CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

1076 HIV-1 DYNAMICS FOLLOWING UNIVERSAL TESTING-AND-TREATMENT WITHIN HPTN 071 (POPART) William Probert 1 , Rafael Sauter 1 , Michael Pickles 2 , Anne Cori 2 , Helen Ayles 3 , Peter Bock 4 , Deborah J. Donnell 5 , Sarah Fidler 2 , Richard J. Hayes 6 , Christophe Fraser 1 , for the HPTN 071 (PopART) Study Team 1 University of Oxford, Oxford, UK, 2 Imperial College London, London, UK, 3 Zambart, Lusaka, Zambia, 4 Desmond Tutu TB Centre, Western Cape, South Africa, 5 Fred Hutchinson Cancer Research Center, Seattle, WA, USA, 6 London School of Hygiene & Tropical Medicine, London, UK Background: A universal HIV testing-and-treatment (UTT) approach has been shown to be effective as an intervention in high prevalence areas in sub-Saharan Africa (SSA) to reduce HIV incidence. Community-wide interventions may change the dynamics of the epidemic. Understanding these changes will inform future policy towards achieving zero new infections. Using an individual- based model (PopART-IBM), developed as part of the HPTN 071 (PopART) trial, we project the impact of four scenarios of UTT to 2030 on the distribution of incident cases stratified by categories of sexual risk-taking behaviour. Methods: Model predictions were made with the PopART-IBM calibrated to data from a representative trial community in Zambia from the HPTN 071 (PopART) trial. The model has been previously validated against the primary endpoint of the trial. The model separates the population into three groups according to sexual risk-taking behaviour based on behavioural questionnaire data, including number of sex partners and use of condoms. The proportions of individuals in each risk group (low 50%, medium 35%, high 15%) were assumed to be static through time. Model projections to 2030 are based on four scenarios: 1) PopART then continuation of UTT in the PopART community; 2) PopART then no UTT; 3) no PopART but nationwide UTT from 2020; 4) no PopART and no UTT. Results: Making antiretroviral therapy universally accessible to all who are HIV- positive in the PopART community would lead to a decline in prevalence in all risk groups but would concentrate new cases in those with the highest levels of risk-taking behaviour (65% of incident cases vs 54% if no UTT was implemented; figure 1). While population HIV incidence to 2030 decreases, the model predicts continued persistence of an HIV epidemic in the high-risk subpopulation in all scenarios unless nationwide UTT is adopted. Conclusion: Our results predict that even with a UTT intervention, the proportion and absolute number of new HIV cases in those with the highest levels of sexual risk-taking behaviour would increase, despite overall HIV prevalence decreasing. Our results highlight that targeting of high-risk individuals may be necessary following successful UTT interventions in order to eliminate HIV as a public health issue in SSA.

Poster Abstracts

1077 DRAMATIC DECLINE OF NEW HIV DIAGNOSES IN SUBJECTS NATIVE FROM FRANCE Adrien Le Guillou 1 , André Cabié 2 , Cyrille Delpierre 3 , Pascal Pugliese 4 , Christine Jacomet 5 , Maxime Hentzien 1 , Claudine Duvivier 6 , Olivia Faucher-Zaegel 7 , Laurent Cotte 8 , François Raffi 9 , Firouze Bani-Sadr 1 1 CHU de Reims, Reims, France, 2 CHU Fort de France, Fort de France, Martinique, 3 INSERM, Toulouse, France, 4 CHU de Nice, Nice, France, 5 CHU de Clermont-Ferrand, Clermont-Ferrand, France, 6 Assistance Publique – Hôpitaux de Paris, Paris, France, 7 Assistance Publique–Hopitaux Marseille, Marseille, France, 8 Hospices Civils de Lyon, Lyon, France, 9 CHU de Nantes, Nantes, France Background: In France, universal ART (TasP) was recommended at the end of 2013 and PrEP in January 2016. The 3rd UN target (90% patients on cART with virological suppression), was reached in 2013, and the 2nd target (90% of individuals diagnosed on sustained cART) was achieved in 2014. As the trends in new HIV diagnosis is a measure of HIV epidemic, we conducted a 6-year longitudinal study to evaluate the change in rates of new HIV diagnosis and describe their epidemiology in a large French multicenter cohort. Methods: Data were obtained for subjects with a new HIV diagnosis date between 2013 and 2018 from the metropolitan centers of the French Dat’AIDS cohort. HIV diagnosis date was defined as the date of the first known positive HIV serology. Analyses were performed by place of birth (France and abroad) and by contamination route. Results: During the study period, a total of 68,376 people living with HIV were followed in the Dat’AIDS cohort; 9,543 subjects were newly diagnosed with HIV, 4,253 born in France (90%male; 70.5%MSM), and 4,737 born abroad (39.1% heterosexual women; 23.0% heterosexual men, 21.9%MSM). The annual number of new HIV diagnosis decreased from 1,856 in 2013 to 1,149 in 2018 (-38.1%); it was more pronounced among subjects born in France, from 858 to 484 (-43.6%) than in those born abroad (-23.8%, from 821 to 626). Among subjects born in France, the decrease over the period was -46.7%, - 43.5% and - 33.3% among MSM, heterosexual women and heterosexual men, respectively; the proportion of patients with CD4 cells count >350/mm 3 at diagnosis decreased by 45.6% from 2013 to 2018. In contrast, the proportion of patients with CD4 cell count <200/mm 3 at diagnosis declined by 26% among patients born in France and remained stable among patients born abroad (-5.8%). Conclusion: Our findings show changes in HIV epidemiology between 2013 and 2018 in subjects followed in metropolitan France, with a more pronounced decrease of new HIV diagnoses in subjects born in France, particularly among MSM and heterosexual women. Our results support the long-term effectiveness of TasP strategy among the various tools for HIV prevention.

CROI 2020 405