gone through LTC; 503 HCV RNA positive patients referred (39% self-referred and 61% referred from 27 facilities in 19 states; 88% Texas); 57% were uninsured; 52% were between the ages of 21-40; 51% males. 398 (80%) patients were contacted by LTCS; 249 (70%) referred to a medical provider; 28% patients awaiting lab results; 2% lost contact. Patients were contacted by a LTCS within 48 hours after referral and twice before scheduling their first clinic appointment. 116 (47%) patients made it to their first appointment; 69 (60%) initiated HCV therapy; 40% were completing evaluation; 11 (16%) have finished HCV therapy; 92% were seen in office vs. 8% through telemedicine. Additionally, 47% of patients were from sober living homes, 47% from addiction treatment facilities and 6% from medical clinics. CONCLUSIONS: Linkage to care is the missing link in treatment of chronic HCV. Our study accentuates a promising role for PWID patient engagement in electronic portals and LTCS as a tool in linking patients to the HCV care cascade. Hence, continued efforts are needed to increase and improve HCV patient electronic health engagement. Mo1383 UNTREATED HCV IN HIV/HCV CO-INFECTION; DATA FROM THE TRIO NETWORK Dushyantha Jayaweera, Keri Althoff, Joseph J. Eron, Gregory Huhn, Scott Milligan, Anthony Mills, Graeme Moyle, Steven Santiago, Paul Sax, Gene Voskuhl, David L. Wyles, Rick Elion BACKGROUND AND AIM Per AASLD-IDSA guidelines, treatment of hepatitis C should be prioritized in patients co-infected with HIV and hepatitis C virus (HCV). This recommenda- tion is based on a higher rate of HCV disease progression in this population, along with reported treatment responses comparable to HCV mono-infected patients. However, in clinical practice many patients with HIV/HCV co-infection do not receive HCV treatment. In this study, we characterize HIV/HCV co-infected populations who were not treated for HCV. METHODS Data were extracted from the electronic medical records of 1303 HIV/ HCV co-infected patients who were in care between Jan 2014 and Sep 2017 at 5 large US- based HIV treatment centers. Co-infection was confirmed by antibody-based test or RNA detection for HIV and detection of HCV RNA (HCV viremia). The primary outcome was initiation of DAA treatment. However, in a subgroup analysis we evaluated all participants who were not prescribed DAA or did not start their regimen over a minimum of 90 days follow up from the last HCV measure. Bivariate analysis was performed to assess demographic and clinical factors associated with DAA prescription and initiation. Baseline measures were relative to DAA treatment or to the last detected HCV viral measurement. RESULTS Of 1303 co-infected patients with detectable HCV, 648 (50%) were not prescribed DAA. Of the 655 (50%) patients who were prescribed DAA, 86 (13%) did not initiate treatment. Baseline characteristics of these groups are provided in the TABLE. Measures appropriate for DAA selection, such as Fibrosis staging and HCV genotype, were sparsely recorded in patients who were not prescribed or prescribed but did not start therapy. Variables significantly associated with not being prescribed DAA include younger age, non-Hispanic, active drug or alcohol drug use, lower baseline ALT, lower baseline CD4 counts, and baseline HIV >200 copies/ml. Variables associated with non-starts after prescription include younger age, white, lower baseline HCV viral load, lower baseline ALT and AST, and patients with FIB-4<3.25. CONCLUSIONS In this large US database, 56% of co-infected patients remain untreated for HCV and those with uncontrolled HIV (high HIV RNA and/or low CD4 cell count) or active alcohol or drug use were less likely to be prescribed HCV therapy. In contrast to prior TRIO studies, payer type was not associated with non-start of therapy. TABLE: Distributions of patients within groups by patient and disease characteristics. Mo1384 REAL-WORLD EXPERIENCE WITH LEDIPASVIR/SOFOSBUVIR COMBINATION AND SOFOSBUVIR/VELPATASVIR COMBINATOIN IN PATIENTS WITH CHRONIC HEPATITIS C GENOTYPE 6 PATIENTS IN THE UNITED STATES Emily Nguyen, Sam Trinh, Huy N. Trinh, Khanh Nguyen, Brian Levitt, My Nguyen, Treta Purohit, Eugenie Shieh, Mindie H. Nguyen Background and Aims: Genotype 6 (GT 6) is a rare sub-type of hepatitis C virus (HCV) that has been underrepresented in the interferon- and ribavirin-free all oral acting agents (DAA's) treatment clinical trials, limiting the generalization of results. A newer DAA combina- tion was recently approved for treatment of HCV GT 6. Therefore, the study's aim was to compare sustained virologic response (SVR-12) rates between DAA ledipasvir (LDV)/ sofos- buvir (SOF) and the newest approved DAA, SOF/ velpatasvir (VEL), for treatment naive, S-1189 AASLD Abstracts cirrhotic, and non-cirrhotic GT 6 patients. Method: Consecutive adult patients with HCV GT 6 (n=148) who were treated with LDV/SOF (n=99) or SOF/VEL (n=49) from 2014- 2017 at two community clinics in the United States were analysed. All the patients in the SOF/VEL group were treated for 12 weeks. Of the 99 patients in the LDV/SOF group, 5 patients were treated for 8 weeks, 91 patients for 12 weeks, and 3 patients for 24 weeks. Two patients treated with LDV/SOF/RBV were included in the LDV/SOF group and one patient treated with SOF/VEL/RBV was included in the SOF/VEL group. After excluding patients who did not have SVR-12 data, patients with hepatocellular carcinoma (HCC), and/ or prior treatment, the LDV/SOF group had 73 patients and the SOF/VEL group had 33 patients. Patients in the prior treatment group (n=8) who were excluded from the primary analysis were analysed separately. Results: Overall, the mean age was 63.3±10.2 years, 67% male, 94% Vietnamese, and 97.3% GT 6 and 2.7% GT 6c (all in the LDV/SOF group). In the SOF/VEL group, 5.1% reported headache (n=5), 2.0% reported fatigue (n=2), 4.0% reported insomnia (n=4), and 3.0% reported other (n=3). In the SOF/VEL group, 2.0% reported fatigue (n=1), and 2.2% reported other adverse events (n=1). There was a higher percentage of cirrhotic patients (47.5% (n=47) in the LDV/SOF cohort than the SOF/VEL cohort (16.3%, p<.001 (n=8). Overall, 94.5% of LDV/SOF cohort achieved SVR-12 compared to 100% of the SOF/VEL cohort. Among the non-cirrhotic patients, 94.9% of LDV/SOF cohort achieved SVR12 compared to 100% of the SOF/VEL cohort. Among patients with cirrhosis, 94.1% of the LDV/SOF achieved SVR-12 compared to 100% of the SOF/VEL cohort. Among the prior treatment group, all received LDV/SOF and achieved a SVR-12 of 87.5%- surprising all prior treatment cirrhotic patients (n=2) achieved SVR-12 (100%) while the prior treatment group non-cirrhotic obtained an SVR-12 of 83.3%. (Table) Conclusion: Real world experience with the use of LDV/SOF and SOF/VEL in GT 6 treatment-naïve non- cirrhotic and cirrhotic patients follows closely to the results reported from the respective clinical trials. Therefore, treatment and cure options for those with HCV GT 6 have expanded and should be considered when treating this cohort of patients. Table: SVR12 for Genotype 6 Patients Mo1385 FAVORABLE SUSTAINED VIROLOGIC RESPONSE RATES USING DIRECT- ACTING ANTIVIRAL THERAPIES AT A LARGE SAFETY NET HOSPITAL Andrew Bryant, Avash Kalra, Angela Keniston, Aimee Truesdale, Alvaro Martinez- Camacho Introduction: Direct-acting antivirals (DAA) have revolutionized the treatment of chronic hepatitis C virus (HCV) infection. All of the randomized, registered clinical trials that assessed the rate of sustained virologic response (SVR) were performed in a structured research environment. Real world experience with DAA demonstrated an acceptably high rate of SVR in large health care systems. However, data regarding the rate of SVR using DAA in a safety net hospital population are lacking. Methods: A retrospective cohort study was performed including 174 patients who received at least one dose of DAA therapy for chronic HCV infection from 1/1/15 to 9/30/16 at Denver Health Hospital and Authority. Patients were prescribed DAA in accordance with contemporary societal recommendations by a provider with hepatology training after a face-to-face clinical assessment. State Medicaid-mandated restrictions included a minimum of stage 3 fibrosis for treatment eligibility during this era. Sociodemographic factors, baseline lab values, as well as indicators of disease severity were collected for analysis. Cirrhosis was defined by biopsy, imaging and laboratory data, or clinical impression of the hepatologist. The primary outcome was rate of SVR defined as undetectable viral load at least 12 weeks after treatment termination. Lack of SVR data was coded as a treatment failure. Compliance with the treatment plan, as defined by completion of treatment on time without premature discontinuations and post-treatment week 12 lab data, was also assessed. Multivariate analyses were performed to assess factors associated with the primary outcome. Results: The average age was 60 years and included a large proportion of ethnic/racial minorities (58%), an average FIB-4 score of 3.40, 49% were considered to have cirrhosis, and many relied on Medicaid or no insurance (34%) for treatment. Genotype 1 infection was most common (77%) and 29% of patients were treatment experienced. Overall, SVR was achieved in 87% which included 15 patients that were lost to follow up (assumed failures). Compliance with the treatment plan was noted in 87% of patients. In this sub-population SVR was achieved in 95%. The rate of SVR for other subgroups is shown in the figure. No covariate (age, gender, race/ethnicity, genotype, treatment experience, FIB-4, cirrhosis, and hepatic decompensation) was associated with a lower probability of SVR in multivariate analysis. Conclusion: A favorable rate of SVR can be obtained in a safety net hospital that included a large proportion of underinsured patients who had advanced fibrosis or cirrhosis. The failure to achieve SVR was mostly due to lost to follow up status despite a pre-treatment assessment for compliance. Reducing the preva- lence of HCV infection in our population will require elimination of state Medicaid restrictions to treatment. AASLD Abstracts