CROI 2015 Program and Abstracts

Abstract Listing

Poster Abstracts

and lower risk groups but to a much smaller degree (<15%). Results depended on assumptions about PrEP coverage, adherence to PrEP, HIV screening on PrEP, and linking HIV awareness and ART uptake. Conclusions: Widespread use of PrEP for IDUs in the US could substantially reduce HIV incidence and prevalence among IDUs and increase their HIV treatment rates. PrEP for IDUs would also benefit MSM and lower risk groups via reduced HIV transmission. 1122 Procreation in HIV-Serodiscordant Couples: TasP, PrEP, or Assisted Reproduction? Guillaume Mabileau 1 ; Michaël Schwarzinger 1 ; Juan Flores 1 ; Catherine Patrat 2 ; Dominique Luton 2 ; Sylvie Epelboin 2 ; Laurent Mandelbrot 3 ; Sophie Matheron 2 ;YazdanYazdanpanah 2 On behalf of ANRS 12008 1 Inserm, Paris, France; 2 AP-HP, Bichat-Claude Bernard Hospital, Paris, France; 3 Louis Mourier Hospital, Colombes, France Background: In the U.S., 2014 CDC guidelines based on expert recommendations have for the first time recommended PrEP as one of several options for fertile HIV-uninfected female/HIV-1-infected male couples on combination antiretroviral therapy (cART) with plasma HIV RNA <50 copies/mL desiring a child. However, in other Northern countries, medically assisted procreation (MAP) is still the recommended strategy. The aim of this study was to assess residual risk of HIV transmission, cost, and cost-effectiveness (CE) of various strategies that can help fertile HIV serodiscordant couples to have a child: (i) unprotected sexual intercourse (TasP); (ii) TasP limited to fertile days (FertilD); (iii) TasP with pre-exposure prophylaxis (PrEP) (tenofovir/emtricitabine); (iv) strategy (ii) + PrEP limited to fertile days; (v) medically assisted procreation (MAP). Methods: We used a decision model. Input variables were from the international literature: 85% probability of live births in different strategies, 0.0083%/month HIV-transmission risk ( β ) with unprotected vaginal intercourse, 1% HIV mother-to-child transmission rate, and 4.4% birth defect risk related to cART when mother infected at conception. FertilD and PrEP were estimated to decrease β by 80% and 67%, respectively, and by 93.4% for PrEP+FertilD (1-(1-0.80)*(1-0.67)). Tenofovir/emtricitabine monthly cost was at € 540. The CE analysis was performed from the French societal perspective (2013 euros), with a 4% annual discount rate. Results: The probability of transmission to the female partner was highest with unprotected sexual intercourse strategy and lowest for MAP, followed by PrEP during fertile period (Table). FertilD was associated with the lowest costs and dominated PrEP, which was less effective with the highest costs. PrEP+FertilD cost-effectiveness ratio was € 1,130,000/life year saved (LYS) when compared with FertilD; € 3,600,000/LYS for MAP when compared with PrEP+FertilD. Results were robust to multiple sensitivity analyses.

* Life expectancy of both woman and child, woman being 33 years of age (113.046 = LE woman = 44.199 + LE baby = 68.847), rounded to three decimal places. Conclusions: In fertile HIV-uninfected female/HIV-1-infected male couples with plasma HIV RNA <50 copies/mL, targeting fertile days lead to a low risk of HIV transmission. Considering PrEP during fertile period or MAP were found to decrease the risk of infections but these strategies were associated with unfavorable CE ratio.

Poster Abstracts

651

CROI 2015