CROI 2016 Abstract eBook

Abstract Listing

Poster Abstracts

750

Diagnostic Yield of TB Testing for Patients Who Present for HIV Testing in Haiti Vanessa R. Rivera 1 ; Diessy Decome 2 ; Marc Antoine Jean Juste 2 ; Patrice Severe 2 ; Colette Guiteau Moise 2 1 Weill Cornell Med Coll, New York, NY, USA; 2 GHESKIO, Port-au-Prince, Haiti

Background: In resource-poor settings where tuberculosis (TB) is endemic and HIV prevalence is high, failure to diagnosis TB before antiretroviral therapy (ART) initiation among HIV-infected patients is associated with an increased risk of early mortality. We evaluated the diagnostic yield of an integrated TB/HIV symptom screen and the added value of Xpert testing for patients at the time of HIV testing at the GHESKIO Center in Port-au-Prince, Haiti. Methods: We included all adult patients (≥18 years) who presented for HIV testing from August 2014 through July 2015. Patients were screened for cough at the time of HIV testing, and those with cough received evaluation for active TB by CXR, AFB smear, and Xpert testing. Results: 30,316 patients were tested for HIV and screened for cough during the one-year study period–20,655 (68%) were women and the median age was 28, and 3,253 (11%) tested HIV-positive.1,081 (33%) of the HIV-infected patients reported cough, and 245 (23%) were diagnosed with TB. 89 were smear and Xpert positive, 3 were smear-positive and Xpert negative, 49 were smear-negative and Xpert positive, 13 were smear or Xpert positive but did not have both tests, 11 were smear and/or Xpert-negative but culture-positive, and 80 were smear, Xpert and/or culture negative but diagnosed with symptoms and CXR findings. 5,455 (20%) of 26,814 HIV-negative patients also reported cough, and1,224 (22%) were diagnosed with TB. 695 were smear and Xpert positive, 45 were smear-positive and Xpert negative, 179 were smear-negative and Xpert positive, 65 were smear or Xpert positive but did not have both tests, 16 were smear and/or Xpert-negative but culture-positive, and 224 were smear, Xpert and/or culture negative but diagnosed with symptoms and CXR findings. 1,469 patients were diagnosed with TB at the time of HIV testing, and 228 patients (16%) were smear-negative but Xpert positive. Conclusions: In countries with high rates of TB and HIV, the early separation of patients with active TB is essential to reducing the transmission of TB. Over one-fifth of patients reported cough at the time of HIV testing, and of these one-quarter of HIV-infected patients were diagnosed with TB. The addition of Xpert testing increased bacteriologically- confirmed (SS/Bac+) diagnoses by 30%. Further studies are warranted to determine the cost-effectiveness of these strategies. 4% of SS/Bac+ patients were smear-positive and Xpert negative–further studies are underway to determine if these represent non-tuberculous mycobacteria.

751 Association of Tuberculosis With CD4 Recovery and HIV RNA Decline on ART in Europe Hansjakob Furrer ; for the Opportunistic Infections ProjectTeam of the Collaboration of Observational HIV Epidemiological Research in Europe (COHERE) in EuroCoord, Bern Univ Hosp and Univ of Bern, Bern, Switzerland Background: Tuberculosis (TB) may play an important role in immune recovery and HIV replication after antiretroviral treatment (ART) initiation among HIV-infected individuals. We examined the CD4 cell and HIV-RNA viral load changes in TB patients on ART. Methods: We included HIV-positive patients (≥16 years) from 25 cohorts who were ART-naïve and started ART after 2000. Patients with a TB diagnosis >12 months before ART start were excluded. We compared patients with prevalent TB (all forms, diagnosis 2 months before/after ART start) or a recent history of TB (diagnosis 2-12 months before ART

Poster Abstracts

start) with patients with no history of TB. We calculated CD4 and HIV-RNA slopes overall and during the first six months after ART start and thereafter using two adjusted linear mixed effects models that included information on origin of patients among other epidemiological variables for each endpoint. Results: We analysed 113,350 patients with a median age of 38 years (interquartile range [IQR] 32-45); 32,185 (28%) were female. At ART start, median CD4 cell count was 254 (IQR 137-371) and HIV-RNA viral load 61,670 (IQR 11,050- 198,000). Overall, 1,914 Results are shown in the table: Overall CD4 cell increases were lower in patients with prevalent (adj. difference -76 cells/μl/year) and recent TB (-32) compared to patients without a TB history. These effect was more pronounced in the first 6 months of ART. Patients with prevalent TB had slower overall viral load decline (adj. difference 0.16 log10 copies/mL/year) especially during the first 6 months (0.44), whereas those with recent TB showed a slower decline only during the first 6 months of ART. Non-European, especially Sub-Saharan Africa origin, was strongly associated with lower CD4 increases and slower HIV-RNA declines, as was female sex. Older age was associated with lower CD4 increases but faster viral load declines. Conclusions: TB had a significant effect on virological and immunological response to ART. While CD4 cell recovery after ART start was worse in patients presenting with TB, viral load decline tended to be slower only in patients with prevalent TB. These unfavorable effects were more pronounced in patients with prevalent disease during the first 6 months of ART and in patients from high-TB incidence countries who may need particular attention in clinical management.

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CROI 2016