CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

incidence rates for primary and recurrent CMVR events with 95% confidence intervals (CI), for each of the different plasma HIV-RNA strata. In all the analyses except for secondary events of cryptococcosis, the lowest incidence in patients with low CD4 counts was found when viral load was suppressed. Point estimates of incidence of secondary events off prophylaxis in patients with suppressed viral load crossed the 10/1000py threshold at a CD4 count of 87 (MAC), 186 (CMVR) and 172/µL (CRC) while the 95% CI of incidences were wide due to the low number of events of these rare OIs. Conclusion: HIV replication is a major risk factor for primary and recurrent events of MAC and CMVR and primary CRC, but not for recurrent CRC in low CD4 strata, where IRIS events may play a role. Our data support current guidelines for stopping secondary prophylaxes in patients with suppressed HIV replication. Patients with unsuppressed HIV load may need continuation of maintenance treatment above currently recommended CD4 thresholds.

infected adults with CD4 count >200 but <350 cells/µL (regardless of age) support the need for updated, formal ZV guidelines, and consideration for expanded use at ages <60.

Poster Abstracts

800 HERPES ZOSTER AND ZOSTER VACCINE RATES AMONG HIV-INFECTED AND UNINFECTED IN THE VACS Kellie L. Hawkins 1 , Kirsha S. Gordon 2 , Myron Levin 3 , Adriana Weinberg 3 , Catherine Battaglia 3 , Maria Rodriguez-Barradas 4 , Sheldon T. Brown 5 , David Rimland 6 , Amy C. Justice 2 , Janet Tate 2 , Kristine M. Erlandson 3 1 Denver Health Medical Center, Denver, CO, USA, 2 Yale University, New Haven, CT, USA, 3 University of Colorado Anschutz Medical Campus, Aurora, CO, USA, 4 Baylor College of Medicine, Houston, TX, USA, 5 James J. Peters VA Medical Center, Bronx, NY, USA, 6 Atlanta VA Medical Center, Decatur, GA, USA Background: Herpes zoster (HZ) is a major cause of morbidity in aging adults. Despite historically higher rates among HIV-infected individuals, comparative studies of HZ by serostatus since the advent of combination antiretroviral therapy (cART) and the zoster vaccine (ZV) are lacking. Further, while ZV is recommended for uninfected individuals age ≥60 years and studies have shown safety and immunogenicity in HIV-infected with CD4 >200 cells/µL, no vaccine guidelines have been established for HIV-infected individuals. Methods: Rates of first-episode HZ and ZV receipt were recorded among HIV-infected and uninfected adults in the Veterans Aging Cohort Study annually from 2002-2015 and stratified by HIV serostatus and age. HZ events were captured using ICD9 codes and ZV using procedural codes and pharmacy data. Results were further stratified by age thresholds, CD4 category, and virologically suppressed/unsuppressed HIV-1 RNA (cut off ≤400 copies/mL). Results: Of 45,177 HIV-infected and 103,040 uninfected adults, mean baseline age was 48 and 49 years, respectively; 46% of the cohort was >50 years and 97%were male. From 2002 to 2015, rates of HZ increased among uninfected adults (2.3 to 4.1/1000) and decreased among the HIV-infected group (17.6 to 8.1/1000), but remained higher than uninfected (8.1 vs 4.1/1000, p<0.001), particularly among HIV-infected adults <60 years (8.7/1000) (Figure 1, Panel A). Among HIV-infected, HZ rates were higher with lower CD4 counts (CD4 <200 cells/µL: 18.0/1000; CD4 201-350: 14.4/1000; CD4 351-500: 7.5/1000; CD4 >500: 6.8/1000) and unsuppressed vs suppressed HIV-1 RNA (21.8 vs 7.1/1000). When restricted to virologically suppressed participants with CD4 >50 cells/µL, HZ rates were similar among HIV-infected adults age <60 and age ≥ 60 (6.6 vs 6.7/1000) (Figure 1, Panel B). By 2015, cumulative receipt of ZV for uninfected was double that of HIV-infected: among age ≥ 50 years (134.3 vs. 58.9/1000) and among those ≥ 60 years (215.1 vs. 93.7/1000) (Figure 1, Panel C). Conclusion: With cART, HZ rates among older HIV-infected adults have markedly decreased, but remain 50% higher than uninfected in this cohort. Lower rates of ZV combined with high rates of HZ, particularly among HIV-

801 CMV VIREMIA AND DISEASE IN PATIENTS WITH ADVANCED HIV INFECTION: A PROSPECTIVE STUDY

Adaia Albasanz 1 , Juliana Esperalba 1 , Ariadna Torrella 2 , Bibiana Planas 2 , Candela Fernández 1 , Antonio Segura 1 , Adrià Curran 1 , Jordi Navarro 1 , Esteban Ribera 1 , Joaquin Burgos 1 , Rein Willekens 2 , Mario Martin 2 , Vicenç Falcó 1 1 Hospital Universitario de la Vall d’Hebron, Barcelona, Spain, 2 Vall d’Hebron Research Institute, Barcelona, Spain Background: The prevalence of CMV viremia is 30% in patients with < 100 CD4 T-lymphocytes. We hypothesize that antiretroviral treatment (HAART) that ensures a correct immune recovery, rather than anti-CMV specific treatment, is the best strategy to clear CMV viremia in patients without end-stage organ disease (EOD). We aim to study the recovery of specific immune response against CMV after the initiation of HAART since it might be a better predictor of CMV-EOD than CMV viremia. Methods: Prospective, observational on-going study of all patients with HIV infection with < 100 CD4 T-lymphocytes registered from September 2015. Variables: HIV viral load (VL), CD4 T lymphocytes and CMV VL were determined at baseline, 4,12,24 and 48 weeks. The specific immune response against CMV was determined at baseline and at 48 weeks (QuantiFERON-CMV®). Therapeutic strategy: Antiretroviral therapy was initiated in all patients. CMV specific therapy was initiated only in patients with CMV-EOD. Here we present the results of a pre-planned interim analysis to check the safety of this strategy. Statistical analysis: Wilcoxon signed-rank sumwas used to assess the evolution over time of CMV-specific immune response. Results: Forty-two patients have been included at the moment of the interim analysis, 26 (61.9%) men and 16 (38.1%) women with mean (SD) age 44.2 (10.8) years. The median (IQR) baseline CD4 lymphocytes was 30.0 (12.5-60.0) cel/mm 3 with a median HIV VL of 420,000.0 (159,5-1,170,500) copies/ mL. Thirteen (31%) had detectable CMV viremia at baseline with a median CMV VL of 40,503 (13,307-73,413) copies/ mL. At 12 weeks after TAR initiation only 1 (3.6%) patient had detectable CMV viremia. At 24 and 48 weeks the CMV VL was negative in all patients. We only registered 1 case of CMV-EOD (stomatitis)

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