CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

1029 CHEMSEX DRUGS USE BY HAIR ANALYSIS AMONG MSM IN THE ANRS IPERGAY TRIAL. Julie Chas 1 , Gilles Peytavin 2 , Diane Carette 3 , Nicolas Fabresse 4 , Isabelle Charreau 3 , Catherine Capitant 3 , Perrine Roux 5 , Eric Cua 6 , Laurent Cotte 7 , Armelle Pasquet 8 , François Raffi 9 , Laurence Meyer 3 , Gilles Pialoux 1 , Jean-Michel Molina 4 , Jean- Claude Alvarez 4 1 Tenon Hospital, Paris, France, 2 Bichat–Claude Bernard Hospital, Paris, France, 3 Paul Brousse Hospital, Villejuif, France, 4 Paris Center Hospital Group, Paris, France, 5 INSERM, Marseille, France, 6 Nice University Hospital, Nice, France, 7 CHU de Lyon, Lyon, France, 8 CHU de Lille, Lille, France, 9 CHU de Nantes, Nantes, France Background: In the ANRS IPERGAY trial conducted among high risk MSM, 86% relative reduction of HIV-incidence was reported with on demand PrEP use with TDF/FTC. Use of Chemsex drugs is increasingly reported among MSM and is associated with higher risk behavior. Methods: During the ANRS IPERGAY trial, participants (pts) were asked every four month to provide hair samples to detect drugs (except the GHB/GBL for technical reasons). When possible a segmental analysis was carried out, 1 cm corresponding to 1 month of drug use. A total of 86 molecules including conventional substances (cocaine, amphetamines, opiates) and 31 New Psychoactive Substances (NPS) were screened and quantified using Triple Quad TSQ Vantage (ThermoFisher®) in MRMmode. Results: Sixty nine volunteers were enrolled, among the 429 pts of the Ipergay study population: median [IQR] age 35 years [28;41], number of sexual partners/2 months 9 [5;15], number of sexual intercourse/4 weeks 10 [5;16], similar to the overall IPERGAY population. A total of 219 hair segments (1.5 to 2.5cm length) were analyzed, corresponding each to 1.5 to 2.5 months of consumption. Drugs of abuse were detected in 87% (60/69) pts: 47 pts (68%) were tested positive to Cocaine, 41 (59%) MDMA, 26 (38%) Ketamine, 26 (38%) to one or more NPS, 9 (13%) Codeine, 6 (9%) Methamphetamine, 4 (6%) Amphetamine. The most frequently detected NPS were two cathinones, 14 Mephedrone and 11 4-MEC, followed by 5 ethylphenidate, 4 methylone, 4 methoxetamine, 3 methiopropamine, 3 PMMA, 3 MDPV, 1 metamfepramone, 1 5F-PB22, 1 methylphenidate, 1 diphenidine, 1 phendimetrazine, 1 phentermine, 1 N-methyl-2-AI and 1 dimethylone. No piperazine like TFMPP, α-PVP or m-CPP was found. No case of NPS use alone was found. MSM pts consumed NPS associated to cocaine, MDMA or ketamine in 25/26 (96%), 23/26 (88%), and 18/26 (69%) of cases respectively, showing poly-consumptions. Segmental hair analysis performed in 69% of cases showed wide range exposures, ranging from unique intake (concentration range 5-20 pg/mg) to chronic abuse (> 90 ng/mg for amphetamines) studied. Drugs detection in our study seems more important than the self-reported consumption of recreational drugs in the ANRS IPERGAY trial (44%). Conclusion: Prevalence of NPS and especially synthetic cathinones use in the MSM PreP population is high but lower than conventional drugs like cocaine and amphetamine, especially MDMA. Hair analysis is the only way to accurately reflect drugs consumption and can improve prevention policies.

1028 FACTORS IMPACTING APPROPRIATE HIV/STI SCREENING AND PrEP PERSISTENCE IN PRIMARY CARE Matthew A. Spinelli 1 , Hyman Scott 2 , Eric VIttinghoff 1 , Albert Y. Liu 2 , Alicia Morehead-Gee 1 , Rafael Gonzalez 2 , Monica Gandhi 1 , Susan P. Buchbinder 2 1 University of California San Francisco, San Francisco, CA, USA, 2 San Francisco Department of Public Health, San Francisco, CA, USA Background: Given increasing PrEP uptake, to optimize PrEP safety and impact, persons at HIV-risk must have appropriate HIV/STI testing and persist on PrEP. We evaluated patient and provider characteristics associated with HIV/ STI testing and PrEP persistence in the San Francisco Public Health Primary Care Clinics (SFPCC). Methods: Demographic, lab, and prescription data were abstracted from charts of SFPCC PrEP users from 3/1/13-7/31/17. Multivariable logistic regression models assessed factors associated with lack of appropriate HIV/STI testing at PrEP initiation defined as HIV testing 30 days prior, and rectal, pharyngeal, urine, or vaginal gonococcus (GC) or C. trachomatis (CT) testing 90 days prior to or 7 days after initial prescription, respectively. We examined factors associated with PrEP persistence (number of days with an active prescription) using a Cox proportional-hazards model, defining discontinuation as 90 days without an active prescription. Results: Overall, 401 PrEP patients had pharmacy and lab data available. Mean age was 37 years; 85%were male; 8% Asian, 13% Black, 26% Latino, and 36%White. PrEP prescriptions increased each year, from 108 patients in 2013/4 to 913 in 2016/7. PrEP panel size was 1, 2-5, or >5 for 19%, 32% and 49% of providers, respectively. Only 76% of patients received an HIV antibody test ≤30 days prior to PrEP initiation: 61% in 2013/14 and 83% in 2016/17. Lack of a baseline HIV test was associated with older age (p=0.01) and earlier prescription year (p=0.001 for trend). Among patients on PrEP for ≥6 months, 70% had follow-up HIV testing at least every 6 months. Only 71% received any baseline testing for GC or CT; lack of testing was also associated with older age (p<0.001) and earlier year (p<0.001 for trend). Median PrEP persistence was 11.3 months. In multivariable analysis, shorter persistence was associated with young age, Black race, earlier PrEP prescription index number, larger provider PrEP panel size, and current prescription of ≤30 pills (Table). Conclusion: SFPCC PrEP users are a diverse and growing population cared for by both high and low volume providers. Short duration prescriptions were associated with worse persistence, and may be a barrier for PrEP users. Appropriate HIV/STI screening is suboptimal but improving with time, possibly related to SFPCC PrEP education initiatives. Strategies to address provider and patient barriers to appropriate HIV/STI screening and PrEP persistence are needed.

Poster Abstracts

CROI 2018 394