CROI 2020 Abstract eBook

Abstract eBook

Oral Abstracts

Methods: BCPP was a community-randomized control trial in 30 rural/peri- urban Botswana communities. Community-wide home-based and mobile HIV test campaigns were conducted in 15 intervention communities from 2013-2017. Although campaigns did not specifically aim to re-test the same individuals, 30% of residents received HIV testing at least twice. We assessed the HIV incidence rate (IR) among these repeat testers. The IR was estimated as the number of new HIV infections occurring per 100 person-years (py) at risk (time to last HIV-negative test or midpoint between last HIV-negative test and first HIV-positive status). HIV infection risk factors were evaluated with right- censored Cox proportional hazards models. Results: During 27,517 person-years at risk, 195 of 18,597 residents (females=54.9%;males=45.1%) from the selected sample became HIV-infected (IR=0.71/100py). Of the 195 seroconversions, 153 (78.5%) were in females and 42 (21.5%) in males; females had a higher IR (1.01) compared to males (0.35). The highest IR was observed among females aged 16-24 years (1.87) with IRs ranging from 0.65 to 5.73 (median=1.74) across 15 communities. Females aged 25-34 years were observed with an IR of 1.24. Among males, the highest IR was in the 25-34 year age group (0.56). The lowest IRs were observed in the older age group (35-64) in both females and males (0.41 and 0.20, respectively). Gender and age were both significantly associated with the HIV incidence (both p<0.0001). The hazard of incident infection was highest among females aged 16-24 (HR=7.05; 95%CI:3.83,14.68). Conclusion: Despite demonstrating an overall reduction in HIV incidence and surpassing the UNAIDS 90-90-90 targets in a community-randomized control trial, high HIV incidence was observed in adolescent girls and young women in the intervention communities. These findings highlight the current urgency for additional prevention services, e.g. PrEP, to achieve epidemic control in this population. 150 RAPIDLY DECLINING HIV INCIDENCE AMONG MEN AND WOMEN IN RAKAI, UGANDA Gertrude Nakigozi 1 , Larry W. Chang 2 , Steven J. Reynolds 3 , Fred Nalugoda 1 , Godfrey Kigozi 1 , Thomas C. Quinn 3 , Ronald H. Gray 4 , Alice Kisakye 1 , Anthony Ndyanabo 1 , Robert Ssekubugu 1 , David Serwadda 1 , Maria Wawer 4 , Joseph Kagaayi 1 , Mary K. Grabowski 2 , for the Rakai Health Sciences Program 1 Rakai Health Sciences Program, Kalisizo, Uganda, 2 Johns Hopkins University School of Medicine, Baltimore, MD, USA, 3 NIAID, Baltimore, MD, USA, 4 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA Background: We previously reported on declines in HIV incidence associated continuously surveyed between 1994 and 2016 in the Rakai Community Cohort Study (RCCS). Prior analyses showed a 42% reduction in HIV incidence by 2016 relative to the period prior to VMMC and ART availability with greater declines observed among men than women (54% vs. 32%). We report here on HIV incidence following the implementation of universal test and treat in 2016. Methods: Population-level trends in HIV incidence among RCCS study communities were assessed between April 1999 and May 2018. Trends in HIV incidence based on observed seroconversion, self-reported male circumcision, and self-reported ART use were assessed using data collected over 13 surveys. Viral loads among all HIV-positive persons were assessed at three surveys, including the two most recent surveys. Relative changes in HIV incidence at each survey after 2006 was compared to the mean HIV incidence before 2006 (i.e., before scale-up of VMMC and ART) using multivariate Poisson regression models and are reported as adjusted incidence rate ratios (adjIRR) with 95% confidence intervals (CI). Results: 37,283 individuals participated, including 19,645 initially HIV-negative persons who contributed at least one-follow-up visit. There were 992 HIV incident cases detected over 107,297 person-years of follow-up. By 2018, HIV incidence was 0.43 per 100 person years (py), a decline of 58% relative to the period prior to VMMC and ART availability (adjIRR=0.42; 95CI: 0.31-0.57). Recent incidence declines were most pronounced among women whose incidence fell from 0.83 per 100 py to 0.48 per 100 py between the final two surveys (adjIRR=0.63; 95%CI: 0.41-0.98) and by 59% since the period prior to VMMC and ART availability (adjIRR=0.41; 95CI:0.28-0.60). Viral load suppression levels in 2018 improved modestly compared to the prior survey, increasing from 76% to 80% overall, from 79% to 85% among women, and from 67% to 71% among men. Prevalence of male circumcision continued to increase with 65% coverage among all men in 2018. with the scale-up of voluntary medical male circumcision (VMMC) and antiretroviral therapy (ART) at CD4 counts of <500 in 30 communities

Conclusion: HIV incidence is rapidly declining among women and men with the continued scale-up of ART and VMMC in Rakai. Sustained investment and targeted efforts to achieve increased levels of viral load suppression and male circumcision coverage could potentially eliminate transmission in this African setting. INCREASED OVERALL LIFE EXPECTANCY BUT NOT COMORBIDITY-FREE YEARS FOR PEOPLE WITH HIV Julia L. Marcus 1 , Wendy Leyden 2 , Alexandra N.Anderson 2 , Rulin Hechter 3 , Michael A. Horberg 4 , Haihong Hu 4 , Jennifer O. Lam 2 , William J. Towner 3 , Qing Yuan 3 , Michael J. Silverberg 2 1 Harvard Medical School, Boston, MA, USA, 2 Kaiser Permanente Division of Research, Oakland, CA, USA, 3 Kaiser Permanente Southern California, Pasadena, CA, USA, 4 Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA Background: Combination antiretroviral therapy (ART) has dramatically improved life expectancy for people with HIV (PWH), but recent data comparing overall lifespan and comorbidity-free years by HIV status are lacking. Methods: We conducted a cohort study of adult (aged ≥21) members of Kaiser Permanente in Northern or Southern California, or Mid-Atlantic States (DC, MD, VA), during 2000-2016. PWH were frequency-matched 1:10 to uninfected adults on age (2-year groups), sex, race/ethnicity, medical center, and calendar year. We used abridged life tables to estimate the average number of total and comorbidity-free years of life remaining at age 21 by calendar era. Comorbidity- free years were prior to diagnosis of any of 6 common comorbidities: cardiovascular disease, respiratory disease, renal disease, liver disease, cancer, or diabetes. For 2014-2016, we also estimated life expectancy for PWH with early ART initiation (i.e., with CD4 ≥500). Results: Among 39,000 PWH and 387,785 matched uninfected adults, there were 2,661 and 9,147 deaths, with mortality rates of 1,303 and 390 per 100,000 person-years, respectively. In 2000-2003, overall life expectancy at age 21 was 37.6 and 57.9 years for PWH and uninfected adults, respectively, corresponding with a gap of 20.3 years (95% CI: 18.4-22.1; Figure). Overall life expectancy for PWH increased to 55.5 years in 2014-2016, narrowing the gap to 7.3 years (6.1-8.6). PWH with early ART initiation had a life expectancy at age 21 of 59.4 years in 2014-2016, further narrowing the gap compared with uninfected adults to 3.4 years (0.9-5.8). In 2000-2003, the expected number of comorbidity-free years remaining at age 21 was 11.0 and 26.1 years for PWH and uninfected adults, respectively, with PWH being diagnosed with comorbidities 15.1 years (13.7-16.4) earlier than uninfected adults. This gap persisted in 2014-2016, with comorbidity-free life expectancy at age 21 of 13.3 and 29.3 years for PWH and uninfected adults, respectively (16.1-year gap, 15.1-17.1), and no improvement for PWH with early ART initiation. Conclusion: Overall lifespan has continued to increase for PWH in care, and only a 3-year gap remains relative to uninfected adults. However, PWH have 16 fewer healthy years than uninfected adults, with diagnoses of common comorbidities beginning at age 34, and no improvement over time or with early ART initiation. Greater attention to comorbidity prevention for PWH is warranted.

151

Oral Abstracts

152

LOW-LEVEL VIREMIA DURING ART AND THE RISK OF DEATH, AIDS, AND SERIOUS NON-AIDS EVENTS Olof Elvstam 1 , Gaetano Marrone 2 , Patrik Medstrand 1 , Carl Johan Treutiger 3 , Anders Sönnerborg 4 , Magnus Gisslén 5 , Per Bjorkman 1 1 Lund University, Lund, Sweden, 2 Karolinska Institute, Stockholm, Sweden, 3 Södersjukhuset, Stockholm, Sweden, 4 Karolinska University Hospital, Stockholm,

52

CROI 2020