CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

1146 Substance Use Is Associated With Higher HIV Viral Load and Reduced Viral Suppression in 6 US Cohorts Robin M. Nance 1 , Ryan P. Kyle 1 , Richard Moore 2 , Pamina M. Gorbach 3 , Brian Mustanski 4 , Shruti H. Mehta 2 , Marianna Baum 5 , Kenneth Mayer 6 , Peter W. Hunt 7 , Oluwaseun Falade-Nwulia 8 , Edward Cachay 9 , Raul N. Mandler 10 , Geetanjali Chander 1 , Heidi M. Crane 1 , Lydia N. Drumright 1 1 University of Washington, Seattle, WA, USA, 2 The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 3 University of California Los Angeles, Los Angeles, CA, USA, 4 Northwestern University, Chicago, IL, USA, 5 Florida International University, Miami, FL, USA, 6 The Fenway Institute, Boston, MA, USA, 7 University of California San Francisco, San Francisco, CA, USA, 8 The Johns Hopkins University, Baltimore, MD, USA, 9 University of California San Diego, La Jolla, CA, USA, 10 National Institute on Drug Abuse, Rockville, MD, USA Background: HIV viral suppression is key to ending the HIV epidemic and maintaining the health of people with HIV (PWH). While prior research links substance use (SU) to lower antiretroviral therapy (ART) adherence, and higher HIV viral loads (VL) in PWH, newer ART regimes may be more resilient to intermittent adherence. We examined associations between active SU and VL suppression in the current ART era across 6 cohorts. Methods: Cohorts included: ALIVE, CNICS, JHHCC, MASH, mSTUDY, and RADAR. PWH with at least one VL from 2010 onward were included, and SU reported at the time of or up to 6 months prior to measurement of VL was included. Prevalence ratios (PR) for viral suppression, dichotomized VL at 200 copies/mL (except for ALIVE, where a 400 copies/mL cutoff was used per study protocol) were obtained using a generalized linear model, adjusting for age, gender, race/ethnicity, and visit year. Each cohort was analyzed independently, with summary estimates obtained through meta-analysis. Results: Of 10,406 PWH, the mean age was 51 years; 2% were gender diverse, and 35% reported White, 46% Black, 14% Latine race/ethnicity, respectively. Adjusted models estimated higher probability of detectable VL among PWH reporting recent SU: cocaine/crack PR=1.7 (95% CI 1.4-2.0), opioids 1.6 (95% CI 1.2-2.1) and cannabis 1.3 (95% CI 1.1-1.5). PWH who used methamphetamine were 2.2 times more likely to have unsuppressed VL compared to non-users (95% CI 1.5-3.4). Associations between SU and viral suppression were broadly comparable across study populations. While the prevalence of SU varied across subgroups, SU was consistently associated with viral nonsuppression in each of the studies. Conclusions: Our results demonstrate that SU is strongly associated with a lack of viral suppression across key demographic subgroups and substances used in the US, even in the current ART era. Methamphetamine use had the greatest impact on these negative outcomes. While there was no observed association with alcohol use in this analysis, the mean AUDIT-C score of 2 suggests that these results apply primarily to light drinkers (median 1, SD 2; IQR: 0, 3).

adults (18-49) and older adults (50+) with and without HIV were estimated using weighted frequencies and percentages and compared using Rao-Scott chi-squared tests. Results: Among younger adults with HIV (n=440,990) versus without HIV (n=35,510,625), the prevalence of past-year marijuana (53% vs 31%, p=0.001), cocaine (8% vs 3%, p=0.008), heroin (3% vs 1%, p=0.028), inhalant (14% vs 1%, p<0.001), and methamphetamine (14% vs 2%, p<0.001) use was significantly higher. Among older adults with HIV (n=492,809) versus without HIV (n=72,272,744), the prevalence of past-year marijuana (54% vs 11%, p<0.001), crack (3% vs 0.4%, p=0.020), heroin (3% vs 0.3%, p=0.008), inhalant (8% vs 0.1%, p<0.001), hallucinogen (4% vs 0.4%, p=0.001), and methamphetamine (15% vs 1%, p<0.001) use was significantly higher. In both age groups, past-year drug use screening was not significantly different among adults with HIV versus without HIV who reported past-year drug use (18-49: 72% vs 73%, p=0.949; 50+: 70% vs 56%, p=0.224). Similarly, discussion with a HCP about drug use among those with and without HIV was not significantly different across age (18-49: 33% vs 29%, p=0.630; 50+: 26% vs 22%, p=0.716). Conclusions: Although past-year drug use was significantly higher in both younger and older adults with HIV compared to those without HIV, there was no difference in the prevalence of drug use screening or discussion with a HCP, suggesting room for improvement for HCP engagement about drug use with patients with HIV. Efforts to maximize opportunities for screening and discussion are needed to decrease drug use and prevent related negative health outcomes among people with HIV. 1148 Impact of Residing or Injecting in Testing Center Catchments on HIV Testing in Churachandpur, India Talia A. Loeb 1 , Allison M. McFall 1 , Mihili Gunaratne 1 , Jiban J. Baishya 2 , Ashwini Kedar 3 , Archit Sinha 3 , A. K. Srikrishnan 3 , Sunil S. Solomon 2 , Gregory M. Lucas 2 , Shruti H. Mehta 1 1 The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 2 The Johns Hopkins University School of Medicine, Baltimore, MD, USA, 3 YR Gaitonde Center for AIDS Research and Education, Chennai, India Background: While India has made significant progress towards UNAIDS 95-95-95 targets, there are still gaps in HIV testing, particularly among people who inject drugs (PWID). HIV testing in India is provided free-of-charge through government-supported integrated care and testing centers (ICTCs). Additionally, beginning in 2013, our team established PWID-focused integrated care centers (ICC) in several cities across India that provide free HIV testing alongside other services (e.g., medication for opioid use disorder). We evaluate whether proximity to one of these services was associated with recent HIV testing. Methods: 752 PWID in Churachandpur, India, were recruited via respondent driven sampling November 2022–February 2023. Participants were ≥18 years and reported injection drug use in the past 2 years. Via interviewer administered surveys, participants provided locations for their primary residence and up to 4 places in which they injected drugs in the past year, HIV testing history and other related behaviors, and completed onsite HIV testing. Catchment areas within a 30-minute walking radius from ICTCs (N=10) and the ICC (N=1) were calculated using service area network analysis. Among those that self-reported living without HIV, logistic regression was used to assess the association between being within an ICC or ICTC catchment area and testing for HIV in the past year or past 6 months, with age, daily injection, and undiagnosed HIV as potential covariates. Results: Among 538 PWID who did not self-report living with HIV, the median age was 27, 84% reported daily injection in the past 6 months and 6% were living with undiagnosed HIV. 66% reported living or regularly injecting within a catchment area for the ICCs, while 70% were within the catchment for ICTCs. After adjustment, those within a catchment for the ICC had 2.02 (95% CI 1.17-3.48) times the odds of testing for HIV in the past year and 1.97 (95% CI 1.03-3.76) times the odds of testing in the past 6 months compared to those not within a catchment area. Those within the ICTC catchment had higher odds of testing in the past year and in the past 6 months, though this was not statistically significant ( Table ). Conclusions: Proximity to a community-based testing location (ICC) appeared important for regular HIV testing. Despite the presence of multiple government ICTCs, proximity to ICTCs did not impact recent testing, potentially reflecting additional barriers. Centers specifically oriented toward PWID populations may facilitate HIV testing.

Poster Abstracts

1147 Missed Opportunities for Drug Use Screening and Discussions Among People With HIV Sydney Bornstein, Blair Altman, Hannah Yellin, Madhu Balachandran, Irene Kuo, Manya Magnus MPH, PhD The George Washington University, Washington, DC, USA Background: Drug use is more prevalent among people with HIV and can worsen HIV-related outcomes. Screening and discussions about drug use with a healthcare provider (HCP) have been found to be associated with higher perceived need and receipt of drug treatment. We explored differences in past year drug use, screening, and discussion with a HCP among younger and older adults with and without HIV. Methods: We used nationally representative data from the 2021-2022 National Survey on Drug Use and Health among the civilian, non-institutionalized population in the US. Past-year drug use (marijuana, cocaine, crack, heroin, inhalants, hallucinogens, and methamphetamine), screening (HCP asked about drug use), and discussion about drug use with a HCP among younger

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