CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

1060 HIV Status Disclosure Among ART-Experienced Adolescents and Young Adults in 4 African Countries Nicole Dear 1 , Seth Frndak 2 , Natalie Burns 1 , Ajay P. Parikh 1 , Hannah Kibuuka 3 , John Owuoth 4 , Valentine Sing’Oei 4 , Jonah Maswai 5 , Emmanuel Bahemana 6 , Abdulwasiu Tiamiyu 7 , Zahra Parker 8 , Trevor Crowell 1 , Neha Shah 2 , Julie Ake 1 , for the African Cohort Study (AFRICOS) Study Group 1 United States Military HIV Research Program, Bethesda, MD, USA, 2 Walter Reed Army Institute of Research, Silver Spring, MD, USA, 3 Walter Reed Program–Makerere University, Kampala, Uganda, 4 Walter Reed Project–Kisumu, Kisumu, Kenya, 5 Walter Reed Project–Eldoret, Eldoret, Kenya, 6 Walter Reed Program–Tanzania, Mbeya, United Republic of Tanzania, 7 Walter Reed Program–Nigeria, Abuja, Nigeria, 8 Walter Reed Project–Lagos, Lagos, Nigeria Background: Adolescents and young adults living with HIV (ALHIV) face multifaceted challenges to long-term treatment success. We characterized HIV status disclosure among ALHIV and assessed relationships between status disclosure, antiretroviral therapy (ART) adherence and viral suppression. Methods: The prospective African Cohort Study enrolls people with and without HIV, ≥15 years, at 12 PEPFAR-supported facilities in Kenya, Nigeria, Tanzania, and Uganda. Socio-behavioral questionnaires are administered at enrollment and six-monthly visits; responses to questions around voluntary status disclosure are self-reported. Participants living with HIV on ART and <25 years old were included. Patterns of status disclosure were described. Robust Poisson regression was used to assess relationships between disclosure to an immediate family member (spouse/partner, parent, sibling, or child) and 1) ART adherence (none vs 1+ missed doses of ART in past 30 days); 2) viral suppression (<1000 vs >1000 copies/mL) using data from participants’ most recent visit. Models were stratified by sex. Results: Between January 2013 and December 2023, 3381 (81.7%) participants living with HIV were enrolled. At most recent visit, 698 were <25 years, living with HIV and on ART including 625 complete cases. Of these, 244 (35.0%) had ever disclosed their HIV status (Figure). A greater proportion of females vs males had disclosed to a spouse/partner (12.4% vs 6.9%; p=0.09). A greater proportion with vertical vs nonvertical transmission had disclosed to a parent (28.6% vs 17.0%; p=0.02), while a smaller proportion with vertical transmission had disclosed to a spouse/partner (4.5% vs 11.5%; p=0.08). After adjusting for age and program site, females who disclosed to an immediate family member were less likely to have missed ART doses compared to those who had not disclosed (aRR: 0.54; 95% CI: 0.32-0.93); for males, the association was not statistically significant (aRR: 1.32; 95% CI: 0.76-2.31). Although not significant, females who disclosed to an immediate family member were less likely to be virally unsuppressed (aRR: 0.74; 95% CI: 0.37-1.50) after adjusting for age, program site and ART adherence, while males were more likely to be unsuppressed (aRR: 1.73; 95% CI: 0.79-3.81). Conclusions: HIV status disclosure among ALHIV was low. Sex differences suggest targeted interventions for young men may improve treatment outcomes. Social support, violence and stigma should also be investigated.

immunosuppression in the aging population of young adults with perinatally acquired HIV (YAPHIV) in the US. Methods: Among YAPHIV ≥18 years in the Pediatric HIV/AIDS Cohort Study AMP and AMP Up protocols, we calculated incident mortality and CDC-C/WHO-4 rates and the proportion of person-time with elevated viral loads (≥200 copies/mL) and low CD4 counts (<200 cells/mm 3 ) by age strata 18-21, 22-25, 26-29, and ≥30 years. We used Cox models to identify risk factors at age 18-24 years which best predicted mortality/CDC-C events for YAPHIV at ≥25 years. Results: 617 participants were followed for incident events (median follow-up 6.5 years; 63% were 18-21 years, 61% female, and 63% Black non-Hispanic; median CD4 count 561 cells/mm 3 and 66% viral load <200 copies/mL at baseline). Mortality (per 1000 PY) was highest at ≥30 years at 8.1 (95% CI: 3.0,22.0) and lowest at 3.1 participants (95% CI: 1.0,9.9) at ages 22-25. Black non-Hispanic female and male YAPHIV had mortality rates 11.5 (95% CI: 5.8,23.1) and 4.7 (95 CI: 2.0,11.3) times higher than Black non-Hispanic females and males in the US population, and 14.9 (95% CI: 7.4,29.7) and 7.1 (95% CI: 3.0,17.1) times higher than white non-Hispanic females and males in the US population. 44 CDC-C/WHO-4 events were reported over 4034 PY; incidence was highest at 18-21 years at 20.0 (95% CI: 11.5,34.7) events per 1000 PY. The proportion of person-time with viral suppression <200 copies/mL increased as participants aged, but CD4 count <200 cells/mm 3 also increased. Among 307 participants in follow-up at age 25 years, those with high viral load, low CD4 count, a prior CDC-C/WHO-4 event, poor medication adherence, current marijuana use, or who were unemployed were more likely to have an incident CDC-C/WHO-4 event or death after age 25 years. In multivariable analyses, the most important independent predictors of incident CDC-C/WHO-4 event or death were high viral load, low CD4 count, and a prior CDC-C/WHO-4 event (C-index: 0.92), conferring a 54.6% risk of CDC-C/WHO-4 event or death by year 3 of follow-up compared to 0.3% risk for participants without these risk factors. Conclusions: There is increased mortality with age for YAPHIV, particularly for Black non-Hispanic young adults. Providers should identify interventions that lower the risk for high viral load, low CD4 count, and incident CDC-C/WHO-4 events for YAPHIV.

Poster Abstracts

1062 WITHDRAWN

1061 Long-Term Outcomes of Young Adults With Perinatal HIV Infection in the US and Puerto Rico Leah Kern 1 , Alicia Jaramillo-Underwood 2 , Kunjal Patel 2 , Renee Smith 3 , Stephen Spector 1 , for the Pediatric HIV/AIDS Cohort Study (PHACS) 1 University of California San Diego Medical Center, La Jolla, CA, USA, 2 Harvard TH Chan School of Public Health, Boston, MA, USA, 3 University of Illinois at Chicago, Chicago, IL, USA Background: More data are needed to understand the rates and associated risk factors of mortality, serious clinical events, elevated viral load, and

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