CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

CDC, Atlanta, GA, USA Background: Diagnosis of HIV infection at an early stage may provide an opportunity to prevent transmission because early (including acute) infection has been associated with viral loads much higher than those in later stages. We aimed to confirm this association by comparing viral loads in the first 6 weeks after diagnosis (or on the same date), by week and stage of disease at diagnosis. Methods: We analyzed data on the 163,215 infections diagnosed in 2012-2015 reported to the US National HIV Surveillance System through June 2016. Diagnosis and staging were based on the 2014 US surveillance case definition for HIV infection, in which early infection is stage 0. We limited the analysis to records with exact specimen collection dates, and to first viral loads to minimize the effect of antiretroviral therapy and reveal the natural history of viral loads. Results: 95,606 infections (59% of the total) were reported with a quantifiable first viral load within 6 weeks after diagnosis and with enough criteria to determine the stage at diagnosis. Of these, 3,473 (3.6%) were stage 0; 26,894 (28.1%) stage 1; 35,135 (36.8%) stage 2; and 30,104 (31.5%) stage 3. The median first viral load among infections diagnosed in stage 0 fell from 581,501 copies/mL in week 1 to 97,564 in week 2, and 36,806 by week 6; among infections in stage 1, it was 8,980 in week 1, and ranged from 13,094 to 15,170 in week 2 through week 6; among infections in stage 2, it ranged from 39,495 to 42,070 in week 1 through week 6; among infections in stage 3, it dropped from 201,000 in week 1 to 170,213 in week 2, and 116,000 by week 6 (see figure). The percentage of infections with a first viral load of ≥500,000 copies/mL among those in stage 0 fell from 53.8% in week 1 to 27.7% in week 2, and to 11.4% by week 6; among infections in stage 1, it dropped from 6.6% in week 1 to 2.9% in week 2, and 1.1% by week 6; among infections in stage 2, it decreased from 10.9% in week 1 to 5.2% in week 2, and 2.8% by week 6; among infections in stage 3, it declined from 27.1% in week 1 to 24.0% in week 2, and 18.9% by week 6. Conclusion: In the 1st week after diagnosis, viral loads are generally much higher among infections diagnosed in stage 0 than among infections in other stages. By the 2nd week, they are generally less than those in stage 3. These findings imply that the period when early infections are highly infectious lasts only about 1 week after diagnosis, so prevention of transmission should start as soon as possible after diagnosis.

Poster and Themed Discussion Abstracts

891 HIV SELF-TEST (HIVST) AWARENESS, EXPOSURE, AND USE, NEW YORK CITY, 2015–2016 Paul M. Salcuni , Zoe R. Edelstein, Demetre C. Daskalakis, Julie Myers New York City DHMH, Queens, NY, USA

Background: The HIV self-test (HIVST) can increase status awareness, but barriers to access exist along a proposed continuum from awareness to use. Among a large, urban sample of men and transgender people who have sex with men (MTSM) who participated in an HIVST Giveaway (HTG), we examined associations between sociodemographic and behavioral factors and prior HIVST awareness, pharmacy exposure, and use. Methods: Data were derived from online eligibility and follow-up surveys, 11/2015-4/2016. Participants were recruited through dating apps and sites. Adult NYC residents who were MTSM and reported no prior HIV diagnosis were eligible. Data included sociodemographic factors (age, race/ethnicity, education, income), recent HIV-related behaviors [timing of last HIV test before HTG; last condomless anal sex (CAS; <1/1-3/>3 months ago/never); gender(s) and HIV status of partners; number of CAS partners (0-1/>1); sexually transmitted infection (STI) diagnosis; pre-exposure prophylaxis (PrEP) use; recreational drug use]. Outcomes were HIVST awareness, pharmacy exposure (ever seen at a pharmacy), and use (ever) prior to HTG. Factors associated with outcomes in bivariate analysis (p<0.05) were included in logistic regression models adjusted for age, race/ethnicity, education, and income. Results: Eighty-five, 57% and 23% of respondents were aware of, had seen, and had used the HIVST, respectively (Table). After adjusting for sociodemographics, all outcomes were associated with higher income and recent HIV testing. Awareness did not differ by age or race/ethnicity; exposure and use were associated with both. Among HIV-related behaviors, awareness was associated with recent PrEP use [adjusted odds ratio (aOR) 1.85, 95% CI 1.12-3.06] and having an HIV-positive partner (aOR 2.35, CI 1.20-4.63); similar relationships existed for exposure. Awareness was also associated with CAS in the past month vs. never (aOR 3.26, CI 1.61-6.57) and partnering only with men (aOR 2.10, CI 1.05- 4.18). Among behaviors examined, use was associated with >1 recent CAS partner (aOR 1.68, CI 1.22-2.31). Conclusion: While most respondents knew about the HIVST prior to HTG, fewer had seen one, and only 1 in 4 had used one. Associations with recent HIV testing suggest that less frequent testers may not be adequately informed of this option. Disparities along an HIVST continuum by income suggest that barriers to access are present even before purchase, underlining the importance of efforts to bring this testing strategy to diverse populations.

CROI 2017 387