CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

the Distress Thermometer (DT) for anxiety/stress (score 0-10) were measured before and 24 weeks after ART. Participants who received other ART regimens were excluded. Results: From 2009-2019, 415 participants (98%male, median age 26 years) initiated ART at AHI (EFV-based=325; DTG-based=90). By week 24, 15 (5%) EFV users reduced their daily EFV dose from 600mg to 300mg due to side effects and super-therapeutic plasma EFV levels. Another 23 (7%) discontinued EFV due to EFV-associated adverse events (AEs) and/or resistance; 2 (2%) DTG users discontinued DTG, both for acute hepatitis C with liver enzyme elevations (p=0.130). At baseline, both groups (EFV=302; DTG=88) were similar in age, sex composition, CD4/CD8 ratio, plasma HIV-1 RNA, PHQ-9 and DT scores (p>0.05); 167 (43%) had moderate depression symptoms (PHQ-9>9). The DTG group had lower CD4 and CD8 T-cells and higher rates of Fiebig III and CRF01 AE/B recombinant subtype than the EFV group (p<0.05). HIV suppression (<50 copies/ml) rates were 98% and 93% in the DTG and EFV group respectively (p=0.124). Comparing the change of parameters (i.e. difference between week 24 and baseline) by ART regimen showed greater gain in CD4 and CD8 T-cells in DTG users (Table). DTG-based ART remained independently associated with greater CD4 recovery (mean diff +78.0, 95%CI [40.2 to 115.8], p<0.001) in multivariable analysis. At week 24, the rate of PHQ-9>9 in the DTG and EFV groups were 15% vs 13% respectively (p=0.644). Both groups had lower PHQ-9 and DT scores than at baseline (p<0.001) but both scores were similar across the groups (p>0.05). Conclusion: Compared to EFV, initiating DTG-based ART at AHI was associated with a greater gain in CD4 T-cells and a higher absolute CD4 count at week 24. There were no DTG related AEs leading to discontinuation. Self-reported depression symptoms observed at AHI improved with ART regardless of the regimen.

Spain, 4 Hospital General Universitario de Alicante, Alicante, Spain, 5 Hospital de Basurto, Basurto, Spain, 6 Hospital Marina Baixa, Hospital Marina Baixa, 7 Hospital San Agustín, Guadalupe, Mexico Background: A low CD4/CD8 ratio during ART identifies subjects with heightened immunosenescence and increased risk of mortality. We aimed to assess the effects of the INSTI, PI or NNRTI-based first-line ART on long-term CD4/CD8 ratio recovery in a large prospective cohort. Methods: Prospective cohort study in 13,026 HIV-infected individuals registered in the Spanish HIV Research Network (CoRIS) cohort. We included subjects who started triple ART and achieved HIV RNA suppression at 48 weeks. We used multilevel mixed models with linear splines to compare longitudinal changes in the CD4/CD8 ratio and Cox proportional-hazard models to compare the times to CD4/CD8 normalization by treatment groups (NNRTI, PI, INSTI) at 0.4, 1 and 1.5 cut-offs. Analyses were adjusted for sex, country of origin, mode of transmission, calendar year, educational level, baseline HIV RNA, presence of AIDS, pre-ART nadir CD4, acme CD8 count and backbone NRTI and censored at virologic failure. Results: A total of 6,804 individuals contributing to 37,149 persons/years and 37,680 observations were analyzed. Median follow-up was 49 months (IQR 22-89). As compared to NNRTI and PI treatment, INSTI treatment was associated with greater CD4/CD8 gain. Differences were observed since the first year of therapy and were driven by changes in both CD4 and CD8 counts. At year 4, the adjusted mean CD4 count for INSTI, NNRTI and PI was 904, 718 and 696 cells/ uL (p<0.0001) and the adjusted mean CD8 count was 832, 875 and 996 cells/ ul, respectively (p<0.0001). Within INSTI, the greatest CD4/CD8 ratio gain was observed with elvitegravir, followed by dolutegravir, and was largely due to higher CD8 count declines. Compared to INSTI, the NNRTI and PI groups showed lower rates of CD4/CD8 ratio normalization ≥1 (NNRTI, aHR 0.80 [0.72–0.89]; PI, aHR 0.79 [0.69–0.89] and ≥1.5 (NNRTI, aHR 0.79 [0.65–0.95]; PI, aHR 0.78 [0.64–0.97]. Subanalyses adjusted for backbone NRTIs or allowing observations after virologic failure yielded similar results. Conclusion: INSTI-based first line ART is associated with a greater CD4/CD8 ratio gain compared to NNRTI and PI-based ART. This study in real life indicates that ART initiation with INSTI improves immune recovery with respect to other ART classes, which could affect long-termmortality.

Poster Abstracts

476 RAPID ART IN BLOOD DONORS WITH ACUTE AND RECENT HIV CLADE C INFECTION IN SOUTH AFRICA Karin Van Den Berg 1 , Marion Vermeulen 1 , Sonia Bakkour 2 , Mars Stone 2 , Coreen Barker 3 , Christopher McClure 4 , Darryl Creel 4 , Ute Jentsch 1 , Genevieve Jacobs 1 , Brian Custer 2 , Michael P. Busch 2 , Edward Murphy 5 , for the NHLBI Recipient Epidemiology and Donor Evaluation Study-III (REDS-III) 1 South African National Blood Service, Johannesburg, South Africa, 2 Vitalant Research Institute, San Francisco, CA, USA, 3 Clinical HIV Research Unit, Johannesburg, South Africa, 4 RTI International, Rockville, MD, USA, 5 University of California San Francisco, San Francisco, CA, USA Background: Blood donations in South Africa are tested in parallel for HIV antibody (Ab) and RNA using individual-donation nucleic acid testing (ID-NAT), allowing annual detection of ~60 Acute (RNA+/ Ab-; Fiebig stages I-III) and >400 Recent (RNA+/Ab+; Fiebig stages IV to VI) HIV infections. We hypothesized that initiation of antiretroviral therapy (ART) in earlier Fiebig stages would correlate with smaller HIV reservoir size. Methods: A prospective cohort study enrolled Acute and Recent HIV clade C infected blood donors. HIV Ab (Abbott Prism) and RNA (Grifols ID-NAT) were measured on samples taken at index donation and enrolment. Recency (< 195 days) was detected by limiting-antigen avidity assay (Sedia). Enrolled donors were referred rapidly for ART with RAL/TDF/FTC X 6 months followed by EFV/ TDF/FTC. We measured plasma RNA using the Aptima HIV-1 Quant Assay (Hologic) with 5 replicates. Cell-associated (CA) HIV RNA and total DNA were measured by qRT-PCR and real-time nested PCR, respectively. After median treatment duration of 20 months, we compared HIV reservoir size between

475 CLINICAL AND LABORATORY OUTCOMES 24 WEEKS AFTER STARTING DTG VERSUS EFV IN ACUTE HIV Phillip Chan 1 , Orlanda Goh 1 , Donn J. Colby 1 , Carlo Sacdalan 1 , Camilla Muccini 2 , Nittaya Phanuphak 1 , Suteeraporn Pinyakorn 3 , Praphan Phanuphak 4 , Nitiya Chomchey 1 , Robert Paul 5 , Sandhya Vasan 3 , Serena S . Spudich 6 , Jintanat Ananworanich 1 , Eugène Kroon 1 , for the RV254 Research Group 1 SEARCH, Bangkok, Thailand, 2 San Raffaele Vita-Salute University, Milan, Italy, 3 US Military HIV Research Program, Bethesda, MD, USA, 4 Thai Red Cross AIDS Research Center, Bangkok, Thailand, 5 University of Missouri St Louis, St Louis, MO, USA, 6 Yale University, New Haven, CT, USA Background: This study compared clinical and laboratory parameters before and after initiating Efavirenz(EFV)- and Dolutegravir(DTG)-based antiretroviral therapy (ART), the prior and current 1st line ART, during acute HIV infection (AHI). Methods: Individuals with AHI (Fiebig I-V) enrolled in the RV254 cohort in Thailand initiated ART within days (median=0; IQR 0-1) after diagnosis (EFV+2 NRTI: 2009-Jan2017; DTG+2 NRTI: Feb2017 onwards). Plasma HIV-1 RNA, blood CD4 and CD8 T-cell counts, and mood parameters, measured by the 9-item Patient Health Questionnaire (PHQ-9, score 0-27) for depression symptoms and

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