CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

people who have undetectable HIV-1 RNA increased from 70.2% (Gaolathe et al. 2016 Lancet HIV 3:e221-30) to 71.7%, after taking into account undisclosed ARV use. Conclusion: Among household survey participants in Botswana who had HIV-1 RNA<400 copies/mL but who reported not being on ART, undisclosed ART use was found in 39%. The overall proportion of virologically-suppressed HIV-infected adults increased by 1.5% after accounting for undisclosed ART. National estimates of treatment coverage should include methods that account for undisclosed ART use, to more accurately reflect achievement against 90-90-90 targets. Testing for ARV traces in those without detectible virus should supplement self-report of ART use in population surveys.

infection. Understanding the combined effects of systemic and mucosal innate immunity on susceptibility to acquire HIV is an essential step in preventing new infections. 943 RELATIONSHIP BETWEEN DEPRESSION AND RISK BEHAVIORS IN A US MILITARY HIV COHORT Brandon W. Carney 1 , James White 2 , Xiaohe Xu 2 , Thankam Sunil 2 , Colton Daniels 2 , Morgan Byrne 3 , Anuradha Ganesan 3 , Robert Deiss 3 , Grace E. Macalino 3 , Brian K. Agan 3 , Jason Okulicz 1 1 San Antonio Military Medical Center, San Antonio, TX, USA, 2 University of Texas at San Antonio, San Antonio, TX, USA, 3 Infectious Disease Service, San Antonio, TX, USA Background: Previous studies have suggested links between psychological symptoms, such as depression and anxiety, and sexual risk behaviors. We evaluated the multifaceted relations between depression trajectories, depression diagnosis, and risk-taking behaviors among participants in the US Military HIV Natural History Study. Methods: Participants with risk behavior survey data and either a coded diagnosis of depression (including anxiety, dissociative, and somatoform disorders) or available self-reported Center for Epidemiological Studies Depression (CES-D) measure were included (n=646) to explore ties between depression trajectories, depression diagnoses, and sexual risk behaviors. Latent class analysis was employed to create 3 classes of depression trajectories from 1988-2016, namely low depression (LD, n=369), recent-onset depression (ROD, n=166), and high depression (HD, n=111) trajectories. The latent class was further dummy-coded with the LD trajectory class serving as the reference. Results: Overall, participants with clinically diagnosed depression were less likely to report often/always using condoms with new sexual partners in the past 3 months than those who have never been clinically diagnosed with depression (OR 0.15, 95% CI 0.49-2.53; p<.001). Participants with both ROD (OR 0.52, 95% CI 0.28-0.97; p<.05) and HD (OR 0.48, 95% CI 0.24-0.96; p<.05) trajectories were less likely to report often/always using condoms with new sexual partners in the past 3 months than those with LD trajectories. Moreover, those with either ROD (OR 2.13, 95% CI 1.19-3.80; p<.01) or HD (OR 2.74, 95% CI 1.43-5.24; p<.001) trajectories were more likely to have had sex with ≥2 new sexual partners in the last 3 months than those with LD trajectories. Furthermore, participants with HD trajectories (OR 4.07, 95% CI 2.09-7.96; p<.001) were more likely to have one or more anonymous male sexual partners in the last 3 months than those with LD trajectories. Regression models also indicated that the cumulative odds of using alcohol was higher for those with ROD (OR 1.61, 95% CI 1.15-2.25; p<.01) than for whose with LD trajectories. Conclusion: Persons with HIV infection and ROD or HD trajectories were more likely to engage in greater sexual risk behaviors than those with LD trajectories. Educational efforts targeting those with known mental health disorders are warranted to reduce sexual risk behavior in this high-risk population of HIV- infected persons. 944 ARE REAL-TIME PHYLOGENY GUIDED INTERVENTIONS FEASIBLE? A LONGITUDINAL ANALYSIS Larissa V. Mulka 1 , Manon Ragonnet-Cronin 2 , Jaime Vera-Rojas 1 , Jackie Cassell 1 , Anna Tostevin 3 , David Dunn 3 , Andrew Leigh Brown 2 1 Brighton and Sussex Medical School, Brighton, UK, 2 University of Edinburgh, Edinburgh, UK, 3 University College London, London, UK Background: The use of real-time HIV phylogenetics to guide public health interventions is an area of growing interest, but questions remain over how this technology may be applied in a way that is both of public health benefit and acceptable to patients. A previous phylogenetic analysis found no likely transmitter for 74% of recent HIV infections (RHI) within the studied population in Brighton, UK. Brighton has the highest prevalence of HIV outside London and the cohort is predominantly composed of men who have sex with men (MSM). We aimed to identify sources of RHI more accurately within this cohort, to determine whether real-time phylogenetic reconstruction is a feasible component of intervention within this population. Methods: Subtype B sequences were retrieved from the Brighton population, diagnosed 1981-2015 (n=1,840) alongside the most similar UK and global sequences from the UK HIV Drug Resistance and Los Alamos databases. Maximum likelihood trees were built in RAxML (GTR + Γ), and dated phylogenies reconstructed in BEAST. Demographic and clinical data available for Brighton patients included CD4 counts, viral loads, sexually transmitted infections, AIDS diagnoses and antiretroviral history. RHI were identified by testing history and

Poster Abstracts

942 CONCOMITANTLY SUPPRESSED SYSTEMIC AND IMBALANCED MUCOSAL IMMUNITY INCREASE HIV RISK Charles S. Morrison 1 , Raina Fichorova 2 , Pai-Lien Chen 1 , Sophie Gao 1 , Cynthia Kwok 1 , Hidemi Yamamoto 2 , Sharon Anderson 3 , Christopher Bukowsky 2 , Robert Barbieri 2 , Anna Wald 4 , Tsungai Chipato 5 , Robert Salata 6 , Gustavo Doncel 7 1 FHI 360, Durham, NC, USA, 2 Brigham and Women’s Hospital, Boston, MA, USA, 3 Eastern Virginia Medical School, Norfolk, VA, USA, 4 University of Washington, Seattle, WA, USA, 5 University of Zimbabwe, Harare, Zimbabwe, 6 Case Western Reserve University, Cleveland, OH, USA, 7 CONRAD, Arlington, VA, USA Background: We found previously that women in Uganda and Zimbabwe had different individual biomarkers of altered cervical immunity associated with progestin-only (DMPA) versus combined oral contraceptive use; however, only one cervical marker – higher RANTES - altered in DMPA use was associated with subsequent HIV seroconversion. Here we expand the analysis to examine concomitantly altered systemic and cervical immunity as a risk factor for HIV. Methods: Ten cervical and four systemic immune biomarkers were measured in 2347 cervical and serum specimen pairs at quarterly visits from 218 HIV seroconverters (median 4.4 months prior to seroconversion) and 784 matched controls. Biomarker activation/suppression was defined as Box-Cox transformed levels above/below the median of all HIV-negative visits. Odds ratios (OR) and 95% confidence intervals were calculated for likelihood of HIV seroconversion with biomarker activation. Results: In multivariable modeling subsequent HIV seroconversion was associated with 5 of the 14 individual biomarkers: suppressed systemic CRP (OR=0.63, 0.51-0.79, p<0.001), cervical SLPI (OR=0.63, 0.49-0.80, p<0.001) or cervical VEGF (0.71, 0.54-0.94, p=0.016), or activated cervical IL-1β (OR=1.38, 1.07-1.78, p=0.012) or IL-6 (OR=1.35, 1.02-1.79, p=0.036). Additional significant patterns emerged when concomitantly suppressed systemic immunity biomarkers (CRP, IL-6 and IL-7) were combined with activated RANTES (OR=1.47, 1.09-1.98, p=0.013), activated cervical IL-1β and IL-6 (OR=1.92, 1.29-2.83, P=0.001), or with suppressed cervical immunity, measured by suppressed SLPI (OR=1.56, 1.13-2.15, =0.007), IL-1RA (OR=1.66, 1.20-2.29, p=0.002) or VEGF and ICAM-1 (OR=1.99, 1.29-3.06, p=0.002). Systemic sCD14 activation, a possible sign of subclinical endotoxin exposure, combined with the same patterns of activated/suppressed cervical biomarkers resulted in similarly increased risk of HIV. Conclusion: Suppressed systemic immunity (low CRP, IL-6 and IL-7) concomitant with cervical inflammation (high primary proinflammatory cytokines IL-1β and IL-6, or low anti-inflammatory mediators IL-1RA) or low cervical innate immunity (e.g., SLPI, VEGF, ICAM-1) indicated vulnerability to HIV

CROI 2018 360