CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

Methods: Third-line ART for adults in the public sector in South Africa is accessed through a national committee that assesses eligibility and makes regimen recommendation on each case. Criteria for third-line treatment include a minimum of one year of PI based ART with virologic failure despite adherence optimization and a genotypic antiretroviral resistance test (GART) showing PI resistance. We present a cross-sectional analysis and descriptive statistics on this cohort. PI resistance was defined by a resistance mutation score of ≥15 on the Stanford University HIV Drug resistance Database. Results: 152 patients were submitted to the national third line committee between Aug 2013 and July 2014 and granted access to third line. Median age was 41 years (IQR: 24-47) and 60%were female. The median CD4 count and viral load was 170 (IQR: 127-337) and 17013 (IQR: 396-104178) respectively. In terms of second line ART, 5% started before 2005, 22% started second line between 2004 and 2009 and 62% started second-line between 2008 and 2011.Of the 146 (96%) patients with resistance test results, 74% and 77% had resistance (≥15) to efavirenz and nevirapine respectively. 85%, 72%, 69% and 92% had resistance to lamivudine, zidovudine, tenofovir and abacavir respectively, while 97% and 98% had resistance to lopinavir and atazanavir respectively. In addition 57% and 37% had resistance to darunavir and etravirine respectively. Of the 146, 145 were initiated on a third-line regimen containing either raltegravir (n=106), darunavir (n=145) or etravirine (n=33) or some combination thereof. Among those with at least one viral load post

resistance testing (n=117), a large proportion (94%, n = 102) were able to resuppress their viral load to below 400 copies/ml Conclusion: Despite high levels of resistance, viral suppression was high in a programmatic roll out of third line ART.

Poster and Themed Discussion Abstracts

1021 “I WON’T DIE WITH THE CAUSE OF AIDS”: 10 YEARS ON ART IN SOUTH AFRICA’S HIV PROGRAM Cheryl J. Hendrickson 1 , Sophie Pascoe 1 , Aneesa Moolla 1 , Mhairi Maskew 1 , Matthew Fox 2 1 Univ of the Witwatersrand, Johannesburg, South Africa, 2 Boston Univ, Boston, MA

Background: As South Africa enters the second decade of its National Antiretroviral Treatment (ART) program, it is important to take stock of a decade of achievement. This mixed-methods study describes 10-year treatment outcomes of patients initiated at the start of the rollout and explores what motivated testing, initiation and continued care. Methods: We conducted a cohort analysis and in-depth interviews among adults initiating ART between April 2004 and March 2006 at a large public clinic in Johannesburg. We ascertained 10-year all-cause mortality and loss to follow-up (LTF) for two ten-year cohorts (Y1 initiated 04/2004-03/2005 and Y2 04/2005-03/2006). We describe associations using adjusted hazard ratios (aHR). Twenty-four patients were purposively selected and interviewed (09/2015-03/2016). Results: 3003 adults (31.2%male) were followed for 18,687 person-years (median 6.9). Median ages at Y1 and Y2 were 35.3 and 35.0 and baseline CD4 counts were 78 and 87 cells/mm3 respectively. After ten years, 21.5% had died and 24.3%were LTF; 957 (31.9%) were still alive and in care. Being male (aHR=1.40 (1.18-1.66), older at initiation (>50 vs 18-30 aHR=1.56 (1.14-2.14) and WHO Stage III/IV (vs Stage I/II aHR 1.31 (1.09-1.58) increased the risk of mortality (Table 1). Patients were more likely to be LTF if they initiated in the second year of the treatment program (vs Y1 aHR=1.57 (1.29-1.91). Older initiators were less likely to be LTF (18-30 vs >50 aHR=0.39 (0.24-0.63). Interviewed individuals reported that having children, a strong desire to survive and being the only provider at home were strong facilitators for continued treatment. Patients cited supportive counselling and informal support groups prior to, and at, treatment initiation as key to their decision to start treatment. Observed quality of life improvement on ART encouraged long-term adherence and continued care. Conversely, conflicts in work/life commitments, health issues, side-effects, and clinic staff attitude were barriers. Few participants reported gaps in care during treatment (n=4); those who did indicated that severe side-effects, travel and domestic abuse resulted in them defaulting. Conclusion: Many patients who initiated treatment at the beginning of the national programme have successfully remained on ART for ten years. A supportive and flexible clinic environment, which minimises negative aspects of treatment should be prioritised for continued long-term treatment and adherence, particularly as policy moves to test- and-treat.

CROI 2017 440