CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

duration of hospitalization (linear regression); all analyses were adjusted for sex and age at admission. Results: IL-6 was detected in 103(99.04%) children, IL-1β in 7(6.31%), IL-2 in 26(25%), and TNF-α in 47(45.19%). IL-1β detection was independently associated with higher log10 cytomegalovirus (CMV) DNA-level (p<0.01) and pneumonia diagnosis (p<0.01). Receipt of steroids was associated with lower prevalence of IL-1β detection (p<0.01). Total neutrophil count (p<0.01), hemoglobin level (g/dL) (p<0.01), and CD4% (p<0.01) were independently associated with decreased IL-2 detection. Higher C-reactive protein (p<0.01) and higher CD4% (p<0.01) were associated with higher IL-6 levels. Each doubling of IL-6 levels was associated with a 27% increased hazard of death (aHR=1.27 (95%CI=1.07, 1.50), p<0.01). No correlates of TNF-α were identified. No association between any cytokines and hospitalization duration or the combined outcome were found. Conclusions: These findings provide novel insights into drivers of inflammation in severely-ill ART-naïve CLHIV and suggest IL-6 is a prognostic marker for increased risk of death in this population.

VL trajectories. However, those in care in Nigeria were least likely to be in either the low probability for VF by 24 months (p<0.001), moderate probability for VF (p<0.001) or high probability for VF (p=0.004) compared to Côte d’Ivoire. Conclusions: We identified four different patterns among CALHIV initiating DTG. Those in VF at DTG initiation remained at moderate or high probability for VF, unable to achieve VS by 24 months on DTG. While our current model was not able to capture individual factors associated with HIV VL trends, adherence and resistance studies are needed to explain VF at DTG initiation and guide interventions to improve clinical outcomes among CALHIV. The figure, table, or graphic for this abstract has been removed. 1054 Viral Suppression 12 Months After Switch to Dolutegravir by nRTI Backbone in Children/Adolescents Renee de Waal 1 , Andrew Boulle 1 , Carolyn Bolton-Moore 2 , Safari Mbewe 3 , Karl Gunter Technau 4 , Cleophas Chimbetete 5 , Cordelia Kunzekwenyika 6 , Geoffrey Fatti 7 , Idiovino Rafael 8 , Nosisa Sipambo 9 , Irene Ayakaka 10 , Mark Cotton 11 , Mary-Ann Davies 1 , Lee Fairlie 12 , for the International Epidemiology Databases to Evaluate AIDS (IeDEA) Collaboration - Southern Africa 1 University of Cape Town, Cape Town, South Africa, 2 Centre for Infectious Disease Research in Zambia, Lusaka, Zambia, 3 Lighthouse Trust, Lilongwe, Malawi, 4 Empilweni Service and Research Unit, Johannesburg, South Africa, 5 Newlands Clinic, Harare, Zimbabwe, 6 SolidarMed Zimbabwe, Masvingo, Zimbabwe, 7 Stellenbosch University, Cape Town, South Africa, 8 SolidarMed Mozambique, Cabo Delgado, Mozambique, 9 University of the Witwatersrand, Johannesburg, South Africa, 10 SolidarMed Lesotho, Maseru, Lesotho, 11 Family Clinical Research Unit, Tygerberg, South Africa, 12 Wits Reproductive Health and HIV Institute, Johannesburg, South Africa Background: The World Health Organization recommends dolutegravir (DTG) for treatment-experienced children and adolescents regardless of their viral load (VL). There is evidence to support continuing tenofovir in treatment experienced adults, even if their current antiretroviral treatment (ART) regimen is failing; evidence for continuing abacavir, recommended for pediatric treatment, is limited. We describe viral suppression at 12 months by nucleoside/ nucleotide reverse transcriptase inhibitor (NRTI) backbone in ART-experienced children and adolescents at 11 treatment programs in South Africa, Zambia, Malawi, Zimbabwe, Mozambique, and Lesotho. Methods: We included all ART-experienced children (aged <10 years) and adolescents (10-19 years) who started DTG from 01 Jan 2019, with ≥12 months follow up on DTG plus 2 NRTIs, at sites in the International epidemiology Databases to Evaluate AIDS Southern Africa collaboration. We described the proportion with viral suppression (VS), (VL <1,000 copies/mL), at 12 months (8–18 months) on DTG, by age, NRTI, and VL at DTG start (6 months before DTG start until 2 weeks after). Results: We included 2,631 children and 10,169 adolescents. At DTG start, in children and adolescents respectively, median (interquartile range, IQR) age was 8.0 (6.8–9.1) and 14.7 (12.5–16.9) years; 1,268 (48%) and 4,554 (45%) were male; and median (IQR) ART duration was 5.1 (2.8–7.0) and 7.4 (3.3 to 11.0) years. VL was available at 12 months in 1,900 (72%) children and 7,158 (70%) adolescents. VS at 12 months occurred in 1,727 (91%) children and 6,427 (90%) adolescents overall; and in 126/172 (73%) children and 461/649 (71%) adolescents with VL≥1,000 copies/mL at DTG start. VS proportions were similar regardless of whether NRTI was switched, or abacavir or tenofovir were continued (see Figure), even in those with VL≥1,000 copies/mL at DTG start, where 242/331 (73%), 100/140 (71%), 73/101 (72%) had VL<1,000 respectively. Of those with VL≥1,000 at 12 months, 69/118 (58%) children and 321/521 (62%) adolescents had VL<1,000 at their next VL measurement, at a median (IQR) of 4.6 (3.7–6.0) and 5.5 (3.7–7.8) months later respectively. Conclusions: In our cohort of ART-experienced children and adolescents who switched to DTG-based ART, 12-month VS rates were high, although below the 95% UNAIDS target; and were similar in those who switched their NRTI or continued abacavir or tenofovir. Further studies are needed to assess long-term outcomes such as DTG resistance and effects of low level viraemia.

Poster Abstracts

1053 HIV Viral Load Patterns Since Dolutegravir Initiation in Children and Adolescents Living With HIV Sophie Desmonde 1 , Joycelyn Dame 2 , Emile Sodinyessi 1 , Agatha David 3 , Sylvie N'Gbeche 4 , Madeleine Amorissani-Folquet 5 , Mariam Sylla 6 , Kouadio Kouacou 7 , Lehila Bagnan Tossa 8 , Caroline Yonaba 9 , Valériane Leroy 1 , for the IeDEA Pediatric West African Database on AIDS (pWADA) 1 Université Toulouse III - Paul Sabatier, Toulouse, France, 2 Korle Bu Teaching Hospital, Accra, Ghana, 3 Nigerian Institute of Medical Research, Lagos, Nigeria, 4 CePReF Yopougon Attie, Abidjan, Côte d'Ivoire, 5 Centre Hospitalier Universitaire de Cocody, Abidjan, Côte d'Ivoire, 6 Hôpital Gabriel Touré, Bamako, Mali, 7 Côte d'Ivoire auprès du Centre Intégré de Recherches Biocliniques d'Abidjan, Abidjan, Côte d'Ivoire, 8 Centre National Hospitalier Universitaire Hubert Koutougou Maga de Cotonou, Cotonou, Benin, 9 Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso Background: We modelled patterns of virological response to Dolutagravir (DTG)-based ART in a cohort of children and adolescents living with HIV in West Africa. Methods: All CALHIV aged 0 to 19 years initiating DTG-based ART between 2019-2023 and enrolled in the West African pediatric International epidemiological Database for Evaluating AIDS (IeDEA pWADA) were included and followed up to 24 months since DTG initiation (baseline). Baseline viral load (VL) was the closest measurement within 6 months prior and 2 weeks post DTG initiation. We used group-based trajectory modelling to assign each CALHIV to a group based on their VL accross visits; a logistic trajectory was used to identify groups with similar 24-month longitudinal patterns of VL based on dectable VL at a 1000-copy threshold. Multinomial regression analysis adjusted for age, sex and program was used to identify factors associated with each VL trajectory. Results: Overall, 2,319 CALHIV (46% female) were included; 1,649 (71%) were aged 10-19 years. Median follow-up time on DTG was 15 months [IQR 5 – 29]; 0.6% died and 6.4% were lost to follow-up (≥7 months since last visit). At baseline, 1,149 (50%) were in viral suppression (VS, VL<200 copies), 100 (4%) had low level viremia (LLV: 200 1000 copies); 622 (27%) had no available baseline VL. Four trajectory groups were identified over 24 months (Figure 1): those with sustained VS (79%), decreasing probability for VF over time (5%), increasing probability for VF over time (9%) and high probability for VF (7%). Among those in VF at baseline, 54% reached VS but 46% remain in the high probability group, with sustained VF throughout follow-up. Age and sex were not associated with

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