CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

846 MILESTONES AND OUTCOMES OF YOUNG ADULTS WITH PERINATAL HIV INFECTION OR EXPOSURE Elaine J. Abrams 1 , Claude A. Mellins 2 , Amelia Bucek 3 , Curtis Dolezal 2 , Jeannette Raymond 2 , AndrewWiznia 4 , Cheng-Shiun Leu 2 1 ICAP at Columbia University, New York, NY, USA, 2 New York State Psychiatric Institute, New York, NY, USA, 3 Columbia University, New York, NY, USA, 4 Albert Einstein College of Medicine, Bronx, NY, USA Background: With aging of the population with perinatal HIV infection (PHIV+) in the US, concerns have emerged about transition into adulthood. Using data from CASAH, one of the largest behavioral longitudinal cohort studies on PHIV+ and perinatally HIV-exposed uninfected (PHEU) youth, we examined young adult (YA) milestones, and behavioral and biomedical outcomes. Methods: Participants were recruited from 4 NYC medical centers in 2003- 2008, at ages 9-16yrs and followed every 12-18mos with validated psychiatric and psychosocial interviews and medical chart abstraction. Data from visits conducted in 2014–2017 were analyzed. Descriptive statistics, chi-square and t-tests were used to compare YA milestones, sexual and reproductive health, psychiatric disorders, substance use (SU) and neurocognitive (NC) function between PHEU and PHIV+ YA. Results: Among 246 participants (149 PHIV+), 53%were female; 69% African American/Black, 50% Latino; mean age 22yrs (SD2.6; range18-28). Participants achieved many YA milestones: 70% graduated high school/GED, 20%were currently in college; 41%were working; only 38%were not in school or working; 48%were in romantic relationships and 5%married/engaged. Also, 92% initiated sex; 62% had vaginal or anal sex in past 3mos; 41% reported condomless sex in past 3mos. There were no HIV status differences in these outcomes. Pregnancy was reported by 39% of females and males, over half reported at least one live birth (PHIV+> PHEU, p<.05) and 67% reported living with the child. The majority (68%) of PHEU were living with family or friends rent free, whereas PHIV+ YA were significantly more likely to be paying/ contributing rent (54%; p<.001), likely due to higher rates of HIV-related public assistance (p<.001). Rates of psychiatric disorder (26%, most prevalent mood and anxiety) and SU disorder (27%, most prevalent alcohol and marijuana) were similar by HIV status. PHIV+ YA performed worse on 2 tests assessing working memory, processing speed and planning. Among the PHIV+, mean CD4 488 cells/mm 3 , range, 2-1430, 44% had CD4>500, 15% had CD4<100. For 52%most recent viral load (VL) was <50 copies/mL, while 32% had a VL>1000 copies/mL; 94%were on ART, 63% and 30% taking 2 and 3 drug class regimens respectively. Only 32%were taking 1 pill once daily regimens. Conclusion: Similar to PHEU, most PHIV+ YA are achieving age appropriate adult milestones, but high rates of psychiatric and substance use disorders, neurocognitive dysfunction and viremia on ART warrant attention.

Background: Suicide is the leading cause of death among 15-29 year olds globally, and self-harm is the strongest predictor for subsequent suicide. The prevalence of self-harm among adolescents aged 16-17 years in a large birth cohort in the general population in England was 19%. Adolescents with perinatal HIV (PHIV+) may be at increased risk of poor mental health outcomes, however limited evidence exists on the prevalence of self-harm in this population. We investigated prevalence of self-harm among PHIV+ adolescents and an HIV negative but affected comparator group living in England. Methods: 303 PHIV+, and 100 HIV- adolescents with a family member with HIV (12-21yrs and 13-23yrs respectively), completed computer-assisted self-interview questions on self-harm, and underwent standardised mental health tests during face-to-face interviews in 2013-15. Z-scores for Rosenberg self-esteem scores were calculated using data from an Irish study of almost 5000 youths aged 13-17. Chi2 compared proportions, and logistic regression identified predictors of self-harm. Results: Median age of both groups was 17 years (PHIV+: IQR 15, 18, HIV-: IQR 15, 19), and 41% of PHIV+ and 31% of HIV- participants were male. Most participants in both groups were of Black African ethnicity (PHIV+: 86%, HIV-: 73%, p=0.003). Overall 14% (56/403) reported having ever self-harmed, with no difference between PHIV+ and HIV- (12% vs. 19% respectively, p=0.089). Of those who self-harmed, 46% (26/56) reported suicidal intent. After adjustment, predictors of self-harmwere female sex (AOR 5.3, 95%CI 1.9, 14.1, p=0.001 vs male), lower self-esteem (AOR 1.2 95%CI 1.1, 1.2, p‹0.001 per 1 unit decrease in Rosenberg score) and ever having alcohol (AOR 3.8, 95%CI 1.8, 7.8, p‹0.001 vs. no alcohol). Mean self-esteem z-scores for PHIV+ and HIV- participants were -1.9 {standard deviation 1.5} and -1.9 {1.6} respectively. Comparing mental health test scores between those with no self-harm, those with self-harm without suicidal intent and those with self-harmwith suicidal intent, there was a progressive worsening of z scores across tests, with those reporting no self-harm having the highest z scores (ie better mental health), and those with self-harmwith suicidal intent the lowest z scores (Figure). Conclusion: Self-harm is common among PHIV+ and HIV- affected adolescents in England, but comparable to age matched population data. However, levels of self-esteem in both groups fell well below population normative levels and warrants further attention.

Poster Abstracts

848 MONITORING THE 3 RD 90: ARE WE ON TRACK WITH ADOLESCENTS AND YOUTH? Evelyne Ngugi 1 , Agnes Natukunda 2 , Tai Ho Chen 1 , Kenneth Masamaro 1 , Lucy Ng’ang’a 1 , Jonathan Mwangi 1 , Immaculate Mutisya 1 , Abraham Katana 1 , Peter W. Young 1 1 US CDC Nairobi, Nairobi, Kenya, 2 University of California San Francisco, San Francisco, CA, USA Background: Kenya has implemented the UNAIDS 90-90-90 strategy; the 3rd 90 target has implications for patient outcomes and secondary HIV prevention. As of June 2017, over one million persons living with HIV were on antiretroviral therapy (ART); with a viral load (VL) uptake of 85% nationally, with consistently lower viral suppression rates among adolescents and youth. We evaluated viral suppression rates among patients aged ≥15 years.

847 SELF-HARM IN ADOLESCENTS WITH PERINATAL HIV AND HIV-AFFECTED ADOLESCENTS IN ENGLAND Julie Copelyn 1 , Lindsay Thompson 2 , Marthe Le Prevost 2 , Kate Sturgeon 2 , Katie Rowson 2 , Susie Brice 2 , Ali Judd 2 1 UCL Great Ormond Street Institute of Child Health, London, UK, 2 University College London, London, UK

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