P920Understanding arrhythmia mechanisms in patients with atrial septal defects

Background

Atrial arrhythmias represent a major cause of morbidity and hospitalization in patients with atrial septal defects (ASD). Optimum treatment strategies are unknown since the mechanisms of arrhythmia are undefined in this cohort.

Purpose

We investigated whether percutaneous ASD closure reduces atrial arrhythmias and subsequently examined the electrical and structural changes underpinning arrhythmogenesis in ASD patients.

Methods

Meta-analysis was used to study the effect of closure on arrhythmias. Bi-atrial electrical dysfunction was assessed through invasive measurement of atrial voltage, refractory periods (ERP) over three drive trains (600, 450 and 300ms) and local conduction velocity (CV) with subsequent assessment of ERP and CV restitution. Structural remodelling was assessed through non-invasive quantification of fibrosis using cardiac MRI (CMR). Origin of ectopy was evaluated invasively using isoprenaline infusion and non-invasively using 24-hour Holter monitoring. Comparison was made to normal heart controls.

Results

Meta-analysis

Meta-analysis of 25 studies found that percutaneous closure was associated with a weak reduction in atrial arrhythmias only in patients >40 years old (OR 0.777, 95% CI 0.616-0.979, P = 0.032).

Electrical Remodelling

On invasive assessment (21 ASDs; 21 controls), proportion of right atrial low voltage (<0.5mV) and scar (<0.05mV) was greater in ASD vs control patients (P = 0.02 and P = 0.039). In ASD patients, these parameters were greater in the right atrium vs the left atrium (P = 0.002 and P = 0.01). Right atrial ERP restitution slopes were steeper in ASD vs control patients (P = 0.016). Maximum right atrial CV and CV restitution slopes were greater in ASD vs control patients (P= 0.005 and P < 0.001 respectively) and CV decrement occurred at longer coupling intervals in the right atrium in ASD patients (P = 0.015).

Structural Remodelling

On CMR assessment (36 ASDs; 36 controls), bi-atrial fibrosis was greater in ASD vs control patients (P < 0.001). In ASD patients right atrial fibrosis was burden greater in patients with vs without atrial arrhythmias (P = 0.034).

Arrhythmia Triggers

On 24-hour Holter monitoring and during invasive isoprenaline infusion right and left atrial ectopy was equally prevalent in ASD vs control patients.

Conclusion

This study highlights the importance of right atrial electrical dysfunction to the occurrence of arrhythmias in ASD patients with extensive right atrial remodelling (fibrosis, low voltage, steeper ERP and CV restitution) seen in ASD patients compared to normal heart controls.

From the results of the meta-analysis it appears that percutaneous closure alone is insufficient to treat arrhythmias in ASD patients. Given the predominance of right atrial remodelling, right-sided ablation as an adjunct to conventional left-sided ablation should be investigated as a strategy to treat atrial arrhythmias in these patients.

Abstract Figure.

COVID-19 and the Otolaryngologist: Preliminary Evidence-Based Review

The SARS-CoV-2 virus, which causes coronavirus disease 2019 (COVID-19), has rapidly swept across the world since its identification in December 2019. Otolaryngologists are at unique risk due to the close contact with mucus membranes of the upper respiratory tract and have been among the most affected healthcare workers in Wuhan, China. We present information on COVID-19 management relevant to otolaryngologists on the frontlines of this pandemic and provide preliminary guidance based on practices implemented in China and other countries and practical strategies deployed at Stanford University. Laryngoscope, 130:2537-2543, 2020.

Role of family caregivers regarding sexual and reproductive health for women and girls with intellectual disability: A scoping review

BACKGROUND

While people with intellectual disability (ID) face disparities relating to sexual and reproductive health (SRH) services, little is known about the role of family caregivers who assist women and girls with ID access SRH services. This scoping review examined the findings of studies to elucidate the role of family caregivers with regard to SRH for women and girls with ID.

METHOD

We used Arksey and O'Malley's six-stage scoping framework, with Levac, Colquhoun and O'Brien's revisions, to evaluate identified sources. We searched three electronic databases, six ID journals and reference lists in full-text articles. Inclusion criteria included (1) primary and secondary source research studies in peer-reviewed journals; (2) published in English; (3) all research methodologies (i.e. qualitative, quantitative, mixed methods and systematic reviews or commentaries); (4) published between 2000 and 2016; and (5) studies from any country.

RESULTS

The search yielded 2062 studies; 57 articles met inclusion criteria. Most studies employed purposive, convenience or criterion sampling. Participants included people with ID, family caregivers, paid caregivers and health-care professionals. Findings were summarised thematically: (1) menstruation and menopause; (2) vaccinations and preventive screenings; (3) supporting sexuality and healthy relationships; (4) coordinating with health-care providers and (5) contraception and sterilisation.

CONCLUSIONS

Findings from this scoping review underscore the need for more and better-quality research, including how family caregivers assist women and girls with ID access perinatal and preventive SRH services and sexual abuse education. Family caregivers, women and girls with ID and health-care providers need increased access to information about SRH.

P1486 An unexpected case of paediatric heart failure

A 9-month-old male presented in heart failure with a 2-day history vomiting that followed a viral upper respiratory tract infection 10 days previously. Echocardiography demonstrated a normally connected heart with a severely dilated and poorly functioning left ventricle with bright mitral valve papillary muscles. It was difficult to demonstrate the origin of the left coronary artery and retrograde flow was seen in the vessel (Fig 1, Panel A). The right coronary artery appeared normal. A gated cardiac CT was performed and showed a normal right coronary origin and no clear connection of the LCA to Ao and there was suspicion of retrograde filling. Images of the left coronary origin did not show clear connection of the LCA to Ao (Fig 1, Panel B). As the case was extremely unusual coronary angiography was performed which confirmed the suspicion of a dominant right coronary system with collateral connection to the left coronary system and retrograde filling and no antegrade filling of the LCA from the Ao (Fig 1, Panel C). This was consistent with atresia of the left coronary ostium, which was confirmed at operation. The left coronary sinus was opened, as was the roof of the left coronary artery and an anastomosis was performed to aorta using an autologous patch. The post operative TOE showed good flow into the LCA (Fig 1, Panel D). There was good and quick post op clinical recovery but the left ventricular function remains still poor at the moment with slow recovery as expected. The cardiac function will be monitored echocardiographically and the reconstructed coronary artery with CT.

Abstract P1486 Figure 1

Review of clinical trials in intraoperative molecular imaging during cancer surgery

Most solid cancers are treated by surgical resections to reduce the burden of disease. Surgeons often face the challenge of detecting small areas of residual neoplasm after resection or finding small primary tumors for the initial resection. Intraoperative molecular imaging (IMI) is an emerging technology with the potential to dramatically improve cancer surgery operations by allowing surgeons to better visualize areas of neoplasm using fluorescence imaging. Over the last two years, two molecular optical contrast agents received U.S. Food and Drug Administration approval, and several more drugs are now on the horizon. Thus a conference was organized at the University of Pennsylvania to bring together oncologic surgeons from different specialties to discuss the current clinical status of IMI trials with a specific focus on phase 2 and phase 3 studies. In addition, phase 1 and experimental trials were also discussed briefly, to highlight other novel techniques. Our review summarizes the discussions from the conference and delves into the types of cancers discussed, different contrast agents in human trials, and the clinical value being studied.

The Sentinel Margin: Intraoperative Ex Vivo Specimen Mapping Using Relative Fluorescence Intensity

PURPOSE

Despite major advancements in surgical oncology, the positive margin rate for primary head and neck cancer resection remains around 15%-30%. In particular, the deep surface margin is the most challenging to adequately assess. Inadequate margins are directly correlated to poor survival, and as such, mitigation of these rates is critical to improve patient outcomes. We have developed an ex vivo imaging strategy that utilizes fluorescence intensity peaks (relative to background signal) of an injected anti-EGFR antibody conjugated to a fluorescent probe to locate potential close or positive margins on the deep surface of the resected tumor specimen.

EXPERIMENTAL DESIGN

Twelve patients with head and neck cancer scheduled for surgery received systemic administration of a tumor-specific contrast-agent (panitumumab-IRDye800CW). After surgical resection, the tumor specimen was imaged using a fluorescence imager. The three highest fluorescence intensity-peaks on the deep surface of the specimen were isolated and correlated to histology to determine the margin distance at these regions.

RESULTS

Relative fluorescence peak intensities identified the closest margin on the deep surface of the specimen within 2.5 minutes. The highest intensity peak consistently (100%) detected the closest margin to the tumor. The difference in tumor margin distance between the first and second highest fluorescence intensity peak averaged 2.1 ± 1.4 mm. The tumor-margin difference between the second and third highest peak averaged 1.6 ± 0.6 mm.

CONCLUSIONS

Fluorescence intensity peaks can identify the region on the specimen where tumor is closest to specimen's edge on the deep surface. This technique could have broad applications in obtaining adequate margins in oncological surgery.

Abstract P4-09-04: Associations between clinical factors in v7.02 of the Tyrer-Cuzick model and a SNP-based residual risk score

Background: Genome-wide association studies (GWAS) have identified common variants, primarily single-nucleotide polymorphisms (SNPs), that individually confer modest risk but together explain a significant proportion of genetic breast cancer (BC) predisposition. GWAS have also demonstrated that SNPs cannot replace family history evaluation: familial BC assessment captures a large magnitude of risk information that is not captured by SNPs. Thus, improved BC risk stratification may be achieved by combining family history assessment with SNP markers. However, to avoid double-counting shared risk information, familial and/or SNP-based risks must be adjusted for confounding.

Additional clinical and biological factors that contribute to BC risk are included in version 7.02 of the Tyrer-Cuzick model. These include height; weight; BMI; age of menarche; parity and age of first childbirth; menopausal status and age of onset; and use of hormonal replacement therapy (HRT). Confounding of SNPs with these factors is not well understood. Here we present an analysis of associations between an 86-SNP Residual Risk Score (RRS) and factors included in version 7.02 of the Tyrer-Cuzick model.

Methods: De-identified clinical records and genotypes were collected from a consecutive series of patients referred for hereditary cancer testing with a multigene panel. Study subjects included unaffected women age 18-84 who reported European ancestry and tested negative for mutations in 11 genes associated with BC (BRCA1, BRCA2, TP53, PTEN, STK11, CDH1, PALB2, CHEK2, ATM, NBN, BARD1).

For each risk factor, we constructed a univariate linear regression model with RRS as the dependent variable and the clinical factor as the independent variable. From these models, we examined regression coefficients, p-values based on F-statistics, and Pearson correlation coefficients. Scatterplots and boxplots were used to visually assess associations. All analyses were conducted using R version 3.4.4. P-values were reported as two-sided with no corrections for multiple testing.

Results: 5,489 patients met the study selection criteria. The median age at hereditary cancer testing was 42 years. Nearly one third (33.1%) of women reported a BC diagnosis in a first degree relative.

The RRS was significantly associated with familial BC (p<10-08). We observed marginal evidence of association between the RRS and HRT use (p=0.04). However, this association would not survive a multiple testing correction, and was not significant after multivariate adjustment for family cancer history. We found no evidence for association of the RRS with height, weight, BMI, menopausal stage, age of menarche, age of menopause, duration of menarche, parity, age of first live birth, HRT type, or HRT length of use.

Conclusions: The RRS is largely independent from the non-familial risk factors in version 7.02 of the Tyrer-Cuzick model, but is significantly associated with BC family history. Risk assessment based on Tyrer-Cuzick and SNPs must be adjusted for confounding to avoid double-counting familial risk.

Citation Format: Hughes ER, Rosenthal E, Morris B, Wagner S, Lanchbury JS, Gutin A. Associations between clinical factors in v7.02 of the Tyrer-Cuzick model and a SNP-based residual risk score [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-09-04.

Abstract P4-03-04: Genetic testing contributes significantly to improved identification of women eligible for increased breast cancer screening compared to the Tyrer-Cuzick risk model

Background: Increased screening, including breast MRI, is recommended for women carrying pathogenic variants (PVs) in certain breast cancer risk genes, as well as women with an estimated remaining lifetime risk of breast cancer >20% based on risk models such as Tyrer-Cuzick (TC). We determined the extent to which genetic testing identifies women as candidates for increased screening who would not have been flagged using the TC model.

Methods: We evaluated 100,318 women who underwent clinical genetic testing for suspicion of hereditary breast cancer risk between June 2017 and June 2018. Testing with a 28 gene pan-cancer panel included 5 established breast cancer risk genes for which there are National Comprehensive Cancer Network (NCCN) recommendations for increased screening including breast MRI (BRCA1, BRCA2, ATM, CHEK2, PALB2). A remaining lifetime breast cancer risk estimate was calculated using TC V 7.02, unless the woman was ineligible due to a breast cancer diagnosis, age over 85, or if the sample was submitted without any of the necessary TC data. Risk estimates were calculated entering the BRCA1/2 status as unknown.

Results: 4,640 (4.6%) women were found to carry a PV in one of the five genes, with 57.0% of the PVs in BRCA1 or BRCA2, and 43.0% in ATM, CHEK2 or PALB2. Among the women with a PV, 1,479 (31.9%) had a diagnosis of breast cancer, and 407 (8.8%) were ineligible for TC for another reason. A TC risk estimate was calculated for 2,754 women, of whom 41.5% did not meet the 20% threshold using TC. Table 1 shows the breakdown for each gene by age at the time of testing. Women with PVs in BRCA1 were the least likely to have a TC score <20% and those with PVs in BRCA2 and ATM were the most likely to fall below the 20% threshold. Remaining lifetime risk declined with age in all groups.

Table 1.Percentage of women carrying PVs in breast cancer risk genes with a remaining lifetime risk of breast cancer risk estimated at <20% by Tyrer-Cuzick.Age at time of testingBRCA1 (N=1215)BRCA2 (N=1432)ATM (N=609)CHEK2 (N=971)PALB2 (N=413)<2014.8%11.1%0.0%33.3% 20-2922.0%27.3%29.5%28.4%19.1%30-3928.7%38.1%30.3%36.4%22.6%40-4938.4%48.8%47.7%42.5%50.0%50-5949.4%62.7%64.3%52.3%44.4%60-6987.5%78.8%71.9%77.8%71.4%70-79--100.0%100.0%100.0%100.0%80+100.0%--------All ages33.6%45.7%46.3%42.6%37.4%

Conclusions: Among the women included in this analysis, the TC model failed to identify approximately 40% of women eligible for high risk breast cancer screening due to PVs in breast cancer risk genes. This demonstrates that risk models based on clinical factors alone will fail to identify a significant fraction of women who are candidates for modified medical management. Additionally, it may be desirable to re-evaluate setting thresholds based on remaining lifetime risk, since this dramatically reduces the likelihood that high-risk women will be flagged for increased screening at older ages, when their immediate risk of a breast cancer diagnosis is likely to be highest.

Citation Format: Gorringe HM, Rosenthal E, Morris B, Manley S. Genetic testing contributes significantly to improved identification of women eligible for increased breast cancer screening compared to the Tyrer-Cuzick risk model [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-03-04.

An Assessment of Small Simulators Used to Teach Basic Airway Management

This study assessed small simulators sold for teaching basic airway management. The assessment used criteria based on guidelines produced by the Australian Resuscitation Council and our experience teaching health professional trainees. Criteria included how well the simulators demonstrated manoeuvres to open the airway, mouth-to-mouth and mask-to-mouth expired air resuscitation and artificial ventilation using a bag and mask. Simulators with permanently open airways (as is the case with some intubation manikins) were not tested. Each simulator was also assessed for realism in relation to look and feel, hygiene and sturdiness of construction.

Clinical staff and medical students who teach basic airway management undertook a standardized assessment of nine simulators. There were significant differences between simulators that could impact on learning. Generally, models with hard surfaces tended to be less realistic in both look and feel compared to those with flexible “skin”. Realism of lung inflation and its relationship to airway opening manoeuvres varied greatly between simulators.

The Little Anne small simulator functioned most realistically in our tests.

Abstract LB-366: Cryo-fluorescence tomography as a new tool in 3D visualization of tumor heterogeneity, metastatic proliferation and immuno-oncology

Cryo-fluorescence tomography (CFT) is an imaging modality based on serial slicing with off-the-block fluorescence imaging and is capable of imaging a whole animal, producing a 3D dataset. This technique is also able to image isolated tumors at higher resolution either from rodent models, or human patients. It is a strong complement to traditional in vivo imaging techniques and fills in gaps these techniques leave such as MRI's lack of sensitivity and specificity or PET, SPECT and optical techniques lack of resolution. High value sections are also selectively identified and transferred to slide for further histology and co registration back to the whole sample data set in the many instances where a whole animal/organ microscopy data set is not feasible. In this study, we utilize CFT in several tumor models to track tumor microenvironment and heterogeneity, metastatic spread, and expression of specific markers in excised human tumors. A 4T1 mouse mammary tumor model expressing both luciferase and DsRed was used to study metastasis. CFT showed a complete account of metastatic disease in our subject animals when compared to bioluminescence imaging. The high resolution molecular 3D data is invaluable to measure tumor burden, even with very small tumors, and is supported with whole body white light imaging for anatomical landmarking. A unilateral intracranial inoculation with GL26-luc2 cells in a mouse model was imaged two weeks later with T1-weighted MRI and Gadolinium contrast. Additional bioluminescence was also acquired. The subjects were then injected with indocyanine green (ICG) and Angiosense680Ex prior to sacrifice and CFT imaging. The CFT data had very high specificity to the tumor and a very high correlation to the MRI meaning the 2 techniques are equally good at assessing tumor angiogenesis. Further fluorescent markers can also be employed in the CFT study to provide additional information on gene/protein expression or presence of immunologic factors as well. To investigate the translation potential of this technique we imaged clinical squamous cell carcinoma tumors resected under fluorescence guided surgery using Cetuximab-IRDye800. These samples were formalin fixed paraffin embedded (FFPE) prior to CFT. The heterogenous distribution of Cetuximab in the tumors is compared to pre-operative and operative images to assess tumor margin and characterization. CFT has proven to be a powerful technique for oncology investigations. This technique can characterize the 3D bio-distribution and localization of antibody drug conjugates, or diagnostic antibodies, across an entire sample. More complete and precise data sets fluorescent labeled CAR T cells or tumor associated macrophages can aid the development of immuno-oncologic therapies.

Citation Format: Mathew Brevard, Mohammed Farhoud, Hemi Dimant, Gary Sahagian, Eben Rosenthal, Quang-De Nguyen. Cryo-fluorescence tomography as a new tool in 3D visualization of tumor heterogeneity, metastatic proliferation and immuno-oncology [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr LB-366.

In-vivo optical imaging in head and neck oncology: basic principles, clinical applications and future directions

Head and neck cancers become a severe threat to human's health nowadays and represent the sixth most common cancer worldwide. Surgery remains the first-line choice for head and neck cancer patients. Limited resectable tissue mass and complicated anatomy structures in the head and neck region put the surgeons in a dilemma between the extensive resection and a better quality of life for the patients. Early diagnosis and treatment of the pre-malignancies, as well as real-time in vivo detection of surgical margins during en bloc resection, could be leveraged to minimize the resection of normal tissues. With the understanding of the head and neck oncology, recent advances in optical hardware and reagents have provided unique opportunities for real-time pre-malignancies and cancer imaging in the clinic or operating room. Optical imaging in the head and neck has been reported using autofluorescence imaging, targeted fluorescence imaging, high-resolution microendoscopy, narrow band imaging and the Raman spectroscopy. In this study, we reviewed the basic theories and clinical applications of optical imaging for the diagnosis and treatment in the field of head and neck oncology with the goal of identifying limitations and facilitating future advancements in the field.

Abstract PD1-08: Development and validation of a combined residual risk score to predict breast cancer risk in unaffected women negative for mutations on a multi-gene hereditary cancer panel

Background: Unaffected women with a strong family history of breast cancer (BC) are often referred for hereditary cancer testing with multi-gene panels; however, typically <10% test positive for clinically actionable mutations. Large-scale genotyping studies have identified common variants (primarily single-nucleotide polymorphisms) that individually confer modest BC risk, but together partially explain BC genetic susceptibility in many women without monogenic mutations. In addition, a number of factors relating to reproductive and medical history modify risk for BC. Here, we describe the development and validation of a combined polygenic residual risk score (cRRS) which takes into account non-genetic factors, in a large, consecutive cohort of women who tested negative for mutations in known BC susceptibility genes.

Methods: This IRB-approved study includes women of European ancestry tested with a multi-gene hereditary cancer panel who were negative for mutations in 11 genes associated with BC (BRCA1, BRCA2, TP53, PTEN, STK11, CDH1, PALB2, CHEK2, ATM, NBN, BARD1). Clinical information was collected from provider-completed test request forms. The dataset was divided into a training (July 2016– February 2017) and validation cohort (February 2017 – May 2017). 94 previously published variants (Mavaddat et al 2015; Michailidou et al 2015) were genotyped using NGS. Multivariable logistic regression models were used to evaluate the 94 variants, to develop a residual risk score (RRS) as a predictor of personal BC history in the training cohort, and to assess the performance of the RRS in the validation cohort. Independent variables included age, personal/family cancer history, and ancestry. In an additional cohort, reproductive and medical history variables will be recorded and used to calculate BC risk according to the Tyrer-Cuzick model.

Results: Accurate genotyping results were produced for 92 out of 94 variants. The training (validation) cohort included 24,259 (10,575) women, 18% (15%) of whom reported a personal history of BC. In the validation cohort RRS was strongly associated with personal history of BC (p<10-31) with odds ratio per unit standard deviation of the RRS being 1.41 (95% CI = 1.33-1.49). The RRS outperformed a published polygenic risk score (PRS) based on 77 SNPs (Mavaddat et al 2015): in a model with both scores included, the RRS score was significantly associated with BC (p=2x10-6) while the PRS was not (p=0.29). The RRS score also outperformed a PRS score based on the 92 variants with literature-derived odds ratios for association with BC: in a model with both scores included, the RRS score was significantly associated with BC (p=0.022) while the PRS was not (p=0.28). The RRS will be combined with the Tyrer-Cuzick model to deliver an optimized combined residual risk score (cRRS) and compared to risk predicted by Tyrer-Cuzick model alone in a separate cohort of women testing negative for BC mutations.

Conclusions: The validation and clinical implementation of a combined residual risk score for women at risk for hereditary BC may offer significant potential for the management of high-risk, unaffected women who test negative for monogenic BC mutations.

Citation Format: Hughes E, Judkins T, Wagner S, Rosenthal E, Wenstrup R, Lanchbury JS, Gutin A. Development and validation of a combined residual risk score to predict breast cancer risk in unaffected women negative for mutations on a multi-gene hereditary cancer panel [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr PD1-08.

Efficacy, safety and patient-reported outcomes of ledipasvir/sofosbuvir in NS3/4A protease inhibitor-experienced individuals with hepatitis C virus genotype 1 and HIV coinfection with and without cirrhosis (ANRS HC31 SOFTRIH study)

OBJECTIVES

Studies evaluating the efficacy and safety of the fixed-dose combination ledipasvir (LDV)/sofosbuvir (SOF) in patients coinfected with HIV-1 and hepatitis C virus (HCV) have mainly included treatment-naïve patients without cirrhosis. We aimed to evaluate the efficacy and safety of this combination in treatment-experienced patients with and without cirrhosis.

METHODS

We conducted a multicentre, open-label, double-arm, nonrandomized study in patients coinfected with HIV-1 and HCV genotype 1 with and without cirrhosis, who had good viral suppression on their antiretroviral regimens. All patients were pretreated with a first-generation NS3/4A protease inhibitor (PI) plus pegylated interferon/ribavirin. Patients received a fixed-dose combination of LDV/SOF for 12 weeks, or for 24 weeks if cirrhosis was present. The primary endpoint was a sustained virological response (SVR) 12 weeks after the end of therapy. Secondary endpoints included safety, pharmacokinetics and patient-reported outcomes.

RESULTS

Of the 68 patients enrolled, 39.7% had cirrhosis. Sixty-five patients [95.6%; 95% confidence interval (CI): 87.6-99.1%; P < 0.0001] achieved an SVR, with similar rates of SVR in those with and without cirrhosis. Tolerance was satisfactory, with mainly grade 1 or 2 adverse events. Among patient-reported outcomes, only fatigue significantly decreased at the end of treatment compared with baseline [odds ratio (OR): 0.36; 95% CI: 0.14-0.96; P = 0.04]. Mean tenofovir area under the plasma concentration-time curve (AUC) at week 4 was high, with mean ± SD AUC variation between baseline and week 4 higher in cirrhotic than in noncirrhotic patients (3261.57 ± 1920.47 ng/mL vs. 1576.15 ± 911.97 ng/mL, respectively; P = 0.03). Mild proteinuria (54.4%), hypophosphataemia (50.0%), blood bicarbonate decrease (29.4%) and hypokalaemia (13.2%) were reported. The serum creatinine level was not modified.

CONCLUSIONS

LDV/SOF provided a high SVR rate in PI-experienced subjects coinfected with HCV genotype 1 and HIV-1, including patients with cirrhosis.

Psychiatric and substance use disorders in HIV/hepatitis C virus (HCV)-coinfected patients: does HCV clearance matter? [Agence Nationale de Recherche sur le SIDA et les Hépatites Virales (ANRS) HEPAVIH CO13 cohort]

OBJECTIVES

The objective of this nested study was to assess the prevalence of psychiatric disorders in a sample of HIV/hepatitis C virus (HCV)-coinfected patients according to their HCV status.

METHODS

The nested cross-sectional study, untitled HEPAVIH-Psy survey, was performed in a subset of HIV/HCV-coinfected patients enrolled in the French Agence Nationale de Recherche sur le SIDA et les Hépatites Virales (ANRS) CO13 HEPAVIH cohort. Psychiatric disorders were screened for using the Mini International Neuropsychiatric Interview (MINI 5.0.0).

RESULTS

Among the 286 patients enrolled in the study, 68 (24%) had never received HCV treatment, 87 (30%) were treatment nonresponders, 44 (15%) were currently being treated and 87 (30%) had a sustained virological response (SVR). Of the 286 patients enrolled, 121 patients (42%) screened positive for a psychiatric disorder other than suicidality and alcohol/drug abuse/dependence, 40 (14%) screened positive for alcohol abuse/dependence, 50 (18%) screened positive for drug abuse/dependence, 50 (17.5%) were receiving an antidepressant treatment and 69 (24%) were receiving an anxiolytic. Patients with an SVR did not significantly differ from the other groups in terms of psychiatric disorders. Patients receiving HCV treatment screened positive less often for an anxiety disorder. The highest rate of drug dependence/abuse was among HCV treatment-naïve patients.

CONCLUSIONS

Psychiatric disorders were frequent in HIV/HCV-coinfected patients and their rates were comparable between groups, even for patients achieving an SVR. Our results emphasize the need for continuous assessment and care of coinfected patients, even after HCV clearance. Drug addiction remains an obstacle to access to HCV treatment. Despite the recent advent and continued development of directly acting antiviral agents (DAAs), it is still crucial to offer screening and comprehensive care for psychiatric and addictive disorders.