CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

in HIV/AIDS, Vancouver, BC, Canada, 7 Kaiser Permanente Northern California, Oakland, CA, USA, 8 Universidad Central del Caribe, Bayamon, Puerto Rico, 9 University of Washington, Seattle, WA, USA, 10 University of California San Diego, San Diego, CA, USA Background: Transwomen (TW) are uniquely vulnerable to poor HIV control due to gender identity-related stigma and discrimination. Standard HIV care continuum estimates ignore how long people spend in each stage and may artificially inflate positive outcomes by excluding people who die. Methods: We included antiretroviral therapy (ART)-naïve TW, ciswomen (CW) and cismen (CM) who engaged in care between 2000-2016 in 15 United States (US)-based NA-ACCORD cohorts that contributed data on transgender patients. We estimated the proportion of the cohort alive, engaged-in or lost-to-clinic, ART-initiated, and virally suppressed or not over the first 7 years in care. We summarized over time by reporting the average years over 7 years that each gender identity group spent in each stage. To do this, we added and subtracted series of cumulative incidence functions for death (from registry or medical record data); loss-to-clinic (12 months without a clinic visit, CD4 cell count, or viral load) and subsequent return-to-clinic; ART initiation; and viral suppression or loss of suppression after ART initiation. We report crude estimates and also adjusted for age, race/ethnicity, and calendar year. We report 95% confidence intervals (CI) around these estimates from 1000 non-parametric bootstrap resamples. Results: We included 123 TW, 6979 CW, and 35751 CM. TWwere younger (median age=30 years, vs. 39 and 40 years for CW and CM) and enrolled into care later during the study period (2009 vs. 2007 and 2007). Over the first 7 years in care, TW spent an average of 3.2 (95% CI: 2.7, 3.7) years virally suppressed after ART initiation, 1.1 (0.8, 1.4) years not virally suppressed after ART initiation (includes gaps in treatment, poor adherence, and virologic failure), 1.2 (0.9, 1.6) years in care prior to ART initiation, and 1.3 (0.7, 1.8) years lost-to-clinic, and they lost 0.3 (0.0, 0.6) years to death (figure). Compared with CW and CM, respectively, TW spent 0.7 (95% CI: 0.2, 1.2) and 0.2 (-0.3, 0.8) more years virally suppressed. After adjustment, differences between TW and CW and CM were generally smaller. Conclusion: In several US clinics, longitudinal engagement in HIV care among TWwas similar to that seen for CW and CM. Many of the HIV clinics in this analysis provide gender-affirming care; these results may not generalize to other contexts. Given the small sample of TW, further studies are recommended to explore other care outcomes in this highly vulnerable population.

1 INSERM, Paris, France, 2 AP–HP, Hôpital Bichat-Claude Bernard, Paris, France, 3 APHP - Ambroise Paré, Boulogne-Billancourt, France, 4 COREVIH, IDF Ouest, Argenteuil, France, 5 Acceptess-T Association, Paris, France Background: HIV prevalence in Transwomen (TW) has been estimated at 19.1%worldwide with a risk of HIV infection 48.8- fold higher than adults of reproductive age (Confidence Interval 95% [21,2-76,3]). Few studies are however available on HIV care continuum in this population, with in addition discordant results. The objective of this study is to describe characteristics of this population and compare to cisgender men (CM) and cisgender women (CW) living with HIV. Methods: This study was conducted in HIV-infected adults who began their follow-up between 2008 and 2018 in two HIV clinical cohorts, namely Ambroise Paré and Bichat-Claude Bernard Hospitals, in which sociodemographic, clinical, and immunovirological data were prospectively collected at each patient visit. We compared TW characteristics with CM and CW; in patients recently diagnosed (<6 months), we in addition compared, adherence to care and virological response (VR) defined by a viral load less than 50 copies/ml. Individuals were considered loss of follow-up when they did not attend clinical visits for 24 months. We estimated time of loss of follow-up and time of VR using survival analysis (survival curves with Kaplan Meier’s method, Logrank method, and Cox’s model). Results: From 2008 to 2018, 456 TW began their follow-up for an HIV infection in the two Hospitals, 93.4%were from South-America (44% Peru, 34% Brazil). Age at diagnosis was lower in TW than CM (n = 2960) and CW (n = 1481) (mean 29.3 y vs 35.3 y and 33.6 y, respectively, p <0.01). Tuberculosis was responsible for 62.5% of AIDS cases among TW vs 25.5% and 35.5% for CM and CW, respectively. Patients recently diagnosed represented 28.9% of TW (132/456), 46.5% of CM (1375/2960) and 38.2% of CW (566/1481). Median baseline CD4 cell count was 399/mm 3 , 390/mm 3 (p = 0.30) and 340/mm 3 (p = 0.01) in recently diagnosed TW, CM and CW. Median Time of VR was 35 weeks in TW (InterQuartile Range (IQR) [19-68]), 31 weeks in CM (IQR [19-57]; p= 0.32), and 27 weeks in CW (IQR [16-47]; p = 0.01) (Figure). Median time of loss of follow-up was 6 months in TW (IQR [2.3-31]), 10.5 months in CM (IQR [1.6-33.4]; p = 0.61), and 10 months in CW (IQR [1.6-29.5]; p = 0.73). Being a TWwas not found to be independently associated with time of loss of follow-up or time of VR. Conclusion: Our study highlights that TW are infected younger than other gender groups, but without lower CD4 cell count at initiation of care. They are not an increased risk of loss of follow-up or later VR than other groups.

Poster Abstracts

884 IMPROVING DATA ON THE NYC HIV EPIDEMIC BY IDENTIFYING TRANSGENDER PEOPLE ON MEDICAID

Cristina Rodriguez-Hart 1 , Beverly Obeng 1 , Asa Radix2, Zil Goldstein 2 , Gagarin Zhao 1 , Lucia V. Torian 1 1 New York City Department of Health and Mental Hygiene, Long Island City, NY, USA, 2 Callen–Lorde Community Health Center, New York, NY, USA Background: Since 2005, the New York City Department of Health and Mental Hygiene HIV Surveillance Program has ascertained transgender status among people living with HIV (PLWH) using data on sex assigned at birth and gender identity. Due to challenges in data availability, undercounting of transgender PLWH in NYC remains prevalent. In order to improve our ability to accurately enumerate transgender PLWH and address their needs for gender-affirming HIV care, we used claims data to identify transgender Medicaid enrollees and match these persons to the HIV registry.

883 HIV CARE AMONG TRANSGENDER WOMEN IN NORTHERN AND WESTERN PARIS: 2008-2018 Lucas Maisonobe 1 , Florence Michard 2 , Anaenza Freire Maresca 3 , Sylvie Le Gac 2 , Zélie Julia 2 , Juliette Gerbe 4 , Giovanna Rincon Murillo 5 , Elisabeth Rouveix 3 , Yazdan Yazdanpanah 2

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