CROI 2015 Program and Abstracts

Abstract Listing

Poster Abstracts

1094 Immunodeficiency at the Start of ART: A Global View Klea Panayidou 1 ; Ole Kirk 3 On behalf of the IeDEA Collaboration and the COHERE Collaboration 1 University of Bern, Bern, Switzerland; 2 Université Victor Segalen Bordeaux 2, Bordeaux cedex, France; 3 University of Copenhagen, Copenhagen, Denmark Background: Early initiation of antiretroviral therapy (ART), at higher CD4 counts, prevents disease progression and reduces sexual transmission of HIV-1. We describe the CD4 count at the start of ART for five continents. Methods: Data are from the International epidemiologic Databases to Evaluate AIDS (IeDEA) from North America, the Caribbean, Central and South America, Asia-Pacific and West, Central, East and Southern Africa and from the Collaboration of Observational HIV Epidemiological Research in Europe (COHERE). Patients aged >=16 years with known sex were eligible. Analyses were stratified by World Bank country classification (as of 01/2013) and sex. CD4 counts were multiply imputed (50 imputations). Weighted additive mixed models were used to smooth aggregated median CD4 counts over the years per income group, country and sex. Fitted / predicted CD4 counts were aggregated using Rubin’s rules. Results: 747,684 patients from 42 countries were included in the analysis: 47,155 from North America (2 countries), 15,738 from the Caribbean, Central and South America (7), 3,066 from Asia Pacific (2), 539,064 from sub-Saharan Africa (19) and 142,661 from Europe (12). Trends in median CD4 counts at start of ART from 2002, when ART was scaled up globally, were similar in low-income and upper middle-income countries (table). Overall, median counts were slightly higher in lower middle-income and highest in high-income countries. All countries except the United Republic of Tanzania (171 cells/ m L) reached median CD4 counts >=200 cells/ m L. Six countries reached counts >=350 cells/ m L: Australia; Belgium; France; Sweden; Switzerland; United States. In all except high-income countries, median counts were higher and increased to a greater extent in women than men.

Conclusions: Median CD4 count at start of ART increased in most countries, but remained below 350 cells/ m L in all low- and middle-income countries in 2013. Substantial effort and resources are needed to achieve earlier implementation of ART globally. 1095 Providers’Attitudes and Practices Related to ART Use for HIV Care and Prevention Kate Buchacz 1 ; Jennifer Farrior 2 ; Gheetha Beauchamp 3 ; Laura McKinstry 3 ; Ann Kurth 4 ; Barry S. Zingman 5 ; Fred Gordin 6 ; Deborah Donnell 3 ;Wafaa M. El-Sadr 7 ; Bernard M. Branson 1 1 US Centers for Disease Control and Prevention (CDC), Atlanta, GA, US; 2 FHI360, Durham, NC, US; 3 Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA, US; 4 New York University School of Medicine, New York, NY, US; 5 Montefiore Medical Center and Albert Einstein College of Medicine, New York, NY, US; 6 Veterans Affairs Medical Center and George Washington University, Washington, DC, US; 7 Columbia University and Harlem Hospital, New York, NY, US Background: HPTN 065 examined the feasibility of an enhanced Test, Link to Care, plus treat (TLC-plus) approach for HIV prevention in the Bronx, NY and Washington, DC. We surveyed ART-prescribing providers in the two jurisdictions twice to assess temporal changes in knowledge, attitudes and practices pertaining to early initiation of ART over the 3-year study period, during which DHHS guidelines evolved to recommend universal ART for HIV-infected persons in the U.S. Methods: All ART-prescribing providers (including physicians, nurse practitioners, physician assistants, and residents/fellows) at 39 participating HIV care sites were asked by email to complete an anonymous web-based survey with a nominal incentive upon survey completion. The survey was administered at baseline (9/2010-5/2011) and follow- up (5/2013-12/2013). Baseline and follow-up data were not linked by respondent. We used t-tests and Kruskal-Wallis tests to assess for statistical differences in distribution of responses across the two surveys. Results: We analyzed data from 165 providers at baseline and 141 providers at follow-up (survey response rates of 57% and 53%, respectively). In both surveys, almost 60% of respondents were female; median age was 46 years; about 60%were white, two-thirds were physicians, and nearly 80% considered themselves HIV specialists. The percentage of providers who reported recommending ART initiation irrespective of CD4 cell count increased from baseline to follow-up (15% vs. 68%, p<0.01) as did the percentage who would initiate ART earlier for patients having unprotected sex with partners of unknown HIV status (64% vs. 82%, p<0.01) and for those in HIV-discordant sexual partnerships (75% vs. 87%, p<0.01). The percentage of providers who strongly agreed with the statement “Early initiation of ART can slow the spread of HIV in a community by making patients less infectious to others” also rose (65% to 88%, p<0.01). Providers reported initiating more patients on ART in the past year with the main goal of making it less likely that patients would transmit HIV to their sexual partners (median of zero vs. three patients, p<0.01). Conclusions: From 2011 to 2013, a greater percentage of ART-prescribing providers in the two jurisdictions supported initiating ART for all HIV-infected patients and using ART to prevent transmission, consistent with new scientific evidence and changes in HIV treatment recommendations during the conduct of HPTN065.

Poster Abstracts

637

CROI 2015