CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

Methods: AFRICOS is an ongoing cohort enrolling HIV-infected and uninfected participants at 11 clinical sites in Uganda, Kenya, Tanzania, and Nigeria. Clinical assessments, including viral load testing, are performed every six months. We evaluated participants who were prescribed ART for at least six months without virologic failure for pLLV and blips. We defined pLLV as HIV RNA 20-999 copies/ ml for at least two consecutive study visits, a blip as one HIV RNA 20-999 copies/ ml preceded and followed by an undetectable measurement, and virologic failure as one HIV RNA ≥1,000 copies/ml. We used generalized estimating equations with a binomial distribution to calculate adjusted odds ratios (AORs) to assess associations between pLLV, blips, and factors of interest. Results: As of June 1, 2017, we enrolled 2,635 HIV infected participants of which 1553 participants met our inclusion criteria. The median age was 40 years (IQR: 34-47) and 58%were female. PLLV was observed in 520 participants while blips were observed in 519 participants. In the multivariable analysis, Kenyan and Tanzanian sites (Kenya AOR: 0.18, 95% CI: 0.14, 0.24; Tanzania AOR: 0.64, 95% CI: 0.47, 0.88), duration of ART ≥5 years (AOR: 0.73, 95% CI: 0.57, 0.94), and higher CD4 count (AOR: 0.77, 95% CI 0.60, 0.99) were all associated with lower odds of pLLV. Participants on a protease inhibitor (PI) had a 3.28 times higher odds of pLLV (95% CI: 1.17, 9.19). Study site, longer duration of ART, and being on an NRTI were significantly associated with blips. Conclusion: PLLV and blips were common with 1/3 of participants experiencing these outcomes. The difference in significant risk factors supports that those experiencing LLV blips may be clinically different than those with pLLV. The increased odds of pLLV among those on a PI may have implications for the rollout of tenofovir-lamivudiine-dolutegravir (TLD) and will warrant close monitoring. With the high incidence of pLLV in this population, a better understanding of the long-term impacts on virologic failure, drug resistance, and clinical outcomes is needed.

p=0.03), higher viral loads (median 22,695 vs. 1,649 copies/mL, p<0.001), were less likely to have had any suppressed viral load measurements in the past year (20% vs. 51%, p=0.002), and more often had illicit substance or hazardous alcohol use (90 vs. 70%; p=0.006), unstable housing (64 vs. 36%; p=0.001), or a history of incarceration (68 vs. 31%, p <0.001) documented in medical records. The proportion with diagnosed psychiatric illness did not differ significantly (78 vs. 73%, p=0.51). Viral suppression increased in both groups from the 12 months pre-baseline to post-baseline (Table), but the improvement among MAX Clinic patients (20 to 82%) was significantly greater than control patients (51 to 65%). Continuous viral suppression and engagement in care increased from pre- to post-baseline among MAX patients, but not significantly compared to controls. Conclusion: A low-threshold clinic with extensive support services and incentives can substantially increase viral suppression among high need, complex HIV+ patients.

Poster Abstracts

1126 CLINICAL OUTCOMES OF US YOUNG BLACK MEN WITH HIV RECEIVING MEDICAL CARE, 2009–2014 Pranesh P. Chowdury , Linda Beer, R. L. Shouse, Heather Bradley CDC, Atlanta, GA, USA Background: Nearly one-third of HIV diagnoses among blacks in the United States in 2015 occurred among young people aged 15–24 years, and three- quarters were among men. Viral suppression, which greatly reduces the risk of HIV transmission, increased from 72% in 2009 to 80% in 2013 among persons in HIV care. National data on viral suppression or other clinical outcomes among young black men in HIV care are lacking. Methods: We analyzed 2009–2014 Medical Monitoring Project (MMP) interview and medical record data collected from 336 black men aged 18–24 years. MMP is a surveillance system that produces nationally representative information about adults with diagnosed HIV in the US. We estimated the proportion of young black men in HIV care who were virally suppressed at last test (current viral suppression) and at all tests in the previous 12 months (durable viral suppression). We also estimated the proportion prescribed antiretroviral therapy (ART) and adherent to ART. We assessed changes over time in all clinical outcomes and certain characteristics associated with each outcome. Results: During 2009–2014, 60% of young black men in HIV care were currently virally suppressed, and 36% had durable viral suppression. There was no significant change over time in either viral suppression measure. ART prescription increased from 61% in 2009–2010 to 88% in 2013–2014 (β=0.13, P for trend <0.05). Overall, 73% of young black men were adherent to ART; this did not change significantly over time. Current viral suppression was lower among the 45% of young black men who used injection or non-injection drugs than among those who did not (49% vs. 68%, P <0.05). Durable HIV viral suppression was lower among the 12% of young black men who were homeless compared with those who were not homeless (23% vs. 38%, P <0.05) and also lower among those who used injection or non-injection drugs than among those who did not (28% vs. 42%, P <0.05). ART adherence was lower among the

1125 IMPROVED OUTCOMES WITH MAXIMUM ASSISTANCE, LOW-THRESHOLD HIV CARE (THE “MAX CLINIC”) Julia C. Dombrowski , Sean Galagan, Meena Ramchandani, Shireesha Dhanireddy, Robert D. Harrington, Matthew R. Golden University of Washington, Seattle, WA, USA Background: The MAX Clinic is designed for HIV+ persons with extensive psychosocial barriers who do not engage in standard HIV care. It includes walk-in access to primary care in an STD clinic, intensive coordinated case management, food vouchers, free bus passes and cell phones, and financial incentives for blood draws and achieving viral suppression. We conducted a retrospective cohort study comparing outcomes in the first 50 patients enrolled in the MAX Clinic to matched control patients attending a Ryan White Part C-funded clinic with wrap-around support services. Methods: For each MAX patient we identified 2 control patients who had ≥1 encounter in the Madison Clinic within 2 months of the MAX patient’s enrollment (“baseline”) and had a most recent viral load (VL) >200 copies/mL. We examined outcomes at 6 and 12 months post-baseline. The primary outcome was viral suppression (≥1 VL <200 copies/mL). Continuous viral suppression (≥2 consecutive VL<200 copies/mL ≥60 days apart) and care engagement (≥2 visits ≥60 days apart) were secondary outcomes. We compared outcomes in the 12 months post- vs. 12 months pre-enrollment for each patient using χ2 tests. To compare the pre-post changes in MAX vs. control patients, we used generalized estimating equations adjusted for housing status, substance use, and psychiatric diagnoses. Results: Compared to control patients (N=100), MAX Clinic patients enrolled 12/2014-11/2015 (N=50) had lower CD4 counts (median 172 vs. 262 cells/mm 3 ,

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