CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

Poor adherence among YLWH was independently associated with a history of IDU (aOR=1.69, 95%CI=1.08-2.63). Conclusion: Between 2010-2016, we observed significant improvements in the proportion of YLWH adhering to cART. Despite these improvements, YLWH in BC continue to have significantly poorer adherence compared to adults. Such inequities are aggravated among youth with a history of IDU. Scale-up in youth-focused and harm-reduction adherence supports, are needed to address persistent gaps in adherence among YLHIV accessing care within settings where cART is universally available.

of substance use and depression. Despite these advances, health disparities remain a significant challenge that need to be addressed to meet national viral suppression goals.

Poster Abstracts

1137 EVALUATING CARE OUTCOMES FOR ACUTE HIV INFECTION IN PHILADELPHIA, 2014-2016

1136 VIRAL SUPPRESSION AFTER INTERMITTENT VIREMIA: WOMEN’S INTERAGENCY HIV STUDY 1994-2015

Melissa Miller 1 , Tanner Nassau 1 , Coleman Terrell 1 , Kathleen Brady 1 1 Philadelphia Department of Public Health, Philadelphia, PA, USA Background: Detection and treatment of acute HIV infection (AHI) improves both individual-level health by preserving immune function and community-level health by reducing infectiousness and HIV transmission. The implementation of 4th generation HIV testing has resulted in an increase in the proportion of individuals identified as AHI in Philadelphia from 3.2% in 2014 to 6.3% in 2016. This analysis aims to evaluate characteristics and care outcomes associated with AHI among individuals newly diagnosed with HIV in Philadelphia. Methods: Data were extracted from the Enhanced HIV/AIDS Reporting System (eHARS) for individuals aged 13+ and newly diagnosed with HIV between 2014 and 2016. Chi-square tests were used to assess significant differences in continuummeasures including: linkage to care at 14 and 30 days after diagnosis, retention in care at 1 year after diagnosis (2 CD4/VL > 90 days apart), and viral suppression (VS; VL <200 copies/ml ) at 180 and 365 days after diagnosis between AHI and established infections. Bivariate and multivariable regression models assessed primary outcomes linkage to care < 30 days of diagnosis, retention in care at 1 year after diagnosis, and VS in 180 days of diagnosis. Multivariable models were adjusted for potential demographic and clinical confounders. Results: 1,827 Philadelphia residents were eligible for inclusion in analysis, of which 86 (4.6%) were categorized as AHI and 1752 (95.4%) as established infection. Cases of AHI were significantly more likely to be male, aged 13-24, HIV-non AIDS cases, and report MSM as their transmission risk. Care continuum data for each outcome is presented in Figure 1. Results indicated that AHI were three times more likely to be linked to care within 30 days of diagnosis compared to those diagnosed with established infection (AOR,3.3; 95%CI:1.5- 6.8). AHI were twice as likely to be retained in care in the year following diagnosis (AOR,2.1; 95%CI:1.1-3.7) and achieve VS within 180 days of diagnosis (AOR,2.0; 95%CI:1.2-3.3) when compared to those with established infections. Conclusion: Detecting AHI is vital for both individual and community-level health. Our data show that individuals diagnosed with AHI have better engagement in care and VS outcomes in the year following diagnosis than those with established infection. Further increasing early detection of HIV may be impactful in improving engagement in care among newly diagnosed individuals and reducing HIV transmission overall.

Amanda B. Spence 1 , Cuiwei Wang 1 , Tracey Wilson 2 , Kathryn Anastos 3 , Mardge H. Cohen 4 , Ruth Greenblatt 5 , Margaret Fischl 6 , Igho Ofotokun 7 , Mirjam-Colette Kempf 8 , Adaora Adimora 9 , Joel Milam 10 , Joanne Michelle F. Ocampo 1 , Kate G. Michel 1 , Seble Kassaye 1 1 Georgetown University, Washington, DC, USA, 2 SUNY Downstate Medical Center, Brooklyn, NY, USA, 3 Albert Einstein College of Medicine, Bronx, NY, USA, 4 Stroger Hospital of Cook County, Chicago, IL, USA, 5 University of California San Francisco, San Francisco, CA, USA, 6 University of Miami, Miami, FL, USA, 7 Emory University, Atlanta, GA, USA, 8 University of Alabama at Birmingham, Birmingham, AL, USA, 9 University of North Carolina Chapel Hill, Chapel Hill, NC, USA, 10 University of Southern California, Los Angeles, CA, USA Background: Long term HIV viral suppression (VS) decreases morbidity, mortality, and limits transmission. Previous studies suggest that failure to an initial treatment regimen decreases the likelihood of subsequent VS. We studied viral outcomes among women in the nationwide Women’s Interagency HIV Study (WIHS) with intermittent viremia (IV). Methods: This study included women in the multisite WIHS who contributed ≥ four semi-annual visits from 1994-2015. Trajectory analysis identified the number of groups that fit the HIV RNA viral load (VL) data, and assigned women to a group based on their VL pattern over time. We determined the proportion of women with VS (VL<80 c/mL) at each visit for each trajectory group. We compared differences between IV and non-viremia (NV) groups, before and after 2006 when viral suppression in the IV group exceeded 50% (fig. 1). Univariate and multivariable generalized linear modeling for repeated measures accounted for correlated responses from the same woman. All variables were time-varying, except race/ethnicity. We used SAS v9.1.3. for all analyses. Results: Three groups emerged: sustained viremia (N=1010); IV (N=719); and NV (N=711). Before 2006, comparing IV and NV groups, the IV group had lower mean CD4+ (387 vs 544/mm 3 , aOR 0.78, p<0.0001) higher depression CES-D ≥16 (47.0% vs 36.2%, aOR 1.28, p=0.02), were more likely African American (55.5% vs 46. 2%, aOR 1.86, p=0.004) and had lower NNRTI use (17.2% vs 30.2%, aOR 0.7, p=0.006), adjusted for age, employment, alcohol and drug use, depression, cART use and adherence. After 2006, women with IV had lower CD4+ (583 vs 670, aOR 0.91, p<0.0001), higher depression (31.6% vs 26. 5%, aOR 1.30, p=0.01); were more likely to be African American (58% vs 51%, aOR 1.8, p=0.007); were more likely to use integrase (15.4% vs 10.1%, aOR 1.60, p=0.004) and protease inhibitors (59.9% vs 40.3%, aOR 1.85, p=0.0003), adjusted for age, employment, and insurance. Alcohol, drug use, cART uptake, and adherence were similar between IV and NV groups after 2006. Conclusion: The majority of women in the IV group were able to achieve viral suppression with potent, better tolerated protease and integrase inhibitors. This provides ecological support for the use of these agents even in the setting

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