs in
Switzerland, and that 42% (27%-58%) of PWIDs are HCV
infected. In addition, an estimated 17,000 – 25,700 individuals
were enrolled in opioid substitution therapy (OST) and
1,598 in heroin substitution therapy (HeGeBe) with 300,000
syringes distributed monthly in 2012. Among individuals on
OST and HeGeBe, an estimated 27.4% and 54%, respectively,
continued to inject while on treatment. Understanding HCV
transmission dynamics among high-risk populations requires
robust epidemiological data and country-specific mathematical
modeling to assess the potential impact of new HCV treatment
strategies. Recent therapeutic advances promise greater convenience
(oral therapies) with higher efficacy (>90% sustained
viral response) and shorter duration of treatment. Methods -
HCV transmission was modeled using cohorts to track HCV
incidence and prevalence among PWIDs in the general population,
as well as active PWIDs enrolled in OST and/or needle
exchange programs (NEP). Model assumptions were derived
from published literature and expert consensus. The relative
impact of increasing treatment among PWIDs was considered,
including the annual number needed to treat in order to reduce
the HCV-infected PWID population by 2030. Results - If the
current transmission paradigm continues, there are projected
to be 3,150 HCV infected PWIDs in 2030. Annually treating
45 HCV-infected PWIDs (1% of HCV-infected PWID population
in 2014) resulted in an 11% reduction in HCV-infected
PWIDs by 2030, while annual treatment of 200 PWIDs (4.5%
of 2014 population) resulted in a reduction of over 50% by
2030. Treating 322 PWIDs annually (7.5% of 2014 population)
resulted in a >90% reduction in HCV-infected PWIDs by
2030. Targeting treatment to PWIDs engaged in OST and NEP
provided the greatest reduction in prevalence for the number of
individuals treated. To achieve a 1-person reduction in overall
prevalence by 2030, it was necessary to treat 1.6 PWIDs in
OST/NEP as compared with 3.4 PWIDs in the general population.
Conclusions - Treating a relatively small number of PWIDs
results in substantial decreases in the HCV infected PWID population
by 2030. Additionally, the impact of treatment is higher
among PWIDs engaged in harm reduction programs. These
data support implementation of a screening and treatment strategy
among PWIDs, and particularly among PWIDs engaged
in OST and NEP.
Disclosures:
Francesco Negro - Advisory Committees or Review Panels: Bristol-Myers Squibb,
MSD, Gilead, AbbVie; Grant/Research Support: Gilead
Philip Bruggmann - Advisory Committees or Review Panels: Merck, Gilead, BMS,
Abbvie, BMS; Grant/Research Support: BMS, Merck, Janssen, Gilead, Abbvie;
Speaking and Teaching: BMS
Sarah Blach - Employment: Center for Disease Analysis
Pierre Deltenre - Consulting: Abbvie, Gilead, BMS; Grant/Research Support:
Abbvie, Gilead, BMS, Janssen, MSD; Speaking and Teaching: Abbvie, Gilead,
BMS
Beat Mullhaupt - Consulting: MSD, Novartis, MSD, Janssen; Grant/Research
Support: Bayer, Gillead
Homie Razavi - Management Position: Center for Disease Analysis
Andri Rauch - Advisory Committees or Review Panels: Gilead Sciences, Abbvie,
MSD, Janssen Cilag
The following authors have nothing to disclose: Jan Fehr, Roger Kouyos, Daniel
Lavanchy, Patrick Schmid, David Semela, Martin Stoeckle