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Background Improvements in tolerability and cure rates of hepatitis C virus (HCV) with direct acting antiviral (DAA) treatment led to expansion of patients treated for HCV; however, research examining the impact of these changes on linkage to care and treatment initiation among patients with hepatitis B (HBV) and HIV co-infection is limited. We compared the care cascades for patients with HBV and HIV co-infection before and after the introduction of DAAs, among a large population-based cohort in British Columbia (BC). Methods We analyzed data from the BC Hepatitis Testers Cohort, including all individuals tested for HCV or HIV between 1992 and 2015 at the BC Centre for Disease Control Public Health Laboratory, as well as cases of HIV (1980–2015), HCV (1990–2015), HBV (1990–2015), and active tuberculosis (1990–2015) included in registries of reportable diseases in BC. Care cascades were stratified by HIV and HBV co-infection and compared for all individuals with HCV alive at the end of 2012 (pre-DAA) and 2017 (post-DAA), including the following stages: (1) HCV diagnosed; (2) HCV RNA tested; (3) HCV RNA positive; (4) HCV genotyped; (5) initiated antiviral treatment; and (6) sustained viral response (SVR). Results 53,030 individuals diagnosed with HCV were alivein 2012 and 52,987 in 2017, were included in respective care cascades. In comparison to the pre-DAA era (2012), there were considerable increases in genotyping, treatment, and cure among individuals from all co-infection categories in 2017. For example, the proportion of those with known active infection who initiated treatment was 52% versus 23% among HCV/HIV (p Conclusion Considerable improvements have been noted in linkage to care and treatment of HCV in BC following introduction of DAAs, particularly among patients with HBV and HIV co-infections. Disclosure No significant relationships.

Background Enumeration or measurement of populations of men who have sex with men (MSM) is critical to developing and evaluating sexually transmitted and bloodborne infection (STBBI) prevention and treatment programs. However, there is a lack of data sources in which sexual orientation or behaviour is measured. In this study, we present the development and validation of a novel model (i.e., ‘computational phenotype’) to predict MSM status using multiple data sources. Methods Three disease case surveillance databases (HIV, hepatitis B and C, and syphilis), a public health laboratory database (which performs ≥95% of all HIV, hepatitis C and syphilis tests in British Columbia), and five administrative health record databases were linked and aggregated, resulting in a retrospective cohort of 727,091 adult men from 1990 to 2013. Self-reported MSM status (‘gold-standard’) from the three disease case surveillance databases was used to develop a multivariable prediction model for identifying MSM in the larger cohort. Models were selected using ‘elastic-net’ (combination of lasso and ridge regression), implemented through the GLMNet package in R, and a final model optimized area under the receiver operating characteristics curve (AUC). Results History of gonorrhea and syphilis diagnoses, HIV tests in the past year, history of visit to identified gay and bisexual men’s clinics, and residence in MSM-dense neighborhoods (based on self-reported MSM) were all positively associated with being MSM. The selected model had a sensitivity of 72%, specificity of 94%, and AUC of 92%. Combining self-reported MSM (n=6,280) and predicted MSM (n=85,521), a total of 91,801 men (13% of the cohort) were classified as MSM. Conclusion Applying a computational phenotyping method to administrative data yielded a cohort of 85,521 MSM, which may be used to monitor and evaluate health outcomes and healthcare utilization. Sensitivity and specificity of this model were comparable to interviewer-administered self-report measures of sexual orientation. Disclosure No significant relationships.

Background Increasing rates hepatitis C virus (HCV) infection associated with ongoing risk activity have been reported after successful cure or viral clearance. We assessed factors associated with reinfection after treatment-induced or spontaneous clearance (SC) in both HIV-infected and uninfected men who have sex with men (MSM) in British Columbia. Methods We followed HIV-infected and uninfected MSM who achieved sustained virologic response (SVR) to HCV treatment or had SC with ≥1 subsequent HCV RNA measurement in the British Columbia Hepatitis Testers Cohort. Crude reinfection rates per 100 person-years (PYs) were calculated. Cox regression was used to model adjusted hazard ratios (HRs) and 95% confidence intervals (CI) for reinfection. Results We identified 1,349 HCV-infected MSM with SVR (n=856) or SC (n=493), of which 349 (26%) were HIV-positive. HIV-infected MSM were more likely to have histories of injection drug use (41% vs 21%), alcohol use (22% vs 14%) and mental health disorders (47% vs 28%), compared to HIV uninfected. A total of 98 reinfections were identified, yielding an overall reinfection rate of 1.9 per 100 PY (1.0 for SVR patients and 2.7 for SC). HIV-infected MSM had higher rates of reinfection (3.1 vs 1.6 per 100 PY) than HIV uninfected individuals. In multivariable analysis, age Conclusion Rates of HCV reinfection remain elevated among HIV-infected and uninfected MSM. Substance use is driving reinfection among HIV-negative MSM, while sexual transmission may be more important among HIV-positive MSM. Disclosure No significant relationships.

Background HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV) infections each are associated with increased cancer risk. In this study, we assessed the effect of co-occurrence of HIV, HBV and HCV on all cancers, anal cancer, non-Hodgkin Lymphoma (NHL) and liver cancer. Methods We used the British Columbia Hepatitis Testers Cohort (BC-HTC) which includes all individuals (∼1.7 million) tested for HCV or HIV, or diagnosed with HCV, HIV, or HBV linked with data on cancers. We included individuals tested for all three infections since 1990 and followed them from the date of their last test until the first cancer diagnosis, death, or 12/31/2015. We utilized the Fine and Grey competing risks regression model to estimate adjusted sub-distributional hazard ratios (aHRs) for outcomes, with death as a competing risk. Results Among 514,501 individuals tested for all infections, 12,586 had any cancer (2.45%), 100 had anal cancer (0.02%), 552 had NHL (0.11%), and 1,081 had liver cancer (0.21%) during a median follow-up of 4.19 years. Compared to no infection, the aHR for all cancers was the highest for HIV/HBV co-infections (HR 2.55, 95% CI: 1.91–3.42) followed by triple infections (aHR 2.29, 95% CI: 1.80–2.89). The risk of anal cancer was higher among individuals with HIV (triple infection aHR 22.61, 95% CI: 7.27–70.33), while risk of the liver cancer was higher among those with HBV or HCV mono or co-infections and triple infections. The risk of NHL was the highest among HIV/HBV co-infections followed by triple infection. Conclusion HIV, HBV and HCV infections are associated with an overall higher risk of cancer. The highest risks for anal cancer and NHL were among those living with HIV infection. The observed association between HCV and anal cancer, which may be due to the presence of human papillomavirus and/or residual confounding, requires further investigation. Disclosure No significant relationships.