CROI 2016 Abstract eBook

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Poster Abstracts

RNA test <400 copies/ml at >10 years of age, or the 10 th birthday for those with prior suppression. Cox proportional hazard models were used to identify factors associated with post-suppression virologic rebound (HIV RNA >1,000 copies/ml). Median values are provided with interquartile ranges (IQR). Results: Of 1,379 eligible adolescents, 47%were male. At baseline, 22%were on protease inhibitor (PI)-based regimens, the median CD4 count was 685 (448-937) cells/mm 3 , and 2% had a documented history of pre-adolescent virologic failure before subsequent suppression. The median number of HIV RNA measurements was 1.6 (1.2-2.2) per year. During adolescence, 180 individuals (13%) experienced post-suppression virologic rebound at a rate of 3.4 (95% confidence interval: 2.9-3.9) per 100 person-years (PYs). Median time to rebound was 3.3 (2.1-4.8) years. In multivariate analysis, wasting (weight-for-age Z-score <-2.5), having a grandparent as a primary caregiver, receiving PI-based regimens, starting their first cART regimen after 2005, and having an episode of pre-adolescent virologic failure were significantly associated with post-suppression virologic rebound during adolescence (Table 1). At virologic rebound, the median age was 14.8 (13.2-1.4) years; the most recent CD4 cell count was 507 (325-723) cells/mm 3 . Overall, 16 adolescents were lost to follow-up at a rate of 0.3 events per 100 PYs, and 11 died at a rate of 0.2 deaths per 100 PYs. Conclusions: Post-suppression virologic rebound was not uncommon among adolescents in our cohort on stable cART. Those with wasting, being cared for by grandparents, using PI-based regimens, commencing cART after 2005, or having pre-adolescence virologic failure were at higher risk of rebound, and may benefit from increased monitoring to support long-term treatment success.

832 Longitudinal Virologic Suppression Among a Cohort of Behaviorally HIV-Infected Youth SarahWood 1 ; Elizabeth D. Lowenthal 1 ; Susan S. Lee 2 ; Nadia Dowshen 3

1 Univ of Pennsylvania Perelman Sch of Med, Philadelphia, PA, USA; 2 Children’s Hosp of Philadelphia, Philadelphia, PA, USA; 3 Univ of Pennsylvania, Philadelphia, PA, USA Background: Cross-sectional virologic suppression rates among HIV-infected adolescents and young adults (AYA) are significantly lower than those among adults. However, little is known about the longitudinal patterns of virologic suppression among AYA. Recent treatment guidelines suggest reduced monitoring of adolescents and adults with well controlled HIV, however it is unknown if these guidelines relevant for AYA. Methods: This retrospective cohort study included all behaviorally HIV-infected AYA enrolled in care at a U.S. academic medical center from January, 2002-October, 2011. Youth were included if they initiated antiretroviral therapy (ART) during the study period and had a minimum of six months of follow up time after ART start. Subjects were followed until the first episode of virologic failure (defined as HIV plasma RNA >1000 copies /ml once or >200/ml on two consecutive measurements) or censored at transition of care, loss to follow up, death or the end of the study period (December, 2013). Results: Of the 296 eligible AYA, 176 (59.5%) received ART. Of these, 116 (65.9%) initiated during the study period and had a minimum of 6 months follow up time, comprising the study cohort. The cohort was 91% African American and 83%male. Transmission was by male-male sexual contact in 82%. The median age at HIV diagnosis was 18.3 years (IQR 16.9-20). The median age at ART initiation was 20.1 years (IQR 18.6-22) and subjects were followed for a median of 2.6 years (IQR 1.7-4) after ART start. The median time from diagnosis to first regimen was 12.2 months (IQR 5.2-24.8). Virologic suppression on first ART regimen was achieved by 102 (88%) subjects, 31.3% (n=32) of whom experienced virologic failure within 2 years of ART initiation, with a median time to failure of 8.2 months (IQR 5.2-11.7). There were 45 subjects (44%) who had two years of sustained virologic suppression, and were followed for a median of 3.2 years (IQR 2.6-4.3) after ART initiation. Of these patients, 20% (n=9) subsequently developed virologic failure in their remaining time in the cohort, with 55% of these failing between their second and third years of ART. AYA remained at high risk of virologic failure throughout the course of treatment, even among those with sustained virologic suppression of >=2 years duration. These finding may suggest that recent changes in treatment guidelines recommending decreased frequency of laboratory monitoring among patients with suppression of ≥2 years duration may not be applicable to AYA. 833 Psychological Reactance Is a Novel Risk Factor for Adolescent HIV Treatment Failure Elizabeth D. Lowenthal 1 ;Tafireyi Marukutira 2 ; Jennifer Chapman 3 ; OntibileTshume 2 ; Mogomotsi Matshaba 2 ; Gabriel Anabwani 2 ; Robert Gross 1 1 Univ of Pennsylvania Perelman Sch of Med, Philadelphia, PA, USA; 2 Botswana-Baylor Children’s Clinical Cntr of Excellence, Gaborone, Botswana; 3 Children’s Hosp of Philadelphia, Philadelphia, PA, USA Background: Antiretroviral (ARV) treatment failure rates and death rates among adolescents with HIV remain alarmingly high and adolescent-specific interventional approaches are desperately needed. Adolescents’ high failure rates may be partially due to risk factors that are unique to or enhanced by their developmental stage. Psychological reactance is an aversive response to perceived threats to behavioral freedom that may be more common among adolescents. Reactance can be measured and can be increased or decreased through specific parenting or counseling approaches.

Poster Abstracts

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CROI 2016