CROI 2018 Abstract eBook

Abstract eBook

Oral Abstracts

87 GETTING TO ZERO NEW HIV DIAGNOSES IN SAN FRANCISCO: WHAT WILL IT TAKE? Susan P. Buchbinder 1 , Stephanie E. Cohen 1 , Jen Hecht 2 , Ling Hsu 1 , Robert P. Kohn 1 , Henry F. Raymond 1 , Albert Y. Liu 1 , Hyman Scott 1 , Oliver Bacon 1 , Tracey Packer 1 , Susan Philip 1 , Diane V. Havlir 3 , Susan Scheer 1 1 San Francisco Department of Public Health, San Francisco, CA, USA, 2 San Francisco AIDS Foundation, San Francisco, CA, USA, 3 University of California San Francisco, San Francisco, CA, USA Background: San Francisco’s Getting to Zero (SF GTZ) initiative aims to reduce new HIV diagnoses by 90% from 2013-2020; SF GTZ protocols are replicated by other cities. This analysis reports on progress toward this goal and potential facilitators and barriers. Methods: Data are collected on SF residents with newly diagnosed HIV using active and passive surveillance of mandatory lab reporting. Data on PrEP use came frommen who have sex with men (MSM) in the 2014 National HIV Behavioral Surveillance Survey (NHBS, n=411), a community-based survey (STOP AIDS, n=1049 in 2015, n=910 in 2016) and the municipal sexually transmitted disease clinic (SFCC, n=4954 in 2014, n=5224 in 2015, n=5432 in 2016). MSM were considered eligible for PrEP if they were not known to be HIV infected and reported condomless anal sex, a sexually transmitted infection, or an HIV positive partner in the prior 12 months. Results: New HIV diagnoses declined 43%, from 392 in 2013 to 223 in 2016. In 2016, 79% of new diagnoses were in MSM, 11% in cis women and 2% in trans women. HIV diagnosis rates/100,000 men in 2016 were highest in African Americans (96) and Latinos (77), and lowest in Whites (39) and Asian/Pacific Islanders (25). Median time from diagnosis to viral suppression declined from 134 days to 61 days from 2013-2016. Among those living with HIV who were last known to reside in SF, 73%were virally suppressed at the end of 2015 but viral suppression was less common among women (66%), African Americans (67%), Latinos (69%), persons under 50 years (66%) and the homeless (31%) (p<0.0001 for all). The estimated proportion of PrEP-eligible MSM reporting PrEP use was similar between datasets and increased from 10% in 2014 to 38-42% in 2016 (Figure). Uptake increased in all racial/ethnic groups over time, although Latino MSM had consistently lower rates than average in all surveys except SFCC 2014. The largest cohort of African American MSMwas in SFCC; uptake in that group was lower than for all others in 2016. We estimate the number of eligible MSM on PrEP in SF increased from about 4700 in 2014 to 12,300 in 2016. Conclusion: New HIV diagnoses have declined at a much faster rate in SF than the national average, likely a result of faster viral suppression after diagnosis and increased PrEP uptake in recent years. However, disparities in viral suppression and PrEP uptake suggest slower progress in people of color, younger people, women and the homeless; population-specific efforts will be required to achieve the GTZ SF 2020 goals.

1 University of New South Wales, Sydney, NSW, Australia, 2 Macquarie University, North Ryde, NSW, Australia, 3 New South Wales Ministry of Health, Sydney, NSW, Australia, 4 ACON, Sydney, NSW, Australia, 5 Taylor Square Private Clinic, Sydney, NSW, Australia, 6 Holdsworth House Medical Practice, Sydney, NSW, Australia, 7 North Coast HIV Sexual Health Services, Lismore, NSW, Australia, 8 Sydney Sexual Health Centre, Sydney, NSW, Australia Background: Randomized trials of pre-exposure prophylaxis (PrEP) in men who have sex with men (MSM) have reported efficacy of more than 85%. Modelling predicts PrEP will have greatest population-level efficacy if rapidly targeted, with high coverage, to those at high risk. In New South Wales (NSW), more than 80% of HIV diagnoses occur in MSM. Despite substantial increases in testing and treatment since 2012, and the state approaching the UNAIDS 90/90/90 targets, annual HIV diagnoses varied little over the decade to 2016. Methods: The expanded PrEP Implementation in Communities in NSW study (EPIC-NSW) is an open-label implementation study of the use of co-formulated TDF/FTC to prevent HIV. Commencing March 1 2016, we aimed to recruit all estimated 3700 MSM at high-risk of HIV in NSW by end 2016, in over 20 clinics across the state. High-risk eligibility criteria were based on local epidemiologic data. Co-primary outcomes of the study are (a) HIV incidence among study participants, collected by electronic data capture from clinic data management systems and (b) state-wide HIV diagnoses in MSM, utilizing NSWMinistry of Health HIV surveillance data. HIV surveillance data were reported as (a) all diagnoses and (b) early infection, defined as likely HIV infection in the last 12 months, based on HIV testing history and/or clinical and/or laboratory diagnosis of recent infection. Results: The initial target of 3700 high-risk MSM was reached in October 2016, with an average monthly recruitment of 499 (range: 442-555). Recruitment is continuing (currently 7293). By September 2017 only one HIV seroconversion in a study participant was documented. In the first half-year of 2017 there were 101 HIV diagnoses in MSM in NSW, 35% lower than the 156 diagnoses in the half-year immediately prior to commencement of recruitment (June-Dec 2015). This was the lowest half-yearly number of HIV diagnoses in MSM since HIV surveillance commenced in NSW in 1985. Early HIV infections in MSM declined from 82 to 46, a 44% decrease. Conclusion: The high-level, targeted and rapid roll-out of PrEP in NSW led to a 35% decline in state-wide HIV diagnoses in MSM, and a 44% decline in early HIV infections in MSM, to levels unprecedented since the beginning of the HIV epidemic. This was achieved less than one year after the target recruitment was reached. In a concentrated epidemic with high testing and treatment coverage, PrEP scale up led to a rapid decline in HIV transmission at the population level. 89LB LOW DOSE MK-8591 PROTECTS RHESUS MACAQUES AGAINST RECTAL SHIV INFECTION Martin Markowitz 1 , Agegnehu Gettie 1 , Leslie St. Bernard 1 , Hiroshi Mohri 1 , Brooke Grasperge 2 , James Blanchard 2 , Li Sun 3 , Kerry Fillgrove 4 , Daria Hazuda 4 , Jay Grobler 4 1 Aaron Diamond AIDS Research Center, New York, NY, USA, 2 Tulane National Primate Research Center, Covington, LA, USA, 3 Merck & Co, Inc, Upper Gwynedd, PA, USA, 4 Merck & Co, Inc, West Point, PA, USA Background: MK-8591 (4’-ethynyl-2-fluoro-deoxyadenosine; EFdA), a nucleoside reverse transcriptase translocation inhibitor (NRTTI), was previously shown to completely protect rhesus macaques (RM) against SHIV infection following intrarectal (IR) challenge when dosed at 3.9 mg/kg weekly. At this dose, the mean intracellular MK-8591-triphosphate (TP) concentration of 805 fmol/10Λ6 PBMCs at time of challenge exceeds the lowest MK-8591-TP C168hr that demonstrated potent antiviral activity in HIV infected patients. To determine the lowest drug levels that confer protection, RMs were challenged at progressively lower doses until protection was no longer observed. Methods: The eight male RM that had been successfully treated with 3.9 mg/ kg MK-8591 after 20 weeks (w) were dosed with 1.3 mg/kg MK-8591 orally on day 0 and qw for 6 doses. All animals were again challenged IR with 1 mL of 50TCID50 of SHIVC109P3 on day 6 and weekly thereafter for up to 4 challenges or until infection was confirmed. Prior to challenge, blood was drawn for virology and PK. Infection was confirmed by real-time RT PCR in plasma. Proviral DNA was measured qw by PCR and virus-specific antibody responses were assessed. Intracellular levels of MK-8591- TP were measured by LC/MS/MS. After a 4 w washout, the treatment sequence was repeated on uninfected RM, (0.43 mg/kg weekly for 6 doses) with challenge on day 6 and weekly for up to 4 challenges or

Oral Abstracts

88 RAPID REDUCTION IN HIV DIAGNOSES AFTER TARGETED PrEP IMPLEMENTATION IN NSW, AUSTRALIA

Andrew Grulich 1 , Rebecca J. Guy 1 , Janaki Amin 2 , Heather-Marie Schmidt 3 , Christine Selvey 3 , Jo Holden 3 , Karen Price 4 , Robert Finlayson 5 , Mark Bloch 6 , Iryna Zablotska 1 , Fengyi Jin 1 , David Smith 7 , Anna McNulty 8 , David A. Cooper 1

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CROI 2018