CROI 2020 Abstract eBook

Abstract eBook

Oral Abstracts

Background: The burden of HIV in sub-Saharan Africa has aged substantially over the last decade, yet little is known about age-specific shifts in HIV incidence. Methods: Between 2004 and 2017, data were collected from individuals enrolled in the Africa Health Research Institute’s population-based HIV cohort in rural South Africa. A population-based cohort study was conducted to quantify changes in age-specific incidence among men 15-54 and women 15-49. Poisson generalized additive models were used to test changes in the age-distribution of HIV incidence and explore potential drivers. Results: We observed 3,144 HIV seroconversions among 20,388 HIV negative individuals contributing 87,882 person-years of observation from 2004-2017 (incidence rate of 3.5 per 100 person-years). The age-distribution of HIV incidence shifted older in both men (p=0.021) and women (p<0.001). Age of peak incidence increased by four years among men, from 27 (95% CI, 25-33) to 31 (95% CI, 28-34); and by three years among women, from 22 (95% CI, 21-23) to 25 (95% CI, 23-31). Incidence declined by 50% among men 15-19, IRR = 0.53 (0.33-0.82). Age-specific incidence relative to 15-19 year-olds doubled among men 30-34 years, IRR=2.30, 95% CI, 1.24 - 4.26; and increased by 50% among women 30-34 years, IRR=1.51, 95% CI, (1.09-2.05). Conclusion: HIV-1 incidence shifted older over a 14-year period during scale-up of HIV treatment and prevention in a hyperepidemic South African cohort. The aging risk of HIV acquisition will require expanding demographic targets for HIV prevention beyond the youngest cohorts in high burden settings.

1 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 2 YR Gaitonde Center for AIDS Research and Education, Chennai, India, 3 Johns Hopkins University School of Medicine, Baltimore, MD, USA Background: While much attention has focused on the US opioid crisis, misuse of opioids is rapidly becoming a global epidemic with >80% of drug seizures in Africa/Asia in part due to increased use of opioids to manage pain and expansion of heroin trafficking routes. Little is known about the drug using networks in these settings which contribute to HIV/HCV transmission. Methods: 2512 people who inject drugs (PWID) in New Delhi, India were recruited (2017-19) into a cohort by a chain referral approach. Index participants were asked to name and recruit people they injected with in the past month (egocentric network of the index). Each recruit was asked to name and recruit their recent injection network members (egocentric network of recruit; sociometric network of index). Biometrics were used to identify duplicates and cross-network linkages. Participants underwent a survey and blood draw semi-annually. Blood was tested for HIV and HCV antibodies, HIV RNA and HCV RNA. Network viral load was calculated as the number of egocentric network members with HIV RNA>150 copies/ml. Poisson regression was used to identify predictors of incident HIV. Results: At baseline, 36.9% had HIV infection of whom only 7.4%were virologically suppressed; HCV prevalence was 65.1%; recent heroin and other opioid use were 26.6% and 95.3%, respectively. Among 1,066 with at least one follow-up as of 9/1/19, 96 seroconversions were observed in 370 person-years (p-y) (HIV incidence: 25.9 per 100 p-y); 64 HCV antibody seroconversions were observed in 188 p-y (primary HCV incidence: 34.0 per 100 p-y). Of 96 incident HIV cases, 74%were directly connected to at least one viremic person in their egocentric network (Figure). In multivariable analysis adjusting for recent needle sharing and injection frequency, HIV incidence increased by 23% per unit increase in egocentric network member with detectable HIV RNA (incidence rate ratio [IRR]: 1.23; p<0.01); further, every increased step in the path between a participant and a sociometric network member with detectable HIV RNA decreased HIV incidence by 37% (IRR: 0.63; p<0.01). Conclusion: We observed explosive HIV and HCV epidemics among PWID in New Delhi, largely driven by exposure to viremic individuals in both egocentric and sociometric networks, highlighting the importance of achieving broad viral suppression in order to curb transmission. Expanding treatment and prevention efforts in such disenfranchised populations will be critical for epidemic control.

Oral Abstracts

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HIGH HIV INCIDENCE IN YOUNG WOMEN IN THE BOTSWANA COMBINATION PREVENTION PROJECT Faith Ussery 1 , Pamela J. Bachanas 1 , Mary Grace Alwano 2 , Refeletswe Lebelonyane 3 , Lisa Block 4 , Kathleen Wirth 5 , Gene Ussery 4 , Baraedi W.Sento 6 , Tendani Gaolathe 7 , Etienne Kadima 7 , William Abrams 2 , Shahin Lockman 5 , Janet Moore 1 1 CDC, Atlanta, GA, USA, 2 CDC Botswana, Gaborone, Botswana, 3 Botswana Ministry of Health, Gaborone, Botswana, 4 Northrop Grumman Corp, Atlanta, GA, USA, 5 Harvard T.H. Chan School of Public Health, Boston, MA, USA, 6 Tebelopele Voluntary Counseling and Testing Center, Gaborone, Botswana, 7 Botswana Harvard AIDS Institute Partnership, Gabarone, Botswana Background: The Botswana Combination Prevention Project (BCPP) demonstrated a 30% reduction in community HIV incidence through expanded HIV testing, enhanced linkage to care, and universal antiretroviral treatment and exceeded the UNAIDS 90-90-90 targets. In this analysis we report rates and characteristics of incident HIV infections occurring during the study, using data from repeat HIV testing performed over time in the intervention arm.

148 THE AGING OF HIV-1 INCIDENCE IN HYPERENDEMIC RURAL SOUTH AFRICA AdamN. Akullian 1 , Alain Vandormael 2 , Joel Miller 3 , Anna Bershteyn 4 , Edward Wenger 1 , Diego F. Cuadros 5 , Frank Tanser 6 1 Institute for Disease Modeling, Bellevue, WA, USA, 2 University of KwaZulu-Natal, Durban, South Africa, 3 Monash University, Melbourne, VIC, Australia, 4 New York University Langone Medical Center, New York, NY, USA, 5 University of Cincinnati, Cincinnati, OH, USA, 6 Africa Health Research Institute, Mtubatuba, South Africa

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CROI 2020