CROI 2015 Program and Abstracts

Abstract Listing

Oral Abstracts

156 Who Are the 10-Year AIDS Survivors on Antiretroviral Therapy in Haiti? Samuel Pierre 1 ; Ashita Batavia 2 ; Patrice Severe 1 ;Vanessa Rouzier 1 ; Benedict Charles 1 ; Jean Pape 1 ;Warren Johnson 2 ; Daniel Fitzgerald 2 ; Margaret L. McNairy 2 On behalf of Les Centres GHESKIO CTU 1 Les Centres GHESKIO, Port-au-Prince, Haiti; 2 Weill Cornell Medical College, New York, NY, US

Background: Access to antiretroviral therapy (ART) has rapidly expanded over the past decade in resource-limited settings but long-term clinical outcomes of patients, including characteristics of those who have survived for the last decade, have not been reported. We describe the 10-year outcomes and characteristics of the first cohort of patients receiving ART in Haiti. Methods: Data from 910 ART-naïve patients, age > 13 years, who initiated ART from 2003-4 at GHESKIO were included. Retention was defined as the proportion of patients known to be alive and attending care; lost to follow-up (LTF) was defined as no clinic or pharmacy visit for > 6 months. Cumulative incidence of survival after ART initiation was estimated using Kaplan-Meier methods. Factors associated with LTF and death were assessed using Cox proportional hazard modeling. Results: Among 910 adults who initiated ART, 55%were female, median age was 38 years (IQR 33-45), and median CD4 was 131 cells/uL (IQR 55-211). Ten years after ART initiation, 477 (52%) patients were retained, 246 (27%) dead, 116 (13%) LTF, and 71 (8%) transferred, with 151 cases of incident TB. The rate of death decreased over time from 25 deaths/100 PY in the first 6 months to 3.60/100 PY (6 months to 5 years) and 1.32/100PY (5 to 10 years). Predictors of death in the first 6 months were age > 50, lowest quartile weight, CD4 < 50 cells/uL, WHO stage III/VI and baseline TB. Death after 6 months was associated with age, both 13-24 and > 50 age groups, and lowest quartile weight. The rate of LTF decreased from 3.91/100 PY in the first 6 months to 1.36/100 PY (6 months to 5 years) and 1.82/100PY (5 to 10 years). Lowest quartile weight was associated with LTF across the 10 years. Among the 473 persons alive and in care at 10 years, median age was 49 (IQR 43-55), 57%were female, median CD4 was 541 cells/uL, and 74%were on first-line therapy. 177 survivors (25%) had documentation of a non-communicable disease (195 cases: 58% hypertension, 3% diabetes, and 39% chronic lung disease). Conclusions: This analysis documents the long-term effectiveness of an ART program among the first cohort of patients to receive ART in the Caribbean and Latin American Region. Excellent retention and a lower death rate were observed during the 5 to10 year follow-up period as compared to the first 5 years. High prevalence of non-communicable diseases among this population points to the changing needs of aging populations on ART. 157 Nationwide Evaluation of Antiretroviral Therapy Coverage on Prevention in Rwanda: A Multisectional Time-Trend Analysis Sabin Nsanzimana 2 ; Eric Remera 2 ; Steve Kanters 1 ; Eric Dusabe 2 ; Adeline Dukuze 2 ;Till Barnighausen 3 ; Eran Bendavid 1 ; Julio Montaner 4 ; Edward Mills 1 On behalf of the RwandaTreatment as PreventionWorking Group 1 Stanford University, Vancouver, Canada; 2 Rwanda Biomedical Centre, Kigali, Rwanda; 3 Harvard School of Public Health, Boston, MA, US; 4 BC Centre for Excellence in HIV/AIDS, Vancouver, Canada Background: Rwanda is one of the most successful countries in terms of antiretroviral therapy (ART) coverage and recently changed guidelines to immediately initiate ART for key groups and at CD4 status of 500 cells/mm 3 among the general population. We aimed to examine the effect of treatment scale-up on the incidence of new infections using a time-staggered causal design. Methods: We applied a Bayesian hierarchical design that assessed the scale-up of ART across 416 health sectors among 30 districts in Rwanda. We assess the number of infections detected within these health sectors in three-month periods over ten years (2004-2014). We assessed the projected number of new infections per health sector and modeled the change in slope between cases detected and projected cases. We used three different methods to evaluate incidence within each health sector. Results: In our study period, 123,317 patients initiated ART across Rwanda. Figure 1 displays the reduction in VCT detection and increase in coverage between 2005 and 2013. New cases detected peaked in 2007 and reduced to 12,993 in 2013. We found that for every 10% increase in coverage per health sector, a 6.07 percent reduction in incidence occurred. At the current coverage of 50% of all eligible patients in Rwanda, the effect of ART has contributed a reduction of 26.9% (95% Confidence Intervals [CI] 21.9-31.9%) year by year in a multiplicative way – increasing to 71% by four years. The new target goal of providing ART at 500 cells/mm 3 is estimated to reduce incidence by 36% per year (83% in four years).

Oral Abstracts

Change in positive HIV test detection and ART coverage between 2005 and 2013.

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CROI 2015