CROI 2015 Program and Abstracts

Abstract Listing

Poster Abstracts

999 Late HIV Diagnosis in Metropolitan Areas of the United States and Puerto Rico H. Irene Hall 1 ;TianTang 2 ; Lorena Espinoza 1 1 US Centers for Disease Control and Prevention (CDC), Atlanta, GA, US; 2 ICF International, Atlanta, GA, US Background: The majority of persons diagnosed with HIV are residents of large metropolitan areas and many large metropolitan areas have implemented intensified HIV testing programs. Yet many persons are diagnosed with late stage disease (stage 3, AIDS). Methods: Using data reported through December 2013 from the National HIV Surveillance System, we determined the percentage of persons diagnosed with late stage disease (stage 3 based on CD4 count <200 cells/mL or opportunistic illness within 3 months of HIV diagnosis) among persons diagnosed with HIV during 2012 in metropolitan statistical areas (MSAs) (population ≥ 500,000, including individual MSAs; and population 50,000 to 499,999) and non-metropolitan areas. We also determined trends in late diagnosis from 2003-2012 and assessed change using linear regression. Data were statistically adjusted for missing HIV transmission categories. Results: Overall, 24% of persons diagnosed in 2012 in the Unites states had a late diagnosis; 23.3% in large MSAs, 26.3% in small to mediumMSAs, and 29.7% in non-metropolitan areas. In the 105 large MSAs, the percentage diagnosed late ranged from 13.5% in Birmingham-Hoover, AL to 44.4% in Modesto, CA. In large MSAs, overall the percentage diagnosed late was 22.7% for blacks/African Americans, 24.7% for Hispanics/Latinos, and 23.1% for whites; however, in some MSAs a higher percentage of blacks/African Americans was diagnosed late compared with Hispanics/Latinos or whites (e.g., New York MSA, 23.9%, 20.8%, 18.2%, respectively). In the majority of large MSAs, persons with infection attributed to male-to-male sexual contact had a lower percentage diagnosed late compared to persons with infection attributed to injection-drug use or heterosexual contact. During 2003-2012, the percentage diagnosed late decreased in large MSAs (32.2% to 23.3%), smaller MSAs (33.4% to 26.3%), and non-metropolitan areas (33.3% to 29.7%); however, the percentage remained stable since 2008 in non-metropolitan areas. Significant decreases (P<0.01) occurred in 41 of 105 large MSAs overall and among men who have sex with men. Conclusions: During the past decade, the percentage of persons with a late HIV diagnosis decreased overall and in many individual areas with high HIV burden. However, even in areas with intensified HIV testing interventions, about 1 in 5 persons were diagnosed with advanced disease. In addition, there are disparities by race/ethnicity and transmission risk group in some areas. 1000 HIV Care During the Last Year of Life H. Irene Hall 1 ; Lorena Espinoza 1 ; Shericka Harris 2 ; Jing Shi 2 1 US Centers for Disease Control and Prevention (CDC), Atlanta, GA, US; 2 ICF International, Atlanta, GA, US Background: Death due to HIV remains a leading cause of death among some U.S. populations, in particular among persons aged 25 to 44 years old and blacks/African Americans. Little information is available about HIV care and care outcomes at the end of life among persons living with HIV. Methods: We used data from the National HIV Surveillance System to determine disease stage and care received within 12 months prior to death among persons living with HIV who died in 2012. Data were available from 18 U.S. jurisdictions on CD4 and viral load test results. Persons were considered to be in care within the 12 months before death if they had one or more CD4 or viral load test results, and in continuous care if they had two or more CD4 or viral load test results at least 3 months apart. Viral suppression (defined as <200 copies/mL) was based on the most recent viral load test result in the 12 months before death. Data were statistically adjusted for missing HIV transmission categories. Results: Among 6,932 persons infected with HIV who died in the 18 jurisdictions, 47.5% had disease classified as stage 3 (AIDS) within 12 months before death; 13.8% had stage 1 (CD4 count ≥ 500 cells/ μ L), 22.5% stage 2 (CD4 count 200–499 cells/ μ L), and 16.2% unknown stage disease. Overall, 86.3% had ≥ 1 test result, 64.7% had ≥ 2 tests at least 3 months apart, and 42.3% had a suppressed viral load. While blacks/African Americans and Hispanics/Latinos had higher percentages of continuous care compared with whites, (65.5%, 67.4% and 60.1%, respectively), they had lower percentages of viral suppression (36.3%, 44.2% and 49.3%, respectively) and higher percentages with late stage disease (50.9%, 51.9%, and 39.1%, respectively). The percentage in continuous care was somewhat higher and the percentage with viral suppression was substantially higher among older persons compared with those aged 20-29 years (e.g., 20-29 vs. ≥ 65 year olds, ≥ 2 test results, 59.5% vs. 65.4%; viral suppression, 21.1% vs. 52.4%). Viral suppression was similar among the 83.6% of persons who ever had late stage disease (stage 3, AIDS) (42.5%) compared with those never diagnosed with AIDS (41.1%). Conclusions: The majority of persons infected with HIV who died in 2012 had HIV medical care visits in the year before death. However, almost half of them had late stage disease, and late stage disease and lack of viral suppression was more common among blacks/African Americans and Hispanics/Latinos and younger persons. 1001 Reductions in the Time FromHIV Infection to ART Initiation in New York City Sarah L. Braunstein 1 ; McKaylee Robertson 2 ; Julie Myers 1 ; Bisrat Abraham 3 ; Denis Nash 4 1 New York City Department of Health and Mental Hygiene, Queens, NY, US; 2 City University of New York, New York, NY, US; 3 Weill Cornell Medical College, New York, NY, US; 4 City University of New York School of Public Health, New York, NY, US Background: Many state and local jurisdictions in the US, including New York City (NYC), support implementation of national recommendations for immediate ART initiation among persons diagnosed with HIV (PWH) and have implemented geographically targeted HIV testing campaigns to facilitate earlier HIV diagnosis. We used population-based data on CD4 cell count at HIV diagnosis and ART initiation to estimate the rate at which efforts aimed at earlier diagnosis and ART initiation are progressing. Methods: We used laboratory (CD4, viral load (VL)) data reported to NYC HIV Surveillance on PWH age ≥ 13 years diagnosed during 2006-2012. The CD4 count at diagnosis was the first CD4 count within 6 months of diagnosis; we estimated the date of probable ART initiation following HIV diagnosis to be the mid-point between two VLs bracketing the first occurrence of: 1) a ≥ 2-log drop in a 3 month period; or 2) a detectable VL followed by an undetectable VL (<400 copies/mL). The CD4 count at ART initiation was defined as that closest to and within 3 months of the estimated date of ART initiation. Results: A total of 24,358 persons were newly diagnosed with HIV in NYC from 2006-2012. Of these, 17,773 (73%) had a CD4 count within 6 months of diagnosis, and 14,051 (79%) of those persons had probable ART initiation during 2006-2013. 12,809 (91%) of those initiating ART had a CD4 count within 3 months of the date of probable ART initiation. The overall median CD4 count at diagnosis increased from 325 cells/ μ L in 2006 to 379 cells/ μ L in 2012 (average: 7.7 cells/year), while the median CD4 count at ART initiation increased from 157 cells/ μ L in 2006 to 410 cells/ μ L in 2013 (average: 31.6 cells/year). All demographic and risk subgroups experienced increases in CD4 at diagnosis and ART initiation during 2006-2013, although increases were substantially slower among some subgroups (Figure). In 2012, only half of PWH were diagnosed at CD4 count >379 cells/ m L; 53% of persons who initiated ART in 2012 were diagnosed that year.

Poster Abstracts

589

CROI 2015