Microelimination or Not? The Changing Epidemiology of Human Immunodeficiency Virus-Hepatitis C Virus Coinfection in France 2012–2018

Background

The arrival of highly effective, well-tolerated, direct-acting antiviral agents (DAA) led to a dramatic decrease in hepatitis C virus (HCV) prevalence. Human immunodeficiency virus (HIV)-HCV–coinfected patients are deemed a priority population for HCV elimination, while a rise in recently acquired HCV infections in men who have sex with men (MSM) has been described. We describe the variations in HIV-HCV epidemiology in the French Dat’AIDS cohort.

Methods

This was a retrospective analysis of a prospective cohort of persons living with HIV (PLWH) from 2012 to 2018. We determined HCV prevalence, HCV incidence, proportion of viremic patients, treatment uptake, and mortality rate in the full cohort and by HIV risk factors.

Results

From 2012 to 2018, 50 861 PLWH with a known HCV status were followed up. During the period, HCV prevalence decreased from 15.4% to 13.5%. HCV prevalence among new HIV cases increased from 1.9% to 3.5% in MSM but remained stable in other groups. Recently acquired HCV incidence increased from 0.36/100 person-years to 1.25/100 person-years in MSM. The proportion of viremic patients decreased from 67.0% to 8.9%. MSM became the first group of viremic patients in 2018 (37.9%). Recently acquired hepatitis represented 59.2% of viremic MSM in 2018. DAA treatment uptake increased from 11.4% to 61.5%. More treatments were initiated in MSM in 2018 (41.2%) than in intravenous drug users (35.6%). In MSM, treatment at the acute phase represented 30.0% of treatments in 2018.

Conclusions

A major shift in HCV epidemiology was observed in PLWH in France from 2012 to 2018, leading to a unique situation in which the major group of HCV transmission in 2018 was MSM.

Clinical Trials Registration. NCT02898987.

1029. Outcome of Candida Graft Vascular Infection: Results From a Prospective Cohort

Background

Candida graft vascular infections (CGVI) are rare events and little data are available in the literature. The aim of this study was to describe the characteristics and outcome of patients admitted for fungal graft vascular infections, in a reference center for CGVI treatment.

Methods

Patients admitted for a CGVI in our center from 1 January 2000 to 1 February 2018 were prospectively included. Clinical, biological, and outcome data were recorded.

Results

Two hundred patients were admitted with graft vascular infections (GVI) in our center, and 11 of them (6%) presented CGVI. They were mainly men (7; 64%), and median age was 74 years old [min–max: 39–83]. All patients had benefited from prosthetic bypass surgery prior to CGVI, and infection was considered as an early disease in six patients (55%). Candida albicans was found in 72% of cases. Infection was plurimicrobial in 10 patients (92%), involving Staphyloccocus aureus in only one case and Bacille gram negatif in six (55%) cases. The management consisted in a total or partial graft replacement for five patients (45%), and surgical revision was required in four of them (30%). The empirical antifungal therapy included an echinocandin (Caspofungine) for eight patients (73%), and was changed to fluconazole or voriconazole according to antifungigram. Two patients received Amphotericin B therapy, complicated by acute kidney injury. Intensive care unit admittance was required for nine patients (82%). After the curative treatment period, antifungal therapy could not be removed in two patients and was long-continued using fluconazole. Finally, six patients (55%) died, all within the year after CGVI.

Conclusion

To our knowledge, we report here the biggest CGVI cohort. CGVI resulted in very high morbidity and mortality, requiring ICU admission for a long time. Despite multidisciplinary management involving anesthesiologists, surgeons, intensive care, and infectious disease physicians, outcome of CGVI patients remains poor.

Disclosures

All authors: No reported disclosures.

2141. Characteristics and Prognosis of Patients with a Prosthetic Vascular Graft Infection (PVGI): A Prospective Cohort of 200 patients

Background

The aim of the present study was to describe the characteristics and prognosis of patients admitted for a PVGI and to assess the factors associated with the death of these patients.

Methods

All consecutive patients admitted in our department between January 1, 2000 and January 1, 2018 for a PVGI were enrolled in the present prospective cohort study. PVGIs were divided into extracavitary (femoro-femoral, femoro-popliteal and axillo-femoral) and cavitary (aorto-iliac, aorto-femoral, ilio-femoral, aortic); into “early” infection (<4 months) and late. Patients’ baseline characteristics and their follow-up were described, and factors associated with death were assessed by using a logistic multivariate regression model.

Results

Overall, 200 patients were included during this period. The median age of patients was 69 years [IQR: 61–78], mainly of men (86%). One hundred and sixteen patients had an intracavitary PVGI (58%). Enterobacteriaceae and MSSA were the most frequent pathogens (n = 60 and 59), followed by coagulase negative staphylococci (n = 30), Streptococcus (n = 26) and enterococcus (n = 25). Surgery with replacement of the infected prosthesis was performed in 102 patients (53%). Culture of material samples taken during surgery were plurimicrobial in 67 patients (34%). After surgery, the median follow-up of patients was 7.5 months [IQR: 2–19] during which 30 presented a failure (15%) and 85 patients died, 41 due to the PVGI (21%). Factors independently associated with death in multivariate analysis were: to be over 70 years old (OR = 8.2; P < 0.01), to stay in ICU for more than 6 days (OR = 5.9; P = 0.01) and to have an intracavitary PVGI (OR = 9.0; P = 0.02). Antibiotic therapy regimen combining rifampicin to another antibiotic was associated with a decreased mortality (OR = 0.11; P < 0.01).

Conclusion

Our results suggest that the prognostic of patients admitted for PVGI depends on the site of infection and the occurrence of a shock after the admission. We found a better prognosis for patients with an extracavitary PVGI, without sepsis. Finally, PVGI treated with an antibiotic combination including rifampicin had a better outcome.

Disclosures

All authors: No reported disclosures.

Imported malaria in pregnant women: report from a French University Centre

OBJECTIVE

To describe malaria during pregnancy outside endemic areas.

MATERIALS AND METHODS

We retrospectively reviewed all cases of imported malaria during pregnancy, diagnosed over a 11-year period in a French hospital.

RESULTS AND CONCLUSION

We recovered 18 cases, all from sub-Saharan countries. The infection could appear distantly from arrival in France (up to 36 months), was asymptomatic in 3 cases, with anemia being the most common marker of infection (n = 14). The adverse consequences for the fetus (n = 3) or the newborn (n = 4) were frequent. Physicians should be aware of these atypical presentations in order to anticipate the diagnosis and improve the maternal and fetal prognosis.