CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

1033 62% of New HIV Infections and 63% of Deaths Now Reported in Countries Outside Southern/East Africa Toby Pepperrell 1 , Andrew Hill 2 1 University of Edinburgh, Edinburgh, United Kingdom, 2 University of Liverpool, Liverpool, United Kingdom Background: UNAIDS targets aim to reduce new HIV infections below 370,000 by 2025. However, there were 1.3 million new HIV infections worldwide in 2022. Most international funding for treatment and prevention is allocated to countries in Southern/East Africa, with the highest prevalence of HIV. However, countries in West Africa, South America and Asia have significant HIV epidemics despite lower overall HIV prevalence. As shown in clinical trials and incidence surveys, PrEP with TDF/FTC needs to be given to at least 60 people at high risk of HIV transmission to prevent 1 new infection. Methods: Epidemiological data were collected from the UNAIDS AIDSinfo 2022 database, which analyses country-level HIV data using the Spectrum model. Key variables were epidemic size, annual HIV infections, HIV-related deaths, ART coverage, PrEP coverage and MTCT. Results were supplemented by PUBMED/ EMBASE searches and national reports. We separated countries with epidemics of >40,000 cases into higher-prevalence (≥3.5%) countries (HPCs) and lower prevalence (<3.5%) countries (LPCs). Results: Overall, there were 19.5 million HIV infections in 14 HPCs in Southern/ East Africa (53% of epidemic), versus 17.5 million in 54 LPCs (47%). In 2022, despite a smaller total epidemic size, there were more new HIV infections (770,000 vs 468,000), more HIV-related deaths (383,000 vs 225,000), higher rates of MTCT (16% vs 9%), lower ART coverage (67% vs 83%) in LPCs vs HPCs. The rate of HIV epidemic growth (new infections/epidemic size) was 4.4% in LPCs vs 2.6% in HPCs. PrEP was used by 1.3 million in HPCs vs 1.2 million in LPCs. Total use of PrEP is far below the 74 million people required to optimise preventative efficacy. Conclusion: Worldwide, 62% of new HIV infections and 63% of HIV-related deaths are now reported in LPCs outside Southern/East Africa. Many of these countries in South America, Asia and West Africa are not as intensively targeted by access programmes, such as PEPFAR and GFATM. To bring global new infections below the UNAIDS target of 370,000 per year by 2025, ART coverage needs to be optimized worldwide, and PrEP coverage expanded to 74 million people, versus 2.5 million currently treated. 1034 Factors Associated With Low-Level Viremia in People Living With HIV: 9-Year Retrospective Study Eunmi Yang , Doh Hee Kim, Subin Kim, Mi Young Ahn, Dong Hyun Oh, Jae-Phil Choi Seoul Medical Center, Seoul, Korea, Republic of Korea Background: The goal of antiretroviral therapy (ART) is to sustain the suppression of human immunodeficiency virus (HIV) viral load. The prognostic value and clinical outcomes of low-level viremia (LLV) remain unclear. The goal of this study was to investigate the risk factors for LLV and their association with virologic rebound in Korea. Methods: We retrospectively reviewed the records of all patients registered with HIV infection at Seoul Medical Center, South Korea from January 2014 to December 2022. Patients starting ART and achieving viral suppression were included in the study. LLV was defined as at least 2 consecutive viral loads between 40 and 199 copies/ml with >4 weeks interval. LLV patients were compared with patients who remained in viral suppression (viral loads < 40 copies/mL). We analyzed the association between the clinical factors and LLV using multivariable logistic regression. Results: During the study period, 382 patients were enrolled and 13 (3.4%) patients experienced LLV. Compared to controls, LLV patients have higher incidence of diabetes mellitus than control patients (p = 0.04). Age, sex, Charlson comorbidity index, ART regimen, initial acquired immune deficiency syndrome (AIDS) defining conditions, and resistance-associated mutation did not differ between the two groups. During the study period, there was no virologic rebound, new onset AIDS-defining illness, or death in LLV patients. We analyzed a multivariate logistic regression model that incorporated age,

diabetes mellitus, and resistance-associated mutation. Age was an independent risk factor for LLV (aOR, 1.07; 95% CI,1.01–1.12). Conclusion: In this cohort, LLV was not associated with AIDS, virologic rebound, and death. The age at which patients achieve viral load suppression may be a risk factor for LLV. Further research with larger cohorts is warranted to evaluate the risk factors and outcomes of LLV.

1035 Incidence of Viral Rebound and Associated Risk Factors Among Adults Living With HIV in Tanzania Patrick E Mwanahapa 1 , Andrew E. Mganga 1 , Shafii S. Mgenzi 1 , Goodlucky Ngoda 1 , Emanuel Sarakikya 1 , Stephen W. Kazimir 1 , Paschal Muhonde 2 , Melissa Kyamani 2 , Mbaraka Amuri 3 , Jonathan Grund 3 , Swaminathan Mahesh 3 , Andrea Mbunda 3 , Josephine J. Mwakisambwe 1 , Theodora Mbunda 1 1 Management and Development for Health, Dar es Salaam, United Republic of Tanzania, 2 Tanzania Ministry of Health, Dar es Salaam, United Republic of Tanzania, 3 Centers for Disease Control and Prevention, Dar es Salaam, United Republic of Tanzania Background: Viral rebound (≥50 copies/ml) after a period of undetectable levels, increases the likelihood of HIV morbidity, mortality, and onward transmission, which slows progress to reaching 95-95-95 UNAIDS targets by 2025. We estimated the incidence and risk factors associated with viral rebound among adults living with HIV in Kagera, Geita, Tabora, and Dar es Salaam regions, Tanzania. Methods: This was a retrospective cohort study, and we extracted 100,052 records of new PLHIV from the national care and treatment (CTC) database on ART in 2019 and reviewed client-level data for 3.6 years. A standard Cox model was used to determine hazard ratios (HR) for viral rebound across different demographic and clinical characteristics. An adjusted model was developed on variables that were significant in univariate analysis. The results of the regression analysis present HR and their corresponding 95% confidence intervals. All analyses were conducted using STATA Version 18. Results: The overall viral rebound rate was 152.0 (95% CI:144.7-157.7) per 1,000 person-years. The rates were higher in Dar es Salaam (178.0; 95% CI:165.0-192.1) and Tabora (177.9;95% CI:163.2-194.2) followed by Kagera (137.1; 95% CI:125.5 149.8) and Geita (116.4; 95% CI:107.2-126.2) per 1000 person-years. Among patients with poor adherence to antiretroviral therapy (ART), viral rebound was 209.43; (95%CI:167.3-263.9), and with good adherence, viral rebound was 151.25; 95% CI;144.0-158.9). In the adjusted analysis, the following factors were found to be associated with viral rebound: WHO classification Stage IV at diagnosis (adjusted hazard ratio (aHR) 1.07, 95% CI 0.94-1.22); Not changing ART regimen (aHR 2.10, 95% CI 1.95-2.25); Poor ART adherence (aHR 1.49, 95% CI 1.22 -1.82); Female sex (aHR 1.49, 95% CI 1.22 -1.82);) (aHR0.89 95% CI 0.76 0.96) and viral load of 20-49 copies/mL (1.44, 95% CI 1.36-1.53). Conclusion: These findings suggest that enhanced and targeted efforts to support adherence to ART and monitoring of viral load in adults living with HIV, especially for those with advanced HIV disease, females, and those who have not changed ART regimen for a long duration of time, and a viral load of 20-49 copies/ml to reduce their risk of viral rebound and improve long-term health outcomes. Pido Bongomin 1 , Victor Williams 1 , Normusa Musarapasi 1 , Magnus Beneus 1 , Makhosazana Dlamini 1 , Thokozani Maseko 1 , Phetsile Mdluli 1 , Elisha Nyandoro 1 , Rhinos Chekenyere 1 , Rufaro Mapaona 1 , Clara Nyapokoto 2 , Arnold Mafukidze 1 , Deus Bazira 1 , Samson Haumba 1 , Sylvia Ojoo 1 1 Georgetown University, Washington, DC, USA, 2 Swaziland National AIDS Programme, Mbabane, Eswatini Background: Eswatini has adopted the WHO guideline-recommended cut-off of HIV RNA above 1000c/ml as a criterion for virologic treatment failure. Consequently, we describe the association between different detectable viral load (VL) levels and subsequent virological failure in a cohort of ART clients in Eswatini. 1036 Detectable Viral Load Predicts Virological Failure at Follow-Up

Poster Abstracts

CROI 2024 332