CROI 2018 Abstract eBook

Abstract eBook

Oral Abstracts

until infection was confirmed. After 10 w, this was repeated on the remaining uninfected RM at a dose of 0.1 mg/kg. Results: All 8 animals remained uninfected after challenges at the 1.3 & 0.43 mg/kg dosing levels. At 0.1 mg/kg, 2/8 animals became infected, with one animal infected after 3 challenges and the other after 4 challenges. Mean levels of intracellular MK-8591-TP at the time of challenge were 282 and 102 fmol/10Λ6 PBMCs at the 1.3 and 0.43 mg/kg dosing levels, respectively. At the 0.1 mg/kg dose MK-8591-TP levels are estimated to be ~24 fmol/10Λ6 PBMCs. Conclusion: In rhesus macaques MK-8591 completely protects against SHIV infection at weekly doses of 1.3 and 0.43 mg/kg and is partially protective at 0.1 mg/kg (HR 7.2, p=0.0004). MK-8591-TP levels that are protective in this model are achievable in humans at weekly doses of less than 250 μg weekly or 10 μmg daily, suggesting MK-8591 utility in extended duration prophylaxis against HIV infection. 90 HIV TREATMENT, PREVENTION, AND INCIDENCE IN A HYPERENDEMIC UGANDAN FISHING COMMUNITY Joseph Kagaayi 1 , Gertrude Nakigozi 1 , Godfrey Kigozi 1 , Mary K. Grabowski 2 , Victor Ssempijja 3 , Fred Nalugoda 1 , Ronald H. Gray 2 , Robert Ssekubugu 1 , Caitlin E. Kennedy 2 , Thomas C. Quinn 3 , David Serwadda 4 , Maria Wawer 2 , Steven J. Reynolds 3 , Larry W. Chang 2 1 Rakai Health Sciences Program, Kalisizo, Uganda, 2 Johns Hopkins University, Baltimore, MD, USA, 3 NIAID, Bethesda, MD, USA, 4 Makerere University College of Health Sciences, Kampala, Uganda Background: In a prospective population-based cohort study conducted in an HIV hyperendemic fishing community (HIV prevalence ~40%), we measured trends in uptake of antiretroviral therapy (ART) and voluntary medical male circumcision (MC), population-level viral load suppression, sexual risk behaviors, and HIV incidence. Methods: From Nov 2011 to Feb 2017, four surveys were conducted in a fishing community on Lake Victoria in Rakai, Uganda as part of an open cohort of all consenting persons aged 15-49. We assessed trends in self-reported ART/MC coverage, population-level HIV viral load suppression (proportion of HIV-positive population with <1000 copies/ml), sexual risk behaviors, and HIV incidence. Poisson multivariate regression with generalized estimating equations and robust variance estimators was used to estimate incidence rate ratios (IRR) and 95%CI of HIV incidence comparing the first to the final survey interval. Results: 5005 individuals participated in the cohort, including 1823 HIV- negative persons with at least one follow-up who contributed 5188 person- years (py) and 134 incident HIV cases. Over the study period, ART coverage increased among all HIV-infected participants from 19% (95%CI: 16-22%) to 81% (95%CI:75-87%), and MC coverage increased among all men from 39% (95%CI: 35-42%) to 63% (95%CI: 59-67%). ART and MC increases occurred in all age groups (Figure). Population-level HIV viral suppression was 78% (95%CI: 72-83%) by study end. Sexual behaviors remained unchanged. Overall HIV incidence declined (Figure) from 3.98/100 py to 1.61/100 py (adjIRR=0.46; 95%CI: 0.27-0.80). Declines in HIV incidence were similar in men (3.78/100py to 1.57/100py) and women (4.27/100py to 1.68/100py). Declines in HIV incidence were observed in persons aged 15-24 years (5.53/100py to 1.87/100py), 25-34 years (3.56/100py to 1.56/100py) and 35+ years (2.96/100py to 1.47/100pys). Overall, HIV prevalence declined from 41% to 36% (p=0.002). Figure: HIV incidence trends; ART and MC coverage over calendar time by age group. Conclusion: Over about 5 years, HIV incidence significantly declined by approximately 54% as ART and MC coverage increased in a hyperendemic fishing community. These results suggest that HIV treatment and prevention interventions can be rapidly scaled and have substantial population-level impact on HIV incidence in high prevalence settings.

Oral Abstracts

91 PROGRESS TOWARD 90-90-90: 2016 LESOTHO POPULATION-BASED HIV IMPACT ASSESSMENT RESULTS Kyaw Thin 1 , Koen Frederix 2 , Stephen McCracken 3 , Andrea Low 4 , Hetal Patel 3 , Nahima Ahmed 4 , Bharat S. Parekh 3 , Jessica E. Justman 4 , Amee M. Schwitters 5 1 Ministry of Health, Maseru, Lesotho, 2 ICAP at Columbia University–Lesotho, Maseru, Lesotho, 3 CDC, Atlanta, GA, USA, 4 ICAP at Columbia University, New York, NY, USA, 5 CDC, Maseru, Lesotho Background: Lesotho is severely impacted by the HIV epidemic. As the leading cause of premature death, HIV has contributed to Lesotho reporting the shortest life expectancy at birth among 195 countries and territories. In 2016, as part of the national response, Lesotho became the first country in sub-Saharan Africa to implement Test and Start. The 2016 Lesotho Population-based HIV Impact Assessment (LePHIA) was conducted nationwide to measure HIV prevalence, incidence, and viral load suppression. Progress towards meeting the UNAIDS 90-90-90 targets among adults 15-59 years of age is presented here. Methods: A nationally representative sample of eligible households was conducted in 418 enumeration areas between November 2016 and May 2017; analyses account for the survey design. Consenting participants provided socio- demographic information and blood samples for rapid HIV testing as per the national algorithm, with confirmation of positive results using a supplemental assay and viral load were performed on all HIV+ samples at central labs. Viral load suppression (VLS) was defined as an HIV RNA <1000 cp/ml. Results: In total, 11,682 adults provided interviews and blood samples (response rate: ~90%). Interview and blood draw participation among eligible adults was higher among females than males (91% v. 88% and 95% v. 87%, respectively). Among participants, 25.6% of adults 15-59 (female 30.4%, male 20.8%) were HIV infected. Viral load suppression among all HIV positive adults regardless of ART use was 67.6% (female 70.6%, male 63.4%). Among adults who tested HIV positive during the survey, 77.2% reported already knowing their HIV status (female 81.5%, male 71.0%) (1st 90), 90.2% (female 90.6%, male 89.4%) of PLHIV who reported knowing their status also reported ART use (2nd 90), and 88.3% (female 88.3%, male 88.4%) of these PLHIV who reported ART use were virally suppressed (3rd 90). Conclusion: Although HIV prevalence remains high in Lesotho, significant progress is being made towards meeting the UNAIDS 90-90-90 targets. The high prevalence of reported ART use among HIV+ individuals and high VLS prevalence provide evidence of an effective national HIV response, although differences remain between males and females. Enhanced testing is needed to identify persons unaware of their HIV+ positive status, particularly among males and youth. Continued support of innovative prevention and treatment programs are needed to reach epidemic control in Lesotho.

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CROI 2018