CROI 2015 Program and Abstracts

Abstract Listing

Poster Abstracts

Results: During four years of follow up there were 97 new HIV infections (3.4 per 1000 person years (pyrs); 30 men and 67 women). The HIV incidence was 2.4 (95% CI 1.6 – 3.4 per 1000 pyrs) and 4.3 (95%CI 3.3 – 5.4 per 1000 pyrs) in men and women, respectively. Age specific rates are shown in Figure 1. HIV incidence rates did not differ materially across surveys (p trend >0.05). The association with marital status varied by sex (p heterogeneity <0.05) with never married women and polygynously married men at increased risk for HIV infection compared with monogamously married individuals of the same sex (hazard ratio (HR) for never married women 5.5; 95% CI 2.3 -13.2 and HR for polygynous men 1.8; 95% CI 1.0 - 9.6). Roadside living was associated with a higher HIV incidence than rural residence (4.7 per 1000 pyrs vs. 2.0 per 1000 pyrs: HR 2.6; 95%CI 1.6 – 4.1). Education level was not associated with risk for HIV infection (p>0.05).

Conclusions: In this rural population, rates of new infection are low and did not vary materially during 2007 to 2011 despite increasing availability of ART although risk for infection varied by age, location of residence and marital status. 1047 HIV-1 Incidence Among Adult STI Clinic Patients in Blantyre, Malawi Fatima Zulu 1 ; Isaac Singini 1 ; Newton I. Kumwenda 1 ; Johnstone Kumwenda 1 ; Sufia Dadabhai 2 1 Johns Hopkins University Research Project, Blantyre, Malawi; 2 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, US Background: Measuring HIV incidence is the gold standard for determining the stage of the country’s epidemic. There are limited incidence data fromMalawi, where national adult HIV prevalence ia 10.6%. We conducted a study to measure incidence of HIV and associated risk factors in patients seeking sexually transmitted infection (STI) screening and care at Queen Elizabeth Central Hospital in Blantyre, Malawi. Methods: We conducted a prospective cohort study among adults, presenting at the STI clinic at the main public referral hospital in Blantyre. Between August 2010 and December 2012, all patients presenting at the clinic were counseled and tested for HIV using HIV rapid tests. HIV negative individuals were consented for enrollment. A blood sample was collected for HIV RNA PCR testing to determine Acute HIV Infection. We collected demographics, sexual behavior, and medical history. Participants were followed-up every 3 months for 18 months or until seroconversion confirmed by Western Blot. HIV incidence was calculated by dividing total number of new infections by total observed person-years (PY); 95% confidence intervals (CI) were calculated. Incidence rates were compared using the Chi-square test for categorical variables and t-test for continuous variables. Adjusted relative risks were used to identify significant risk factors for HIV seroconversion. Results: We screened 3335 patients,1045 enrolled. Mean age was 28.2 years (range 18-52) among women and 27.9 years (range 18-59) among men. Overall HIV incidence was 3.9/100PY [95% CI 3.1 - 4.9]. Incidence among participants aged ≤ 25 years was 4.1/100PY [95% CI 2.8-5.8] compared to 3.8/100PY [95% CI 2.8-5.1] among those aged >25 years (p-value 0.16). Across age groups, HIV incidence rate was significantly higher among men (4.9/100PY 95% CI 3.7-6.4) compared to women (2.6/100PY, 95% CI 1.7 - 3.9, p-value 0.001), with the exception of young women ( ≤ 20 years) who had an incidence rate of 4.7/100PY (95%CI 3.1-7.3) compared to young men 3.1 (95% CI 1.6 - 5.9). Genital ulcerative disease (GUD) (RR=3.78, 95% CI 2.0, 7.18) and history of STI (RR=2.1 95% CI 1.6 -4.7) were independently associated with HIV seroconversion. Conclusions: We found high HIV incidence among adults seeking STI care in Blantyre but lower than previously reported (3.4). These results suggest the comprehensive national response to HIV may be curbing new infections. Specific vulnerable populations still require targeted prevention services.

Poster Abstracts

THURSDAY, FEBRUARY 26, 2015 Session P-W6 Poster Session

Poster Hall

2:30 pm– 4:00 pm Disease Progression, Morbidity, and Mortality 1048 CD4 Cell Dynamics in HIV-1 Infection Before and After ART: Overview and Determinants Anne Cori 1 ; Mike Pickles 1 ; Ard van Sighem 2 ; Luuk Gras 2 ; Daniela Bezemer 2 ; Peter Reiss 2 ; Christophe Fraser 1 On behalf of the ATHENA Observational Cohort 1 Imperial College London, London, United Kingdom; 2 HIV Monitoring Foundation, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands Background: CD4 cell count is a key measure of HIV disease progression, and has been the basis of successive international guidelines for treatment initiation. CD4 cell dynamics are used in mathematical and econometric models for evaluating public health needs and interventions.

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CROI 2015