CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

1 Taipei Veterans General Hosp, Taipei, Taiwan, 2 Kirby Inst, Sydney, Australia, 3 Inst of Infectious Diseases, Pune, India, 4 Rsr Inst for Trop Med, Manila, Philippines, 5 Cipto Mangunkusumo Hospital, Univ of Indonesia, Jakarta, Indonesia, 6 Rsr Inst for Hlth Scis, Chiang Mai Univ, Chiang Mai, Thailand, 7 Mahidol Univ, Bangkok, Thailand, 8 HIV-NAT, Thai Red Cross AIDS Rsr Cntr, Bangkok, Thailand, 9 Univ of Hlth Scis, Phnom Penh, Cambodia Background: Co-trimoxazole (CTX) is recommended as prophylaxis against Pneumocystis jiroveci pneumonia, malaria and other serious bacterial infections in HIV-infected patients. Despite its in vitro activity against Mycobacterium tuberculosis, the effects of CTX preventive therapy (CPT) on tuberculosis (TB) remains unclear. Methods: Adult patients enrolled in TREAT Asia HIV Observational Database (TAHOD) cohort who have initiated combination antiretroviral therapy (cART) were included. Factors associated with new TB diagnoses after cohort entry and survival after cART initiation were analysed using Cox regression, stratified by site. CTX and isoniazid initiated within 60 days prior to TB diagnosis were not regarded as routine prophylaxis. Results: A total of 7355 patients from 12 countries in Asia were included in the study. There were 368 new cases of TB after cohort entry with an incidence rate of 0.99 per 100 person-years (/100pys). Multivariate analyses adjusted for viral load (VL), CD4 count, body mass index (BMI), and cART duration showed that CPT had a protective effect against the development of TB (HR 0.72, 95% CI: 0.56-0.93, p=0.011). Mortality after cART initiation was 0.85/100pys with a median follow-up time of 4.63 years. Predictors of survival included age (41-50 years, HR 1.49, 95% CI: 1.05-2.13, p = 0.027; and >50 years, HR 3.90, 95% CI: 2.70-5.62, p<0.001, compared to age ≤30 years), female sex (HR 0.70, 95% CI: 0.53-0.94, p=0.017), hepatitis C co-infection (HR 1.90, 95% CI: 1.33-2.72, p<0.001), TB diagnosis (HR 2.50, 95% CI: 1.73-3.63, p<0.001), HIV viral load (≥5000 copies/mL, HR 1.59, 95% CI: 1.09-2.34, p=0.017, compared to VL <400 copies/mL), CD4 count (51-100 cells/µL, HR 0.42, 95% CI: 0.29-0.62; 101-200 cells/µL, HR 0.19, 95% CI: 0.13-0.28; and >200 cells/ µL, HR 0.06, 95% CI: 0.04-0.09, all p<0.001, compared to CD4 ≤50 cells/µL) and BMI (≥25 kg/m2, HR 0.40, 95% CI: 0.24-0.68, p=0.001, compared to BMI <25 kg/m2). Patients receiving CPT had improved survival; however, the effect was not statistically significant (HR 0.78, 95% CI: 0.58-1.03, p=0.081). Conclusion: CPT had a protective effect against new TB infection in our Asian HIV cohort. The potential preventive effect of CTX against TB during periods of severe immunosuppression should be further explored.

Poster and Themed Discussion Abstracts

706 ISONIAZID PREVENTIVE THERAPY INITIATION, COMPLETION, & RETENTION IN CARE IN ETHIOPIA

Andrea Howard 1 , Katharine Yuengling 1 , Yael Hirsch-Moverman 1 , Suzue Saito 1 , Tsigereda Gadisa 2 , Wafaa M. El-Sadr 1 , Zenebe Melaku 3 1 ICAP at Columbia Univ, New York, NY, USA 2 ICAP at Columbia Univ, Maseru, Lesotho, 3 ICAP at Columbia Univ, Addis Ababa, Ethiopia

Background: Isoniazid preventive therapy (IPT) reduces risk of TB in people living with HIV (PLHIV); yet only 18% of PLHIV in Ethiopia received IPT in 2012. The ENRICH Study evaluated the effectiveness of a combination intervention package (CIP) to improve IPT initiation, adherence, completion and retention in care among PLHIV in Ethiopia. Methods: Ten health centers were provided with IPT registers and site-randomized to receive CIP or standard of care (SOC). CIP included: nurse training and mentorship; IPT data review at multidisciplinary teammeetings; patient transport reimbursement; and education and adherence support using interactive voice response messages and peer educators. Routine data were abstracted for newly-enrolled HIV+ patients >18 years. Interviewers administered monthly questionnaires to a subsample of patients initiating IPT to assess adherence based on 30-day recall. Generalized linear mixed models were applied to test for differences between study arms for IPT initiation, adherence, completion, and retention in care; frailty models were used to examine differences in time to IPT initiation. Results: Among 883 patients enrolled in HIV care between 1/2013 and 11/2015 and eligible for IPT, mean age was 33.9±9.7 y; 57%were female; median (IQR) CD4 count among 756 patients with data was 247 (128-440). 60% (293/492) of CIP patients initiated IPT vs. 57% (222/391) of SOC patients (RR 1.05 95% CI 0.88-1.25). Time from enrollment to IPT

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