CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

Methods: We conducted a cohort study using data from the Aid for AIDS (AfA) private sector disease management program in South Africa and from the NA-ACCORD collaboration of HIV cohorts in the United States and Canada. We included PWH aged 18-84 years with follow-up in AfA (2011-2020) or NA-ACCORD (2000-2020). We computed excess LYL associated with an ICD-9/10 diagnosis for any mental illness, organic disorder, psychotic disorder, bipolar disorder, depressive disorder, and anxiety disorder, by gender and region. Excess LYL measures the average difference in remaining life expectancy in PWH diagnosed with a mental illness compared with PWH of the same age without a mental illness. We disaggregated LYL into natural, unnatural (due to injuries or violence), and unknown causes of death. Results: We included 126,058 PWH from South Africa (58% women, 4.6 median years of follow-up) and 85,296 from North America (9% women, 5.8 median years of follow-up). In South Africa, 45% of men and 50% of women were diagnosed with a mental illness. In North America, 63% of men and 65% of women were diagnosed with a mental illness. In both regions, depressive and anxiety disorders were the most common. In South Africa, mental illness was associated with 3.5 LYL (95% CI 2.6-4.3) in men and 3.0 LYL (95% CI 1.3-4.6) in women (Figure). In North America, mental illness was associated with 2.9 LYL (95% CI 2.5-3.3) in men and 3.4 LYL (95% CI 1.2-5.9) in women. In men, 68% of the LYL associated with mental illness in North America were attributable to natural causes of death, compared with 79% in South Africa. For women, in both regions the entire excess mortality burden was due to natural causes. The excess LYL ranged from 1.3 (95% CI -0.7-3.2) in South African women with anxiety to 17.2 (95% CI 14.5-19.2) in South African women with an organic disorder. Conclusion: ICD diagnoses for mental illness were associated with excess mortality in South African and North American PWH. Death from natural causes was the main contributor to their excess mortality. These findings support the implementation of strategies for the prevention, early detection, and treatment of mental illnesses in PWH, and for the screening and treatment of physical comorbidities in PWH who have a mental illness.

African (SSA) countries. Prevalence of CD4 <200 was 54–90% in 2005, 29–45% in 2015, and 30–45% in 2019. Median (IQR) CD4 was 309 (156–497) in 2019. CD4 availability was similar between age and sex groups. Among those with a CD4 in 2015–2019, prevalence of CD4 <200 was higher in males than females in SSA, including South Africa (43% versus 28%), but not in the other regions (35% in males versus 38% in females); and higher in older ages in all regions (40% in ages ≥45 versus 19% in ages 15–24). Conclusion: Our findings add to the evidence that CD4 measurement has declined in recent years to very low levels, especially in SSA, with the exception of South Africa. PWH with a CD4 might not reflect those without a CD4; however, among those with a CD4, the prevalence of CD4 <200 at ART initiation remains concerningly high. CD4 measurement around the time of ART initiation should be more widely adopted and adequately funded. The figure, table, or graphic for this abstract has been removed. 1047 Difficult-to-Treat HIV in Sweden: Describing the Current Landscape Olof Elvstam 1 , Viktor Dahl 2 , Anna Weibull Wärnberg 3 , Susanne von Stockenström 4 , Aylin Yilmaz 5 1 Lund University, Lund, Sweden, 2 Södersjukhuset, Stockholm, Sweden, 3 Karolinska University Hospital, Stockholm, Sweden, 4 Gilead Sciences, Inc, Solna, Sweden, 5 Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden Background: Our aim was to examine the prevalence and characteristics of difficult-to-treat HIV in the current Swedish HIV cohort and to compare treatment outcomes between people with difficult and non-difficult-to-treat HIV. Methods: In this cross-sectional analysis of the Swedish HIV cohort, we identified all people with HIV currently in active care in 2023 from the national register InfCareHIV. We defined five categories of difficult-to-treat HIV: 1) advanced resistance, 2) four-drug regimen, 3) salvage therapy (ibalizumab, fostemsavir, enfuvirtide, maraviroc, etravirine, BID dolutegravir, BID darunavir), 4) virologic failure within the past 12 months, and 5) ≥ 2 regimen switches following virologic failure since 2008. People classified as having difficult-to treat HIV were compared with non-difficult for background characteristics as well as treatment outcomes (viral suppression [< 50 copies/mL] and self-reported physical and psychological health [based on a validated health questionnaire]) using Pearson's χ2 test as well as logistic regression adjusted for sex, age, and risk group. Results: Nine percent of the Swedish HIV cohort in 2023 met at least one criterion for difficult-to-treat HIV. The most frequent category was "≥ 2 switches following failure" (6%), followed by "advanced resistance" (2%) and "salvage therapy" (2%). Compared with non-difficult, people with difficult to-treat HIV were older, had an earlier first year of positive HIV test and lower CD4+ T-cell counts. Women were overrepresented among people classified as having difficult-to-treat HIV, especially in the categories "recent virologic failure" and "≥2 switches following failure". The viral suppression rate among people with difficult-to-treat HIV was 84% compared with 95% for non-difficult (p < 0.001). This difference was similar both among men and women, and it remained statistically significant after multivariable adjustment (aOR, 0.28; 95% CI, 0.22–0.35). People with difficult-to-treat HIV reported worse physical (but not psychological) health, and this also remained statistically significant in multivariable analysis (aOR, 0.74; 95% CI, 0.60–0.92). Conclusion: Although 9% of the HIV cohort in Sweden in 2023 were classified as having difficult-to-treat HIV, a large proportion of these were virally suppressed. Challenges such as advanced resistance and need for salvage therapy are rare in the current Swedish cohort. 1048 Life-Years Lost Associated With Mental Illness in People With HIV in South Africa and North America Yann Ruffieux 1 , Keri N. Althoff 2 , Brenna Hogan 2 , Greg Kirk 2 , Raynell Lang 3 , Angela Parcesepe 4 , Michael J. Silverberg 5 , Chunyan Zheng 2 , John Joska 6 , Mpho Tlali 6 , Naomi Folb 7 , Gary Maartens 6 , Mary-Ann Davies 6 , Matthias Egger 1 , Andreas Haas 1 1 University of Bern, Bern, Switzerland, 2 The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 3 University of Calgary, Calgary, Canada, 4 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 5 Kaiser Permanente Northern California, Oakland, CA, USA, 6 University of Cape Town, Cape Town, South Africa, 7 Medscheme, Cape Town, South Africa Background: Mental illness is known to reduce life expectancy in people with HIV (PWH). We estimated excess life-years lost (LYL) associated with mental illness among PWH in South Africa and North America, compared with PWH without a mental illness.

Poster Abstracts

1049 Modeled Estimates of Disease Burden Att ributable to Interactions Between HIV and Depression in Kenya Daniel T Citron 1 , Hae-Young Kim 1 , Rosco Kasujja 2 , Samuel Mwalili 3 , Josiline Chemutai 3 , Ingrida Platais 1 , Frey Assefa 1 , Anna Bershteyn 1 1 New York University Langone Medical Center, New York, NY, USA, 2 Makerere University College of Health Sciences, Kampala, Uganda, 3 Strathmore University, Nairobi, Kenya Background: In sub-Saharan Africa, AIDS is the leading cause of mortality, while depression is the leading causes of morbidity. Depression is known to increase HIV acquisition and impede effective treatment, while people living with HIV have elevated risk of depression, but these interactions have not previously been modeled in the context of overlapping HIV and mental health crises. We used a simulation model to estimate how the HIV pandemic has

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