CROI 2015 Program and Abstracts

Abstract Listing

Poster Abstracts

Conclusions: These data demonstrate strong benefits of continuous HIV care, regardless of cultural and geographic differences. Further, despite widespread availability of therapy, these results demonstrate continued improvements are needed in optimizing delivery and care for HIV-infected individuals to translate viral reductions to the population level. 997 Disparities in HIV Viral-Load Suppression Among MSM, the HIV Outpatient Study, 2013 Kate Buchacz 1 ; Carl Armon 2 ; EllenTedaldi 3 ; Frank J. Palella 4 ; Richard Novak 5 ; DougWard 6 ; BenjaminYoung 7 ; Rachel Debes 2 ; Marcus Durham 1 ; JohnT. Brooks 1 1 US Centers for Disease Control and Prevention (CDC), Atlanta, GA, US; 2 Cerner Corporation, Vienna, VA, US; 3 Temple University School of Medicine, Philadelphia, PA, US; 4 Northwestern University, Chicago, IL, US; 5 University of Illinois at Chicago, Chicago, IL, US; 6 Dupont Circle Physicians Group, Washington, DC, US; 7 International Association of Providers in AIDS Care, Washington, DC, US Background: The National HIV/AIDS Strategy has prioritized reducing disparities in virologic suppression (VS) by race/ethnicity among gay, bisexual and other men who have sex with men (collectivey referred to as MSM). Improving VS for black MSMmay decrease HIV morbidity and sexual transmission of HIV. Methods: We analyzed data from the HIV Outpatient Study (HOPS) MSM participants in care at 9 HIV specialty clinics in the United States. We limited analyses to MSM with ≥ 2 HOPS visits since HOPS inception in 1993, of which at least one occurred in 2013, and who were of non-Hispanic white (NHW), non-Hispanic black (NHB) or Hispanic/Latino race/ ethnicity (Hispanic). We assessed the frequency of VS, defined as an HIV RNA (viral load, VL) < 50 copies/mL, measured closest but prior to 31 December 2013 among all MSM and those prescribed ART for ≥ 6 months. Using logistic regression, we assessed factors associated with VS among MSM prescribed ART. Results: Among 1,239 MSM studied, 266 (21%) were NHB, and 117 (9%) were Hispanic. NHB MSM were younger than NHW and Hispanic MSM (median age 43 vs. 51 and 45 years, respectively), more frequently HIV-diagnosed after 2006 (35% vs. 14% and 23%), less frequently privately insured (36% vs. 71% and 53%) and more frequently cared for at public rather than private clinics (66% vs. 14% and 39%) all p < 0.001. The median nadir and current CD4 cell counts (cells/mm 3 ) were: for NHB, 242 and 532; for NHW, 235 and 628; and for Hispanics, 207 and 576. Fewer NHB MSM were prescribed ART at the time of VL measurement (92% vs. 98% and 97%) and VS was less common among NHB than NHW and Hispanic MSM, p < 0.001 (Figure). In analyses restricted to MSM prescribed ART, which adjusted for clinic type and demographic and clinical factors, NHB MSM had lower odds of VS than NHW (odds ratio [OR] 0.54, 95% confidence interval [95% CI] 0.35-0.84) but Hispanic MSM did not (OR 1.22, 95% CI 0.63-2.37); MSM seen in public clinics had lower odds of VS (OR 0.48, 95% CI: 0.32-0.73) than those seen in private clinics, and MSM with higher CD4+ cell counts had higher odds of VS (OR, 1.19 per 100 cells/mm 3 , 95% CI: 1.11-1.27); insurance type was not independently associated with VS.

Poster Abstracts

Conclusions: In our large heterogeneous HIV cohort, NHB MSM had significantly lower rates of VS than NHW and Hispanic MSM. The associations of race/ethnicity and clinic type with VS suggest that interventions to improve HIV care outcomes for all MSMmay need to address structural factors and social disparities. 998 Early Linkage to HIV Care and Antiretroviral Therapy Use Among PeopleWho Inject Drugs: 20 US Cities, 2009 and 2012

Brooke Hoots ;Teresa Finlayson; Dita Broz; Gabriela Paz-Bailey US Centers for Disease Control and Prevention (CDC), Atlanta, GA, US

Background: Approximately 16% of infections among those living with diagnosed HIV infection are attributable to injection drug use. Antiretroviral therapy (ART) is recommended for all infected persons to improve health and prevent transmission. Timely linkage to care is a key step for ART initiation. One goal of the National HIV/AIDS Strategy is to increase early linkage to care from 65% to 85% by 2015. Using data from the National HIV Behavioral Surveillance System, we evaluated changes in early linkage to care and ART use from 2009 to 2012 among persons who inject drugs (PWID). Methods: PWID were recruited by respondent-driven sampling in 20 cities in 2009 and 2012. Early linkage was defined as a clinic visit for HIV care within 3 months of diagnosis and ART use as use at time of interview. Analyses were restricted to PWID with a previous HIV-positive test. Early linkage models were restricted to those diagnosed with HIV ≥ 3 months prior to interview. We used log-linked Poisson GEE regression to examine differences in the outcomes between 2009 and 2012. Models were adjusted for year, city, peer network size, gender, race/ethnicity, education, and insurance; the early linkage model included age at diagnosis, and the ART model included current age. Interaction terms were included to explore demographic variations. Results: Early linkage to care was 57% (285/504) in 2009 and 62% (353/569) in 2012 ( P = .07). In both years, early linkage was higher among those with an older age of diagnosis (>25) and those with insurance. In a multivariable model, early linkage did not change overall ( P = .61) and only increased significantly for whites ( P = .05). ART use was 58% (319/548) in 2009 and 67% (410/608) in 2012 ( P = .001). In both years, greater ART use was observed among males, blacks, older age groups, and those with insurance. In a multivariable model, ART use significantly increased from 2009 to 2012 ( P = .03). ART use also increased among females ( P = .04), Hispanics ( P = .003), and those with less education ( P = .02). Despite the increase among females, males were 18%more likely to be on ART when data from both years were combined ( P = .0017). Conclusions: While early linkage to care among PWID did not increase significantly between 2009 and 2012, ART use did. These findings show progress in getting those in care on treatment. Strengthening intervention efforts among PWID may improve early linkage to care and coverage of ART in this population.

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CROI 2015