CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

Conclusion: Adults living with paHIV have high HIV-related morbimortality and HIV-related complications are the leading cause of death in our cohort. To our knowledge, this is the largest description of a cohort of adults living with paHIV in Latin America. Further research is needed to complete the characterization of this population in order to design and implement differentiated service delivery models that contemplate their singularity.

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Adult Outcomes Among Young People With Perinatal HIV Infection and Exposure in the United States Elaine J Abrams 1 , Reuben Robbins 1 , Afifa Ahmed 1 , Curtis Dolezal 1 , Luke Kluisza 1 , Ohemaa Poku 1 , Michael T. Yin 1 , Andrew Wiznia 2 , Claude Mellins 1 1 Columbia University, New York, NY, USA, 2 Jacobi Medical Center, New York, NY, USA Background: Most young people with perinatal HIV infection (YPPHIV) and with perinatal HIV exposure but who are uninfected (YPPHEU) born in the United States are from vulnerable, under-resourced, marginalized communities and are now entering adulthood. Yet, little is known about their adult outcomes (i.e., medical, behavioral, psychiatric, substance use [SU], neurocognitive, and milestone achievement [e.g., employment, school, offspring]). Methods: CASAH is a New York City-based longitudinal behavioral health cohort study of YPPHIV and YPPHEU that began in 2003; data are presented from visits in 2019-23. Psychiatric and SU disorders were assessed using the young adult version of the Diagnostic Interview Schedule for Children, and cognitive functioning with NeuroScreen. Results: Among 187 participants (124 YPPHIV; 63 YPPHEU), mean age was 27.8 years; 60% female; 64% Black, 47% Latino. Among YPPHIV: median CD4+ =450 cells/mm 3 ; 64% had viral load <200 cps/ml; 57% received 2NRTI+INSTI or bPI; 24% 2NRTI+INSTI+bPI or NNRTI. Most participants were never married (94%) and currently sexually active (73%); over half in both groups reported condomless sex in past 3 months. Over 50% of females and 42% of males reported pregnancy in self or partner, with no group differences. Overall, 27% met criteria for a non-SU psychiatric disorder (14% depression; 16% anxiety); 32% met criteria for a SU disorder (primarily alcohol and/or marijuana). YPPHIV performed worse on cognitive tests with 20% (vs 4% YPPHEU, p =.01) having global test performance 2 SDs below the sample mean. Overall, 78% completed high school or GED; 50% were in school or currently employed with higher rates in YPPHEU vs YPPHIV (65% vs 43%, p=.004). YPPHIV were more likely than YPPHEU to receive housing assistance (73% vs 53% p=.007), public assistance (29% vs 8%, p=.001) and food stamps (68% vs 29%, p>.001). Homelessness history was higher in YPPHIV (46% vs 26% YPPHEU, p=.009); 18% of participants reported incarceration history with no HIV-status differences. Conclusion: Despite early challenges, many YPPHIV and YPPHEU had positive behavioral health outcomes. Yet psychiatric and SU disorders, neurocognitive deficits, and challenges with education and employment were also observed and can be associated with poor health and adult functioning problems, especially in the context of HIV infection. These findings underscore an urgent need to identify those at risk for poor outcomes and develop and escalate interventions. High Burden of HIV-Related Disease Among Adults With Perinatally Acquired HIV in Argentina Violeta Z Ortiz 1 , Julian Vega 1 , Maria L. Santos 1 , Solange Arazi Caillaud 2 , José A. Barletta 1 , María J. Rolón 1 1 Hospital Juan A. Fernandez, Buenos Aires, Argentina, 2 Hospital Juan P. Garrahan, Buenos Aires, Argentina Background: Limited data is available regarding population size and burden of HIV-related disease among adults living with perinatally-acquired HIV (paHIV) in Latin America. This study is aimed at describing HIV-related burden of disease in a cohort of adults living with paHIV from Buenos Aires, Argentina. Methods: This is a retrospective cohort study. People living with paHIV aged >16 and linked to care in an HIV referral clinic in Buenos Aires, Argentina between Oct-2008 and Sep-2023 were included. Data was collected from clinical records and epidemiological surveillance systems. Clinical status was classified as per WHO HIV staging system, and advanced HIV disease was defined as WHO stages 3-4. Ethics approval was obtained as appropriate. Results: A total of 170 adults (60% females) with paHIV were included in the analyses. Median age at baseline was 19 years and median individual follow-up was 5.7 years (Q1-Q3 3.6-9.5). Prevalence of clinically advanced HIV disease was 47% (79/170); 34/79 participants presented 1, 36/79 presented 2-5 and 9/79 presented >5 WHO stage 3-4 events. Graphic 1 shows frequency of incident WHO stage 3-4 events (1a) and proportion of undetectable viral loads and CD4 counts ≥200 cells/uL per participant (1b)(data available for 161 and 165 individuals, respectively). There were 133 HIV-related hospital admissions in 49 participants. Global mortality was 11% (18/170) and median age at the time of death was 23.5 years (Q1-Q3 21.2-27). The majority (11/18) of the deaths were HIV-related and one third (6/18) occurred within the first year after transition to adult care.

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No Early Signal That DTG Improves 24-Week Viral Suppression in Infants in Botswana Maureen Sakoi-Mosetlhi 1 , Gbolahan Ajibola 1 , Oganne Batlang 1 , Kenneth Maswabi 1 , Molly Pretorius Holme 2 , Kathleen M. Powis 3 , Shahin Lockman 4 , Michael D. Hughes 1 , Joseph M. Makhema 1 , Daniel R. Kuritzkes 4 , Mathias Lichterfeld 5 , Roger Shapiro 2 1 Botswana Harvard AIDS Institute Partnership, Gabarone, Botswana, 2 Harvard TH Chan School of Public Health, Boston, MA, USA, 3 Massachusetts General Hospital, Boston, MA, USA, 4 Brigham and Women's Hospital, Boston, MA, USA, 5 Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA Background: The World Health Organization recommends dolutegravir (DTG)-based 3-drug antiretroviral therapy (ART) in children >4 weeks weighing >3kg. DTG-based ART achieves rapid viral load decline in adults and low rates of treatment failure in older children, but outcomes for children treated from birth, a time when adherence challenges are of particular concern, are limited. Methods: We compared prevalence of 24-week HIV-1 RNA suppression in early-treated children on lopinavir-ritonavir (LPV/r)–based ART in the EIT cohort (2015-2018) to DTG-based ART in the Moso cohort (2022-2023) in Botswana. All children started nevirapine (NVP)+lamivudine (3TC)+zidovudine (ZDV) in the first week of life and switched to LPV/r+3TC+ZDV at 2-5 weeks (in EIT) or DTG+abacavir (ABC)+3TC at 4-6 weeks (in Moso). The proportion of children with HIV-1 RNA<40 copies/ml at 24 weeks of age was compared between both cohorts and logistic regression models were fit to evaluate risk factors for non-suppression. Results: Thirty-eight of 40 EIT participants and 7 of 11 Moso participants had 24-week results (2 EIT deaths <24 weeks; 1 Moso death <24 weeks and 3 Moso participants <24 weeks follow-up). HIV-1 RNA was <40 copies/mL at the 24-week visit in 27/38 (71%) EIT participants on LPV/r and in 4/7 (57%) Moso participants on DTG. Figure 1 summarizes viremia over time in both cohorts. Median log 10 infant HIV-1 RNA at birth was 4.1 copies/mL and 3.8 copies/mL for EIT and Moso, respectively. Median time on LPV/r and DTG prior to 24 weeks was 154 days (range 130, 168) and 140 days (range 126, 148), respectively. No maternal or infant factors significantly predicted viral suppression at 24 weeks in either cohort, but caregiver-reported adherence challenges were common in most children with detectable viremia at 24 weeks. Conclusion: Despite its proven benefit for achieving rapid and durable viral suppression in adults and older children, data from a small number of early treated infants in Botswana indicate no improvement in viral suppression with the use of DTG-based ART through 24 weeks.

Poster Abstracts

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CROI 2024 312