CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

TB care access. Among 26 (15%) who experienced TB stigma, few reported that experienced TB stigma in the community (15%), at work (8%), in the hospitals/ clinics (0), or at home (0) inhibited TB care access. In multivariable analyses, felt HIV stigma was associated with younger age (p=0.004), HIV co-infection (p=0.019), and rural residence (p=0.049). Community HIV stigma was associated with younger age (p=0.001), rural residence (p=0.023), and HIV co infection (p=0.057). There were no significant predictors of TB stigma, except for HIV status in univariate analyses (Table). Conclusions: Individuals with TB in East Africa endorsed substantial felt HIV stigma, particularly among younger individuals, those in rural areas, and those living with HIV. TB stigma was comparatively lower, with little self-reported impact on TB care access. Further work is needed to evaluate stigma impacts on TB care outcomes and wellbeing.

952

High Incident TB Among Individuals Switched to Dolutegravir or Protease Inhibitor Based 2nd Line ART Claudia Danielle Minkoulou Engamba 1 , Sivile Suilanji 1 , Lameck Chirwa 1 , Chitalu Chanda 1 , Nyuma Mbewe 2 , Lloyd Mulenga 3 , for the VISEND Study Team 1 University Teaching Hospital, Lusaka, Zambia, 2 Zambia National Public Health institute, Lusaka, Zambia, 3 Government of Zambia Ministry of Health, Lusaka, Zambia Background: Antiretroviral therapy (ART) is known to reduce active tuberculosis (TB) incidence among people living with HIV (PLWH). The introduction of Dolutegravir (DTG) based ART regimen has led to higher and sustained viral suppression. However, due to DTG associated rapid viral load (VL) drop and CD4 increase, the risk of immune reconstitution syndrome (IRIS) maybe anticipated with possible increased in Unmasking TB IRIS. There is however, very limited data on incident TB among those switched to DTG based second line ART and who were screened negative for TB prior to switch. We, therefore, evaluated incident TB cases and associated risk among individuals enrolled under the VISEND clinical study, a 144 week clinical trial which evaluated virological outcomes among individuals switched from failing NNRTI based ART to DTG or boosted protease inhibitor (bPI) (lopinavir or atazanavir) based second line ART while recycling the NRTIs. Methods: We conducted an analysis of PLWH aged ≥ 18 years enrolled in the VISEND trial and screened negative for TB prior to regimen switch. Participants were followed and reviewed at 4, 8,12, 24, 48, 64, 72, 92 and 144 weeks, for routine HIV care. They were further routinely prescribed Isoniazid as TB Preventive Therapy (TPT). Participants who developed clinical features of TB underwent laboratory evaluation (sputum for AAFB, Gene Xpert, Culture) and/or imaging (chest X-ray, CT scan, ultrasound). Time to the TB event model was used to derive the TB cumulative incidence after ART switch, and factors associated with incident TB cases were evaluated. Results: Of 1,201 PLHIV enrolled in the study, 4% developed incident TB contributing for an incidence of 1,276 cases per 100,000 persons-year of follow up (PYFU). TB infected individuals had a median age of 42 (±12 SD) years; 55% female; 30% severely immunocompromised (CD4 < 200 cells/mm 3 ) and 47% with BMI < 18 kg/m 2 ; on DTG regimen (61%) and on bPI (39%). 20/46 (44%) developed incident TB within 4 weeks of switching ART. Individuals switched to DTG had a 3.54 log drop from time of switch to TB diagnosis (P<0.001) whereas those switched to bPI had 3.62 log drop (P<0.001). Conclusions: In the VISEND trial, incident TB was high especially in the first month of switching to DTG or bPI regimen and was associated with rapid viral decline, low baseline CD4 and malnutrition. There is need to intensively screen for TB among those individuals failing and switched to DTG second line ART. Unmasking and Tracking Tuberculosis Risk During HIV Acquisition and Antiretroviral Therapy Fatoumatta Darboe 1 , Alaa Abdellatif 1 , Shaista Afzal 1 , Delia Pinto-Santini 2 , Siavash Pasalar 2 , Gabriela K. Fragiadakis 1 , Ann Duerr 2 , Peter W. Hunt 1 , Sara Suliman 1 1 University of California San Francisco, San Francisco, CA, USA, 2 Fred Hutchinson Cancer Center, Seattle, WA, USA Background: The risk of progression from Mycobacterium tuberculosis (Mtb) infection to active TB disease is estimated to be up to 20 times higher in people living with HIV (PLWH), with fatality rates of 16 – 35%. We have previously shown that blood transcriptional biomarkers can predict risk of TB progression

Poster Abstracts

951

Neuropsychiatric Outcomes in Adults With HIV and TB on Twice-Daily BIC/FTC/TAF With Rifampicin Gillian L. Dorse 1 , Rubeshan Perumal 1 , Kogieleum Naidoo 1 , Marothi P. Letsoalo 1 , Kelly E. Dooley 2 , Anushka Naidoo 1 1 Centre for the AIDS Programme of Research in South Africa, Durban, South Africa, 2 Vanderbilt University Medical Center, Nashville, TN, USA Background: Integrase strand transfer inhibitors (INSTI), such as dolutegravir and bictegravir, may be associated with neuropsychiatric symptoms in people living with HIV. Due to drug-drug interactions during co-treatment with rifampicin-based TB treatment, the dose of the INSTI is often doubled. However, the neuropsychiatric outcomes in people with TB/HIV during bictegravir double dosing has not been evaluated. Methods: We conducted a secondary analysis of the INSIGHT study (NCT04734652) and assessed neuropsychiatric outcomes in participants randomized to receive bictegravir/emtricitabine/tenofovir alafenamide (BIC arm) or tenofovir, lamivudine, dolutegravir (DTG arm).The bictegravir or dolutegravir regimens were dosed twice daily during TB treatment and once daily thereafter. Participants underwent regular follow-up, including neuropsychiatric assessments, at baseline and weeks 4, 8, 12, 24, 32,40 and 48. Self-reported anxiety, depression and sleep were assessed using the General anxiety disorder screener (GAD-7), Patient Health Questionnaire(PHQ-9) and a study modified Global Sleep Assessment Questionnaire (GSAQ) tools, respectively. Results: A total of 122 adults with HIV and TB were enrolled, 80 in the BIC arm and 42 in the DTG arm. Median age was 35 years, 65% were male, and 60% had baseline CD4 < 200 copies/ml . Mild anxiety and depression were observed in 3% and 18% of individuals on BIC arm, and 10% and 17% on DTG (Table 1). Moderate depression was observed in 1% and 5% of BIC and DTG groups, respectively. One event of severe anxiety and depression occurred two days into treatment in the BIC arm, with full symptom resolution after five days with no drug intervention or study treatment discontinuation. Self-reported sleep disruption was noted with a sleep score of ≥ 6 and was reported in 73% of individuals in the BIC arm and 88% in the DTG arm. Conclusions: The use of double-dose bictegravir was not significantly associated with a greater number of neuropsychiatric events than double dose dolutegravir, and none of the identified events required neuropsychiatry interventions , treatment disruption or dose modifications in this study.

953

CROI 2025 299