studies

1102A AASLD ABSTRACTS HEPATOLOGY, October, 2015
ratio for models including behavioural risk heterogeneity. Conclusions:
Preferential mixing by HIV status and behavioural risk
heterogeneity could be the main factors that have resulted in
much higher HCV prevalence amongst HIV-positive MSM than
in HIV-negative MSM. Greater HCV transmission could occur
amongst HIV-negative MSM if HIV-negative MSM start using
condoms less or mix more with HIV-positive MSM, something
that may occur with widespread use of HIV pre-exposure prophylaxis.
The effects of new HIV prevention interventions on
HCV transmission should be considered.
Disclosures:
The following authors have nothing to disclose: Louis W. MacGregor, Peter Vickerman,
Natasha K. Martin, Ford Hickson, Peter Weatherburn
1831
Positive Impact of Point of Care Testing and an Informational
Brochure on Screening of the HCV Birth Cohort in
a Rural New England Tertiary Care Center
Arvind Suguness 1 , Casey M. Kolb Nava 1 , Kristen Ray 2 , Rolland C.
Dickson 2 ; 1 Internal Medicine, Dartmouth Hitchcock Medical Center,
White River Junction, VT; 2 Gastroenterology and Hepatology,
Dartmouth Hitchcock Medical Center, Lebanon, NH
Background. Hepatitis C Virus (HCV) screening of the Birth
Cohort (BC) has been recommended by the CDC and USPSTF
due to the high prevalence of HCV and advanced liver disease
in this population. The use of risk-based screening was
previously shown to be ineffective at identifying patients with
HCV infection. To address these guidelines, we implemented
a point-of-care testing (POCT) strategy for HCV, and surveyed
patients within the cohort. The aim of this study was to assess
factors in a HCV testing algorithm that influenced screening.
Methods. A HCV BC screening initiative was fully implemented
in an Internal Medicine Residents Clinic in a rural tertiary care
center in the NE United States on 4-1-2014. BC patients (1945-
1965) were identified by a prompt in the electronic medical
record prior to arrival to clinic. They were given a brochure on
HCV natural history, POCT, and HCV treatment at the time of
check in. When patients were roomed they were offered testing
with the Orasure finger prick test. The patients were given a
questionnaire while they waited for the provider. HCV screening
(+ or -) results were available within 20 minutes during the
provider visit. Patients were informed of the results and those
with positive results were offered same day PCR testing, with
genotype performed if viral load was present. Results. There
were 325 total respondents to the survey. Sixty three (19.4%)
reported being asked by a health care provider to be tested
for HCV in the past. Twenty one reported prior HCV testing
(6.5%) and 8 reported a prior positive test (2.5%). Of the total
respondents, 86 (26%) opted out of screening entirely, while
239 patients (73.5%) chose to be screened at that visit. Of
those screened, 117 (49.0%) said the information in the brochure
or having test results immediately available influenced
their decision to be tested. At least one reported risk factor
was present in 142 patients (43.69%). Patients with at least
one risk factor were no more likely to desire screening than
those without risk factors (73.2% vs 73.8%, p=0.914). Patients
with risk factors were no more likely than those without risk
factors to report that the brochure or the immediately available
results influenced their decision to get tested (43.2% vs 53.3%,
p=0.123). Summary and Conclusion. Prior to initiation of a
POCT strategy, relatively few patients in the birth cohort at
our institution had been approached by health care providers
about HCV screening and fewer still had been tested. The presence
of an informational brochure, combined with point-of-care
testing, significantly increased the number of patients with and
without risk factors to undergo testing.
Disclosures:
Casey M. Kolb Nava - Consulting: AbbVie
Kristen Ray - Advisory Committees or Review Panels: Abbvie
Rolland C. Dickson - Advisory Committees or Review Panels: Biotest; Speaking
and Teaching: gilead
The following authors have nothing to disclose: Arvind Suguness
1832
Stability and prevalence of the NS3 Q80K polymorphism
over time within HCV genotype 1a infected
patients in Canada
Jeffrey B. Joy 1 , Weiyan B. Dong 1 , Celia B. Chui 1 , Chanson J.
Brumme 1 , Art Poon 1,3 , Huong Hew 2 , Richard Harrigan 1,3 ; 1 BC
Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada;
2 Clinical Affairs, Janssen Incorporated, North York, ON, Canada;
3 Medicine, University of British Columbia, Vancouver, BC, Canada
Background: HCV genotype 1a (GT1a) infections harbouring a
baseline Q80K polymorphism in the NS3 gene display reduced
virologic response to IFN-based HCV treatments containing
simeprevir. The prevalence of this and other NS3 resistance
mutations in Canadian populations is not well described. Further,
in the context of individual infections, the stability of this
polymorphism among untreated patients over time is unknown.
Methods: Using plasma samples serially collected over a
10-year period from 121 HCV treatment naïve GT1a infected
seroconverting injection drug users, we sought to investigate
gain or loss of the Q80K polymorphism over time. A 1200-
or 564-bp HCV NS3 fragment was sequenced by Sanger
methods. Each sample was HLA typed to confirm database
annotations on source individuals. HCV sequences were multiply
aligned using MAFFT v7.154b. Phylogenetic trees were
inferred using an approximate maximum likelihood method
(FastTree2) and rooted under a molecular clock model using
Path-O-Gen. To establish the prevalence of Q80K in Canadian
Provinces, samples from GT1 LiPA HCV+ individuals were
examined. Sequences were also screened for mutations associated
with boceprevir/telaprevir resistance. Results: No patients
whose first and last samples formed a monophyletic group
altered their Q80K status. Nine patients changed genotypes
(6 GT3a to GT1a, 2 GT1a to GT3a, and 1 GT1b to GT1a).
Furthermore, in 10 patients, GT1a infections did not form a
monophyletic group. Both between genotype and within genotype
changes in viral lineage between collection dates suggest
either (1) clearance followed by reinfection with a new variant
or (2) a mixed infection. In sum, we observed 9 changes in
Q80K in 121 patients, but in every case this resulted from
patients switching HCV lineages rather than a mutation in
their original HCV lineage. Prevalence of Q80K in Canada
was 956/1835 (52%) in GT1a and provinces displayed no
significant difference in prevalence of Q80K. Mutations associated
with boceprevir or telaprevir resistance in this newly
diagnosed population were also observed. Conclusions: These
results suggest that, in the absence of therapy, Q80K is highly
stable within HCV lineages and does not evolve in response
to immune or other host specific effects. Observed changes
in infection status amongst these patients supports genotypic
and resistance testing of patients prior to starting IFN-based
therapy, particularly amongst those at high risk of exposure to
new variants of HCV such as intravenous drug users.
Disclosures:
Huong Hew - Employment: Janssen
Richard Harrigan - Consulting: ViiV Health Care, Tobira Therapeutics, Selah
Genomics Inc, Quest Diagnostics; Stock Shareholder: Merck, Gilead