CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

Methods: We analyzed TB screening and diagnostic testing data collected at PEPFAR-supported sites during October 2017–March 2019. Countries reporting TB screening data with ≥90% completeness were included. Using pooled and country-specific data, we determined the proportion of patients screened for TB symptoms and those who screened positive among PLHIV newly initiating ART vs those already receiving ART at the time of screening. We also determined the proportion of patients with a positive TB screen who had TB diagnostic testing, including Xpert MTB/RIF. Results: Of 30 countries reporting TB screening data, we included 20. Of the 8,337,799 PLHIV already receiving ART, 7,273,266 (87%) were screened at least once for TB symptoms in the most recent biannual reporting period. In the same period, the pooled rate of positive TB symptom screens was 2.6% (7.0% among ART-naïve PLHIV vs 2.3% among those already receiving ART). Median country-specific rates of positive TB screening results were 2.5% (interquartile range [IQR], 1.7%–5.8%) overall (ART-naïve PLHIV, 7.4% [IQR: 5.8%–13.8%]; PLHIV already receiving ART, 2.1% [IQR, 1.5%–5.3%]). Since 2017, the rate of positive TB screens globally has increased from 3.9% to 6.9% among ART-naïve PLHIV and has decreased to 2.8% from 3.4% among those already receiving ART. Among all PLHIV with a positive TB screen result, 85% had sputa sent for diagnostic testing (58% for Xpert MTB/RIF testing); trends in specimen testing decreased over the analysis period. Conclusion: The proportion of ART-naïve PLHIV with a positive TB screen result is increasing but remains lower than expected for high-burden settings. We identified gaps in TB diagnostic services: roughly 1 in 6 PLHIV with TB symptoms does not receive diagnostic testing. Our findings suggest that improved TB screening and GeneXpert-based TB testing will be crucial in improving progress.

initiated in the previous reporting period increased from 59% to 69%. During the same time, among those already receiving ART, completion increased from 73% to 76%; completion was consistently lower (35–53%) in those newly initiating ART (Figure 1). Conclusion: Programmatic data suggests TPT implementation remains low. Only one in six eligible patients who were newly initiated on ART completed a course of TPT in the most recent data. A marginal increase in completion rates was observed among those newly initiating ART; however, overall, completion rates remained consistently higher among those already receiving ART. Accelerated efforts will be necessary to provide TPT to all eligible PLHIV by reducing barriers to TPT initiation and completion among both new and existing patients.

725 POTENTIAL IMPACT OF LATENT TUBERCULOSIS IN PEOPLE LIVING WITH HIV Katharina Kusejko 1 , Huldrych F. Günthard 1 , Kyra Zens 2 , Katharine Darling 3 , Nina Khanna 4 , Hansjakob Furrer 5 , Pauline Vetter 6 , Enos Bernasconi 7 , Pietro L. Vernazza 8 , Roger Kouyos 1 , Johannes Nemeth 1 , for the Swiss HIV Cohort Study 1 University Hospital Zurich, Zurich, Switzerland, 2 University of Zurich, Zurich, Switzerland, 3 Lausanne University Hospital, Lausanne, Switzerland, 4 University Hospital Basel, Basel, Switzerland, 5 University Hospital of Bern, Bern, Switzerland, 6 University Hospitals of Geneva, Geneva, Switzerland, 7 Ospedale Regionale di Lugano, Lugano, Switzerland, 8 St. Gallen Cantonal Hospital, St Gallen, Switzerland Background: Approximately 28% of the human population harbour Mycobacterium tuberculosis (MTB), with more than 90% of infected individuals not developing disease. Recent findings in the animal model suggest that latent MTB infection (LTBI) may have symbiotic effects by protecting against MTB-unrelated infections via activation of the innate immune system. So far, potential interactions of LTBI in HIV-infected individuals have not been investigated. Methods: We included all participants of the Swiss HIV Cohort Study (SHCS) with at least one documented MTB test. LTBI was defined as either a positive skin reactivity test or a positive IGRA test; patients who developed active MTB were excluded. Logistic regression was used to analyse the frequency of the most common opportunistic infections and laboratory conditions between patients with and without LTBI. Linear regression was used to detect differences in the setpoint viral load between patients with and without LTBI. In multivariable models we corrected for baseline demographic characteristics, i.e., year of HIV diagnosis, HIV transmission group and ethnicity. In the analysis of opportunistic diseases, we corrected as well for the CD4 nadir. Results: Out of 13675 patients tested for MTB, 1027 (7.7%) had a LTBI and 316 (2.3%) developed active MTB. Patients with LTBI had significantly lower odds of having oral candidiasis (univariable (UV) odds ratio (OR)=0.31, p<0.0001; multivariable (MV) OR=0.61, p<0.0001) and oral hairy leukoplakia (UV OR=0.36, p<0.0001; MV OR=0.72, p=0.028) as compared to MTB uninfected patients. For other opportunistic diseases, the significant interaction with LTBI disappeared in the MV model (Figure). LTBI was associated with a reduced setpoint viral load (UV=0.27, 95%-confidence interval=[0.35,0.20], log- reduction; MV=0.24 [0.32,0.18]). Conclusion: The finding that LTBI is independently associated with a reduced risk for oral candidiasis and oral hairy leukoplakia points towards a yet not appreciated interaction between LTBI and other infections. In addition, a significant reduction of the setpoint viral load in asymptomatic HIV-infected individuals suggests a more complex interaction between MTB infections and HIV than previously assumed. In conjunction, these findings potentially suggest

Poster Abstracts

724 TUBERCULOSIS PREVENTIVE TREATMENT IN NEW VS EXISTING ANTIRETROVIRAL THERAPY PATIENTS Meaghan L. Peterson 1 , Rena Fukunaga 1 , Joseph S. Cavanaugh 1 , Allison Moffitt 1 , AdamMacNeil 1 1 CDC, Atlanta, GA, USA Background: Tuberculosis (TB) preventive treatment (TPT) has been shown to drastically reduce mortality among people living with HIV (PLHIV). The World Health Organization recommends TPT for all PLHIV without contraindications or active TB disease. Accordingly, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) is committed to providing TPT to the eligible 14 million PLHIV currently supported by this program. In 2017, PEPFAR-supported programs began biannual reporting on TPT among all new and existing antiretroviral (ART) patients. Methods: We conducted a descriptive analysis of TPT completions and expected completions (i.e. those initiated on TPT in the previous six-month reporting period) in PEPFAR-supported sites during 2017–2019. Countries with >90% TPT data completion were included for analysis. We calculated the proportion of PLHIV who completed TPT of those that initiated in the previous reporting period. We then determined the proportion that initiated TPT in the previous reporting period and the proportion that completed TPT among all eligible PLHIV on ART (based on negative TB symptom screen), disaggregated by those newly initiating ART versus already receiving ART in the reporting period. Results: Nineteen of twenty-nine countries were retained for analysis. In the most recent reporting period (October 2018—March 2019), number of PLHIV eligible for TPT based on negative TB symptom screen ranged from 555— 981,037 per country. Among eligible patients newly initiating ART, only 33% were initiated on TPT, and only 17% completed TPT. Among eligible patients already receiving ART, only 8%were initiated on TPT and only 6% completed a course. Since October 2017, overall TPT completion among all PLHIV that

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