CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

without IDU risk (respectively) until 7 years after ART initiation when differences decreased (Figure 1a). Cumulative transmissible HIV RNA incidences at 5 years after ART initiation were 36%, 21%, and 19% for participants who initiated ART during 2000-04, 2005-09 and 2010-14, respectively (Figure 1b). Conclusion: After achieving and maintaining suppression within 2 years of ART initiation, annual rate and risk of plasma HIV RNA rebound to levels associated with sexual transmission of virus declined with continued suppression. The annual rate and risk of transmissible HIV RNA were lowest in 2010-2014, but had not improved significantly compared with 2005-2009.

Poster Abstracts

905 INFECTION PRESSURE IN MEN WHO HAVE SEX WITH MEN AND THEIR SUITABILITY TO DONATE BLOOD Ward P. van Bilsen 1 , Hans L. Zaaijer 2 , Amy Matser 1 , Katja van den Hurk 2 , Maarten F. Schim van der Loeff 1 , Ed Slot 2 , Maria Prins 1 , Thijs J. Van de Laar 2 1 Public Health Service Amsterdam, Amsterdam, Netherlands, 2 Sanquin Research, Amsterdam, Netherlands Background: Since the HIV outbreak, most Western countries (temporarily) have excluded men who have sex with men (MSM) from blood donation. The rationale for MSM deferral has weakened over time with the implementation of sensitive tests for HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV). We compared the infection pressure between MSM and donors to provide scientific evidence to reevaluate current MSM donor deferral policies. Methods: In 2016, we studied 520 MSM from the Amsterdam Cohort Studies and 594 age-matched repeat male donors from Amsterdam. MSM were classified as eligible/non-eligible using the Dutch donor criteria for permanent exclusion and as low/high sexual risk based on self-reported behavior. Low-risk was defined as no anal sex, a monogamous relationship or consistent condom use in the past year. MSM and donors were tested for 10 blood-borne and sexually transmitted infections (see table). Infection pressure was calculated by summing antibody-reactive infections with major infections (i.e. HIV, HBV, HCV, HTLV and syphilis) weighted double. Stored samples of MSM were tested to distinguish recent (within last year) from past major infection. Willingness to donate was measured on a seven-point Likert scale. Results: We identified 197 eligible low-risk MSM (lrMSM), 48 non-eligible lrMSM, 183 eligible high-risk MSM (hrMSM) and 92 non-eligible hrMSM. Median infection pressure was 3 (IQR 2-4) among both eligible lrMSM and eligible hrMSM, and was higher than in donors (infection pressure 2; IQR 1-2; P-value<0.001). Neither eligible lrMSM nor donors had antibodies to HIV, HCV, HTLV or syphilis; 15 eligible lr-MSM and 6 donors had antibodies to HBV. None of the lrMSM had recent infections. Eligible hrMSM had antibodies to syphilis (n=5) and HBV (n=17); 4 eligible and 7 non-eligible hrMSM had recent infections. Antibody prevalence to herpes viruses was higher in MSM than in donors (P-value <0.001). 73% of MSM had a moderate to high intention to donate. Intention did not differ between MSM groups (P-value 0.223). Conclusion: Infection pressure in MSM is higher than in male donors; in hrMSM partly due to recent infections and antibodies to major infections, but in lrMSM solely due to a higher prevalence of herpes viruses. The absence of recent infections in lrMSM and similar antibody-reactivity to major infections in male donors and ‘eligible’ lrMSM suggest that self-declared lrMSM form a low threat for blood safety and should be considered for blood donation.

904 RATE AND RISK OF TRANSMISSIBLE HIV RNA (>1500 COPIES/ML) AMONG ADULTS ON ART Keri N. Althoff 1 , Kate Buchacz 2 , Richard D. Moore 1 , Stephen J. Gange 1 , Mari Kitahata 3 , Michael A. Horberg 4 , Ronald Bosch 5 , Jennifer S. Lee 1 , Jeffrey N. Martin 6 , Kenneth H. Mayer 7 , Pragna Patel 2 , Charles Rabkin 8 , Jennifer E. Thorne 1 , John T. Brooks 2 1 Johns Hopkins University, Baltimore, MD, USA, 2 CDC, Atlanta, GA, USA, 3 University of Washington, Seattle, WA, USA, 4 Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA, 5 Harvard University, Cambridge, MA, USA, 6 University of California San Francisco, San Francisco, CA, USA, 7 Fenway Health, Boston, MA, USA, 8 National Cancer Institute, Bethesda, MD, USA Background: U.S. guidelines recommend that clinicians consider decreasing the frequency of viral load monitoring after two years of persistent suppression. We estimated the incidence of transmissible HIV RNA among U.S. patients under these circumstances. Methods: We defined transmissible HIV RNA as a single plasma HIV RNA 1500 copies/ml (≥1500) after suppression with ART to <1,500 copies/mL; this viral load value represented a lower threshold at which sexual transmission of HIV could occur excluding “blips.” We included NA-ACCORD participants who initiated ART between 1 Jan 2000 and 31 Dec 2015 then achieved and maintained HIV RNA <1500 for two years. Observation continued until HIV RNA ≥1500, death, last CD4 cell count or plasma HIV RNA measurement + 1.5 years (as a surrogate for loss to follow-up), or 31 Dec 2015, whichever came first. Incidence rates (95% confidence intervals) per 100 person years (100py) and Kaplan Meier cumulative incidence rates of HIV RNA ≥1500 were estimated, stratified by age, sex, race, HIV transmission risk group, and calendar year of ART initiation. Results: Among 30,103 eligible adults with median follow-up of 2.8 years (interquartile range [IQR] 1.3, 5.4) and a median of 8 (IQR 7, 10) HIV RNA tests per participant, annual incidence of viral rebound decreased from 14.9 (14.5, 15.4) per 100py at 3 years after ART initiation to 2.9 (2.4, 3.5) per 100py at 10 years after ART initiation. Adults who rebounded (8,730 or 29%) were more likely to be younger, male, black, had injection drug use (IDU) HIV transmission risk factor, initiated ART in the earlier years, and had CD4 counts <200 cells/ mm 3 at ART initiation compared to those who did not; they did not differ by HIV RNA at ART initiation. Persons who were younger, women, black, and with IDU risk consistently had higher incidence rate than older, men, non-black, those

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