CROI 2015 Program and Abstracts

Abstract Listing

Poster Abstracts

1056 Higher Economic Well-Being Among Virally Suppressed HIV-Infected Adults With CD4>500 Harsha Thirumurthy 1 ; Aleksandra Jakubowski 1 ; James G. Kahn 2 ; Norton Sang 5 ;Tamara Clark 2 ; Edwin Charlebois 2 ; Maya Petersen 3 ; Moses R. Kamya 4 ; Diane Havlir 2 SEARCH Collaboration 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, US; 2 University of California San Francisco, San Francisco, CA, US; 3 University of California Berkeley School of Public Health, Berkeley, CA, US; 4 Makerere University College of Health Sciences, Kampala, Uganda; 5 KEMRI, Kisumu, Kenya Background: The investment case for HIV treatment as prevention requires consideration of the household economic effects of early initiation of antiretroviral therapy (ART). We examined the association between CD4+ T-cell counts, viral suppression, and economic well-being among HIV-infected adults in 32 rural communities in Kenya and Uganda. We also compared economic outcomes to HIV-uninfected adults in the same communities. Methods: We conducted socio-economic surveys in households of 100 HIV-infected and 100 HIV-uninfected adults sampled after baseline HIV testing in each of the 32 communities in the SEARCH ‘test and treat’ study (NCT01864603). CD4+ T-cell counts and HIV RNA were measured for all HIV-infected individuals. Undetectable HIV RNA was defined as <500 copies/mL. Logistic and linear regression models were used to compare employment status, domestic labor, and healthcare utilization between HIV-uninfected adults and HIV-infected adults in different HIV RNA and CD4 strata, adjusting for sociodemographic characteristics and community of residence. Robust standard error estimators were used to account for cluster sampling. Results: Data were analyzed for 6,608 adults (1,646 HIV-infected, 4,962 HIV-uninfected). After multivariate adjustment, compared to a reference group of HIV-infected adults with CD4 ≤ 350 cells/ μ L, those with CD4>500 and undetectable HIV RNA were significantly more likely to be employed, significantly less likely to lose work due to illness, significantly less likely to spend time receiving healthcare, and significantly less likely to be hospitalized (Table 1). Adults with CD4>500 and undetectable HIV RNA also spent 4.8 fewer hours seeking care in the past month (P<0.01). No significant differences were found between virally suppressed HIV-infected adults with CD4 351-500 and CD4 ≤ 350. Finally, outcomes did not differ significantly between virally suppressed HIV-infected adults with CD4>500 and HIV-uninfected adults.

Table 1 Conclusions: HIV-infected adults with higher CD4 counts and undetectable HIV RNA had better economic outcomes and lower healthcare utilization than those with lower CD4 counts, after adjusting for sociodemographic characterstics. The results are consistent with the possibility that ART restores economic outcomes to levels observed prior to a CD4 decline. Ongoing prospective longitudinal evaluation including data on ART usage is needed to rule out alternative explanations and determine whether ART initiation at higher CD4 counts protects economic well-being.

THURSDAY, FEBRUARY 26, 2015 Session P-W7 Poster Session

Poster Abstracts

Poster Hall

2:30 pm– 4:00 pm HIV Stigma 1057 Internalized Stigma in a Population-Based Sample of US HIV-Infected Adults in Care Amy R. Baugher ; Linda Beer; Jennifer L. Fagan; Christine L. Mattson; Mark Freedman; Jacek Skarbinski US Centers for Disease Control and Prevention (CDC), Atlanta, GA, US

Background: Internalized stigma–the extent to which HIV-infected persons hold negative beliefs about HIV as being true about themselves–has been associated with poor HIV medication adherence, non-disclosure of HIV status to sex partners and poor health outcomes. There are no national estimates of the extent of and factors associated with stigma among HIV-infected persons. Methods: We conducted cross-sectional analyses of data from a nationally representative sample of 4385 HIV-infected U.S. adults receiving medical care who participated in the Medical Monitoring Project in 2011. Stigma was assessed with the Internalized AIDS-Related Stigma Scale (range 0(low)-6(high)). Multivariable linear modeling was conducted to investigate sociodemographic factors that may independently predict mean stigma score. In bivariate analyses, we compared mean stigma scores by behavioral and clinical outcomes using one-way ANOVA ( p <0.05). Analyses are adjusted for clustering, unequal selection probabilities and non-response. Results: The overall mean stigma score was 2.6 (standard error = 0.04). Characteristics associated with higher stigma scores include: being older, female, black, Hispanic/Latino, heterosexual, foreign born, recently diagnosed (<5 years), homeless; having less than a high school education, having a gap in insurance coverage; and living in poverty. Stigma was independently associated with older age, heterosexual orientation, being foreign born, a gap in insurance coverage and a more recent diagnosis date. In bivariate analysis of outcomes, stigma was related to depression, binge drinking, non-disclosure of HIV status and lower adherence to HIV medicines, but not drug use, sex without a condom in the past 12 months or viral load (Table 1).

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CROI 2015