CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

data together with prevalence studies were used during model calibration. Time trends in ART survival rates were estimated. The impact was assessed as incidence and mortality reductions up to 2015 in the presence of ART, condoms, and needle exchange programs. Furthermore, three forward-looking scenarios were simulated to assess the impact as the cascade in Brazil moves towards 90-90-90 goals by 2020. Results: We estimated that 18% to 22% of HIV infections were averted from 1996 to 2015 due to ART. In the recent period of 2011 to 2015, the reductions rose to 34% to 41%, matching the observed increments in the number of people treated for that period. ART has impacted Brazil’s overall survival by contributing 1,660,000 Life-Years since 1996 – which is 0.005 years per person-year on ART. Levels of impact have been uplifted by the wealthier regions in southern Brazil where better and earlier access yielded reductions between 35% and 52% in the last five years. Forward projections show that between 22% and 35% of infections can be averted by 2020 if current levels of coverage stay unchanged. Additionally, if all regions reach the highest levels of coverage observed in the south, reductions reach levels between 37% and 49%. Finally, reaching 90-90-90 goals could produce reductions between 43% and 56% by 2020. Conclusion: This is the first assessment of Brazil’s wealth of data on the impact of ART on the HIV epidemic. ART expansions attained important reductions in incidence and mortality in a context of combined prevention. Substantial regional differences give scope for realistic projections of improved impact if all regions match the best-performing programs in the country. Further expansions to the 90-90-90 goals, would entail far-reaching changes, but would lead to an increase in impact.

Poster and Themed Discussion Abstracts

1041 EARLIER DIAGNOSIS AND TREATMENT REDUCES HIV TRANSMISSION IN MSM IN THE NETHERLANDS Ard van Sighem 1 , Daniela Bezemer 1 , Eline Op de Coul 2 , Judith Branger 3 , Mark de Boer 4 , Peter Reiss 5 , for the ATHENA National Observational HIV Cohort 1 Stichting HIV Monitoring, Amsterdam, Netherlands, 2 Natl Inst for Pub Hlth and the Environment, Bilthoven, Netherlands, 3 Flevoziekenhuis, Almere, Netherlands, 4 Leiden Univ Med Cntr, Leiden, Netherlands, 5 Stichting HIV Monitoring and Academic Med Cntr Amsterdam, Amsterdam, Netherlands Background: Since 2012 treatment guidelines in the Netherlands recommend starting combination antiretroviral treatment (cART) immediately after HIV diagnosis, irrespective of CD4 cell counts. At the same time, cART effectiveness and tolerability improved considerably. We investigated to what extent the observed decrease in HIV diagnoses among men who have sex with men (MSM), from 766 in 2011 to 558 in 2015, could have been the result of earlier diagnosis and treatment. Methods: We used an existing mathematical model describing HIV transmission, disease progression, and the effects of cART to study changes in the HIV epidemic among MSM. Treatment-related parameters were derived from data in the national ATHENA cohort, including time to viral suppression and rates of viral rebound. Viral suppression was defined as HIV RNA <1000 copies/ml; below this threshold HIV transmission is unlikely. We estimated changes over calendar time in duration from HIV infection to diagnosis, per-capita transmission rate (a proxy for risk behaviour), and annual number of newly acquired infections needed to explain annual data on HIV and AIDS diagnoses up to 2015. In a hypothetical scenario, we assumed treatment guidelines did not change in 2012. Results: Median time to viral suppression in MSM diagnosed with asymptomatic HIV and CD4 counts ≥200 cells/mm³ decreased from 0.97 (interquartile range, 0.29-3.30) years in 2000 to 0.76 (0.24-1.99) years in 2011 and 0.16 (0.10-0.25) years in 2015, and was shorter in MSM with CD4 <200 cells/mm³, symptomatic HIV, or AIDS. During the same time, the proportion with viral rebound decreased from 55% to 11%. Our model estimated that HIV-positive individuals were diagnosed earlier: average time from infection to diagnosis decreased from 2.86 (95% confidence interval [CI], 2.72-3.02) years in 2000-2003 to 2.07 (1.93-2.19) years in 2012-2015, while the transmission rate increased by 20% (9-36). Annual number of newly acquired HIV infections decreased from a peak of 710 (95% CI, 650-780) in 2007 to 590 (540-650) in 2011 and 350 (320-400) in 2015. In 2012-2015, there were 1864 (1722-2074) estimated new HIV infections, which is 832 less than in a counterfactual scenario with no earlier treatment after 2011. Conclusion: Our model suggests that immediate treatment, in combination with earlier diagnosis and less viral rebound, contributed to a substantial decrease in the annual number of new HIV infections in MSM in the Netherlands despite an increase in risk behaviour. 1042 ACHIEVING THE 90-90-90 TARGET BY 2020: THE EXPERIENCE IN BRITISH COLUMBIA, CANADA Viviane D. Lima, Martin St-Jean , Jean A. Shoveller, P. Richard Harrigan, Bohdan Nosyk, Robert S. Hogg, Paul Sereda, Rolando Barrios, Julio S. Montaner

CROI 2017 450