CROI 2015 Program and Abstracts

Abstract Listing

Oral Abstracts

Conclusions: Sertraline provides fungicidal activity against C. neoformans with improvements in CSF clearance rates and appears to reach therapeutic levels in vivo . This widely available off-patent oral medication ($0.05 per 100mg tablet) provides a promising adjunct for CM treatment when added to standard antifungal therapy. This pilot justifies a larger randomized trial to elucidate whether sertraline has a survival benefit for the treatment of CM. 1060 Trends in Sexual Behaviors Among MenWho Have Sex With Men in the United States, the Role of Antiretroviral Therapy and Seroadaptive Strategies

Gabriela Paz-Bailey 1 ; Maria Mendoza 1 ; Binh Le 1 ; Charles E. Rose 1 ;Teresa Finlayson 1 ; CyprianWejnert 1 ; Henry F. Raymond 2 ; Joseph Prejean 1 1 US Centers for Disease Control and Prevention (CDC), Atlanta, GA, US; 2 San Francisco Department of Public Health, San Francisco, CA, US

Background: CDC data from the National HIV Behavioral Surveillance System (NHBS) suggest that condom use has decreased among men who have sex with men (MSM). The reasons for this decrease are not known but may reflect the adoption of risk-reduction strategies other than consistent condom use, such as engaging in unprotected sex only with partners perceived to have the same HIV status as one’s own (sero-adaptive behaviors). We used data among MSM participating in NHBS to evaluate changes from 2005 to 2011 in condomless anal sex at last sex. Methods: MSMwere recruited through venue-based sampling in 2005, 2008 and 2011 in up to 21 U.S. cities. Among men reporting ≥ 1 male partner and self-reporting as HIV- positive or HIV-negative, we evaluated changes in condomless anal sex at last sex with a partner reported to have 1) HIV concordant status (proxy for sero-adaptive behavior), or 2) HIV-discordant or unknown status, by participant’s reported HIV status and antiretroviral therapy (ART) use (HIV-positive only). We used GEE modeling with a robust variance estimation, and assumed a Poisson distribution to explore whether temporal changes in the outcomes varied by selected characteristics. Results: In adjusted analyses among 23,125 HIV-negative MSM, concordant condomless sex at last anal sex increased significantly (20%, 22% and 24%, in 2005, 2008 and 2011, respectively, p<0.001) as well as discordant/unknown condomless sex (7%, 10%, 11%, respectively, p<0.001). Among 3,785 HIV-positive MSM, there were no significant changes in concordant (19%, 21% and 26%, p=0.14) or discordant/unknown condomless sex (14%, 16%, and 14%, p=0.11). Concordant condomless sex increased among MSM on ART (18%, 22%, and 26%, p<0.001) but not among MSM not on ART (21%, 20% and 27%, p=0.11). There were no significant changes in discordant/unknown condomless sex by ART use. Conclusions: There were modest increases in condomless sex at last sex both with partners of concordant and discordant/unknown HIV status among HIV-negative MSM, and only with a partner of concordant status among HIV-positive MSM on ART. These data suggest that the increases in condomless sex among MSM are in part due to the adoption of sero-adaptive behaviors but that discordant condomless sex is also increasing among HIV-negative MSM. HIV-negative MSM who engage in condomless sex would benefit from having access to risk-reduction interventions, including pre-exposure prophylaxis. 1061 Changes in Condomless Sex and Serosorting Among MSM After HIV Diagnosis Christine M. Khosropour 2 ; Julia C. Dombrowski 2 ; David A. Katz 2 ; Matthew R. Golden 2 1 University of Washington, Seattle, WA, US; 2 University of Washington, Seattle, WA, US Background: Among men who have sex with men (MSM) diagnosed with HIV, high-risk sexual behaviors may decline in the year after diagnosis, but changes in serosorting post- diagnosis are not well defined. Few studies have assessed changes in these behaviors both pre-diagnosis and for several years after. Methods: We created a retrospective cohort (seroconversion cohort) of MSM attending an STD clinic in Seattle, WA who tested HIV positive between 2002-2013 and had a negative HIV test <2 years prior to diagnosis (pre-diagnosis visit). Potential controls were MSM who never tested HIV-positive and had a negative test <2 years prior to a randomly selected index visit. We randomly selected 1,000 controls frequency-matched to the seroconversion cohort based on HIV diagnosis year/index date. Sexual behavior data in the 12 months prior to each visit were collected by clinicians using standardized forms or a computer self-interview as part of routine clinical care. We examined condomless anal intercourse (CAI) with HIV-negative and -positive partners at 5 time points: before diagnosis/index, at diagnosis/index, and each year up to 3 visits after diagnosis/index. We used McNemar’s chi- square to compare behaviors reported at the 2 visits before/at diagnosis vs. the 3 visits after diagnosis and used linear regression to examine trends over time. Results: There were 655 (2.5%) new HIV diagnoses at 26,144 clinic visits where MSM tested for HIV; 186 (28%) men with a new diagnosis tested negative <2 years before diagnosis and were included in the seroconversion cohort. The 1,000 persistently HIV-negative controls were selected from 3,083 eligible MSM. In the seroconversion cohort, the percent reporting CAI with HIV-negative partners declined after diagnosis (34% vs 19%, P=.003) while the percent reporting CAI with HIV-positive partners increased (10% vs 35%, P<.001; Figure). Thus, the proportion who serosorted (i.e. reported only HIV concordant CAI) did not change before or after diagnosis (34% vs 35%, P=.85) and remained stable in the years after diagnosis (P-value for trend post-diagnosis=.79). Among HIV-negative controls, serosorting and CAI with HIV-positive partners remained relatively constant.

Oral Abstracts

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CROI 2015