CROI 2015 Program and Abstracts

Abstract Listing

Poster Abstracts

prevalence of NVP resistance with longer times between acquisition of infant HIV infection and cessation of NVP prophylaxis. Most of the infants (69%) with NVP resistance had different mutations than their mothers carried. Conclusions: Infants on NVP prophylaxis during breastfeeding are at reduced risk of acquiring HIV, but are at increased risk of NVP resistance if they do become infected. The rate of NVP resistance in the infant NVP arm of BAN (50%) was lower than that observed with NVP prophylaxis in the SWEN (92%), PEPI-Malawi (76%), and HPTN 046 (74%) studies, and may have been due to fewer mothers carrying NVP resistance after receiving AZT/3TC for a week after their single-dose NVP. These findings point to the need for frequent HIV diagnostic testing of infants while on NVP prophylaxis, and for availability of antiretroviral regimens excluding NVP for treating infants who become infected while on such a prophylactic regimen.

TUESDAY, FEBRUARY 24, 2015 Session P-U1 Poster Session

Poster Hall

2:30 pm– 4:00 pm HIV Diagnosis in Infants and Children 910 Birth HIV PCR Testing in South Africa: Diagnostic Challenges and Risk Factor Analysis Karl-Günter Technau 1 ; Louise Kuhn 2 ; Lucia Hans 3 ; Sergio Carmona 3 ; Ashraf Coovadia 1 ; Gayle Sherman 4 1 University of the Witwatersrand, Johannesburg, South Africa; 2 Columbia University, New York, NY, US; 3 National Health Laboratory Service, Johannesburg, South Africa; 4 National Institute for Communicable Diseases, Johannesburg, South Africa Background: The South African Prevention of Mother to Child Transmission program reported infant HIV transmission rates at 6 weeks of 2% in 2013. Since a large proportion of HIV infections can be detected at birth, testing at this time could facilitate earlier treatment and thereby reduce HIV-related morbidity and mortality. Methods: From Sept 2013, Rahima Moosa Mother and Child Hospital in Johannesburg, South Africa, provided birth HIV PCR testing for low birth weight or preterm neonates in accordance with national guidelines (era A). From June 2014 (era B) all HIV-exposed neonates were tested (weekend cover commencing Aug 2014). The Roche COBAS® TaqMan® HIV-1 Qual Test (Versions 1 and 2 in era A and B respectively) was used. Results are returned ~1 week from birth and all neonates with positive or indeterminate results are followed. PCR negative neonates are referred for routine testing at 6 weeks. Here we describe coverage, transmission rates and risk factors for transmission. Results: Over 9 months in era A, 16% (193/1240) of all HIV-exposed neonates (66% [193/261] of targeted neonates) were offered testing with 100% uptake. Over 4 months in era B, 90% (675/750) of all HIV-exposed neonates were offered testing with 99% uptake. In era A, 6.7% (13/193) (95% CI: 3.2-10.3) of infants tested PCR positive (n=9) or indeterminate (n=4) with 38% (5/13) female. In era B, 2.1% (14/663) (95% CI: 1.0-3.2) tested positive (n=10) or indeterminate (n=4) and 86% (12/14) were female (p=0.018). Further testing of 8 neonates with indeterminate results found detectable HIV RNA or positive qualitative results in six. Two infants (both in era B) have had only negative HIV results on subsequent tests. All of the children with positive birth tests subsequently had at least one positive qualitative PCR or quantitative HIV RNA assay. The median highest HIV RNA quantity was 5.7 log copies/ml (IQR: 4.0-6.0) in era A and 3.2 log copies/ml (IQR: 2.2-4.5) in era B (p=0.009).

Poster Abstracts

Conclusions: We achieved excellent coverage with universal birth testing revealing a transmission rate similar to that reported by national statistics at 6 weeks. Targeted testing would require testing ~half (52.3%) the exposed neonates but would miss ~third of infected neonates. A less sensitive PCR test and/or a higher risk population may account for higher HIV RNA values and fewer diagnostic dilemmas in era A. The high percent of girls in era B requires further investigation. Diagnostic problems raised by indeterminate results require urgent attention. 911 System Gaps Result in Late Diagnosis and Treatment of ChildrenWith HIV in Hospital Irene N. Njuguna 3 ; Anjuli D.Wagner 1 ;Vincent Otieno 3 ; Lisa Cranmer 2 ; Judy Adhiambo 3 ; Sarah Benki-Nugent 1 ; Elizabeth Maleche-Obimbo 3 ; Jennifer A. Slyker 1 ; DaltonWamalwa 3 ; Grace John-Stewart 1 1 University of Washington, Seattle, Kenya; 2 Emory University School of Medicine, Atlanta, GA, US; 3 University of Nairobi, Nairobi, Kenya Background: The pediatric HIV linkage to care cascade has health systems bottlenecks that require improvement. Despite scale up of PMTCT programs, a substantial number of infants still acquire HIV and are diagnosed when hospitalized through provider initiated testing and counseling (PITC). To identify gaps in pediatric linkage to care, we evaluated maternal HIV testing and child hospitalization history for hospitalized children who were diagnosed with HIV for the first time or who were not on ART at hospitalization. Methods: We identified HIV-infected, ART naïve children aged 0-12 years at Kenyatta National Hospital, Kisumu East District Hospital and Jaramogi Teaching and Referral Hospital and reviewed their PMTCT and past medical history. This was part of an ongoing clinical trial (NCT02063880). HIV infection was determined by rapid HIV test among those over 18months of age and DNA-PCR for those under18 months. We summarized continuous variables using medians and categorical variables using proportions.

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CROI 2015