CROI 2024 Abstract eBook

Abstract eBook

Oral Abstracts

Conclusion: The population-based prevalence of LLV among PWH who have been on ART ≥12 months, based on two sequential, nationally representative general population surveys in five African countries, was stable and relatively low at approximately 10%. Most of the LLV values were under 200 c/mL, suggesting the risk of drug resistance and ongoing HIV transmission due to LLV are likely to be minimal.

disproportionately affecting MSM and PHIV individuals. Our findings suggest ongoing unnoticed community mpox transmission in Rio de Janeiro, Brazil, emphasizing the crucial need to enhance surveillance strategies to promptly identify emergent STIs in the context of HIV care and prevention services. Vaccines should be made available in LMIC to prevent new outbreaks.

Oral Abstracts

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Vaccine Effectiveness Against COVID In-Hospital Mortality by HIV Status Across SARS- CoV-2 Variants Seth Inzaule 1 , Ronaldo Silva 1 , Nathan Ford 1 , Soe Soe Thwin 1 , Jassat Waasila 2 , Meg Doherty 1 , Janet Diaz 1 , Silvia Bertagnolio 1 1 World Health Organization, Geneva, Switzerland, 2 National Institute for Communicable Diseases, Johannesburg, South Africa Background: There is limited data on the impact of COVID-19 vaccines on mortality reduction among people living with HIV (PLHIV) across the different SARS-CoV-2 variant waves. We assessed the impact of COVID- 19 vaccine in reducing in-hospital mortality among PLHIV relative to HIV negative population during the different SARS-CoV-2 variant waves. Methods: We analyzed individual-level data from the WHO Global Clinic Platform comprising 198,886 hospitalized children (0-18 years) and adults (>18 years) with information on COVID-19 vaccine from 43 countries. We used Cox regression to evaluate association of COVID-19 vaccine with in-hospital mortality across SARS-CoV-2 pre-Delta, Delta and Omicron variant waves. Results: Among HIV negative populations, vaccinated individuals had a 40% lower risk of death (aHR 0.60, 95%CI 0.56-0.63) during pre-delta, 38% lower risk during delta (aHR 0.62, 95%CI 0.57-0.68) and 41% lower risk (aHR 0.59, 95%CI 0.53-0.65) during the omicron variant wave compared to unvaccinated people. Compared to the HIV negative unvaccinated population, vaccinated PLHIV had a significant higher risk of death during pre-delta and omicron variant wave (aHR 1.76 95%CI 1.18-2.64) and (aHR 1.44, 95%CI 1.08-1.93) respectively. Among unvaccinated populations, PLHIV faced significantly higher mortality risks compared to HIV negative individuals across variant waves: aHR 1.97 (95%CI 1.81-2.16) during pre-delta, aHR 2.46 (95%CI 2.12-2.85) during delta and aHR 2.43 (95%CI 2.10-2.81) during the omicron variant wave. Conversely, vaccinated PLHIV had a 60% lower risk of in-hospital death during the pre-delta (aHR 0.40, 95%CI 0.31-0.51), 50% lower risk during delta (aHR 0.50, 95%CI 0.33-0.75) and 54% lower risk (aHR 0.46, 95%CI 0.36-0.59) during the omicron variant wave compared to unvaccinated PLHIV. Conclusion: Vaccinated PLHIV had a significant reduced risk of death compared to the unvaccinated PLHIV across the three variant waves. Vaccination reduced the risk of death among HIV negative people compared to the unvaccinated population, and we observed the same pattern among PLHIV but with a lower protective effect when compared to the unvaccinated HIV negative group. Overall, the risk of death remained relatively high among vaccinated and unvaccinated PLHIV across pre-delta, delta and omicron variant waves. These findings highlight the need to implement WHO guidelines recommending booster vaccine for populations most-at-risk of severe COVID-19 outcomes including PLHIV.

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A New 2023-2024 Mpox Outbreak in Brazil: Lessons From a Reemerging Neglected Disease Mayara Secco Torres da Silva 1 , Carolina Coutinho 1 , Thiago S. Torres 1 , Amanda Echeverría- Guevara 1 , Matheus O. Bastos 1 , Pedro S. Martins 1 , Maira B. Mesquita 1 , Estevao P. Nunes 1 , Ronaldo Moreira 1 , Eduardo M. Peixoto 1 , Edson E. Silva 2 , Sandra Wagner-Cardoso 1 , Valdilea Veloso 1 , Beatriz Grinsztejn 1 , for the INI-Fiocruz Mpox Study Group 1 Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, Brazil, 2 Oswaldo Cruz Foundation - Fiocruz, Rio de Janeiro, Brazil Background: The 2022 mpox multi-national outbreak highly affected the Americas, with Brazil reaching 10,962 confirmed cases as of December 11th, 2023. After a peak in July-August, 2022, global mpox diagnoses decreased, and Brazil reported no cases between July and August, 2023 despite the absence of the mpox vaccine. We present initial evidence of an emerging and continuous mpox outbreak in Rio de Janeiro, Brazil, starting in September 2023. Methods: We conducted a prospective cohort of participants (ppts) diagnosed with mpox (detectable MPXV PCR from any site) at a major infectious diseases' referral center in Rio de Janeiro, Brazil. The data were analyzed as 1st outbreak (12th, June 2022 – 31st May, 2023) and 2nd/current outbreak (September 26th, 2023 – January 7th, 2024). Results: We enrolled 471 ppts during the 1st outbreak, with no further mpox cases until the 2nd outbreak, when we enrolled 83 ppts (1 case of reinfection). Compared to the 1st outbreak, the 2nd/current outbreak presented higher proportions of cisgender men (96% vs 90%, p=0.02) and men who have sex with men (MSM) (94% vs 81%, p=0.01). There was an increased number of sexual partners (median 3 vs 2, p<0.01) and reported anal sex (91% vs 68%, p<0.01). Age, race and clinical characteristics were similar across the outbreaks. In the 2nd outbreak, most ppts took more than 5 days from symptoms onset to first assessment (71% [n=58/82] vs 59.3% [n=259/437], p=0.05), and more ppt with mpox live with HIV (63% vs 51%, p=0.05) (Table). Among PLHIV from the 2nd outbreak (n=52), 5.9% had CD4<100 cells/mm 3 , 19% HIV-RNA viral load > 1,000 copies/mL, 9.6% concomitant opportunistic infections and 5.8% had suspected immune reconstitution inflammatory syndrome. During the 2nd outbreak, ppts showed a high frequency of concomitant bacterial STI (36%, n=26/72) and HCV past/current infection (11%, n=9/83). The hospitalization rate was 12% (n=10/83) and as of January 7th, 2024, 18 ppts were still under follow-up. Conclusion: This marks the inaugural report of a recent mpox outbreak in Brazil, following a period without diagnosed cases, once again

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CROI 2024