2233. Hepatitis C Eradication: Who Is Being Left Behind in the HIV Population?

BACKGROUND: HCV treatment has increased since direct-acting antivirals became available. HIV clinics are scaling-up treatment to eradicate HCV. Little is known about HIV patients and access to HCV treatment. METHODS: We retrospectively analyzed all HIV/HCV co-infected patients within our safety-net hospital system who received outpatient care in our HIV clinics from November 1, 2015 to October 31, 2017. Data were abstracted on demographics, insurance, HIV RNA, drug use, homelessness, and number of visits. No visits for >1 year was lost to care and missed visits was missing >1 primary care visit. We examined the association of these variables to risk of having a detectable HCV RNA (surrogate marker for HCV treatment) through multivariate logistic regression. RESULTS: We identified 914 with HIV/HCV (72% male, 55% Black, 35% Medicaid, 29% Medicare, 16% Ryan White, 13% homeless) of which 47% were heterosexual, 36% MSM, and 14% IDU. HIV was undetectable in 74%, 69% were between age 46 and 65, 17% had active alcohol use and 33% had drug use. HCV RNA was available for 868 and was detected in (57%). Whites and Hispanics compared with Blacks were less likely to have detectable HCV RNA. Detectable HCV RNA was more likely in those >50 years of age compared with <40 years, with detectable HIV viral load, >1 missed visit, and lost to care. CONCLUSION: We found that those at risk for not being treated for HCV were Blacks, older patients and those not engaged in HIV care or not suppressed on HIV treatment. To achieve HCV eradication will require efforts to engage older patients, Blacks, those noncompliant with ART, and not engaged in HIV care. DISCLOSURES: M. K. Jain, Gilead Sciences: Grant Investigator, Grant recipient and Research support. Janssen: Investigator, Research support. GSK/ViiV: Investigator, Consulting fee and Research support. Merck: Investigator, Research support.