CROI 2020 Abstract eBook

Abstract eBook

Oral Abstracts

145

NO HIV INCIDENCE INCREASE IN FIRST-TIME BLOOD DONORS WITH 12-MONTH DEFERRAL FOR MSM Eduard Grebe 1 , Edward P. Notari 2 , Roberta Bruhn 1 , Claire Quiner 1 , Mars Stone 1 , Sonia Bakkour 1 , Hong Yang 3 , Debra Kessler 4 , Rita Reik 5 , Michael P. Busch 1 , Susan Stramer 2 , Simone Glynn 6 , Alan Williams 3 , Brian Custer 1 , for the U.S. FDA Transfusion Transmissible Infections Monitoring System 1 Vitalant Research Institute, San Francisco, CA, USA, 2 American Red Cross, Washington, DC, USA, 3 FDA, Silver Spring, MD, USA, 4 New York Blood Center, New York, NY, USA, 5 OneBlood, St Petersburg, FL, USA, 6 National Heart, Lung, and Blood Institute, Bethesda, MD, USA Background: In 2015, the FDA published revised guidance that recommended a change in donor deferral policy for men who have sex with men (MSM) from indefinite to one year. The Transfusion Transmissible Infections Monitoring System (TTIMS) has monitored HIV, HBV and HCV infections in four blood collection organizations since 2015, representing approximately 60% of the US blood supply. We evaluated HIV-1 incidence changes in first-time blood donors following the implementation of the new MSM deferral policy using biomarkers of recent infection. Methods: We utilized an algorithm to identify recent HIV infections amongst 5.7 million first-time donors (NAT-positive/Ab-negative or by applying the LAg Avidity EIA and viral load testing to seropositive donations). We derived a context-specific mean duration of recent infection using a novel Bayesian method and a false-recent rate, and utilized these parameters to estimate incidence rates and incidence rate differences in first-time donors during the 15-month periods preceding and following the deferral policy implementation, as well the entire post-implementation period through end 2018. We used Poisson regression models to identify demographic covariates of incidence. Results: Overall HIV incidence in first-time donors in the 15 months prior to the MSM deferral policy implementation was estimated at 2.63 cases/100,000PY (95% CI: 1.44–3.81), in the 15 months after at 3.19 (1.94–4.43) and in the entire period after at 2.59 (1.71–3.48). Incidence differences were not statistically significant for either comparison. The figure shows incidence difference estimates by sex, age group, race/ethnicity and public health region. Of these, only the Western region showed a marginally significant increase, which becomes non-significant when the post period is expanded to include all available data. Bivariable and multivariable Poisson regression models using data from the entire TTIMS period showed that MSM deferral policy was not a significant correlate of incidence, although male sex (risk ratio 5.0, 95% CI: 2.8–9.5), age 18-24 (RR: 4.3, 1.5–18.3), black race (RR: 10.1, 5.8–17.9), Hispanic ethnicity (RR: 2.6, 1.3–5.0) and Southern region (RR: 2.0, 1.4–7.9) were significant. Conclusion: There is no evidence that the implementation of a 12-month MSM deferral policy resulted in increased HIV incidence in, and therefore transfusion transmission risk from, first-time blood donors in the United States.

146 EXPLAINING RACIAL DISPARITIES IN VIRAL SUPPRESSION AMONG MSM LIVING WITH HIV Justin R. Knox 1 , Jodie L. Guest 2 , Jeb Jones 2 , Eric Hall 2 , Nicole Luisi 2 , Jennifer Taussig 2 , Mariah Valentine-Graves 2 , Eli Rosenberg 3 , Travis Sanchez 2 , Patrick S. Sullivan 2 1 Columbia University Medical Center, New York, NY, USA, 2 Emory University, Atlanta, GA, USA, 3 State University of New York at Albany, Rensselaer, NY, USA Background: National surveillance has documented consistent racial disparities at each step of the HIV treatment cascade, culminating in HIV- infected black men who have sex with men (MSM) having a 30% lower level of viral suppression compared to white MSM. Modifiable reasons for these racial disparities remain unclear. Nearly all supporting data for these findings are from clinical cohorts. Community-based studies that sample people living with HIV are not subject to the bias of selecting on those more likely to be engaged in HIV care, and thus are critical to understand causes of these disparities and to identify targets for interventions. We examined factors associated with racial disparities in baseline viral suppression in a community-based cohort of black and white MSM living with HIV in Atlanta, GA. Methods: Baseline visits occurred from June 2016-July 2017 when laboratory and behavioral survey data were collected. Explanatory factors for racial disparities in viral suppression that were assessed included: sociodemographics, psychosocial variables and biological factors. Poisson regression models with robust error variance were used to estimate prevalence ratios (PR). We first estimated the unadjusted black/white PR for lack of viral suppression. Factors were individually added to that model and those that diminished the adjusted PR for race by ≥10%, were considered to meaningfully attenuate the racial disparity. All variables that met this criterion were included in a multivariable model. Results: Overall, 26% (104/398) of participants were not virally suppressed at baseline. Lack of viral suppression was significantly more prevalent (PR=1.62; 95% CI: 1.05–2.50; p<0.001) among black MSM (33%; 69/206) than among white MSM (19%; 36/192). Adjustment for the following explanatory factors diminished the adjusted PR for race: age (-19%), ART coverage (through health insurance, a government program or a pharmaceutical company drug program) (-16%), income (-12%), housing stability (-11%), and marijuana use (-10%). In a multivariable model, these factors cumulatively diminished the PR for race by 38%, and it was no longer statistically significant (adjusted PR=1.10 [95% CI: 0.76–1.59]). Conclusion: Relative to white MSM, black MSM living with HIV in Atlanta were less likely to be virally suppressed. However, this disparity was attenuated when accounting for explanatory factors, many of which can be targeted or modified by policy and individual-level interventions to help reduce racial disparities.

Oral Abstracts

147 EXPLOSIVE HIV AND HCV EPIDEMICS DRIVEN BY NETWORK VIREMIA AMONG PWID Steven J. Clipman 1 , Shruti H. Mehta 1 , Aylur K. Srikrishnan 2 , Katie J. Zook 3 , Priya Duggal 1 , Shobha Mohapatra 2 , Shanmugam Saravanan 2 , Nandagopal Paneerselvam 2 , Muniratnam S. Kumar 2 , Elizabeth Ogburn 1 , Allison M. McFall 1 , Gregory M. Lucas 3 , Carl A. Latkin 1 , Sunil S. Solomon 3

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CROI 2020