CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

definition. The cumulative risk of all-cause mortality from the time of AHD definition was compared by exposure groups by Kaplan-Meier curves and Cox regression models after controlling for confounding. Results: Overall, 5,436 PWH with a median age of 45 years, a first diagnosis of AHD contributing to 31,788 PYFU were included: 4,671 newly HIV-diagnosed (pAHD) and 765 already in care (iAHD), where 34% and 32% respectively fulfilled the definition of AHD due to an ADE diagnosis. Compared to pAHD, iAHD were more likely to be female (29% vs. 23%, p=0.001) Italian (84% vs. 72%, p<0.001) and injection drug users (IDU) (23% vs. 8%, p<0.001) . The overall incidence (95%CI) of iAHD was 20.4 (16.8,24.8) per 1,000 PYFU which sharply declined below 12% of total AHD in the last decade (Figure A). Univariable survival analysis showed a significantly increased risk of death in iAHD vs. pAHD (by 10 years: 17.0% (13.8,20.7) vs. 10.7% (9.6,11.9), p<0.001). After adjusting for confounding, the risk of death associated with being iAHD was attenuated but remained 31% higher than that of pAHD, mainly determined by ADE, especially in the iAHD group (Figure B). Conclusions: Although the incidence of AHD among PWH on ART has significantly reduced over time, the current magnitude of the estimate is of concern. iAHD, compared to pAHD, were of Italian nationality with a more frequent history of IDU and also showed worse clinical outcomes for a given set of risk factors for death. Reasons for the difference in risk, possibly linked to behaviour and style of life, need to be further investigated to prevent AHD after charging in care and to identify AHD before progression to AIDS. The figure, table, or graphic for this abstract has been removed. 1134 The Effect of Treat-All on People With Advanced HIV Disease in Lesotho Shanyah L. Mitchell 1 , Craig J. Heck 1 , Daniela Quigee 1 , Sara Wallach 1 , Jason Zucker 1 , Shannon Farley 2 , Andrea Howard 2 , Magdalena E. Sobieszczyk 1 , Felix Ndagije 2 , Jessica E. Justman 2 , Wafaa El-Sadr 2 , Delivette Castor 1 1 Columbia University Irving Medical Center, New York, NY, USA, 2 ICAP at Columbia University, New York, NY, USA Background: Lesotho ranks second highest in national HIV prevalence globally. In April 2016, Lesotho was the first African country to adopt the World Health Organization (WHO) recommendation that all people with HIV (PWH) receive antiretroviral therapy (ART), regardless of clinical stage or CD4 cell count (CD4). Although CD4 is no longer used to guide treatment initiation, people with advanced HIV disease (AHD), defined as CD4 <200 cells/mm 3 , have a higher risk of mortality and may contribute to HIV transmission due to uncontrolled viremia. We describe population-level changes in AHD prevalence and examine changes in correlates of AHD since implementing the “treat-all” guidance. Methods: Using data from Lesotho Population-Based HIV Impact Assessments (LePHIA) conducted in 2016-17 and 2019-20, we estimated the prevalence of AHD and examined sociodemographic, clinical, and treatment correlates of AHD. We fit multivariable logistic regression models of all covariates with an unadjusted p-value < 0.05. All analyses were performed with weighted data using SAS (version 9.4). Results: Among 6,391 PWH (2016-17: n=3,159, 2019-20: n=3,232), the prevalence of AHD was 11.45% (95% CI:10.19,12.73) and 6.68% (95%CI:5.71,7.64) ( X 2 p value<0.0001), median CD4 count for all PWH/AHD was 477 (IQR:300-664)/ 132 (IQR:90-165) and 572 (IQR:382-783)/ 147 (IQR:105-175) (Wilcoxon rank sum p-value<0.0001/ p-value = 0.03) in 2016-17 and 2019-20, respectively. After statistical adjustment, covariates associated with AHD in both surveys (Figure) were male sex (aOR 2.07, 95% CI 1.68,2.55), older age (25-59 vs. 15-24 y, aOR 2.23, 95% CI 1.47,3.38), and viral non-suppression (viral load > 1000 copies/ml, aOR 11.00, 95% CI 8.21,14.74). In 2016-17 but not 2019-20, individuals reporting not currently being on ART had higher odds of AHD (aOR: 3.30, 95% CI:1.37,8.00) compared to those currently on ART. Conclusions: Since implementing the treat-all policy in Lesotho, median CD4+ count increased among all PWH, and reported ART use was no longer associated with AHD. Correlates of AHD we report coincide with previous studies. The percent of PWH with AHD decreased by 40%, with unsuppressed viral load remaining associated with AHD. Last mile efforts should focus on reaching PWH who are men, older age, and experience viral non-suppression. The CD4 dynamics observed, highlight the need for continued CD4 monitoring to track remaining gaps in evidence on AHD and the HIV response.

1135 Burden of AIDS-Defining Conditions Among Adults With Perinatal HIV in North America, 2000-2022 Nel Jason Haw 1 , Catherine Lesko 1 , Derek Ng 1 , M. John Gill 2 , Maile Karris 3 , Michael Horberg 4 , Heidi M. Crane 5 , Mona Loutfy 6 , Kathleen McGinnis 7 , Richard Moore 1 , Allison Agwu 8 , Keri N. Althoff 1 , for the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) of IeDEA 1 The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 2 University of Calgary, Calgary, Canada, 3 University of California San Diego Medical Center, La Jolla, CA, USA, 4 Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA, 5 University of Washington, Seattle, WA, USA, 6 Women's College Research Institute, Toronto, Canada, 7 VA Pittsburgh Healthcare System, Pittsburgh, PA, USA, 8 The Johns Hopkins University School of Medicine, Baltimore, MD, USA Background: People living with perinatally acquired HIV (PPHIV) have unique circumstances: lifelong HIV and its associated inflammation, exposure to multiple suboptimal antiretroviral therapy regimens, HIV acquisition affecting early immune system development, and challenges in transitioning from pediatric to adult HIV care. They have higher rates of non-AIDS defining conditions and may potentially be at higher risk of AIDS-defining conditions (ADCs) than people living with non-perinatal HIV (PnPHIV). As PPHIV progress through adulthood in North America, we described the burden of ADCs for PPHIV compared to those with PnPHIV. Methods: Using data from the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) from 2000-2022, we estimated mean cumulative counts (MCC) of ADCs comparing PPHIV and PnPHIV aged 18-40 engaged in adult HIV care. ADCs were defined as having a clinical diagnosis of any ADC as reported in the health record, and were allowed to recur more than once during study follow-up. PnPHIV were categorized into three HIV risk groups: male-to-male sexual contact, injection drug use and heterosexual contact. Other HIV risk groups were excluded due to small sample sizes. MCCs of each PnPHIV group were weighted using a propensity score model adjusting for sex at birth, self-identified race, age and calendar year of study entry, and 95% confidence intervals (CI) were calculated using bootstrapping. Results: Overall, there were 5,715 ADCs among 22,950 people with HIV. There were 109 ADCs among 455 PPHIV. More than half (55%) of PPHIV were female, and 58% were Black. The three most common ADCs among PPHIV were: HIV associated wasting syndrome (n = 21), esophageal candidiasis (n = 19), and P. jiroveci pneumonia (n = 15). Among PPHIV, the MCC of ADCs by three years in adult HIV care was 27 per 100 persons (95% CI: 14, 42) in 2000-2011 and 18 per 100 persons (95% CI: 9, 28) in 2012-2022. The MCCs of PPHIV were similar to PnPHIV groups during both calendar periods. The MCCs of ADCs decreased between 2000-2011 and 2012-2019 for each HIV risk group. Sensitivity analyses stratified by sex at birth yielded similar results. Conclusions: PPHIV who have successfully transitioned to adult HIV care have similar experience of ADC burden than their peers with non-perinatal HIV, and do not need any additional ADC prevention or management beyond what all people with HIV should receive. We also emphasize the importance of retention in HIV care as it provides opportunities for ADC prevention.

Poster Abstracts

CROI 2025 369