CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

were abstracted from the medical record. We defined viral suppression (VS) as HIV-RNA level <200 copies/mL. Patients without VL measures in this window were categorized as non-suppressed. We calculated the odds of VS in each strata of housing status via logistic regression adjusting for age, gender, and race/ ethnicity. Sensitivity analyses excluding participants with missing VL and also counting them as suppressed were performed. Results: 1,222 patients completed the survey, of whom 39 had no VLs within the pre-specified window. Median age was 50 years (IQR 41 to 57); 13%were female; 40%white, 25% black, 26% Latino, 9% other. Across a continuum of housing types, VS rates ranged from 86% (rent/own) to 44% (outdoors) (Figure). Greater housing instability was associated with lower rates of VS in a “dose-response” fashion. The adjusted odds of VS among participants with unstable living arrangements (SRO/hotel, living with friend, shelter, outdoors) were each statistically significantly lower compared to those who rented/owned (all p-values<0.005), except when comparing those in treatment/transitional housing to those who rent/own (p-value 0.84). Results were unchanged in both sensitivity analyses. Conclusion: We demonstrate strong associations between dwelling type and VS among PLHIV across a continuum of unstable housing arrangements. Although living outdoors is associated with the lowest proportion of VS, other forms of instability (including living in a shelter, “couch-surfing”, and being in an SRO) are also associated with lower levels of VS compared to being housed. Interventions are needed to increase VS among PLHIV across a spectrum of unstable housing arrangements.

<50 were significantly more likely to be Black (34% vs 16%) or Hispanic (17% vs 8%) and less likely to be White (44% vs 74%). Overall, 27% reported a detectable viral load, a substantial proportion of both MSM<50 and ≥50 (30% vs. 18%, OR=2.0); CAS (90% vs. 78%, OR=2.4); and CAS with an HIV-negative man (48% vs. 38%, OR=1.5). In addition, MSM<50 and MSM≥50 were equally likely (29% vs 30%, OR=.95) to report CAS with 5 or more men in the past 6 months. In separate multivariable analyses, MSM<50 and ≥50 reporting CAS with 5 or more men were significantly more likely to report an STD diagnosis (AOR=2.2 and 2.9) and having any HIV-negative partners (AOR=3.0 and 2.4). Conclusion: The vast majority of HIV-positive MSM in this large online survey reported CAS regardless of age group and more than a quarter reported a detectable viral load. These findings, taken together with the finding that nearly one third of MSM>50 and <50 reported CAS with 5 or more partners in the last 6 months, reinforces the need for ongoing behavioral risk reduction and antiretroviral adherence education for older HIV-positive MSM, a group that has received considerably less risk reduction attention. 910 UNDISCLOSED HIV INFECTION AMONG MSM IN NATIONAL HIV BEHAVIORAL SURVEILLANCE Brooke Hoots , Cyprian Wejnert, Amy Martin, Richard Haaland, Silvina Masciotra, Catlainn Sionean, Amanda Smith, WilliamM. Switzer, Gabriela Paz-Bailey CDC, Atlanta, GA, USA Background: Many men who have sex with men (MSM) are unwilling to disclose their HIV status, and surveys that rely on self-reported HIV status may be limited by participant misreport. As a proxy for undiagnosed HIV, National HIV Behavioral Surveillance (NHBS) monitors participants who report being unaware of their HIV infection, defining unaware as self-reporting an HIV-negative or unknown status but testing HIV-positive in NHBS. However, participants considered unaware may include some who choose not to disclose their status. To evaluate the validity of the NHBS measure of awareness among MSM, we tested HIV-positive participants for the presence of antiretrovirals (ARVs), which may indicate active treatment. Methods: MSM with HIV-positive test results in 19 U.S. cities in 2014 were included. MSM reporting pre exposure prophylaxis (PrEP) use in the past 12 months (n=3) were excluded. Dried blood spots were tested for 7 ARVs by liquid chromatography-tandemmass spectrometry and viral load (VL) using a validated Abbott RealTime HIV-1 VL assay. Persons unaware with ≥1 ARV detected were defined as misreporters. Prevalence ratios (PRs) and 95% confidence intervals (CIs) were calculated from Poisson regression models to compare unaware misreporters, unaware non-misreporters (defined as unaware and no ARVs detected), and those who correctly self-reported as HIV-positive. Results: Of 1,818 HIV-positive MSM, 299 (16%) self-reported as HIV-negative or unknown infection status. Of the 299 unaware, 145 (49%) were considered misreporters based on ARV detection. Among the unaware, misreporters were more likely than non-misreporters to be older (aged >35 vs 18-34 years) (PR 1.66, CI 1.36-2.04, and have health insurance (PR 1.33, CI 1.16-1.54). Compared to self-reported HIV-positive MSM, misreporters were more likely to be black (PR 1.60, CI 1.40-1.84), and bisexual (PR 2.62, CI 2.01-3.42), and have perceived discrimination (PR 1.18, CI 1.00-1.38). Of 138 misreporters with viral load data, 116 (84%) had a viral load below the limit of detection. Conclusion: ARV testing revealed that half of MSMwho reported being unaware of their HIV infection misreported their status. While off-label PrEP use might explain the presence of ARVs, it is an unlikely explanation because many misreporters were virally suppressed and likely would not have become infected had they been taking ARVs as PrEP. Biomarker validation of behavioral data can improve data quality and usefulness in NHBS and other studies. 911 HIV TRANSMISSION BETWEEN MEN WHO HAVE SEX WITH MEN AND HETEROSEXUAL WOMEN Alexandra M. Oster , Nivedha Panneer, Sonia Singh CDC, Atlanta, GA, USA Background: Previous analyses of U.S. molecular HIV surveillance data have suggested that a substantial percentage of HIV diagnoses among heterosexual women originate frommen who have sex with men (MSM). HIV diagnoses among heterosexual women have decreased substantially in recent years, while diagnoses among MSM have not. One possible explanation for these disparate

Poster Abstracts

909 ONGOING NEED FOR BEHAVIORAL HIV PREVENTION INTERVENTIONS FOR HIV-POSITIVE MSM OVER 50 Mary Ann Chiasson , Martin J. Downing, Irene Yoon, Steven Houang, Sabina Hirshfield Public Health Solutions, New York, NY, USA Background: Most newly diagnosed HIV infections in the U.S. occur among MSM. Moreover, only 50% of MSM living with HIV are virally suppressed, raising concerns about continued HIV transmission. In 2014, 58% of MSM living with HIV were aged 45 years or older. Currently, most HIV prevention activities are targeted to young MSM, but, as the population of MSM living with HIV continues to age because of improved diagnosis and treatment, a better understanding of sexual risk and HIV prevention gaps in older MSM is needed. This analysis compares demographic and sexual risk behaviors between HIV-positive MSM <50 and ≥50. Methods: HIV-positive MSM were recruited from social and sexual networking websites and apps. Of 16,299 men completing the study screening survey, 13,036 U.S. MSM who reported being HIV-positive were eligible for this analysis. Self-reported condomless anal sex (CAS), sex partners’ HIV status, participant viral load (all past 6 months), and STD diagnoses (past 3 months) were compared for MSM<50 and ≥50 in bivariate and multivariable logistic regression analyses (p =<0.001 in all analyses presented). Results: Among 13,036 HIV-positive MSM participants, 73%were <50 and 27%≥50. Race/ethnicity varied by age group. Compared to MSM≥50, MSM

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