CROI 2015 Program and Abstracts

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Oral Abstracts

1987, 28% in 1992, and 12% by 2013 (p<0.001). HIV incidence estimates in 2001 were 2.1% and declined steadily to 0.16% by 2013 (p<0.001). Proportion of HIV+ individuals with viral suppression (<400 c/ml) increased steadily from 23% in 2001 to 59% by 2013 (p<0.001). Consistent with increasing viral suppression, 80% of 214 HIV+ individuals surveyed in 2013 had antiretroviral drugs detected in their sera, a marked increase from 2007 (27%) (p<0.001). The trends in improved outlook were consistent in all demographic subgroups. However, HCV in this population remained at 18-19% from 1988 until 2007 and declined only slightly to 14% by 2013. Dual HIV/HCV infection remained relatively stable (48%-52%) from 2007 to 2013. Conclusions: Over a 25-year period, JHH ED-based HIV testing evolved from describing the local epidemic to playing a major strategic role in locally controlling the epidemic. This is evidenced by declining undiagnosed HIV infection, increased use of ARVs with increasing viral suppression and a consequential decline in incidence among JHH ED patients. While causation is not directly addressed, the improvements in HIV status in this population coincide with JHH ED-based testing, while the linkage to care program is associated with increased ARV therapy. Noting only a comparative slight decrease in HCV infection in the same population underscores the potential for a causal relationship. 99 Linkage to Care and Viral Suppression Among New HIV Diagnoses, New York City, 2006-13 EllenW.Wiewel; Lucia V. Torian ; Qiang Xia; Sarah L. Braunstein New York City Department of Health and Mental Hygiene, Long Island City, NY, US Background: Since 2007, US Department of Health and Human Services (DHHS) HIV guidelines have advocated timely linkage to medical care (LTC) and progressively earlier initiation of antiretroviral therapy (ART) after diagnosis. A 2010 New York State law required LTC for consenting newly diagnosed persons. Less-immunocompromised and younger adults have historically had lower rates of LTC and viral suppression (VS). Trends in LTC and VS in New York City (NYC) can indicate provider uptake of new guidelines and whether differences in outcomes by immune status and age have been reduced. Methods: Using NYC HIV surveillance registry data as of 6/30/2014, we calculated timely LTC and VS among residents 18+ years newly diagnosed in 2006-13 who survived >91 days post-diagnosis, overall and by CD4 count and age at diagnosis. Timely LTC was defined as CD4 or viral load (VL) test 8-91 days post-diagnosis. VS was defined as VL ≤ 400 copies/mL, measured by 6, 9, and 12 months post-diagnosis. CD4 count at diagnosis was imputed from value and timing of first CD4, assuming 50-cell/year decrement, and categorized in intervals of 0-199, 200-349, 350-499, and ≥ 500 cells. Trends by diagnosis year were assessed by Cochran-Armitage and differences by CD4 and age by Chi-square. Results: Timely LTC increased overall (68% to 76%, p <0.0001) and across all CD4 intervals and all age groups <55; LTC did not change for persons ≥ 55. VS also increased overall (24% to 54% by 6 months, 32% to 65% by 9, and 36% to 69% by 12, all p <0.0001) and for all CD4 intervals and age groups. Percent VS by 12 months nearly quadrupled for persons with CD4 ≥ 350 (19% to 73%) and more than doubled for persons 18-34 (30% to 66%). Concordant with changes in guidelines, increases in LTC were steepest in 2010-11, and increases in VS escalated in 2007-8 for persons with CD4 200-349, 2008-11 for 350-499, and 2010-12 for CD4 ≥ 500 (Figure). In 2006, LTC and VS at 12 months differed across CD4 intervals and age groups ( p <0.0001). However, by 2013, differences were observed only between persons with CD4 <500 and ≥ 500.

Oral Abstracts

Conclusions: Timely LTC and VS increased over the entire period (2006-13) among persons newly diagnosed and reported with HIV in NYC, overall and in most CD4 and age groups. Some larger year-over-year increases in LTC and in VS by CD4 follow updated recommendations. These favorable trends notwithstanding, as of 2013, NYC was still far from the ideal of timely LTC and VS for all newly diagnosed residents. 100 Care and Viral Suppression AmongWomen, 18 US Jurisdictions

Ndidi Ike ; Angela L. Hernandez; Qian An;Taoying Huang; H. Irene Hall US Centers for Disease Control and Prevention (CDC), Atlanta, GA, US

Background: Women comprise 25% of persons living with HIV in the United States. The HIV diagnosis rate for black and Hispanic women is 19 and 3.5 times, respectively, the rate for white women. Overall, disparities also exist in care and treatment outcomes by race/ethnicity. We assessed differences in care and viral suppression among women. Methods: We used data from the National HIV Surveillance System reported from 18 US jurisdictions to determine care and viral suppression among women aged ≥ 13 years. Linkage to care, defined as ≥ 1 CD4 or viral load (VL) test within 3 months of diagnosis, was assessed for women diagnosed in 2012. Retention in care (i.e., ≥ 2 CD4 or VL tests at least 3 months apart in 2011) and viral suppression (i.e., most recent VL ≤ 200 copies/mL in 2011) were determined for women living with HIV during 2011. Data were statistically adjusted for missing HIV transmission categories. Results: Among 3,903 women diagnosed with HIV in 2012, 83%were linked to care. Women aged 13-24 years had the lowest percentage of linkage to care compared to those aged ≥ 55 years (78% vs. 85%). Similar percent distributions by age were observed in all race/ethnicity groups. Among 102,726 women living with HIV in 2011, 52%were retained in care. The percentage in care was higher among older women ( ≥ 55 years, 57%) compared with younger women (e.g., 13-24, 54%; 25-34, 46%). The percentage retained in care was comparable among blacks (48%) and whites (51%) but higher among Hispanics (59%); the percentage was lowest among American Indians/Alaska Natives (33%). Overall, 44% of women had a suppressed viral load and it was higher among older ( ≥ 55 years, 53%) compared with younger women (13-24 years, 33%). Viral suppression was highest

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CROI 2015