1. Abstract MOAB0301
Hepatitis C Care Cascade for People Living With HIV in the Country of Georgia
Nikoloz Chkhartishvili1, A. Abutidze1, N. Bolokadze1,
O. Chokoshvili1, N. Dvali1, L. Sharvadze1,2, T. Tsertsvadze1,2
1Infectious Diseases, AIDS and Clinical Immunology Research Center
2Ivane Javakhishvili Tbilisi State University

2. Disclosure
No conflicts of interest to declare

3. Georgia GEORGIA Area: 69,700 km2 Population: 3.7 million
Armenia
Turkey
Russia
Azerbaijan
Black Sea
Area: 69,700 km2
Population: 3.7 million
GNI per capita: $4,160
Upper-middle income economy

4. HIV and HCV Epidemiology in Georgia
HIV Epidemiology
2015 Population Survey
Estimated adult HIV prevalence: 0.4% %
Estimated number
anti-HCV+
7.7%
HCV RNA+
5.4%
New HIV Cases by Transmission Mode
HCV prevalence among PLHIV: 34%
End-stage liver disease due to HCV is
second leading cause of death in PLHIV
Baliashvili D et al. Abstract THU-203; EASL AIDS Health Information System, Infectious Diseases, AIDS and Clinical Immunology Research Center

5. Access HCV Treatment in Georgia
Free PEG/RBV for
HIV/HCV co-infected
Free PEG/RBV
for prisoners
60% price reduction on
PEG/RBV for general public
National Hepatitis C
Elimination Program
TREAT ALL

6. Objective
Evaluate engagement across the HCV care continuum among people living with HIV in Georgia

7. Methods Population: Data source: Stages of cascade: Estimated numbers
Adult (age ≥18 years) HIV-infected individuals known to be alive by September 1, 2016.
Data source:
National AIDS Health Information System (AIDS HIS)
Stages of cascade:
HIV/HCV co-infected (estimated)
Diagnosed both for HIV and HCV
Treated for HCV infection
Achieved sustained virologic response (SVR)
Estimated numbers
Spectrum/EPP software was used to estimate PLHIV
Estimated HIV/HCV co-infection was calculated using observed HCV prevalence and Spectrum derived estimate of PLHIV

8. Standard of HCV Care anti-HCV screening at the entry into HIV care
HCV RNA testing for anti-HCV+
HCV genotyping and liver fibrosis assessment for HCV RNA+
HCV Treatment
: PEG/RBV for 24 or 48 wks
: SOF/PEG/RBV for 12 wks SOF/RBV for weeks
present: LDV/SOF ± RBV for 12 or 24 wks
ART regardless of CD4 cell count for HIV/HCV since 2013

9. HCV Care Cascade
n=3300
n=1099

10. HCV Care Cascade n=3300 58% n=1921 not aware of HIV status n=1099 9%
n=280 diagnosed for HIV but not for HCV
n=1099 diagnosed both for HIV and HCV

11. HCV Care Cascade
n=3300
n=1099
n=697

12. HCV Care Cascade n=3300 366 PEG/RBV 277 DAAs
54 PEG/RBV retreated with DAAs
n=1099
n=697

13. HCV Care Cascade
n=3300
n=1099
n=697
n=480

14. HCV Care Cascade n=3300 n=1231 (38%) n=857 (26%) n=642 n=1099 (19%)

15. Treatment Outcomes of PEG/RBV (Dec 2011 – May 2015)
420 HIV/HCV Co-infected Patients Started on PEG/RBV
EOT: 217 Patients
33 relapsed
203 patients discontinued
108 non-responders
53 severe side effects
42 self-discontinued
184 SVR
Overall SVR rate = 44%

16. Treatment Outcomes of DAA Regimens (Jun 2015 – Sep 2016)
296 88
110 98
109 30 13 66 82 20 50 12
101 37 45 19
331
134 99
125 36 23 95 60
107 38 49
Data for 4 genotype 4 patients not shown

17. Strength and Limitations
National AIDS Health Information System captures information on all PLHIV diagnosed in Georgia
Limitations:
HIV/HCV positive persons might be diagnosed and treated for HCV within national elimination program without identifying HIV status
Estimation of HIV/HCV co-infected persons was based on assumption that HCV prevalence in the same is HIV diagnosed and undiagnosed

18. Conclusions
The major gap in the HCV care cascade is at the stage of diagnosis resulting from deficiencies in HIV diagnosis
Reducing the number of people living with undiagnosed HIV/HCV co-infection will be critical for achieving population level impact of free HCV treatment program

19. Acknowledgement
Regional AIDS Centers in Kutaisi, Batumi, Zugdidi and Sokhumi
Infectious Diseases, AIDS and Clinical Immunology Research Center