CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

965 HIV TRANSMISSION RISKS AMONG HIV-POSITIVE ADULTS IN MEDICAL CARE WHO MISUSE OPIOIDS Ansley Lemons , Nicholas DeGroote, Alejandro Pérez, Jason Craw, Margaret Nyaku, Dita Broz, Christine Mattson, Linda Beer CDC, Atlanta, GA, USA Background: People living with HIV (PLWH) are prescribed opioids more often and at higher doses for pain than uninfected people and many are at high risk for opioid misuse given their disproportionate risk for substance use disorders. PLWH who misuse opioids may be less adherent to antiretroviral therapy (ART), which increases the likelihood of viral rebound and HIV transmission. Injection opioid misuse increases risk of HIV and HCV transmission and other blood-borne infections. Population-based data on HIV transmission risks among HIV-positive adults who misuse opioids in the US is needed. Methods: The Medical Monitoring Project (MMP) is a surveillance system that collects sociodemographic, clinical, and behavioral data from a nationally representative sample of adults receiving HIV medical care in the US. We analyzed weighted data collected 6/2009-5/2015 to estimate the proportion and characteristics of people in HIV care who reported opioid misuse (n=975), defined as any self-reported injection or noninjection use of opioid pain relievers for non-medical purposes or heroin in the past 12 months. Results: In all, 3% of people in HIV care reported opioid misuse and among them, 65%misused pain relievers, 29% used heroin, and 6% used both. Only 32% received drug/alcohol counseling or treatment. People who misused opioids were less likely to be prescribed ART (89%), adhere to ART (78%), and have sustained viral suppression (54%) than people who did not misuse opioids (93%, 88%, and 65%, respectively). People who misused opioids were more likely to have condomless sex while not virally suppressed (Table 1). Among those who misused opioids, 23% reported injecting them, and this group was more likely to engage in distributive syringe/equipment sharing compared to those who injected other drugs (Table 1). Those who injected opioids reported more frequent daily (29%) and weekly (18%) use than those who did not inject (19% and 15%, respectively). Among those who injected opioids, 43% received free sterile needles and 38% received new works. Conclusion: Persons receiving HIV medical care who misuse opioids face significant risks for poor health outcomes and transmitting HIV. Among PLWH who misused opioids, almost ¼ injected them increasing the potential for HIV to spread rapidly through networks of persons who inject drugs. Because so few received drug/alcohol counseling or treatment, our findings suggest a need for increased delivery of drug treatment, harm reduction services, and behavioral interventions.

the United States. We assessed the risk of IDU-related HIV transmission among AI/AN by describing temporal trends in conditions commonly found among persons who inject drugs (PWID) as a proxy for IDU. Methods: We analyzed 2010-2014 data from the Indian Health Service (IHS) claims database, National Patient Information Reporting System (NPIRS), to include all AI/AN persons eligible for service at an IHS funded or contract outpatient or inpatient facility. As there are no ICD-9-CM codes specific to IDU, we enumerated IDU-related ICD-9-CM codes of hepatitis C (HCV) in 18-35 year olds, arm cellulitis, opioid use disorder (OUD), and opioid poisoning (OP) in ≥ 18 year olds; these could represent new or existing diagnoses. For each outcome, we determined the number of persons with at least one ICD-9-CM code in the year per 10,000 adults. HCV analyses were limited to 18-35 year olds as this group is most likley to have recently acquired HCV. We estimated average annual percentage change in occurrence of the outcomes and determined p-values for trend using Poisson regression. For the 18-35 year olds with HCV during 2010 – 2014, we also assessed co-occurrence of OUD, OP, and arm cellulitis in the same period. Results: During 2010 – 2014, an average of 1.06 million adults per year were eligible for analysis (median age = 39 years, interquartile range 27-54 years, 46%male). HCV diagnoses increased 9.41% per year from 2010 (25.5 per 10,000, n=1160) to 2014 (35.1 per 10,000, n=1661) (p < 0.001); and OUD increased 13.19% per year from 2010 (47.1 per 10,000, n= 4806) to 2014 (72.0 per 10,000, n= 7886) (p <0.001), Figure. OP remained constant and arm cellulitis diagnoses decreased 2.97% per year from 2010 (53.3 per 10,000, n= 5435) to 2014 (47.0 per 10,000, n= 5145) (p <0.001). Among 4,546 persons aged 18 – 35 years old with HCV during 2010 - 2014, 26% also had OUD, 1% had OP, and 8% had arm cellulitis. Conclusion: The increasing trend in HCV diagnoses in young AI/AN adults and opioid use disorder among all AI/AN adults is concerning and has important public health implications. Our findings suggest increasing risk for IDU-related HIV outbreaks in this population. These data can be used at a local level to ensure that access to OUD treatment and syringe service programs matches the community’s need.

Poster Abstracts

967 REPORTED DRUG INJECTION BEHAVIORS BEFORE AND AFTER AN HIV OUTBREAK—INDIANA, 2016 Sharoda Dasgupta 1 , Mary Tanner 1 , Monita Patel 1 , Julie O’Donnell 1 , Brandon Halleck 2 , Joseph Amlung 2 , Cameron McAlister 3 , Erika Chapman 2 , Ayriane Bailey 2 , Caitlin Conrad 2 , Michael Spiller 1 , Dita Broz 1 , Philip J. Peters 1 , Paul J. Weidle 1 , Joan Duwve 3 1 CDC, Atlanta, GA, USA, 2 Indiana State Health Department, Indianapolis, IN, USA, 3 Indiana University, Indianapolis, IN, USA Background: In January 2015, a large HIV outbreak among persons who inject drugs (PWID) was detected in rural Indiana. A syringe services program (SSP) was established during April 2015 to reduce injection-related HIV transmission risk and link persons to prevention and treatment services. We examined injection behaviors before and after outbreak detection and use of the SSP after its establishment. Methods: During January–February 2016, we recruited 200 PWID who injected during the prior 12 months through respondent-driven sampling to collect self- reported information on demographics, injection behaviors, SSP use, and HIV status. We restricted our analysis to persons who injected both before (July– December 2014) and after (30 days prior to interview) outbreak detection. We

966 INDICATORS OF INJECTION DRUG USE— INDIAN HEALTH SERVICE, 2010 –2014 Mary Evans 1 , Marissa Person 1 , Brigg Reilley 2 , Jessica Leston 3 , Richard Haverkate 2 , Michelle Van Handel 1 , Michele Bohm 1 , Danae Bixler 1 , Dita Broz 1 , Andrew J. Mitsch 1 , Dana Haberling 1 , Eyasu Teshale 1 , Paul J. Weidle 1 , Philip J. Peters 1 , Kate Buchacz 1 1 CDC, Atlanta, GA, USA, 2 Indian Health Service, Rockville, MD, USA, 3 Northwest Portland Area Indian Health Board, Portland, OR, USA Background: Little is known about the risk of HIV outbreaks linked to injection drug use (IDU) among the American Indian/Alaska Native (AI/AN) population in

CROI 2018 369