CROI 2015 Program and Abstracts

Abstract Listing

Poster Abstracts

Patients with at least 2 medical encounters between 01/2006 and 06/2013 were selected. Patients who had at least once a time interval between 2 visits >15 months were defined to have medical care interruption (MCI), as opposed to the remaining patients who had uninterrupted follow-up (UFU). Patients’ characteristics at the time of HIV-diagnosis and at the censoring date were compared between groups. Cox proportional models taking interruptions as time dependant variables were built to assess the role of interruptions on survival (total and AIDS-free). Among the patients with at least one past interruption, characteristics and consequences were described. Results: Among 11 116 patients, 824 had had at least one care interruption. They were younger at the time of HIV diagnosis (30 versus 33y, p<0.0001). Men having sex with men had a lower risk of care interruption by comparison with heterosexual patients (RR=0.81; 95%CI 0.69 - 0.96). Median MCI duration was 22 months (IQ25 18; 32), and the median CD4 loss during MCI - 169 cells (IQ25 -355; -69). A first AIDS defining event was reported in 91 patients after care resumption. In 53 cases this event was the very reason to come back to care (date of event less than one month after the resumption visit). At the censoring date, 52.2% of the patients with at least one care interruption had viral load below detection, versus 85.3% of the UFU, p<0.0001. MCI was an independent predictive factor of AIDS (RR=2.54; 95%CI 2.10 - 3.09) and death (RR=2.65; 95%CI 1.94 - 3.61). Conclusions: MCI was related with pts overall and AIDS-free survival, and with the proportion of viral loads below detection in our cohort, compromising individual and collective treatment benefits. 1010 Blood Donor Test-Seeking Motivation and Prior HIV Testing Experiences in São Paulo Hong-Ha M. Truong 1 ; Paula Blatyta 2 ; Sandra Montebello 2 ; Sandra Esposti 2 ; Fatima Hangai 2 ; Nanci Salles 2 ; Alfredo Mendrone 2 ; Ester C. Sabino 3 ;Willi McFarland 4 ;ThelmaT. Gonçalez 5 1 University of California San Francisco, San Francisco, CA, US; 2 Fundação Pró-Sangue/Hemocentro de São Paulo, São Paulo, Brazil; 3 University of São Paulo, São Paulo, Brazil; 4 San Francisco Department of Public Health, San Francisco, CA, US; 5 Blood Systems Research Institute/University of California San Francisco, San Francisco, CA, US Background: Blood banks in many countries are working towards universal testing of all donations and are equipped to perform a high volume of HIV tests. However, use of the blood donation process for the purpose of diagnosing HIV among persons at risk is at odds with the mandate to keep the blood supply free of HIV contamination and to provide proper counseling for those at risk. Nevertheless, HIV test-seeking behavior among donors has been observed worldwide and may pose a threat to the safety of the blood supply. We evaluated current testing-seeking motivations and prior alternative HIV testing experiences among blood donors in São Paulo. Methods: All candidate donors presenting between August 2012 and May 2013 at Fundação Pró-Sangue Hemocentro, the largest blood bank in Brazil, were consecutively approached, screened for donor eligibility and recruited. Questionnaires were administered through audio computer-assisted self-interview. Results: Among 11,867 donors, 38% previously tested for HIV apart from blood donation, of whom 47.7% tested at public facilities and 2.7% acknowledged getting tested for HIV as the primary reason for donating. Fifty-five percent of donors had not heard of alternative public testing sites. Lack of awareness of alternative testing sites was significantly associated with test-seeking behavior (p<0.001). Dissatisfaction with a prior alternative testing experience was reported by 2.5% of donors. Current test-seeking motivation was associated with dissatisfaction with a prior alternative testing experience (p=0.004), testing at a public alternative facility (p<0.001) and hepatitis C (HCV) infection (p<0.001). The most common reasons for dissatisfaction were too long a wait to get tested and for results, counseling was too long, lack of privacy and low confidence in the equipment and accuracy of test. Conclusions: Lack of awareness of the availability of free and confidential public HIV testing services and dissatisfaction with past HIV testing and counseling experiences motivate some individuals to test at blood banks. This test-seeking behavior may compromise the safety of the blood supply if donors at elevated risk for HIV donate during the window period. Such donors may also have elevated risk for other transfusion-transmissible infections such as HBV, HCV and syphilis. Test-seeking behavior among blood donors may be best addressed by improving alternative testing programs, particularly with respect to decreasing time delays, increasing privacy and enhancing test accuracy.

TUESDAY, FEBRUARY 24, 2015 Session P-W2 Poster Session

Poster Hall

2:30 pm– 4:00 pm HIV Testing and the Continuum of Care in the DevelopingWorld 1011 Treatment Interruptions in ART Programmes in Resource-Limited Settings: 2003 to 2013 Gail B. Cross 1 ;Tim Spelman 2 ; Daniel P. O’Brien 4 ; Nathan Ford 3 ; Jane Greig 4 ; James H. McMahon 1

Poster Abstracts

1 Monash University/Alfred Hospital, Prahan, Australia; 2 Burnet Institute, Melbourne, Australia; 3 World Health Organization (WHO), Geneva, Switzerland; 4 Médecins Sans Frontières, London, United Kingdom Background: Antiretroviral therapy (ART) treatment interruptions (TI), are associated with increased risk of mortality, opportunistic infections, virological failure and drug resistance. This study describes the frequency and risk factors for TI in Médecins Sans Frontières (MSF) ART programmes in 33 sites across Asia and Africa. Methods: Analysis of routinely collected data from ART programs in 11 countries across Asia and Africa between 2003 and 2013. Included variables were: gender, age, marital status, region (Asia or Africa), CD4 count and WHO stage at ART initiation. TI was defined as a ≥ 90 day unstructured break from ART calculated from the last day the previous ART prescription would have run out until the date of the next ART prescription. Factors predicting TI were assessed in unadjusted and adjusted cox proportional hazards regression with a conditional risk-set to account for repeated events. Tests for interaction were performed in adjusted models. Results: 40632 patients were included from 11 countries across 33 sites (17 Africa, 16 Asia). Median duration of follow-up was 1.61 years (IQR: 0.54-3.31 years) and 3386 (8.3%) patients died. There were 14817 TIs of ≥ 90 days with 10162 (25%) patients having more than one TI. In the adjusted model males were at lower risk of a TI compared with female patients (aHR: 0.94, p=0.003), and age of 20-59 appeared to be protective (20-39 years aHR 0.87, p=0.004; 40-59 years aHR 0.86, p=0.005) as compared to those < 20 years of age (Table). Preserved immune function, CD4 T-cell count 200-350 or > 350, were protective of TI as compared to CD4 < 200 (CD4 200-350 aHR 0.89, p<0.001; CD4 > 350 aHR 0.87, p=0.006). In addition more advanced clinical disease (WHO stage 3 aHR 1.10, p=0.009; stage 4 aHR of 1.21, p < 0.001) was also predictive of increased risk of TI in the same adjusted model. Marital status was not protective of TI while people from Asian countries were less likely to experience a TI when compared with those from African nations (aHR: 0.82, p< 0.001).

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CROI 2015