CROI 2017 Abstract e-Book

Abstract eBook

Oral Abstracts

2.5-3.0) for sLLV200-399 and 3.6 (CI-95% 3.4-3.8) for sLLV400-999. Risk of failure further increased in cases of pLLV, with a HR of 3.0 (CI-95% 2.9-3.2) for pLLV50-199, 4.2 (CI-95% 4.0-4. 4) for pLLV200-399 and 7.7 (CI-95% 7.4-7.9) for pLLV400-999. Lower nadir CD4 was independently associated with LLV. Conclusion: In this large cohort prevalence of LLV was high and patients with LLV were at increased risk of subsequent failure and switching to second line cART. These risks increased further with higher levels and longer duration of LLV. This poses concerns for the long term success of first line cART in treatment programmes in resource limited settings.

Oral Abstracts

114LB REAL PROGRESS IN THE HIV EPIDEMIC: PHIA FINDINGS FROM ZIMBABWE, MALAWI, AND ZAMBIA Jessica E. Justman 1 , David Hoos 1 , Graham Kalton 2 , Rose Nyirenda 3 , Crispin Moyo 4 , Owen Mugurungi 5 , Andrew Voetsch 6 , Hetal Patel 6 , Laura Porter 6 , for the PHIA Project Teams for Malawi, Zambia, and Zimbabwe 1 ICAP at Columbia Univ, New York, NY, USA, 2 Westat, Inc., Rockville, MD, USA, 3 Government of Malawi Ministry of Hlth, Lilongwe, Malawi, 4 Government of Zambia Ministry of Hlth, Lusaka, Zambia, 5 Ministry of Hlth and Child Welfare, Zimbabwe, Harare, Zimbabwe, 6 CDC, Atlanta, GA, USA Background: Estimates of HIV incidence and 90/90/90 achievements have been largely based on modelling and facility-based data, respectively. The Population-based HIV Impact Assessment (PHIA) Project is the first to assess the status of the HIV epidemic in selected African countries by measuring population incidence and viral load suppression. We report the first findings from surveys in Zimbabwe, Malawi and Zambia, three contiguous countries with severe, generalized HIV epidemics. Methods: A nationally representative, household-based sample of adults and children was recruited in each country. Consenting participants provided demographic and clinical information and blood samples for household HIV testing per national guidelines. HIV+ results were confirmed via a supplemental assay and viral load and limiting antigen enzyme immunoassay (LAg) testing were performed on all HIV+ samples. HIV incidence estimates were based on WHO criteria for recent infection (LAg < 1.5 ODn and HIV RNA > 1000 c/ml). Viral load suppression (VLS) was defined as HIV RNA <1000 c/ml. CHAID survey weights were applied and variances were estimated via jackknife series. Results for adults 60-64 y (Zimbabwe, Malawi) were excluded to produce combined estimates across the three countries. Results: In 2015-16, a combined total of 76,442 (55,299 adults and 21,143 children) from among 34,061 selected households provided interviews and blood samples. Participation by eligible adults was higher for women than men (83.4% vs 72.3%, P<0.0001). Combined HIV prevalence estimates among adults and children were 12.4% and 1.5%, respectively. Combined HIV incidence among adults, aged 15-59 y, was 0.5% and combined mean VLS prevalence among all HIV-seropositive adults was 62.0%. Achievement of the 1st 90 target was 71.3%, the 2nd 90 was 86.8% and the 3rd 90 was 88.5% (Table). Conclusion: Based on national population survey results, Zimbabwe, Malawi and Zambia have achieved impressive progress towards the 90-90-90 goals. HIV prevalence is stabilizing and HIV incidence is low, consistent with recent UNAIDS modeled incidence estimates (data not shown) except in Zimbabwe, which had nearly half the modeled estimate. Novel population-based data show a high prevalence of VLS, providing further evidence of effective national HIV responses. Targeted testing to identify those unaware of HIV infection (1st 90 target) and continued expansion of HIV treatment programs and other prevention interventions are needed to facilitate ultimate epidemic control.

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CROI 2017