CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

included for subsequent analyses. Comparison across platforms was performed using repeated measures analysis to test for within-subject effects. Estimates of sensitivity and specificity were obtained separately relative to the composite infection standard (CIS) for rectal and urine samples. For oropharyngeal samples, estimates of sensitivity and specificity were obtained relative to the patient infection standard (PIS) in which two NAATs had to be positive. All statistical analyses were performed using SAS 9.4. Results: Of 151 men enrolled, the median age was 35 and 19.9% had GC or CT detected at one or more of three sites. There were 48 positive tests in this group (27 CT, 21 GC). CT was identified in 16.4% of rectal swabs, 2.1% of urine, and 0.0% of oropharyngeal swabs; while GC was identified in 7.5% of rectal swabs, 2.1% of urine, and 4.9% of oropharyngeal swabs. All of the NAAT CT/GC platforms had statistically similar test characteristics (p=0.06). CT sensitivity estimates ranged from 83.3%-100.0% using CIS and specificity was >98.2% for all sample types. Sensitivity ranged from 63.6%-100.0% using CIS and 75.0-90.0% using PIS for detection of GC infections; and specificity for GC infections was >98.3%. Conclusion: CT or GC was detected in 1 of 5 HIV-infected MSM who reported receptive anal intercourse in the past 30 days. Most extragenital infections would have been missed with urethral screening alone. Each of the four testing platforms performed similarly at rectal and pharyngeal sites.

Poster and Themed Discussion Abstracts

868LB NALTREXONE IMPLANT IMPROVES HIV TX OUTCOMES VS ORAL NTX IN OPIATE ADDICTED PATIENTS Evgeny Krupitsky 1 , Edwina Zvartau 1 , E. Blokhina 1 , Elena Verbitskaya 1 , D. Lioznov 1 , T. Yaroslavtseva 1 , Sabrina Poole 2 , Robert Gross 2 , George Woody 2 1 First Pavlov State Med Univ of St. Petersburg, St. Petersburg, Russian Federation, 2 Univ of Pennsylvania, Philadelphia, PA, USA, Background: Aim: HIV+ opiate users often have poor adherence to antiretroviral therapy (ART). An earlier study found that a one-gm extended release naltrexone implant (NI) prevents relapse for ~ 3 months and improves addiction treatment outcomes. We aimed to assess the impact of NI compared to 50 mg daily oral naltrexone (ON) on ART outcomes. Methods: Methods: 200 detoxified HIV+ opiate addicted patients starting ART in St. Petersburg were randomized 1:1 to 12 months of NI + ON placebo (NI group), or ON + NI placebo (ON group). All were offered every other week drug counseling. The primary outcome was plasma HIV RNA (LLQ = 400 copies/ml) at month 12; secondary outcomes were adherence to addiction treatment, retention in ART and ART adherence indexed by MEMS, CD4 count, and adverse events. Results: Results: Baseline characteristics were similar between groups. HIV RNA suppression was more common in NI than ON (66% vs 50%; OR [95% CI] = 1.94 [1.10-3.43]), addiction treatment was more often completed in NI than ON (32% vs 17%, respectively, p<0.05), and retention in ART care was better in NI than ON (46% vs 32%; p<0.05). The proportion of ART doses taken was higher in completers vs. dropouts: 73.7% (95% CI: 67.2-80.2%) vs. 64.9% (95% CI: 59.7-70.1%; F1, 198 = 4.37; Р= 0.038). CD4 count increase was greater in those who continued naltrexone regardless of group assignment as seen by CD4 change at end of treatment compared to baseline for completers vs. drop outs: +206.2 cells/mm3 ±201.8 vs. +67.3 cells/mm3 ±159.4 (p<0.001). The groups did not differ in adverse events (32% for ON vs. 30% for NI). Conclusion: Conclusions: NI improved HIV treatment outcome and retention compared to ON in patients addicted to opioids and initiating ART in St. Petersburg, Russia. Extended release naltrexone may be a useful alternative to methadone or buprenorphine maintenance for opioid addicted patients starting ART who are not interested in agonist-based medication assisted therapy or where it is difficult to access or otherwise unavailable. Supported by: NIDA grants R01 DA026336; K05 DA 17009; U10DA013043 869 Background: Misuse of prescription opioids (PO) increased dramatically in the US since the early 2000s and may lead to increases in heroin use and drug injection. Understanding the role of PO in injection initiation is key to preventing injection-related harms, including HIV and hepatitis C. We assessed factors associated with PO abuse prior to first injection (prior PO abuse) among people who inject drugs (PWID). Methods: PWID ages ≥18 years were recruited for the 2015 National HIV Behavioral Surveillance using respondent-driven sampling. Data on prior PO abuse (“hooked on painkillers before you injected for the very first time”) among PWID who injected opioids (heroin, PO; alone or in combination) were available in 16 cities. We estimated Poisson regression models with generalized estimating equations clustered on recruitment chain and adjusted for sampling design covariates to assess factors associated with prior PO abuse. We report adjusted prevalence ratios (aPR) and 95% confidence intervals (CI). Results: Of 7,454 PWID, 2,208 (30%) reported prior PO abuse. Prior PO abuse was higher among PWID who began injecting in more recent years (Figure). PWID reporting prior PO abuse compared to other PWID were more likely to be younger (mean age 34 vs. 47 years, p<0.0001), female (32% vs 26%, aPR 1.22, CI 1.13-1.31), non-Hispanic white (65% vs. 33%, aPR 2.14, CI 1.85-2.47), have high school education or higher (74% vs 68%, aPR 1.21, CI 1.12-1.30) and receptively shared syringes (44% vs 33%, aPR 1.28, CI 1.19-1.37). PWID who reported prior PO abuse were less likely to test HIV-positive, even after controlling for age and race/ethnicity (2% vs 6%, aPR=0.59, 95%CI 0.41-0.84). Common sources of first ever PO were prescription by a physician (41%), purchased from friends, family or others (36%), and given by friends (29%). Mean time between first ever PO use and first injection was 5 years (SD=6.4, median 3). Conclusion: Prior PO abuse was substantially higher among PWID who began injecting during the opioid epidemic (i.e., since 2000). PWID with prior PO abuse differed in socio- demographic characteristics and despite lower HIV prevalence, were more likely to engage in practices that increase risk of infection. Efforts to prevent HIV transmission and other blood-borne infections would benefit from injection prevention interventions for people who abuse PO and increased understanding of barriers and facilitators to effective prevention delivery for those already injecting. “HOOKED ON PAINKILLERS” PRIOR TO FIRST INJECTION AMONG PWID IN 16 US CITIES Dita Broz 1 , Maria Zlotorzynska 2 , Michael Spiller 1 , Gabriela Paz-Bailey 1 , for the NHBS Study Group 1 CDC, Atlanta, GA, USA, 2 Emory Univ, Atlanta, GA, USA

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