CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

from 6% for env without hypermutation filtering to 48% for pol with the strictest filter (FigureA). The MAE ranged from +/-1.01 to +/-1.77 years. Recent infection prediction showed an AUC of 0.92 (95% CI 0.86, 0.98) for pol with the strictest filter (FigureB). Conclusion: This work shows the utility of genetic diversity measured from proviral sequences as a proxy for the time between ART initiation and infection. While genetic diversity measured in ART-naive viral RNA is more accurate, a good performance can be achieved with hypermutation filtering and hence allows to determine infection recency in PWH without a baseline RNA sequence.

(53%), and MSM (55%). Discrete phylogeographic analysis of identified clades suggested that the NBHD of Downtown/East Little Havana/Liberty City/ Overtown (21% of all dispersal events, after 2010), Brownsville/Coral Gables/ Coconut Grove (22%), and Aventura/Miami Beach (19%), were the major sources of viral flow to other NBHD in the Miami-Dade region (Fig. 1AB). Overall, heterosexuals and MSM accounted for 49.9% and 46.8%, respectively of putative sources of transmission linking different risk groups. Conclusion: Phylodynamic analyses revealed complex HIV dispersal across NBHD in the Miami-Dade region with some key areas predominating as sources of viral dispersal in recent years. HIV transmissions between risk groups were nearly equally likely to arise from MSM and heterosexuals. These results highlight the role of the central east region in the geographic spread of HIV within Miami-Dade County. These analyses suggest earlier diagnosis and treatment of individuals in these neighborhoods may have outsized impacts across the region.

1072 The Impact of COVID-19 on HIV Mortality Trends in United States Black, White, and Hispanic Adults Elizabeth B Pathak , DaRel M. Barksdale, Mary Y. Masterson, Paul A. Burns National Heart, Lung, and Blood Institute, Bethesda, MD, USA Background: U.S. racial and ethnic minorities disproportionately impacted by HIV have also been severely impacted by COVID-19. This study investigates whether COVID-19 led to excess HIV mortality, using rigorous methods which account for age, gender, and race/ethnicity disparities in pre-pandemic HIV mortality trends. Methods: Death data from CDC WONDER were analyzed for all decedents with HIV listed as either underlying or contributing cause of death. Pre-pandemic trends in HIV mortality were quantified by fitting log-linear models to HIV death rates for the period 2010-2019. Separate models were fit for groups defined by age (25-44, 45-54, 55-64, 65-74, 75+), reported gender (male, female), and race/ethnicity (Black, Hispanic, white). Regression coefficients were used to derive the average annual percent change in HIV mortality from 2010-2019, and to calculate expected death counts and rates for 2020-2022. Regression estimated expected death rates were then compared with observed rates, and the number of excess deaths calculated. Finally, the number of excess HIV deaths for 2020-2022 was compared to the number of HIV deaths for which COVID-19 was listed as a contributing or underlying cause of death. Results: Across all age groups, Black men suffered the highest rates of HIV mortality (see Figure). Across all gender-race/ethnicity groups, HIV mortality declined significantly among young adults (25-44 and 45-54 years). However, there were no declines in HIV mortality for those aged >55 years (Whites and Hispanic women) or >65 years (Blacks and Hispanic men). Moreover, statistically significant increases in HIV mortality were observed for white men >55 years, and for White women and Black women 65-74 years. During 2020-2022, there were 3,263 excess HIV deaths among all groups, and COVID-19 was mentioned on 73.2% of those death certificates. The percent of excess HIV deaths which listed COVID-19 as a contributing cause varied significantly by race/ethnicity, gender, and age. Conclusion: Black and Hispanic adults have continued to experience disproportionately high HIV mortality during the COVID-19 pandemic. HIV mortality trends varied widely by age, with declines in young adults but no declines or increases in older adults. COVID-19 diagnosis may not have been listed for some excess HIV deaths, particularly among 25-44 year olds, Blacks, and Hispanics. Further investigation of direct SARS-CoV-2 infection effects vs. indirect pandemic effects in explaining observed excess HIV mortality is needed. The figure, table, or graphic for this abstract has been removed.

Poster Abstracts

1071 Genetic Diversity From Proviral DNA as a Proxy for Time Since HIV-1 Infection Marius Zeeb 1 , Paul Frischknecht 1 , Karin Metzner 1 , Michael Huber 2 , Christine Leeman 1 , Julia Notter 3 , Andri Rauch 4 , Marcel Stöckle 5 , Alexandra Calmy 6 , Matthias Cavassini 7 , Enos Bernasconi 8 , Dominique Braun 1 , Huldrych F. Günthard 1 , Roger Kouyos 1 , for the Swiss HIV Cohort Study 1 University Hospital Zurich, Zurich, Switzerland, 2 University of Zurich, Zurich, Switzerland, 3 St Gallen Cantonal Hospital, St Gallen, Switzerland, 4 University Hospital of Bern, Bern, Switzerland, 5 University Hospital Basel, Basel, Switzerland, 6 University Hospitals of Geneva, Geneva, Switzerland, 7 Lausanne University Hospital, Lausanne, Switzerland, 8 Ospedale Regionale di Lugano, Lugano, Switzerland Background: Knowing the time since infection in people with HIV (PWH) is relevant for transmission epidemiology, HIV pathogenesis and for many research questions in general. As viral genetic diversity accumulates over time in the absence of ART, diversity-based scores measured from ART-naive viral RNA sequences have been shown to be predictive of the time since infection. However, the validity of this approach is unclear for proviral NGS sequences sampled on ART. A particular challenge is noise from APOBEC3G/F induced hypermutations. Methods: We assessed the association between time since infection (date of infection until ART initiation) and viral genetic diversity calculated as the average pairwise diversity score from proviral pol-, gag-, and env NGS sequences. Samples were taken after ART initiation from PWH with exact infection dates known via a comprehensive assessment of the medical history. All samples were from PWH enrolled in the Swiss HIV Cohort Study or Zurich Primary HIV Infection Cohort study. We used linear regression to determine the R2 and mean absolute error (MAE) of genetic diversity as a proxy for time since infection. We used AUC-ROC to quantify infection recency prediction. Over all analyses we applied different hypermutation filtering thresholds on NGS read level to account for APOBEC3G/F induced G-to-A mutations. Results: We identified 261 PWH with accurate HIV infection dates and available NGS sequences for at least one gene (with >100 codon coverage) across all hypermutation thresholds (n= 233 gag, 233 pol, 208 env). Among those, 146 PWH had full codon coverage (n= 91 gag, 74 pol, 67 env). We found that proviral genetic diversity was predictive for the time since infection: average pairwise diversity scores calculated both with and without hypermutation filters were significantly associated with time since infection (p<5*10-10). The R2 ranged

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