CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

865 POPULATION-LEVEL HIV VIRAL LOAD VARIES BY GENDER, AGE, AND LOCATION IN RAKAI, UGANDA Imogen Kyle 1 , Joseph Kagaayi 2 , Godfrey Kigozi 2 , Gertrude Nakigozi 2 , Robert Ssekubugu 2 , Fred Nalugoda 2 , Mary K. Grabowski 3 , Larry W. Chang 3 , Maria Wawer 2 , David Serwadda 4 , Ronald H. Gray 3 , Thomas Quinn 5 , Steven J. Reynolds 5 , Oliver Ratmann 1 , for the Rakai Health Sciences Program 1 Imperial College London, London, UK, 2 Rakai Health Sciences Program, Kalisizo, Uganda, 3 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 4 Makerere University College of Health Sciences, Kampala, Uganda, 5 NIAID, Bethesda, MD, USA Background: In the ART era, population HIV viral load (PVL) quantifies gaps in the HIV care cascade, as well as the residual transmission potential from population subgroups. Methods: Between January 2015 and September 2016, we measured HIV viral load among HIV+ individuals aged 15-49 years in 40 communities of the Rakai Community Cohort Study, Uganda (Figure 1A). To measure PVL and viral suppression, we respectively quantified the proportion of individuals in the total population with detectable viral load above 1000 copies/ml plasma blood (PDVL) and the geometric mean viral load (PMVL), assigning a VL measurement of zero to HIV uninfected individuals. Sub-analyses were conducted among HIV infected individuals, and infected individuals with detectable viral load. Spatial heterogeneity in PVL measures was assessed with Gaussian kernel maps and spatial scan statistics. Results: Of 18,656 participants, 3,467 (18.6%) were HIV-positive, of whom 3,454 (99.6%) had VL measured. Despite higher HIV prevalence among women (21.8% [21.0%-22.6%]) than men (15.0% [14.2%-15.7%]), PMVL was 1.4 [1.2- 1.7] times higher among men than women. This reflected higher PDVL among men (5.8% [5.3%-6.3%] compared to women (4.8% [4.4%-5.2%]), and 7 (5-10) times higher geometric mean VL among infected men with detectable viral load compared to their female counterparts. PMVL peaked at age 20-24 in men and at age 15-19 in women (Figure 1B). In contrast PDVL peaked later, at age 30-34 in men and at age 25-29 in women. Spatial foci of high PMVL coincided with fishing communities along Lake Victoria. Conclusion: Population-viral load analysis revealed marked differences in viral load suppression across demographic sub-groups and geography, with viral load burden greater in men than women, and concentrated in young age groups. Intensified interventions to improve health and reduce future infections are warranted especially among men and women aged <25 years, and geographic areas with excess detectable viral loads.

Poster Abstracts

864 FIRST HIV VIRAL LOAD REMAINS STRONG PREDICTOR OF TREATMENT SUCCESS IN SOUTH AFRICA Lauren R. Violette 1 , Jienchi Dorward 2 , Justice Quame-Amaglo 1 , Katherine Thomas 1 , Connie L. Celum 1 , Nigel Garrett 2 , Paul K. Drain 1 1 University of Washington, Seattle, WA, USA, 2 CAPRISA, Durban, South Africa Background: In the Simplifying HIV Treatment and Monitoring (STREAM) trial, point-of-care (POC) HIV viral load (VL) testing and task shifting significantly improved retention in care and viral suppression in South Africa. We sought to determine risk factors for poor retention and HIV viremia among trial participants. Methods: STREAM was a randomized controlled trial in Durban, South Africa among people living with HIV (PLHIV) who were clinically stable and on antiretroviral therapy (ART) for six months. Participants (N=390) were randomized to receive either POC VL testing (Xpert® HIV-1 VL, Cepheid) and task shifting to an enrolled nurse or standard laboratory VL testing. A composite primary outcome of retention in care and viral suppression (<200 copies/mL) was assessed 12 months after enrolment. We estimated relative risks using modified Poisson models with robust standard errors to evaluate the association between participant baseline characteristics and 1) not achieving the composite primary outcome and 2) 18-month HIV VL ≥50 copies/mL. Results: Among 390 participants, median age was 32 years (interquartile range [IQR] 27-38), 60.3%were female, and 93.1% had VL <200 copies/mL at study baseline. After 18 months on ART, 67 participants (17.2%) failed to achieve the composite primary outcome of retention and viral suppression. Baseline VL ≥200 copies/mL (RR=3.55, p<.01) and younger age (in 5-year increments, RR=1.15, p=.06) were associated with poor outcomes at study exit in univariate analyses and remained significant (aRR=3.82 p<0.01 and aRR=1.18, p=.04, respectively) when adjusted for distance traveled to the clinic, study arm, and CD4 count at six months. Among those with an 18-month VL, 280 (76.3%) were suppressed at <50 copies/mL. Six-month VL ≥200 copies/mL (aRR=2.51, p<.01) and lower CD4 counts (100 cells/mL increments, aRR=1.12, p<.01) were associated with 18-month VL ≥50 copies/mL, after adjusting for gender. We found no significant associations between failing to achieve the composite outcome or 18-month VL ≥50 copies/mL and education, having a primary partner, alcohol use, current smoking status, drug use, depression, time since HIV diagnosis, or self-reported ART adherence. Conclusion: In the era of universal test and treat, the 6-month VL after ART initiation strongly predicts poor HIV outcomes. Identifying PLHIV with high VL early and focusing on VL suppression should be a priority to improve HIV outcomes in South Africa.

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