CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

1145 Unstable Housing, Methamphetamine Use, and HIV Incidence Among Racial and Ethnic Minority Men Marjan Javanbakht, Allison D. Rosen, Steve Shoptaw, Pamina M. Gorbach University of California Los Angeles, Los Angeles, CA, USA Background: Unstable housing has been linked to substance use (SU) and other health outcomes and evidence that SU especially methamphetamine (meth) drives HIV acquisition, has been well described. Yet the interaction between unstable housing and meth use on HIV acquisition is unclear, especially critical for EHE priority jurisdictions such as Los Angeles, which has the second largest population of people experiencing unstable housing in the US. The objective of this study was to examine the synergistic impact of housing instability and meth use on the incidence of HIV infection. Methods: Data for this analysis are from a cohort study of gay, bisexual, and other men who have sex with men in Los Angeles, CA. Participants were eligible if they were 18-45 years of age, male sex at birth, reported condomless anal intercourse with a male partner in the past 12 months, and tested negative for HIV at baseline. Data from those enrolled from 2014 with at least one follow-up visit through August 2024 were included (n=274; median follow-up 4.6 years). Semiannual visits assessed housing status, SU, and sexual behaviors and collection and testing of biospecimen for STIs/HIV. Kaplan-Meier survival analysis and Cox regression accounting for time varying covariates was used to assess HIV incidence rate and factors associated with HIV seroconversion. Results: At baseline median age was 28 years, 47% identified as Black and 38% Hispanic/Latine. Past 6-month self-reported meth use was 32% (n=88), unstable housing 34% (n=94), PrEP use 36% (n=99), with 18% (n=50) testing positive for chlamydia, gonorrhea, or infectious syphilis. Twenty participants tested positive for HIV at follow-up (HIV incidence rate=1.6 per 100 person years (PY) (95% CI: 1.0-2.4)); highest among those who reported both unstable housing and daily meth use (8.0 per 100 PY; 95% CI 3.3-19.2), compared to those who reported daily meth use without unstable housing (2.7 per 100 PY; 95% CI 0.4-19.4) or unstable housing without daily meth use (2.3 per 100 PY; 95% CI 1.0-5.1). Based on cox regression analyses daily meth use and unstable housing were both associated with HIV seroconversion (HR=5.0; 95% CI 1.8-13.7 and HR=3.0; 95% CI 1.3-7.4, respectively (Table). Conclusions: These findings underscore the powerful interaction between housing instability and daily methamphetamine use, showing there is a multiplicative effect of these factors on HIV risk. Intervening on both housing support and substance use together is essential for reducing HIV transmission.

1144 Increasing Methamphetamine Use and Group Sex Observed in MSM With Acute HIV Infection in Bangkok Phillip Chan 1 , Carlo Sacdalan 2 , Suteeraporn Pinyakorn 3 , Eugène Kroon 2 , Pathariya Promsena 2 , Luxe-Naree Poonpitak 2 , Somchai Sriplienchan 2 , Nitiya Chomchey 2 , Nittaya Phanuphak 4 , Sandhya Vasan 5 , Adam Carrico 6 , Robert Paul 7 , Lydie Trautmann 5 , Serena Spudich 1 , Donn Colby 3 , for the RV254/SEARCH 010 Study Team 1 Yale University, New Haven, CT, USA, 2 SEARCH, Bangkok, Thailand, 3 US Military HIV Research Program, Bethesda, MD, USA, 4 Institute of HIV Research and Innovation, Bangkok, Thailand, 5 Henry M Jackson Foundation, Bethesda, MD, USA, 6 Florida International University, Miami, FL, USA, 7 University of Missouri St Louis, St Louis, MO, USA Background: Clinical data from acute HIV infection (AHI) can provide valuable perspectives on factors associated with ongoing HIV transmission. This analysis examines participant characteristics in the RV254 AHI cohort in Bangkok, Thailand. Methods: From 2009 to 2023, 539,616 blood samples from HIV test seekers were screened for AHI using a combined immunoassay and nucleic acid test approach. Of the 955 AHI events (0.18%) identified, 726 individuals (76%) were enrolled. They were grouped into three 5-year intervals based on year of enrollment: Group 1 (2009–13), Group 2 (2014–18), and Group 3 (2019–23). Demographic, clinical, mood, and behavioral measures were compared using Chi-square test and non-parametric tests accordingly, with Group 1 as the reference. A subgroup analysis was conducted on 234 Groups 2 and 3 participants who completed a standardized questionnaire on risk behaviors introduced in Sep 2017. Results: Of the 726 RV254 participants, 708 (98%) were male, 674 (93%) were men who have sex with men (MSM), with a median age of 26 (interquartile range (IQR) 23,31) years, and 420 (58%) had a bachelor's degree or higher. Age and education level at AHI did not differ between the 3 groups, with consistent predominance of male participants (>90%). Table 1 compares mood and behavioural measures and co-infections across the groups. While depressive scores measured by the Patient Health Questionnaire (PHQ-9) did not statistically differ between groups, Groups 2 and 3 exhibited lower psychological stress scores on the Distress Thermometer than Group 1 (p<0.01). They also showed higher rates of past and recent syphilis (p<0.01). Group 3 also had higher frequencies of hepatitis C infection (p=0.021) and any pre-exposure prophylaxis (PrEP) use (p<0.001), as PrEP was introduced at the Thai Red Cross in 2015 and in community-led services in 2016. In the risky behaviour subgroup analysis, over a fifth in Groups 2 and 3 reported methamphetamine (meth) use and group sex prior to AHI. Compared to non-users, meth users had higher frequencies of group sex (51% vs. 17%, p<0.001), past syphilis (38% vs. 23%, p=0.035) and any PrEP usage (17% vs. 6%, p=0.022). Conclusions: In the last 15 years, young, highly educated MSM predominated new AHI cases detected in Bangkok, Thailand. There was increasing detection of concurrent syphilis and hepatitis C, particularly among meth users, half of whom reported group sex, highlighting the need for integrated service for substance use, HIV and sexually transmitted infections.

Poster Abstracts

CROI 2025 373