CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

Methods: Retrospective cohort using real life data collected by the Brazilian Ministry of Health HIV program. We included all HIV-TB coinfected patients aged ≥18 years-old who had a first ART delivery up to 6 months after TB notification, with regimens containing lamivudine + tenofovir combined with either Efavirenz (EFV), Raltegravir (RAL) or Dolutegravir (DOL) between Jan 2017-Dec 2018. We analyzed the percentage of undetectable (<200 copies/ml) HIV viral load (VL) and mean change in CD4+T cell counts at 90-180 days after ART initiation in each treatment group adjusted for sex, age, social vulnerability index and baseline values of CD4+T cell counts and HIV VL Results: 1427 HIV-TB coinfected patients were included. Patients were mostly young (84%<50 years old), males (79%), of black/mixed color (48%). Baseline HIV VL was >10,000 for most patients (79%), and CD4+T cell counts were <200/ mm 3 for 71% of the sample. Overall, 78.1% of HIV-TB coinfected patients had HIV VL<200/ml at 90-180 days after ART initiation (95% CI 75.8-80.3); CD4+ T cell increment at 90-180 days after first ART prescription was 148 cells/mm 3 (SD 156), with mean increment of 156, 139 and 154 cells/mm 3 among patients receiving RAL, EFV and DOL, respectively. We found no statistically significant differences in the percentage of undetectable HIV VL or CD4+T cell count increment at 90-180 days after ART initiation according to ART regimen in univariable models or after adjustment for potential confounders Conclusion: Although studies comparing different ART regimens in PLHIV without TB suggest that VL suppression is achieved more frequently and faster with regimens containing integrase inhibitors when compared to those with EFV, we failed to find similar results among patients with TB. Our findings are relevant in reassuring that RAL and DOL can replace EFV for HIV-TB coinfected patients. This is of greater importance for HIV-TB coinfected patients with EFV resistance mutations or significant intolerance

William Pape 8 , Domingo Palmero 9 , Stalz C. Vilbrun 10 , Piret Viiklepp 11 , Jonathan W. Walsh 1 , Suzanne Marks 12 1 University of Pennsylvania, Philadelphia, PA, USA, 2 McGill University, Montreal, QC, Canada, 3 International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark, 4 Albert Einstein College of Medicine, Bronx NY, USA, 5 MSF, Cape Town, South Africa, 6 Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany, 7 WHO Collaborating Centre for TB and Lung Diseases, Maugeri Care and Research Institute, Tradate, Italy, 8 Weill Cornell Medicine, New York, NY, USA, 9 efe División Neumotisiología Hospital Muñiz, Buenos Aires, Argentina, 10 GHESKIO, Port-au-Prince, Haiti, 11 NIH, Estonia, 12 CDC, Atlanta, GA, USA Background: HIV is associated with increased mortality during treatment for multidrug-resistant tuberculosis (MDR-TB), but factors affecting this risk have been difficult to identify because of low MDR-TB incidence in any one setting. We examined how the use of HIV anti-retroviral therapy (ART) and effective antitubercular medications modify mortality among adults with MDR-TB and HIV using a large, multi-country database. Methods: We conducted a individual patient data meta-analysis (IPD) from studies published between 2009 and 2018 of adults from 40 countries/regions with MDR-TB, systematic drug susceptibility testing for fluoroquinolones (FQ) and second-line injectables (SLI), and known HIV status who were not lost to follow-up. Data included clinical and demographic characteristics, use of ART, and ever-use of antitubercular medications (grouped according to World Health Organization (WHO) categorizations). The primary outcome was death, compared to treatment success, treatment failure, and relapse. Patients without HIV were compared to HIV+ (all), HIV+/on ART, and HIV+/no or unknown ART using logistic regression after exact matching on country-level income, SLI and FQ resistance and after propensity score matching on age, sex, site, year of treatment initiation, previous TB treatment, directly observed therapy, and acid-fast-bacilli-smear positivity to obtain adjusted odds ratios (aORs) and 95% confidence intervals (CI). Results: Of 10,044 patients, 3,215 (32%) were HIV-infected, 2,504 (25%) were HIV+/on ART, 6,068 (60%) were males, 9,615 (96%) had only pulmonary TB, and 1,611 (16%) had extensively drug-resistant TB. The aOR of death for those with HIV (all) vs HIV-negative patients was 2.4 (2.1-2.8), and varied according to ART use (1.8 [1.5-2.2] for HIV+/on ART vs 4.6 [3.0-7.1] for HIV+/no or unknown ART) (Table). Among persons with HIV, aORs for death were lowest for HIV+/on ART, HIV+ patients receiving at least 5 effective drugs, and HIV+ patients on WHO Group A drugs (later generation FQs, bedaquiline and/or linezolid) (Table). Conclusion: In a large, diverse population of HIV-infected adults with MDR-TB, HIV-infection is associated with an increased adjusted odds of death during MDR-TB treatment, but use of ART and more effective antitubercular drugs lowers the odds. Access to ART and effective antitubercular drugs should be urgently pursued for those with HIV/MDR-TB.

Poster Abstracts

740 SUBOPTIMAL TUBERCULOSIS TREATMENT COMPLETION: A MULTICENTER OBSERVATIONAL STUDY Felipe Ridolfi 1 , Lauren Saag Peetluk 2 , Gustavo Amorin 2 , Megan M. Turner 2 , Marina Cruvinel 2 , Marcelo Cordeiro-Santos 3 , Solange Cavalcante 1 , Afrânio Kritski 4 , Betina Durovni 5 , Bruno Andrade 6 , Timothy R. Sterling 2 , Valéria C. Rolla 1 1 Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro. Brazil, 2 Vanderbilt University, Nashville, TN, USA, 3 Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil, 4 Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil, 5 Oswaldo Cruz Foundation - Fiocruz, Rio de Janeiro, Brazil, 6 Instituto Gonçalo Moniz, Salvador, Brazil Background: Standard anti-tuberculosis (TB) treatment includes two months of isoniazid, rifampicin, pyrazinamide, and ethambutol followed by four months of isoniazid and rifampicin. To meet the WHO target for reduction in TB deaths by 2025, programs must strive for 90% TB treatment completion. Treatment discontinuation due to treatment toxicity or other reasons may interrupt the course of treatment and decrease effectiveness. Methods: This 4-year (2015-2019), multicenter, prospective cohort study in Brazil included culture-confirmed, drug-susceptible, pulmonary TB patients who started standard TB treatment. All participants were followed for > 9 months from enrollment and were categorized into three groups: (I) treatment discontinuation – treatment interruption before 6 months, default, or loss to follow-up prior to treatment completion, (II) treatment completion within 9 months, and (III) treatment completed, but duration >9 months. Results: Among 797 patients included, 592 (74%) completed their first-line treatment regimen, 161 (20%) had early treatment discontinuation, and 44 (6%) were on first-line treatment longer than 9 months. Compared to patients who

739 CD4 COUNT AND VIRAL LOAD DYNAMICS UNDER DIFFERENT ART REGIMENS IN HIV/TB COINFECTION

Rosana Elisa G. Pinho 1 , Ana R. Pati Pascom 1 , Kleydson Alves 1 , Patricia B. Oliveira 1 , Ana Izabel Menezes 1 , Filipe Barros Perini 1 , Ronaldo De Almeida Coelho 1 , Gerson F. Pereira 1 , Vivian I. Avelino-Silva 2 1 Ministry of Health, Brasilia (DF), Brazil, 2 Universidad de São Paulo, São Paulo, Brazil Background: Tuberculosis (TB) is still a leading cause of morbidity and mortality among people living with HIV (PLHIV). Although it is widely accepted that the use of antiretroviral treatment (ART) reduces the risk of death among HIV-TB coinfected patients, studies comparing the efficacy of different ART regimens in this population are scarce

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