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Introduction Cabotegravir + rilpivirine long-acting regimen (CARLA) has no anti-HBV activity and is not recommended for PLWH with active HBV co-infection. No data exist on its hepatic safety among PLWH with resolved HepB (rHepB), especially among those with isolated HBcAb+ (IsHBcAb+).Materials and Methods Retrospective multicenter observational study including PLWH on CARLA. Primary aim was to demonstrate hepatic safety among PLWH with rHepB (HBsAg-, HBcAb+, HBsAb+/-), assessed by analysing FIB-4 and ALT trends. Temporal trends of FIB-4 and ALT were described using a mixed linear model with a random intercept and slope adjustment. The incidence rate of hepatitis flare (increase 3X the ALT normal values) was reported, and factors associated with hepatitis flare including Liver Steatosis assessed by HSI were described using standard survival analyses.Results 394 PLWH were included from 4 centres, with a median follow-up of 1.98 years (IQR: 0.99-2.53). Their main features are shown in table 1. The mixed model did not find any trend for worse evolution of ALT and FIB-4 values in rHepB compared with non-exposure to HBV (coef. -0.14, 95%CI -0.84-0.56, p=0.697 and coef. 0.01, 95%CI -0.02-0.03, p=0.669, respectively), as shown in figure 1 and figure 2. HSI score was significantly associated with ALT increase (coef. 0.88, 95%CI 0.61-1.15, p<0.001).We observed 9/394 (2.3%) hepatitis flares: 4/283 (1.4%) among HBV-unexposed and 5/111 (4.5%) in PLWH with rHepB, 2/24 (8.3%) with IsHBcAb+: incidence was 0.8 and 2.7 per 100PYFU among PLWH HBV-unexposed and with rHepB, respectively (IRR 0.32, 95%CI 0.08-1.25, p=0.090). For people with IsHBcAb+, the incidence rate was slightly higher (6.0 per 100PYFU with IRR 0.18, 95%CI 0.04-1.30, p=0.080). Survival analyses did not find a role of rHepB in the risk of hepatitis flare, whereas a higher HSI score was slightly associated with hepatitis flare, even at the limit of statistical significance (aHR 1.11, 95%CI 1.00-1.23, p=0.061), as shown in figure 3.In IsHBcAb+ PLWH there was a significantly higher risk of flare (aHR 11.15, 95%CI 1.67-74.28, p=0.013), and for this population, a higher HSI had an impact (aHR 1.14, 95%CI 1.02-1.27, p=0.018).No confirmed cases of HBV reactivation were observed. One person with IsHBcAb+ had a flare associated with HBsAb seroconversion and HBV DNA 17 IU/ml, followed by spontaneous resolution.Conclusions CARLA is safe, considering the FIB-4 and ALT trends among PLWH with rHepB. Hepatitis flares seemed to be related to Liver Steatosis. rHepB did not impact hepatitis flares risk, whereas IsHBcAb+ was associated with a higher risk of liver events, even though it was not related to HBV reactivation.These results will be updated soon with data coming from other 4 Italian centres.Abstract SC23 Figure 1–3Abstract SC23 Table 1Main features of study population