CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

1 Walter Reed Natl Military Med Cntr, Bethesda, MD, USA, 2 Henry M. Jackson Fndn for Advancement of Military Med, Bethesda, MD, USA, 3 Naval Med Cntr Portsmouth, Portsmouth, VA, USA, 4 Brooke Army Med Cntr, San Antonio, TX, USA, 5 Uniformed Services Univ of the Hlth Scis, Rockville, MD, USA, 6 Madigan Army Med Cntr, Takoma, WA, USA Background: Current treatment guidelines recommend against antiretroviral therapy (ART) changes until the viral load (VL) is greater than 200 copies/mL on two or more determinations. Whether VLs between 50 and 200 copies, i.e. persistent low level but quantifiable viremia (pLLV) predicts virologic failure (VF) is unclear. We used data from the US Military HIV Natural History Study (NHS), a well-characterized cohort of HIV-infected military members, to examine virologic outcomes and the association of pLLV and VF. Methods: NHS subjects who initiated ART after 1996 were included, if they had two or more viral loads (VLs) measured utilizing an assay with a lower limit of detection of 50 copies/mL; for each subject, one VL had to be measured 6-18 months after ART initiation. The NHS definition of ART, which complies with the definitions discussed in the treatment guidelines, was used in this analysis. VF was defined as a viral load ≥200 copies on two separate determinations. Subjects with VLs ranging from 51 to 199 copies in over 25% of their measured values, while receiving ART, were classified as having pLLV. Continuously suppressed subjects were those with VL <50 copies/mL on all measurements. Descriptive statistics and chi-square were used to compare individuals with/without VF; variables found significant (p<0.05) in a univariate analysis were used in a multivariate logistic regression analysis. Results: 1675 NHS subjects [95%male, 42% African- American, 39% Caucasian] met our inclusion criteria. 801 (47.8%) subjects were continually suppressed, while 141(8.4%) had pLLV. Of the 1675 subjects, 430 (25.7%) experienced VF during follow up. In comparison, 51 (36%) of the 141 subjects with pLLV met criteria for VF. In a multivariate analysis, presence of pLLV, younger age at ART initiation, HIV diagnosis prior to 1996, the use of antiretrovirals (ARV) that did not meet the NHS definition (usually mono or dual therapy) before ART initiation, and use of unboosted protease inhibitor (PI) based regimens were associated with VF (table). Conclusion: In this large well characterized cohort with free access to care and limited confounders pLLV was associated with an increased risk of VF. Other factors identified were consistent with prior reports. Our results suggest that subjects with pLLV should be evaluated for their risk of VF including evaluation of medication adherence, adverse effects, and the need for ART modification.

Poster and Themed Discussion Abstracts

933 LONGITUDINAL VIRAL TRAJECTORY AMONG WOMEN IN THE WOMEN’S INTERAGENCY HIV STUDY

Seble Kassaye 1 , Cuiwei Wang 1 , Jeff Collmann 1 , Tracey Wilson 2 , Kathryn Anastos 3 , Mardge H. Cohen 4 , Ruth Greenblatt 5 , Joel Milam 6 , Steven Gange 7 , Michael Plankey 1 1 Georgetown Univ, Washington, DC, USA, 2 SUNY Downstate Med Cntr, Brooklyn, NY, USA, 3 Albert Einstein Coll of Med, Bronx, NY, USA, 4 John H.Stroger Jr. Hosp of Cook County, Chicago, IL, USA, 5 Univ of California San Francisco, San Francisco, CA, USA, 6 Univ of Southern California, Los Angeles, CA, USA, 7 The Johns Hopkins Univ, Baltimore, MD, USA Background: The HIV treatment cascade provides a cross-sectional estimate of success in achievement of viral suppression, with the global goal of viral suppression in 90% of treated patients. We sought to determine the probability of sustained viral suppression by determining the longitudinal HIV viral trajectories (LHT) among women enrolled in the Women’s Interagency HIV Study (WIHS).  Methods: Women were recruited in 1994-1995, 2001-2002, and 2011-2012. Logistic trajectory modeling was performed to identify longitudinal HIV RNA trajectories among women with >4 semi-annual visits to determine the probability of achieving HIV RNA >80 c/mL. Multinomial regression analysis was conducted to determine risk factors associated with the sustained viremia trajectory (SAS v9.2). Results: 2,440 women contributed 56,209 visits from 1994-2015. The baseline median age was 36.4 years, 58.2%were African American, with a median CD4+ T lymphocyte count of 464/µl and median HIV RNA of 7000 c/mL. Three HIV viral trajectories were identified: sustained viremia (N=1010); intermittently viremic (N=719), and; non-viremic (N=711). Cumulative years of viral suppression were 20 years (non-viremic), 13 years (intermittent-viremia), and 5 years (non-viremic) across groups. The proportion of women with intermittent viremia declined then plateaued starting around 2008, alongside a sharp decline in the proportion with sustained viremia starting in 2012. Significant predictors of sustained viremia in both univariate and multivariate analyses were younger age, African American, depression with CES-D ≥16, illicit drug use, alcohol use >7 drinks/week, self-reported adherence < 95%, or not being on antiretrovirals and enrollment site. Conclusion: This novel approach to determine LHT provides a rich perspective of challenges and successes in achieving and maintaining viral suppression over a long period of time. Long-term viral suppression was uncommon in this non-clinic based cohort, and a surprisingly high proportion of women exhibit intermittent viral suppression. The recent viral trajectories we observe likely reflect availability of potent, well tolerated antiretrovirals, and evolving treatment guidelines that promote universal treatment. Treatment success to achieve current treatment targets of 90-90-90 must address the psychosocial elements that we identify as deterrents to long term viral suppression.

CROI 2017 404