CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

a nonfatal overdose, 6.4% (n=84) died of a fatal overdose. The number of nonfatal overdoses per person ranged from 0-42 (Figure 1A). Of people who had at least one nonfatal overdose, most had one (55.5%); 2.4% had ≥10 nonfatal overdoses throughout the study period, highlighting the healthcare burden of nonfatal overdoses. The highest proportion of fatal overdoses was among people who experienced two nonfatal overdoses (Figure 1B). Among males with HIV, 10.2% (n=922) had at least one nonfatal overdose throughout the study period, compared to 18.9% (n=381) of females with HIV (p<0.0001). Among males with HIV who had a nonfatal overdose, 5.9% (n=54) died of a fatal overdose; 7.9% (n=30) of females with HIV who had a nonfatal overdose died of a fatal overdose (not statistically significant). Conclusions: Our results emphasize that the breadth of the overdose crisis stretch far beyond those who die of an overdose. Potential complications following a nonfatal overdose underscore the impact of this crisis, signaling crucial opportunities for harm reduction and drug use disorder treatment to abate harm from severe nonfatal overdoses and overdose deaths. Findings emphasize a need to link people with HIV who experience a nonfatal overdose with appropriate services. The figure, table, or graphic for this abstract has been removed. 1151 Progress Towards UNAIDS 95-95-95 Targets Among PWID Living With HIV Over 10 Years in Punjab, India Ashwini Kedar 1 , Allison M. McFall 2 , Griffin J. Bell 2 , Talia A. Loeb 2 , Mihili Gunaratne 2 , Jiban J. Baishya 3 , Archit Sinha 1 , A. K. Srikrishnan 1 , Sunil S. Solomon 3 , Gregory M. Lucas 3 , Shruti H. Mehta 2 1 YR Gaitonde Center for AIDS Research and Education, Chennai, India, 2 The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 3 The Johns Hopkins University School of Medicine, Baltimore, MD, USA Background: UNAIDS targets are for 95-95-95% for testing, treatment and viral suppression for people living with HIV (PWH) by 2030. People who inject drugs (PWID) face persistent barriers to engaging in consistent care for HIV. We explored temporal trends in UNAIDS indicators over 10 years in two Indian cities in Punjab, which has an unabating drug use epidemic. Methods: 5315 PWID were recruited from 2 Indian cities (Amritsar 2622,Ludhiana-2693) across 3 cross-sectional surveys (2013,2016,2023) using respondent driven sampling (RDS). PWID ≥18 years and who injected drugs in past 2 years were eligible. Participants completed behavioral surveys and laboratory testing (onsite HIV antibody;HIV RNA on stored sample). Among PWH, we estimated in each survey RDS-II weighted HIV prevalence and UNAIDS treatment indicators:1) awareness of HIV status 2) ART use among those aware and 3) viral suppression among those on ART. Results: Over the decade, HIV prevalence increased in both cities;from 21% to 20% to 35% in Amritsar and from 18% to 22% to 43% in Ludhiana. Median age for PWH across surveys was 30 years and 28 years in Amritsar and Ludhiana, respectively. Almost all were male. Proportion of daily injectors increased from 32% to 87% in Amritsar;13% to 27% in Ludhiana. In Amritsar, needle syringe sharing decreased from 33%(2013) to 14% (2016) but increased to 48% in 2023;while sharing increased from 10% to 20% to 42% in Ludhiana. Proportion reporting heroin injection more than doubled in both cities (5% to 97% in Ludhiana;32% to 99% in Amritsar) while buprenorphine injection declined (90% to 3% at Amritsar;77% to 8% in Ludhiana). As seen in the Figure, awareness of HIV status was stable or increasing between 2013-2016 but declined by >50% in both cities by 2023. Among those aware, percentage on ART increased and remained stable in Amritsar;in Ludhiana ART use increased initially (2013-2016) but then decreased. Among those on ART, viral suppression increased between 2013-2016 but decreased by 2023. Conclusions: Despite initial gains in these two Indian cities that are experiencing a shift in the epidemiology of drug use, from prescription opioid injection to near universal heroin injection and an increase in high risk injecting practices; levels of awareness of HIV status and viral suppression were lower among PWID in 2023 than they were a decade ago and HIV prevalence is increasing. Novel approaches will be required to engage this vulnerable group in prevention and treatment services that address changing needs.

1149 HIV Outcomes Among People With HIV Who Inject Drugs in West Virginia Rebecca Reece, Nicole Bryan, Sally L. Hodder West Virginia University, Morgantown, WV, USA Background: Historically West Virginia has had one of the lowest HIV prevalence rates in the United States. However, newly diagnosed HIV cases began to increase in 2018. Today, there are multiple HIV outbreaks in West Virginia, most of which are among people who inject drugs (PWID). This study examines HIV outcomes among PWID hospitalized with infectious complications related to injection drug use (IDU). Methods: This retrospective study assessed electronic medical records of PWID admitted to Ruby Hospital, the flagship hospital for WVU Medicine, from 2018 to 2022. Among those diagnosed with HIV, we assessed connection to care and virologic suppression, among other outcomes, over the 12 months following hospital admission. Results: A total of 810 PWID hospitalized with IDU-related infectious complications were identified during the four-year period, of whom 15 (mean age 31 years, 93% White, 40% women) were HIV infected (2 were newly diagnosed during hospital admission). Eight of 15 persons (53%) presented with CD4 count <200 cells/mm 3 . Seven of the 13 persons with known HIV were receiving antiretroviral therapy upon admission, and only 2 of those were virologically suppressed. One person died during the hospital stay. Other outcomes are shown (Figure 1). Importantly, only 3 persons (20%) were virologically suppressed one-year after hospitalization, 4 persons were not virologically suppressed, and 7 persons were lost to follow-up. Conclusions: These data suggest that concentrated focus is needed to improve the HIV outcomes among PWID in West Virginia.

Poster Abstracts

1150 Scope of the Overdose Crisis: Fatal Overdoses Among People With HIV Experiencing a Nonfatal Overdose Megan E. Marziali 1 , Katherine Kooij 2 , Wendy Zhang 2 , Michael Budu 2 , Silvia S. Martins 1 , Julio S. G. Montaner 2 , Robert S. Hogg 3 1 Columbia University, New York, NY, USA, 2 British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada, 3 Simon Fraser University, Burnaby, Canada Background: Drug overdoses continue to devastate communities in Canada. British Columbia (BC), Canada’s westernmost province, has one of the highest drug-related mortality rates in the nation, with a fatal overdose rate double the national average (47.0 opioid deaths per 100,000 in BC; 21.1/100,000 in Canada). To better understand the breadth of the overdose crisis, this study evaluates the proportion of fatal overdoses among people with HIV who previously experienced a nonfatal overdose, overall and by sex. Methods: We used data from the Comparative Outcomes And Service Utilization Trends (COAST) study (April 1, 2012–March 31, 2020). COAST is a linkage of administrative health datasets and includes information on all known people with HIV in BC (N=11,050). We identified nonfatal overdoses via hospitalization records, emergency department visits, and physician visits using ICD-9 and ICD-10 codes related to drug poisoning. We identified fatal overdoses in the Vital Statistics database using ICD-10 codes. Results: Within the sample of 11,050 people with HIV, 1,304 (11.8%) had a nonfatal overdose between 2012-2020. Among people who experienced

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