CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

1060 Impact of Accessing Care at an Advanced Stage on Mortality in PWH in France, 2002-2016 Valérie Potard 1 , Malamine Gassama 1 , Emilie Lanoy 1 , Sylvie Abel 2 , Firouze Bani Sadr 3 , Sylvie Bregigeon 4 , Fabienne Caby 5 , Blandine Denis 6 , Pierre de Truchis 7 , Guillaume Martin-Blondel 8 , Lionel Piroth 9 , Axel Ursenbach 10 , Dominique Costagliola 1 , Sophie Grabar 1 , for the ANRS CO4 FHDH Late Presentation Study Group 1 Sorbonne Université, Paris, France, 2 Centre Hospitalier Universitaire de Fort de France, Fort de France, Martinique, 3 Centre Hospitalier Universitaire de Reims, Reims, France, 4 Aix-Marseille Université, Marseille, France, 5 Centre Hospitalier d'Argenteuil (Victor Dupouy), Argenteuil, France, 6 Assistance Publique–Hôpitaux de Paris, Paris, France, 7 Université Paris-Saclay, Paris, France, 8 Centre Hospitalier Universitaire de Toulouse, Toulouse, France, 9 Centre Hospitalier Universitaire de Dijon Bourgogne, Dijon, France, 10 Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France Background: Previous studies have shown the deleterious impact of access to care with an advanced HIV-disease (CD4 ≤200/ or AIDS, no primary infection) on the mortality risk in people living with HIV (PWH). Here, we explored the respective impact of access to care with AIDS or with CD4 ≤50/mm 3 without AIDS or with CD4 50-200/mm 3 without AIDS on the mortality risk up to 5 years after the first access to care, and whether availability of new antiretroviral regimen led to a smaller impact. Methods: Adult participants newly included in the ANRS-CO4-FHDH cohort between 2002-2016, with HIV-1 infection were selected. Besides the 3 categories of advanced HIV-disease at access to care, 2 others were defined as follows: intermediate HIV-disease as CD4 between 200-350/mm 3 without AIDS and early HIV-disease as either CD4>350/mm 3 without AIDS, or primary infection. The impact of the stage at first access to care on the mortality risk was analyzed by using Fine & Gray competing risk models considering lost to follow-up ≥18 months as a competing event. Follow-up after access to care was categorized into 0 – 6, 6 – 12, 12 – 24, 24 – 48, 48 – 60 months. Models were adjusted for age, sex, acquisition mode, region of origin, delay between diagnosis and access to care and period of access to care (2002-2013 vs 2014 2016). Results: Among the 64400 PWH included, 18305 (28.4%) presented with an advanced HIV-disease and 13042 (20.3%) with an intermediate HIV-disease. At 60 months, the cumulative incidence of death was estimated as 1.8% (95%CI: 1.7–1.9) overall, from 6.0% (95%CI: 5.4–6.7) among those with AIDS to 0.9% (95%CI: 0.8–1.0) among those with early HIV-disease (Table). Compared to people with an early HIV-disease, those with AIDS had a very high risk of death, with a sub-distribution hazard ratio (SdHR) of 18.4 (95%CI: 12.0-28.4) in the first 6 months of follow-up, which remained significant 48-60 months after inclusion 2.1 (95%CI: 1.3-3.3) (Table). In the other categories of advanced HIV-disease, the risk of death was also significantly higher while to a smaller extent. There was no statistical difference between calendar periods. Conclusion: A delayed access to care remains associated with an increased risk of death even after 48 months of follow-up. There was no significant improvement in the risk of death after introduction of integrase inhibitors for combined antiretroviral initiation in 2014.

~18 million unweighted hospitalizations each year and represents ~60% of all US hospitalizations. Following Centers for Medicare & Medicaid Services methodology, we excluded those age<18 years; discharged dead, against medical advice or without 30-day post-discharge follow up window, and admissions for primary psychiatric diagnoses, rehabilitation, cancer treatment or COVID-19. The outcome was the probability of 30-day all-cause unplanned readmission since discharge from a prior (index) admission. A readmission could also be an index admission. ICD-9/ICD-10 codes were used to identify PWH. Crude readmission probability was estimated for PWH and PWoH each year. Subgroup analyses were stratified by age, sex, and median ZIP code household income. Survey weights were applied to all analyses to generate nationally representative estimates. Results: The study population included 25,205,538 (weighted) index admissions in 2010, 24,338,782 in 2019, and 21,258,399 in 2020. In 2010 and 2020, PWH contributed 140,014 (0.56%) and 126,029 (0.59%) index admissions, respectively. Overall, PWH had higher readmission risk than PWoH. The readmission probability for PWH decreased gradually from 23.9% in 2010 to 20.3% in 2020. For PWoH, the readmission probability was stable except during 2015, the year of transition from ICD-9 to ICD-10. Stratified by sex, female PWH had slightly higher readmission probability than male PWH and the difference fluctuated over time. However, female PWoH continued to have similar lower readmission probability than male PWoH (Figure). Older PWoH consistently had higher readmission probability than younger PWoH. In contrast, different age groups of PWH had similar readmission risk over time. PWH residing in areas with the lowest median household incomes had the highest readmission risk for all the years. Conclusion: The quality of hospital care for adult PWH in the US has improved in the past decade, but there is still a significant gap in readmission risk between PWH and PWoH, especially among women.

Poster Abstracts

1062 Wastewater Monitoring of HIV-1: Feasibility and Comparison to Surveillance Data Marlene K. Wolfe 1 , Meri Varkila 2 , Julie Parsonnet 2 , Alexandria B. Boehm 2 1 Emory University, Atlanta, GA, USA, 2 Stanford University, Stanford, CA, USA Background: Wastewater-based epidemiology (WBE) is being used to identify and quantify infectious agents circulating in communities without the need to test individuals. HIV has previously been detected in wastewater and HIV RNA and DNA have both been amplified from urine and feces of people living with HIV (PLWH). Thus, measuring HIV in wastewater appears feasible, but has not been used for the purpose of monitoring HIV in communities. Methods: We applied a previously developed hydrolysis-probe based PCR assay targeting the LTR region of HIV-1 to quantify nucleic acids (NA) in wastewater settled solids using droplet digital (RT-)PCR. We performed retrospective monitoring of HIV-1 concentration in longitudinal wastewater samples from two publicly owned wastewater treatment plants, one in San Francisco (OSP) and the other in San Jose (SJ) between February 2021 and April 2023. Samples were collected two times per week. To assess concordance between wastewater data and local surveillance data from public health departments, we compared trends in wastewater HIV-1 concentrations to HIV prevalence estimates per county. Results: Highly abundant HIV-1 NA were detected in 94% (215/230) and 23% (53/229) of samples in OSP and SJ sewersheds, respectively. Samples from the OSP sewershed consistently yielded higher concentrations of HIV NA than samples from SJ (OSP median 7.3*10 3 cp/g [range non-detect to 3.9*10 5 cp/g], SJ median non-detect [range non-detect to 1.1*10 5 cp/g], figure 1) mirroring

1061 Trends in Hospital Readmission Among People With and Without HIV in the US, 2010-2020 Xianming Zhu 1 , Eshan U. Patel 2 , Mary Kate Grabowski 1 , Thomas C. Quinn 3 , Stephen A. Berry 1 , Kelly A. Gebo 1 , Aaron A. R. Tobian 1 1 The Johns Hopkins University, Baltimore, MD, USA, 2 The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 3 National Institute of Allergy and Infectious Diseases, Baltimore, MD, USA Background: Thirty-day readmission is a prominent US hospital quality metric. However, there are limited data to compare readmission trends among people with HIV (PWH) to people without HIV (PWoH) in the era of universal antiretroviral therapy in the US. Methods: We used data from the 2010 to 2020 Nationwide Readmission Database (NRD), the largest readmission database in the US that includes

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