CROI 2016 Abstract eBook

Abstract Listing

Poster Abstracts

840 HIV Antibodies and Reservoir Size in Perinatally Infected Children on HAART Josephine Brice 1 ; FatoumataTiguemTelly 2 ; Maxime Grudé 3 ; Anne Derache 4 ; Deenan Pillay 4 ; Francis Barin 5 ;Vincent Calvez 3 ; Maryam Sylla 6 ; Almoustapha Maiga 7 ; Anne-Geneviève Marcelin 3 1 UMR-S 1136 Pierre Louis Inst of Epi and PH, Paris, France; 2 SEREFO, Univ of Scis Techniques and Technologies of Bamako, Bamako, Mali; 3 Sorbonne Univs, Paris, France; 4 Africa Cntr for Hlth and Pop Studies, Mtubatuba, South Africa; 5 François-Rabelais Univ, Tours, France, Tours, France; 6 CHU Gabriel Toure, Bamako, Mali; 7 SEREFO, Univ of Scis Techniques and Technologies of Bamako, Bamako, Mali Background: Absence of detectable viremia after treatment cessation in perinatally HIV-infected (PHIV) children suggests that early initiation of highly active combination of antiretroviral therapy (HAART) may lead to functional cure. By stopping the viral replication, the early virostatic treatment may prevent the development of the HIV-1-specific antibody responses and limit the establishment of the viral reservoir. Here we describe the factors associated with the anti-gp41 antibodies activity and the viral reservoir size in PHIV HAART-treated children. Our second objective was to identify global HIV seroreversions. Methods: This transversal prospective study involved 97 PHIV HAART-treated children with virological suppression (HIV-1 RNA plasma ≤ 50 copies/mL). It took place in Gabriel Touré hospital, in Bamako, Mali, between August 2013 and April 2014. We measured the anti-gp41 antibodies activity (binding to the immunodominant epitope), determined by an enzyme-immunoassay (ELISA), and the quantification of antibodies to HIV by the Architect ELISA (Abbott). The size of viral reservoir was determined by measuring HIV blood cell associated total DNA. Results: The PHIV children studied had a median of 9.8 years of age (IQR = 7.0 - 13.1) at time of inclusion. In median, they had started HAART at 3.3 years of age (IQR = 1.9 - 7) and were on HAART for the past 5.4 years (IQR = 3.5 - 7). The median level of total HIV DNA was 445 copies/10 6 cells (IQR = 187 - 914), the median anti-gp41 antibodies activity was 0.29 UA (IQR = 0.18 - 0.75). A low activity of anti-gp41 antibodies was associated with a younger age at treatment initiation (p = 0.01). No association was found between anti-gp41 antibodies and HIV DNA (p = 0.17). The 9 children having an HIV DNA under the threshold (< 66 copies/10 6 cells) tended to have a lower anti-gp41 antibodies activity versus children with an HIV DNA > 66 copies//10 6 cells (p = 0.11). Overall, eight seroreversions were identified (negative Architect ELISA) in which 2 children had an HIV DNA under the threshold (1 detectable and 1 undetectable) and a low anti-gp41 antibodies activity. Conclusions: This study may be helpful to identify candidates with low viral reservoir and low antibodies level for future strategies aiming at reduce the burden of antiretroviral therapy or control the HIV reservoir in children. 841 Hybrid HIV Testing Strategy Achieves High Coverage of Rural East African Children James Ayieko 1 ; Gabriel Chamie 2 ; Craig R. Cohen 2 ;Tamara Clark 2 ; Edwin Charlebois 2 ; Maya Petersen 3 ; Moses R. Kamya 4 ; DianeV. Havlir 2 ;Theodore D. Ruel 2 1 Kenya Med Rsr Inst, Kisumu, Kenya; 2 Univ of California San Francisco, San Francisco, CA, USA; 3 Univ of California Berkeley, Berkeley, CA, USA; 4 Makerere Univ Coll of Hlth Scis, Kampala, Uganda Background: Despite scale-up of early infant diagnosis programs, many HIV+ children remain undiagnosed and suffer high mortality. Efficient ways to screen children ≥ 2 years old in the context of universal test-and-treat policies are needed. We evaluated the HIV-testing coverage of children in a hybrid mobile multi-disease screening campaign that achieved 89% HIV testing of adults in Uganda and Kenya (SEARCH, NCT:01864603). Methods: From 2013-14, children in 32 rural Ugandan and Kenyan communities were enumerated by door-to-door census. Children were tested for HIV using a “hybrid” mobile testing strategy that included 2-week multi-disease community health campaigns (CHCs) offering malaria testing, deworming and vitamin A, followed by targeted home-based testing (HBT) for children “at-risk” for HIV, with mothers’ serostatus positive (HIV+) or unknown (HIVunk). Children aged 2-9 years old living in the study community for ≥6 months of the prior year (“stable”) were evaluated for HIV testing coverage, seroprevalence and newly diagnosed infection. Results: Of 87,700 stable children (mean age 5.4 years), maternal serostatus was negative in 57,655 (66%), positive in 7,055 (8.0%), and unknown in 22,990 (26%). Both parents were alive for 92%, 1.3%were maternal orphans, 6.0%were paternal orphans, and 0.9% had lost both parents (unknown in 0.3%). The CHC was attended by 69,906 (80%) children; overall hybrid model testing coverage of at-risk children was 81% (see Table). Among children of HIV+mothers, older children (8-9 vs 2-3 years aOR 2.5,95%CI:2.0- 3.1) and Kenyan residence (aOR 3.4, 95%CI:2.4-4.8) were predictive of not being tested in generalized estimating equation modelling, but low wealth (lowest tertile aOR 1.0, 95%CI:0.8-1.3) and maternal CD4 count < 350 (aOR 1.1, 95%CI:0.9-1.4) were not. Among 819 HIV+ diagnoses, 444 (54%) had no prior positive testing reported. The prevalence of HIV was 0.4% in Southwest Uganda, 0.6% in East Uganda and 2.6% in Kenya, among children tested. Conclusions: The integration of HIV-testing of children into a CHC, with subsequent targeted HBT for at-risk children, resulted in 81% testing coverage of at-risk children and doubled the number of children recognized to be HIV+. In Ugandan communities, coverage of children born to HIV+ women reached 95%. Similar approaches, integrating pediatric screening into mobile population-level health campaigns, could serve as efficient tools for identifying HIV+ children as countries seek to achieve universal testing and treatment.

Poster Abstracts

842 Outcomes of the Test and Treat Policy for HIV-Infected Children and Adolescents Rita Atugonza ; Jacqueline B. Kanywa;VincentTukei; Adeodata Kekitiinwa Baylor Coll of Med Children’s Fndn Uganda, Kampala, Uganda

Background: In 2014, Uganda was the first high-burden country to adopt the Test and Treat model for all children and adolescents living with HIV under the age of 15 years. We compare baseline and 12 months outcomes of children who initiated ART under the Test and Treat model and WHO 2010 guidelines at an HIV clinical center of excellence in Uganda. Methods: All children and adolescents under 15 years were started on ART. For this analysis, participants were eligible if they were aged 5-15 years and had initiated first line ART between 1 st April 2014 and 31 st March 2015. Participants were further categorized into 2 groups namely those eligible for ART based on WHO 2010 guidelines and those only eligible based on the new Test and Treat policy. Data was retrospectively reviewed and comparisons made between the 2 groups for CD4 levels, nutritional status, drug adverse events, viral load and retention in care. Data was analyzed using STATA SE/13.0

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CROI 2016