CROI 2016 Abstract eBook

Abstract Listing

Oral Abstracts

52 Estimating the Lifetime Risk of a Diagnosis of HIV Infection in the United States Kristen Hess ; Xiaohong Hu; Amy Lansky; Jonathan Mermin; H. Irene Hall CDC, Atlanta, GA, USA Background: Estimates of lifetime risk can be used to compare the burden of disease across populations. This method is frequently used to describe cancer risk, but has infrequently been used for HIV infection. We estimated the lifetime risk of an HIV diagnosis for sex, age, and racial/ethnic subgroups as well as by state. Methods: HIV diagnosis, mortality, and census population data were used to derive lifetime and age-conditional risk estimates of being diagnosed with HIV. Data on HIV diagnoses (adjusted for reporting delays) were obtained from the National HIV Surveillance System (NHSS). The numbers of HIV diagnoses (NHSS) and non-HIV deaths (mortality data) between 2009 and 2013 were used to calculate probabilities of a diagnosis of HIV at a given age, conditional on never having developed HIV prior to that age using a competing risks method. The lifetime risk estimate is the cumulative probability of being diagnosed with HIV from birth. Age-conditional risk measures were the probabilities of an individual of a specified age being diagnosed with HIV within ten years. The lifetime and age-conditional risk estimates were calculated for the entire population and each combination of gender and race/ethnicity. Lifetime risk estimates were also calculated by state. All calculations were conducted in DevCan 6.7.3. Comparisons were made to findings from a 2004-2005 analysis. Results: Overall, the estimated lifetime risk of being diagnosed with HIV was 1.05%, meaning that approximately 3 million Americans (or 1 in 96 people) will be diagnosed with HIV in their lifetime. This was a decrease from a 2004-2005 estimate (1.29%). Among males the estimated risk was 1 in 62, and among females it was 1 in 221. At every age, males had a higher estimated lifetime risk than females (Figure 1). For males and females, the highest lifetime risk was among blacks (male: 1 in 19; female: 1 in 46). The estimated lifetime risk among Hispanics/Latinos was 1 in 47 among males and 1 in 214 among females. Among white males the lifetime risk was 1 in 127 and among white females it was 1 in 851. The lifetime risk estimates varied by state from 1 in 43 in Georgia to 1 in 662 in North Dakota. The highest lifetime risk was in Washington D.C. (1 in 13), an urban district. Conclusions: The overall lifetime risk has decreased. However, without improvements in prevention, millions of Americans are expected to acquire HIV infection during their lifetime, and large disparities persist by sex and race/ethnicity.

Oral Abstracts

53 Increased HIV Viral Suppression Among US Adults Receiving Medical Care, 2009-2013 Heather Bradley ; Christine Mattson; Linda Beer; Ping Huang; Roy L. Shouse CDC, Atlanta, GA, USA Background: Persons living with HIV who achieve viral suppression have greatly improved health outcomes and decreased risk of transmitting HIV to others. Increasing the number of persons living with HIV who are virally suppressed is key to reaching national HIV prevention goals in the United States. Methods: We used 2009 – 2013 Medical Monitoring Project (MMP) data to estimate the proportion of persons receiving HIV medical care who achieved HIV viral suppression (< 200 copies/mL) at both last test and at all tests in the previous 12 months. MMP is a surveillance system that produces nationally representative information about persons receiving HIV medical care in the United States. Data were collected from 23,125 persons using interviews and medical record abstractions. We assessed temporal trends in viral suppression overall and by gender, age, race/ethnicity, and sexual behavior/orientation. Results: The proportion of persons whose HIV virus was suppressed at most recent test increased from 72% to 80% from 2009 – 2013 (β=0.02, P for trend < 0.01). This positive trend was statistically significant among men and women; all age groups; non-Hispanic blacks, non-Hispanic whites and Hispanics; and men who have sex with men, men who have sex with women, and women who have sex with men. The largest increases were among 18–29 year olds (56% to 68%; β=0.03, P for trend < 0.01), 30 – 39 year olds (62% to 75%; β=0.03, P for trend < 0.01), and non-Hispanic blacks (64% to 76%; β=0.03, P for trend < 0.01). The proportion of persons whose HIV virus was suppressed at all tests during the previous 12 months increased from 58% to 68% (β=0.03, P for trend < 0.01) from 2009 – 2013. This positive trend was statistically significant among all sub-groups by gender, age, race-ethnicity, and sexual behavior/orientation. The largest increases were among 18–29 year olds (32% to 51%; β=0.05, P for trend < 0.01), 30–39 year olds (47% to 63%; β=0.04, P for trend < 0.01), and non-Hispanic blacks (49% to 61%; β=0.03, P for trend < 0.01). Conclusions: Persons receiving HIV medical care are increasingly likely to achieve viral suppression. Young people and non-Hispanic blacks, who had the lowest levels of viral suppression in 2009, showed the most improvement over time. Recent efforts to engage persons living with HIV in medical care and promote early antiretroviral therapy use may have contributed to these increases, bringing us closer to realizing key goals of the National HIV/AIDS Strategy.

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CROI 2016