CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

1153 Introduction and Acquisition of HIV-1 Related to Recent Migration to Quebec (2016-2023) Bluma Brenner 1 , Réjean Thomas 2 , Jean-Pierre Routy 3 1 Lady Davis Institute for Medical Research, Montreal, Canada, 2 Clinique Médicale l'Actuel, Montreal, Canada, 3 McGill University Health Centre Research Institute, Montreal, Canada Background: There has been a marked rise in new diagnoses in Montreal from 140 cases in 2021 to 310 in 2022. Population-level viral phylogenetics can provide a unique molecular framework to better ascertain the impact of migration on the introduction and crossover of subtype B and non-B subtype epidemics among Men having Sex with Men (MSM) and heterosexual (HET) groups risk populations. This study combined viral phylogenetics with epidemiological data from two clinical sites to characterize evolving trends shaping epidemic growth between 2016 and 2023. Methods: Viral sequences and test requisition data from newly diagnosed persons were accrued from the Quebec drug resistance testing program. Viral clustering at strict (1.0%) and relaxed (2.5%) genetic distance thresholds (2.5%), mapped transmission networks shaping subtype B epidemics among MSM (male only singletons and clusters) and HET (female singletons mixed gender clusters) groups. Non-nominative clinical data (age, sex, gender, sexual orientation, country of birth and date of arrival) was obtained with consent from diagnosed persons seen at Clinique l’Actuel (n= 190, 2016—2020) and the McGill University Health Centre (n= 49, 2021—2023). Results: Improved treatment-as-prevention paradigms have led to 53% declines in the incident infections in 2014—2020 (n=590) vs . 2007—2013 (n=1171). However, epidemic control was thwarted by the episodic development of large cluster outbreaks. Between 2014 and 2020, 36 clusters added median 11 (9-22 IQR) members, contributing to 665 incident infections. Of concern, 26% of recent migrant MSM acquired their infection in the province, segregating with 14 large clusters. In addition, ten non-B clusters arose among MSM (24% of cases) between 2017—2023), with median 9 [8-12.5 IQR} members per cluster, leading to 80 incident infections. In contrast, large non-B subtype HET clusters rarely occurred (4.1% of cases). Conclusions: These findings emphasize the need to target treatment and prevention measures, including preexposure prophylaxis, for high at-risk newcomers to Quebec and increasingly younger populations. The figure, table, or graphic for this abstract has been removed. 1154 HIV Molecular Clusters Attributed to Sexual Transmission in the United States, 2015-2023 Kathryn G. Curran, Nivedha Panneer, Karen Schlanger, Anne Marie France, Alexa M. Oster Centers for Disease Control and Prevention, Atlanta, GA, USA Background: Effectively identifying and responding to HIV molecular clusters, which indicate rapid HIV transmission, is an essential part of Ending the HIV Epidemic in the United States. We described the composition and growth of such HIV molecular clusters attributed to sexual transmission. Our aim was to identify characteristics of clusters with continued rapid growth to help communities prioritize those which may require the most robust and rapid response. Methods: Using National HIV Surveillance System data reported through December 2023, we characterized molecular clusters first detected during December 2015–December 2022. We detected clusters quarterly, using transmission network analysis of HIV-1 pol sequences for all diagnoses in the past 3 years, using a pairwise threshold of 0.005 substitutions/site. Clusters of rapid transmission had ≥ 5 diagnoses during the past 12 months. Sexual transmission clusters are those with >50% of cluster members with transmission category of heterosexual or male-to-male sexual contact (MMSC). We compared characteristics of people in clusters with little/no growth to those in clusters with continued rapid growth (average annual growth <3 vs ≥3 diagnoses/year). Results: Of 432 HIV molecular clusters, 386 (89%) were attributed to sexual transmission. Of 3,515 people in these clusters, most were men (92%), aged 20–29 years (54%), and resided in the South (53%). Transmission categories included MMSC (81%), other or no identified risk (7%), heterosexual transmission (6%), MMSC and injection drug use (IDU) (5%), and IDU (1%). Clusters varied in size at detection (median=8; interquartile range [IQR]: 6–11), annual growth (median=2; IQR: 1–5), and total growth (median=8; IQR: 3–18; range: 0–102). Clusters with continued rapid growth (n=159; 41%) had similar size at detection (median=9; IQR: 7–12) as clusters with little/no growth

1152 The Impact of Semaglutide on Alcohol Use Among People With HIV in Routine Clinical Care in the US Heidi M. Crane 1 , Robin M. Nance 1 , L. Sarah Mixson 1 , Stephanie A. Ruderman 1 , Bridget M. Whitney 1 , Andrew W. Hahn 1 , Mari Kitahata 1 , Amanda Willig 2 , Lara Haidar 3 , Kaitlin A. Zinsli 1 , George Yendewa 4 , Allison Webel 1 , Edward Cachay 5 , Joseph A. Delaney 1 , Geetanjali Chander 1 , for the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) 1 University of Washington, Seattle, WA, USA, 2 University of Alabama at Birmingham, Birmingham, AL, USA, 3 University of Manitoba, Winnipeg, Canada, 4 Case Western Reserve University, Cleveland, OH, USA, 5 University of California San Diego, La Jolla, CA, USA Background: Glucagon-like peptide-1 receptor agonists (GLP-1 RA) such as semaglutide are used to lower serum glucose levels and reduce weight. In animal studies, GLP-1 RA reduce alcohol use, though non-trial human data is limited particularly among people with HIV (PWH). Methods: We examined change in alcohol use among PWH who reported alcohol use and received semaglutide for weight or glucose control in routine clinical care at 8 sites across the U.S. between 4/2018-3/2024 in the CFAR Network of Integrated Clinical Systems (CNICS) cohort. Change in alcohol use was assessed with linear mixed models of AUDIT-C scores prior to and after initiating semaglutide adjusted for age, sex, race/ethnicity, and time. We stratified models by PWH with at-risk alcohol use, defined as AUDIT-C scores of >3 for women and >4 for men and low alcohol use, defined as scores of 1-2 and 1-3 among women and men, respectively. Results: 334 PWH reporting alcohol use received semaglutide. Median number of alcohol assessments after semaglutide was 2 [interquartile range: IQR 1,3] with last follow-up alcohol assessment a median of 422 [IQR 184,682] days after starting semaglutide. The mean age was 54 years, 24% were female, 42% were White, 31% Black, and 22% Hispanic/Latine. Among 98 PWH with at-risk alcohol use at baseline, median AUDIT-C score was 5 (IQR 4,6), vs. 2 (IQR 1,2) among 236 PWH reporting low alcohol use. Median baseline BMI was 33 (IQR 30,38) among those with at-risk alcohol use and 34 (IQR 31,38) among those with low alcohol use. In adjusted analyses, among PWH with baseline at-risk alcohol use, mean AUDIT-C scores decreased by 1.2 points (95% CI: -1.7, -0.7) after initiating semaglutide while there was no change in AUDIT-C score among those with lower baseline alcohol use (see Table ). Conclusions: PWH with at-risk alcohol use receiving semaglutide for weight or glucose management in routine clinical care report decreases in alcohol use as measured by AUDIT-C score providing support for testing semaglutide in future studies of PWH with alcohol use disorder.

Poster Abstracts

CROI 2025 376