CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

are cornerstones of HIV care. COVID-19 caused far-reaching disruptions in health services, including for HIV treatment and laboratory monitoring. We characterized trends in early ART (eART) and early VS (eVS) among PWH before (2018-2019) vs. during (2020-2021) the COVID-19 pandemic to assess potential impacts of these disruptions. Methods: We included treatment-naïve adult (≥18 years old) PWH at entry into care in one of 13 cohorts in the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) from 2018–2021. We examined subgroup differences in the proportion achieving eART (ART initiation ≤30 days after entry) and eVS (HIV-1 viral load [VL] <200 copies/mL, ≤180 days after ART initiation). We followed PWH until ART initiation, VS, cohort close date, study end (12/31/2021), or death; due to the short observation period, we assumed no loss to follow-up. We examined factors associated with timing of ART and VS using multivariable Cox models, including age, enrollment year, race/ethnicity, sex, HIV risk group, CD4 count, VL, diagnosed alcohol or substance use disorders, and mental illness diagnoses at entry. Results: Among 2784 PWH included, 79.8% (n=2223) achieved eART. Compared with 2018 (81.4%, n=874/1074), a higher proportion of PWH entering care in 2019 achieved eART (86.1%, n=794/922); this progress slowed significantly in 2020 (60.8%; n=315/518), then rebounded in 2021 (88.9%; n=240/270; p=0.001). Multivariable analysis showed that PWH in the Northeast had shorter time to ART initiation compared to those in the South (HR=1.27, CI: 1.07-1.52). PWH ≥60 years old had longer time to ART (HR=0.80, CI: 0.67-0.95) than younger PWH. Overall, 91% (n=1778/1953) achieved eVS. Compared with 2018 (89.0%), a higher proportion of PWH entering care in 2019 (92.6%) achieved eVS, with slowing progress in 2020 (87.3%) that improved in 2021 (97.4%; p<0.01). PWH with CD4 <200 cells/mm 3 at entry had slower time to VS than those with higher CD4 counts (all p <0.05). Conclusions: Progress towards ending the HIV epidemic in the US slowed during the first year of the COVID-19 pandemic with lower rates of eART and eVS. Both recovered by 2021, yet persistent gaps remain for PWH in the South, older adults, and those with advanced HIV, who should be prioritized for earlier diagnosis, and engagement in care and treatment. 1097 Disparities in COVID-19 Therapeutics Access Among People With and Without HIV: An N3C Analysis Emmanuel Nazaire Essam Nkodo 1 , Pooja Maheria 2 , Eric G. Hurwitz 3 , Jerrod Anzalone 1 , Dongmei Li 4 , Jessica Islam 5 , Jing Sun 6 , Zachary Butzin-Dozier 7 , Sandra Safo 8 , Tommy Williams 2 , Shukrih A. Hassan 9 , Marlene Camacho-Rivera 10 , Rena C. Patel 11 , Nada Fadul 1 , for the National COVID Cohort Collaborative (N3C) 1 University of Nebraska Medical Center, Omaha, NE, USA, 2 University of Alabama at Birmingham, Birmingham, AL, USA, 3 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 4 University of Rochester Medical Center, Rochester, NY, USA, 5 University of South Florida, Tampa, FL, USA, 6 The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 7 University of California Berkeley, Berkeley, CA, USA, 8 University of Minnesota, Minneapolis, MN, USA, 9 University of Washington, Seattle, WA, USA, 10 SUNY Downstate, Brooklyn, NY, USA, 11 University of Alabama, Tuscaloosa, AL, USA Background: Access to COVID-19 therapeutics has been inequitable in the U.S., stemming from well documented health-related, social, and structural vulnerability . This trend is not known among people living with HIV (PWH), who may face additional challenges in accessing COVID-19 therapeutics. We investigated disparities in access to COVID-19 therapeutics among PWH and people without HIV (PWOH) within the U.S. National COVID-19 Cohort Collaborative (N3C), a nationally sampled electronic health records repository. Methods: We conducted a retrospective evaluation of remdesivir and nirmatrelvir/ritonavir receipt among PWH and PWOH. We used hierarchically nested, additive, and adjusted mixed-effects models with logit link function to assess receipt of either remdesivir or nirmatrelvir/ritonavir, stratifying by HIV status and adjusting for race/ethnicity, age, sex, comorbidities, and area deprivation index (ADI). Results: Between January 2020 and November 2023, the N3C included more than 7 million individuals with incident COVID-19, with median age of 57 (interquartile range (IQR:45, 67), 13.2% non-Hispanic Blacks and 55.9% females, of whom 0.32% were PWH. In the unadjusted analysis, PWH had higher odds of receiving remdesivir (odds ratio [OR] of 2.36, 95% confidence interval [CI]: 2.31, 2.42), and nirmatrelvir/ritonavir (OR 1.55, 95% CI: 1.50, 1.61) when compared to PWOH (Table 1). However, when subsequently adjusting for various factors (age, sex, comorbidities, race/ethnicity, and ADI), the ORs of remdesivir prescription among PWH shifted quantitatively to 0.47 (95% CI: 0.13, 1.40). For nirmatrelvir/

ritonavir, the ORs became statistically insignificant after adjustments 3.37 (95% CI 0.78, 13.77). Conclusions: While corroborating the overall burden of HIV and social vulnerability among racialized minorities, PWH receiving care were more likely to receive COVID-19 therapeutics. However, accounting for race/ethnicity and social vulnerability attenuated any associations between HIV and receipt of COVID-19 therapeutics.

Poster Abstracts

1098 Impact of COVID-19 Pandemic on the Newly Diagnosed PWH: Data From 2 Clinical Centres in Italy Andrea Carbone 1 , Francesca Lombardi 2 , Valentina Iannone 1 , Pierluigi Francesco Salvo 1 , Giorgio Tiecco 3 , Jacopo Logiudice 3 , Francesco Castelli 3 , Roberta Gerami 3 , Antonella Cingolani 1 , Giancarlo Scoppettuolo 4 , Carlo Torti 2 , Simona Di Giambenedetto 2 , Eugenia Quiros-Roldan 5 1 Universita Cattolica del Sacro Cuore, Milan, Italy, 2 Catholic University of the Sacred Heart, Milan, Italy, 3 University of Brescia, Brescia, Italy, 4 Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy, 5 ASST Spedali Civili di Brescia, Brescia, Italy Background: In Italy, particularly in the North, the COVID-19 pandemic have significantly affected access to healthcare services, including HIV screening and management of people with HIV (PWH). We compared data from two clinical centres, one in the North and one in the Centre of Italy, regarding newly diagnosed people with HIV (ndPWH), before, during and after the pandemic. We examined clinical presentation at diagnosis and time to virological success (VS) at 12 months after starting ART. Methods: We conducted a retrospective observational study involving PWH diagnosed between 2015 and 2023 at two large referral centres. Participants, who had at least two HIV-RNA measurements within 12 months, 6±2 months apart, were categorized into pre-pandemic (2015-2017 and 2018-2019), pandemic (2020-2021) and post-pandemic (2022-2023) periods. Kaplan-Meier analysis assessed the probability of achieving overall VS at 12 months (HIV RNA≤50 cps/mL) and Cox-regression identified potential predictors of VS. Results: We enrolled 1.033 ndPWH, main characteristics are shown in Table 1. NdPWH during pandemic were younger (p=0.050) and had a higher viral zenith (p<0.001) compared to those diagnosed pre-pandemic. The frequency of CDC C peaked during the pandemic (32%) (p=0.031). During the pandemic period, the use of triple therapy declined markedly (p<0.001) while dual therapies as first line regimen increased (p<0.001). The overall probability of experiencing VS was 96.6%, with no significant differences between the periods (p=0.453). This was confirmed by multivariable Cox regression, adjusted for age, sex, time to ART initiation, (p=0.448). A higher viral zenith (aHR 0.68, 95%CI 0.64-0.73, p<0.001), CDC C (aHR 0.81, 95%CI 0.69-0.96, p=0.014), being treated in the northern centre (aHR 0.74, 95%CI 0.65-0.85, p<0.001) were associated with a lower likelihood of VS while higher nadir in CD4 count (aHR 1.04, 95%CI 1.01-1.07, p=0.007) and triple therapy INSTI-based regimens (aHR 1.67, 95%CI 1.43-1.96, p<0.001) were related to a higher probability of achieving VS. Conclusions: In this two-centre observational study, we found that ndPWH diagnosed during pandemic had worse initial clinical and viro-immunological conditions. However, this did not impact virological response, likely due to the increasing availability of third-generation INSTIs in the recent years. Northern centre's participants had a lower likelihood of VS, possibly reflecting other unexplored confounders in addition to the greater impact of pandemic in that area.

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