Portal de Periódicos da CAPES

Speaker Abstracts

2017; International AIDS Society; Volume: 20; Issue: S2 Linguagem: Inglês

10.7448/ias.20.3.21954

1758-2652

HIV Research and Treatment

Journal of the International AIDS SocietyVolume 20, Issue S2 21954 Speaker AbstractOpen Access Speaker Abstracts First published: 20 February 2017 https://doi.org/10.7448/IAS.20.3.21954AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat O111 The promise of curing HCV as a way of improving HIV treatment: a novel strategy Carl W Dieffenbach National Institutes of Allergy and Infectious Diseases, National Institutes of Health, US Department of Health and Human Services, Rockville, MD, USA In 2008, the District of Columbia (DC) Department of Health and the NIH launched the DC Partnership for HIV/AIDS Progress, a collaborative research initiative designed to decrease the rate of new HIV infections in the city, improve the health of district residents living with HIV infection, and strengthen the city's response to the HIV/AIDS epidemic. This programme was developed to address the high level of incident HIV infections in the city using state of the art research as the tool. The initial focus was to determine the true status of disease burden in the city. To accomplish this, we created the DC Cohort, which has now collected longitudinal clinical data from approximately 8000 consented HIV-infected outpatients receiving care at 13 treatment clinics in DC. Additionally, through the HIV Prevention Trials Network, a series of clinical trials brought the current state of the art prevention research to the city residents. Combined with public health campaigns aimed at educating city residents, the city has vastly improved treatment coverage and has reduced HIV incidence. In addition, the programme has been seeking ways to better understand HIV/HCV co-infection and has sought to expand HCV treatment options for this population. Through a number of clinical studies we demonstrated how sustained HCV suppression could be reliably obtained in this co-infected population. Further we found that HCV treatment was a gateway for reaching what many public health officials believed was the most difficult population to identify and engage – dually infected people. Further work has focused on defining how best to deliver HCV treatment. The ASCEND study, launched in 2015, examined whether primary care physicians and other healthcare providers, such as nurse practitioners and physician assistants, can use a new antiviral therapy as effectively as specialist physicians to treat people with HCV infection. Validation of this task shifting provides an important piece of information as we advance our plans for HCV eradication. O112 Towards and HIV cure: a clinician's perspective Steven G. Deeks University of California, San Francisco, CA, USA Given the challenge of delivering complex, expensive and potentially harmful antiretroviral therapy (ART) on a global level, there is intense interest in the development of short-term, well-tolerated regimens that will either fully eradicate all HIV (a “cure”) or durable prevent HIV replication in absence of any therapy (a “remission”). Recent heroic interventions such as hematopoietic stem cell transplant suggest that dramatic reductions in the reservoir size can be achieved, but that complete eradication will be challenging. Also, failure to eradicate on HIV is associated with risk of delayed rebounds in viremia, which can have detrimental effects to the HIV-infected person and his or her partners. Most experts agree that a remission will be easier to achieve than a complete cure. Enthusiasm for this approach is supported by observations made in “elite” controllers and perhaps the rare and still controversial post-treatment controllers. Observations from these studies suggest that a sustained remission will likely require a low reservoir size and a potent and durable HIV-specific immune response. Enthusiasm for a remission is also being driven by success using immunotherapies to reduce and control cancer cells. Cancer and HIV persistence share a number of similarities. In each case, a rare population of cells with the capacity to cause harm becomes established in difficult to reach tissues. The local environment in each case is reshaped to prevent immune mechanisms from clearing the diseased cell. Specifically, a chronic inflammatory environment stimulates and immunosuppressive response and therapies that target these immune pathways have either been very successful (in cancer) or now entering the clinic (in HIV disease). These interventions have the potential to enable successful repurposing of preventative vaccines into the HIV cure arena. Efforts to cure or durably control HIV are now entering an era of experimental medicine in which the agenda will be increasingly driven by studies performed in non-human primates and early proof-of-concept clinical studies. Recent progress in these studies will be summarized. A pathway towards testing of viable combination regimens that have the chance to achieve a durable remission will also be discussed. O121 HIV/AIDS treatment guidelines – México Juan Luis Mosqueda Gómez Ambulatory Center for Prevention and Attention of HIV/AIDS and Sexually Transmitted Diseases, Leon, Guanajuato, Mexico Guidelines for using antiretroviral agents in Mexico evolved during the past years to include efficacious, less toxic and simpler regimens. In Mexico, there is universal access to antiretroviral therapy; guidelines are based on the efficacy to get viral suppression, tolerability and toxicity profiles, posology, as well as economic factors. Currently, the preferred regimen for the initial treatment is an efavirenz-based combination, due to its demonstrated viral efficacy, in the co-formulation tenofovir/emtricitabine/efavirenz, is the only single-tablet regimen available in Mexico. This combination is also the most economical regimen. According to the results of multiple clinical trials, Mexican guidelines recommend now also integrase inhibitiors (INSTI)-based regimens as an option when efavirenz is contraindicated or not tolerated. Different factors have influenced the decision to keep INSTI-based regimens after the efavirenz-based options: (1) elvitegravir is currently not available in Mexico, with raltegravir and dolutegravir being the only available options; (2) dolutegravir is not available as a STR; and (3) INSTI-based regimens are the most expensive regimens today. As an option for initial treatment, a Darunavir-based regimen remains the only protease inhibitor-based regimen included in our guidelines. In the near future, changes are expected in our guidelines according to the upcoming availability of new STRs based on INSTIs or NNRTIs, and required changes in costs that allow the increasing use of efficacious, tolerable and easy to use regimens, without threatening the sustainability of a universal access programme. O122 HIV/AIDS guidelines on cART – the Brazilian perspective Adele Schwartz Benzaken Brazil AIDS Programme, Rio de Janeiro, Brazil Brazil has recently incorporated dolutegravir (DTG) in both first and third line ART regimens in the Brazilian Unified Health System (SUS). Darunavir use was also extended as a preferable protease inhibitors (PI) in the second line, alongside its use in the third line. TDF/3TC/DTG is the preferable scheme for people living with HIV/AIDS (PLWHA) starting in 2017. TDF/3TC/EFZ is chosen for pregnant women and TB-HIV co-infection, without criteria of severity. PLWHA with tuberculosis can undergo TDF/3TC/RAL scheme whenever one of the conditions are presented: CD4 <100 cells/mm3, concomitant opportunistic infection, need of hospitalization/serious illness or disseminated TB. Regimens containing EFV are the initial choice for cART in cases of intolerance or whenever DTG is contraindicated. The safe use of ABC is corroborated by the incorporation in the SUS of the HLA B*5701 test. For the PI, ATV is the preferred one, followed by DRV and LPV, all boosted with ritonavir. The innovation is that DRV, previously administered to PLWHA with multiple ARV schemes exposures, can be used in the second line regimens. The Brazilian policy on cART poses challenges still to be solved: (i) the use of raltegravir for late presenter pregnant women living with HIV/AIDS, (ii) drug switch (phase out of nevirapine, fosamprenavir, indinavir, lopinavir and saquinavir) and (iii) new paediatric formulations (DTG). Implementing these guidelines and policies takes into account national budget and new ART, considering cost in the long run and its sustainability as a public health policy. O123 ARV guidelines in Argentina Carlos Zala HIV/AIDS Programme, Buenos Aires, Argentina Antiretroviral therapy in Argentina is free of charge to all eligible HIV infected individuals seeking for HIV care. According to current local guidelines, ARV treatment should be offered to subjects with a confirmed HIV infection regardless their CD4 T cell count. As of December 2016, approximately 50,000 PLWH were receiving ARVs through the National Programme. An additional 20,000 were being covered by the social security and private sector. At the three healthcare sectors, there are ARVs available within the four mayor drug classes, including generics drugs of nucleosides, non-nucleosides and protease inhibitors. The choice of an initial regimen is requested at the Programme by a registered physician within the available options recommended by the Argentinean Society of Infectious Diseases. Accordingly, an NNRTI, or boosted ritonavir protease inhibitor, or integrase inhibitor in combination with two analogue nucleosides are within the available regimens. A national wide survey has recently showed an increase number of primary HIV resistance, mainly to the NNRTIs. Figures close to the 10% prompted to the HIV/AIDS Programme to make available resistance testing prior to initiation of ARV therapy to subjects willing to start an efavirenz based regimen. The need of implementing timely results of resistance testing to newly HIV infected individuals across the country imposes a formidable challenge to the healthcare system. In this scenario, widely access to affordable new drugs, that is integrase inhibitors, should be considered. O131 Treatment of hepatitis C: “where are we now?” Mário Guimarães Pessoa University of São Paulo School of Medicine, São Paulo, SP, Brazil In this lecture, we are going to talk about the management of patients with chronic HCV infection in this new era of highly effective direct-acting antivirals (DAAs). We came from a time of SVR rates of around 60% in the former difficult to treat genotype 1 patients with a poor tolerance to interferon treatment, to achieving a cure in more than 95% of them with few adverse events, with only 12 weeks of treatment in the majority of patients. Patients naïve to treatment with mild fibrosis and low viral load can even be treated with a shorten regimen of 8 weeks. Genotype 3 HCV infection is now the more difficult to cure, especially in patients with cirrhosis, but new combinations of DAAs are under development and we had the opportunity to see very good preliminary results in this population presented at the last AASLD meeting. Most of Latinamerican countries are prioritizing treatment only for patients with advanced liver disease, for budgetary reasons, but we expect in the near future to see more and more patients achieving the cure of this life-threatening infection, before becoming at high risk of hepatocellular carcinoma. O132 Retreatment of patients failing AAD therapy in Spain in a real life setting: updated results from the HEPCREsp GEHEP004 cohort Ana Belen Perez1; Natalia Chueca1; Jose Angel Fernandez Caballero1; Miguel Garcia-del Toro2; Juan Manuel Pascasio3; Francisco Tellez4; Juan Antonio Pineda5; Francisco Vera6; Antonio Collado7; Juan Carlos Alados8 and Federico Garcia1, on behalf of the GEHEP-004 Group 1Clinical Microbiology, Hospital Universitario San Cecilio, Granada, Spain. 2Hospital General, Infectious Diseases, Valencia, Spain. 3Hepatology, Hospital Virgen del Rocio, Sevilla, Spain. 4Infectious Diseases, Hospital Puerto Real, Cadiz, Spain. 5Infectious Diseases, Hospital de Valme, Sevilla, Spain. 6Infectious Diseases, Hospital Cartagena, Cartagena, Spain. 7Infectious Diseases, Hospital Torrecardenas, Almeria, Spain. 8Clinical Microbiology, Hospital de Jerez, Clinical Microbiology, Cadiz, Spain Introduction and aims: To describe the virological characteristics of patients failing approved DAA regimens in ithe HCVREsp-GEHEP004 Cohort in Spain, how they have being retreated and how were efficacy rates of retreatment. Methods: HCVREsp-GEHEP004 is a prospective multicentre cohort enrolling HCV infected patients treated with IFN-free DAA regimens at discretion of the investigators. Population-based sequencing of HCV NS3, NS5A and NS5B genes was performed. After receiving a comprehensive resistance interpretation report, the retreatment regimen was chosen. Results: HCVREsp includes 5521 patients treated with DAAs across Spain. Data of 277 failing patients (GT-1a (n = 96), Gt-1b (n = 81), GT-3a (n = 60), GT-4a (n = 9), GT-4d (n = 31)) are shown. Patients had failed SOF/SIM (18.8%), SOF/DCV (18.4%), SOF/LDV (42.2%) or paritaprevir/ombitasvir ± dasabuvir (15.2%). Patients failing SOF/SIM developed RASs in NS3 in 74% of the GT1a infected patients and 52% of the GT1b, being RASs in position 168 the most prevalent. To date, 41/53 patients failing SOF/SIM have been retreated, 39 with Harvoni and 25 have reached 12 weeks post end of treatment: 22 patients (88%) have achieved SVR12. Almost all the patients failing SOF/DCV showed NS5A RASs, being Y93H highly prevalent in GT-1b (77.8%) and GT-3a (75.0%); to date, 22/48 patients failing SOF/DCV have been retreated, 11 have reached 12 weeks post end of treatment: 7 patients (58%) have achieved SVR12. Patients treated with SOF/LDV also showed a high prevalence of Y93H at failure, especially GT-1b (81.0%), in contrast to GT-3a infected patients (only 11.7% prevalence); of note, three GT-4 patients failing SOF/LDV harboured S282T. To date, 52/112 patients failing SOF/LDV have been retreated, 42% with SOF/SIM, 21 have reached 12 weeks post end of treatment: 18 patients (86%) have achieved SVR12. Most patients treated with 2D/3D developed RASs, and 14.2% showed RASs against the three drugs; almost a half of the patients failing 3D/2D (7/16) have been retreated. Conclusions: Genotype 1a and 1b patients failing DAAs in Spain harbour a high prevalence of RASs, especially in NS5A. Genotype 3 patients failing SOF/LDV are less prone to develop NS5A RASs than SOF/DCV failures. Retreatment of Sof/DCV failing patients was more difficult than SOF/LDV or SOF/SIM, with lower rates of SVR12. Resistance testing may help to guide the retreatment option. O133 Increased age-adjusted mortality and incidence of non-AIDS defining events among people living with HIV enrolled after 50yo and aging in care in Latin America. A CCASAnet cohort study Pablo F Belaunzaran-Zamudio1; Yanink Neried Caro-Vega1; Brenda Crabtree-Ramirez1; Bryan Shepherd2; Fernando Mejía3; Mark Giganti4; Beatriz Grinsztejn5; Marcelo Wolff6; Jean W Pape7; Denis Padgett8; Catherine Mc Gowan9 and Juan Sierra-Madero1 1Department of Infectology, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, Mexico City, Mexico. 2Department of Biostatistics, Vanderbilt University, Nashville, USA. 3Infectious Disease Clinic, Universidad Peruana Cayetano Heredia, Lima, Peru. 4Biostatistics Department, Vanderbilt University, Nashville, TN, USA. 5Instituto de Pesquisa Clínica Evandro Chagas, Fundacão Oswaldo Cruz, Rio de Janeiro, Brazil. 6Department of Infectious Diseases, Fundacion Arriaran, Santiago de Chile, Chile. 7Integrated Care Center and Research Institut, Les Centres GHESKIO, Port-au-Prince, Haiti. 8Department of Infectious Diseases, Hospital Escuela Universitario, Tegucigalpa, Honduras. 9Department of Medicine, Vanderbilt University, Nashville, TN, USA. Introduction: The proportion of people living with HIV (PLWH) older than 50 years is increasing in our region. The growth of this population will increase demands on healthcare systems as comorbidities are expected to rise. This study aims to quantify the frequency of non-AIDS associated comorbidities (NADEs) amongst aging people receiving care for HIV in CCASAnet centres between 2000 and 2015. We also explored whether the incidence of NADEs differs by age at enrolment (<50 years old (yo) and ≥50 yo) in patients of similar age. Methods: We selected HIV-infected adults between 50 yo and 65 yo receiving care in CCASAnet cohort centres between 2000 and 2015. We divided participants in two groups based on age at enrolment in care (<50 and ≥50 yo). We compared mortality between both groups and estimated the frequency of NADEs (cardio- and cerebro-vascular diseases, type 2 Diabetes mellitus “DM2,” hypertension and non-AIDS-related neoplasias) in each group using Kaplan–Meier (KM) curves. We used inverse probability weights techniques and stratification by age-group to adjust for confounders and selection bias. We adjusted by gender, route of transmission, time since diagnosis to art, CD4 count at 50 and age. Results: 4788 patients over 50 years from seven Latin American countries were included. People enrolled in care ≥50 yo (n = 2010, 42%) had a significantly higher crude and adjusted mortality than those <50 yo at enrolment (n = 2788, 58%) (Figure 1). Follow-up information on clinical events was collected for only 2937 patients. Amongst those, there was a higher incidence of DM2, cardiovascular events and non-AIDS-related neoplasias in people enrolled ≥50 yo when compared with those enrolled <50 yo (Figure 2). A high number of diabetes and other events were diagnosed right after enrolment in care in patients enrolled after 50 yo. Conclusions: PLWH enrolled in care in CCASAnet sites after 50 yo have an increased age-adjusted mortality, and incidence of NADEs than those reaching 50 yo in care. In addition to prevalent comorbidities at 50 yo or at enrolment in care after 50 yo, a large proportion of PLWH receiving care in our sites develop chronic NADE while in care. Higher incidence of Non AIDS related morbidity in patients enrolled after 50 yo may reflect a lack of clinical care in this population and the need of planning provision for complex, primary care for adults living with HIV older than 50 yo in our region. Abstract O133–Figure 1. Comparison of the probability of the 10-year survival since 50 yo cohort enrolment by group (<50 vs ≥50 yo) in patients younger than 65 at end of follow-up, adjusted for site, gender, route of transmission, time since diagnosis to art, CD4 count at 50 and age. Abstract O133–Figure 2. Comparison of the probability of NADE event after 50 yo cohort enrolment by group (<50 vs ≥50 yo) in patients younger than 65 adjusted for site, gender, route of transmission, time since diagnosis to enrol, CD4 count at 50 and age. O142 The 90s in the Americas: treatment Pedro Cahn Fundación Huésped, Buenos Aires, Argentina The number of persons on antiretroviral treatment in Latin America and the Caribbean continues to increase, reaching an estimated 1.1 million persons at the end of 2016. This indicates that 55% (47–64%) of all persons living with HIV in LAC are receiving lifesaving treatment. In addition, the percentage of all children living with HIV (0–14 years) on ART is estimated to be 64% (54–76%). Pregnant women receiving ARVS to prevent MTCT, represent 88% (77–95%) of the PW living with HIV. Countries in the region have adhered to the 90-90-90 targets. An additional target of reducing late diagnosis (<200 CD4 cells/mm3) below 10% amongst newly diagnosed individuals was also included. Unfortunately, 35% of new cases were diagnosed late in the course of the infection. In 2013, 79% of patients on first-line were being prescribed a WHO-recommended regimen (preferred or alternative). In 2013, 31% of patients on first-line were using the WHO preferred EFV-based regimen. What are the obstacles to reach the third 90? Of course being far behind the first two nineties is the main issue. Socioeconomic context is not favourable at all, as unemployment is raising in many countries, which implies losing the social security protection. Also housing deficits, malnutrition and cost of surface transportation to the clinics conspire against appropriate and timely periodic visits, and so adherence is at risk. Temporary stock-outs still happen in some countries, with obvious consequences. Last but not least, resistance rates, particularly related to NNRTIs, are as high as 15% in some areas, which highlight the need of obtaining baseline genotypes before first ART start and/or the substitution of efavirenz by drugs with high genetic barrier, like boosted-PIs or dolutegravir. O143 The 90s in the Americas: retention in care/adherence Carlos Beltran Latin American HIV Workshop Study Group, AIDS, Santiago, Chile According to last numbers released by UNAIDS 18.2 million of 36.7 million HIV infected people are on ART, 1.1 million of them in Latin America. This is far below the two first 90-90-90 goals to achieve 81% of all HIV infected people on ART. Testing and linkage/retention are the main gaps in fighting the epidemic, being both essential to reduce HIV transmission and prevent HIV-related morbidity and mortality. Many factors contribute to poor linkage and poor rates of enrolment in care in Latin America such as patient and sociocultural factors as well as economic and health system barriers. Poor linkage to care after diagnosis has been partially blamed for high rates of late presentation to ART in some countries. Comprehensive services including home-based testing and immediate ART initiation, integration and decentralization of healthcare provision, task shifting to trained health-care workers and lay providers to face up human resource constraints and to provide services outside the office setting and even financial incentives for patients along with social and family support and reduction of stigma and discrimination have been proposed to improve linkage to care. Prompt ART initiation and active and continuing patient education for adherence optimization as well as proactive monitoring of adherence are critical in the setting of treatment as prevention goals and to prevent resistance to ARV drugs. The above-mentioned interventions to promote linkage are also crucial for adherence, along with simplicity and safety of ARV drugs and especially quality and fluency of patient–healthcare provider relationship. Some concerns have been raised recently on adherence of adolescents and young adults who initiated ART in good health and with high CD4 counts. New strategies such as communication technologies and financial incentives may be used to increase adherence in particular settings. Linkage and retention in care require appropriate and trained healthcare teams as well as maintenance of drugs and monitoring tests supply chain. Heterogeneity in availability of this resources and even stock outs episodes are observed in the region. Ending the epidemic in Latin America will take a combination of political will, national policies, strategic planning, resources mobilization and novel, comprehensive and standardized interventions to improve testing, care and treatment. O144 The 90s in the Americas: prioritization of treatment – is it necessary? Mauro Schechter Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil In 2014 the UNAIDS launched the 90-90-90 initiative, with a view to help end the AIDS epidemic. Its ambitious goals were that, by 2020, 90% of all people living with HIV would know their serostatus, 90% of all people diagnosed with HIV would be receiving antiretroviral therapy (ART), and 90% of all those on ART would be virally suppressed. Irrespective of the capacity of individual countries to achieve these goals, this initiative provided useful metrics for national programmes to monitor their progress towards universal access to treatment. Optimization of limited and often scarce material and human resources is of paramount importance to achieve the UNAIDS goals. Thus, targeted testing through knowledge of local characteristics of the epidemic and of key affected populations, strengthening of referral systems, identification of patients in more urgent need of care, and improvement of acceptance, adherence and retention in care are some of the issues that need to be addressed in order to achieve the UNAIDS targets. O211 The second decade: cashing in on evolving capacities for better outcomes Linda-Gail Bekker The Desmond Tutu HIV Centre, Cape Town, South Africa The African continent is currently undergoing a youth bulge. It is estimated that by 2030, one in every four individuals will be African, the vast majority of them under the age of 35 years (You et al., 2014). However, over 40% of all new HIV infections occur amongst youth and 85% of young people living with HIV live in Sub-Saharan Africa (Idele et al., 2014). Adolescents and young adults are at increased risk of HIV infection due to the many developmental, psychological, social and structural transitions that take place in this period of the life course, yet engaging and retaining adolescents actively in healthcare promotion and provision is challenging in every setting worldwide. Adolescent girls and young women (AGYW) are particularly effected and in South Africa young women are 4–6-fold more likely to be HIV infected than their male counterparts. Huge success in ARV treatment worldwide has allowed more people to live productive lives with HIV and initiation of treatment early has shown to significantly reduce transmission. The Adolescent population, however, struggles to cope with an HIV diagnosis and often gains that are made during paediatric treatment may be lost in adolescence. To tackle the challenges of care and treatment as well as primary and secondary prevention in this critical age group, we desperately need integrated and tailored programmes that are adolescent-friendly and that incorporate biomedical, structural and social interventions. References 1You D, Hug L, Anthony D. Generation 2030 I Africa. UNICEF Division of Data, Research, and Policy. August 2014. 2Idele P, Gillespie A, Porth T, Suzuki C, Mahy M, Kasedde S, Luo C. Epidemiology of HIV and AIDS among adolescents: current status, inequities, and data gaps. J Aquir Immune Defic Syndr. 2014; 66(Suppl 2): S144– 53. O233 PrEP: unseen benefits of PrEP programmes Florentino Badial Hernandez Clínica Especializada Condesa Iztapalapa, Mexico City, Mexico In Latin America, PrEP should be offered to populations with higher HIV prevalence: men who have sex with men (MSM) and transgender women (TGW). The largest gap in the region's HIV care continuum is between those living with HIV and those who are unaware of their status. Therefore, it is expected that a high proportion of MSM and TGW who seek PrEP test positive in the baseline serology. In order to bring these newly diagnosed individuals to virologic suppression a test-and-treat strategy with proper linkage-to-care is necessary. PrEP programmes should collaborate with diagnostic and counselling services and with HIV care facilities. This could impact HIV incidence not only by offering antiretrovirals to high-risk negative individuals but also – and maybe even more – by contributing in diagnosing and linking to care previously undiagnosed HIV-positive individuals (treatment as prevention). Diagnosis algorithm should incorporate new point-of-care technologies capable of identifying acute HIV infections. PrEP programmes should develop specific strategies for hard-to-reach populations and their comorbid behavioural disorders that may interfere with PrEP adherence. Furthermore, linking PrEP users to combination prevention services could reduce the risk of acquiring HIV through counselling, condom distribution, STD diagnosis and treatment services, harm reduction and substance use programmes, mental health services and also through interventions that address socioeconomic and other structural factors that influence HIV transmission. In order to achieve all the potential benefits of PrEP, strong leadership is needed from the public health, behavioural and social sciences fields both in implementation and in research projects. O314 Treatments for hepatitis C through the Brazilian Unified Health System (SUS) Adele Schwartz Benzaken Ministry of Health, Brasilia, Brazil In 2016, the Ministry of Health (MoH) of Brazil provided 36557 treatments for hepatitis C through the Brazilian Unified Health System (SUS), achieving the highest number of patients in the past years. This accomplishment represents a milestone in the financial negotiations of Brazilian government with pharmaceutical companies to obtain over 30% discount for daclatasvir, simeprevir and sofosbuvir. Since the introduction of the new direct-acting antiviral agents for hepatitis C in October 2015 with the implementation of the new Guidelines for hepatitis C and coinfections, the MoH will have provided 50204 treatments for 12-week and 24-week course of treatment by the end of March 2017. The preliminary analysis of treatment effectiveness in Brazil showed that patients with hepatitis C genotype 1 achieved a cure rate of 97%. Based on results o