CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

Conclusion: Our study showed that subtype C, and specifically variant C3, was the most prevalent in MSM living in France and tend to be associated with less severe epidemic KS clinical form. We also reported 5 “subtype F” isolated in MSM and associated with severe diseases. We suggest that, in view of phylogenic and epidemiological finding, subtype F could be subdivided in 2 genotypes variants.

Conclusion: With increasing ART access, KS incidence in Latin America has decreased in PLWH. However, mortality risk was increased among patients who developed KS after ART initiation. Further research into the determinants of HIV and KS outcomes in Latin America is needed.

Poster Abstracts

275 KAPOSI SARCOMA INCIDENCE BETWEEN 2010 AND 2015 IN THE FRENCH DAT’AIDS COHORT Isabelle Poizot-Martin 1 , Alain Makinson 2 , Camelia Protopopescu 3 , Antoine Chéret 4 , Marc-Antoine Valantin 5 , David Rey 6 , Claudine Duvivier 7 , Christine Jacomet 8 , Tristan Ferry 9 , Clotilde Allavena 10 , Thomas Huleux 11 , Firouze Bani- Sadr 12 , Véronique Obry-Roguet 1 , Patricia Carrieri 3 , for the Dat’AIDS study group 1 Assistance Publique–Hopitaux Marseille, Marseille, France, 2 CHU de Montpellier, Montpellier, France, 3 INSERM, Marseille, France, 4 Hôpital Bicêtre, Le Kremlin-Bicetre, France, 5 AP–HP, Hôpitaux Universitaires Pitié Salpêtrière, Paris, France, 6 Hôpitaux Universitaires de Strasbourg, Strasbourg, France, 7 Necker Hospital, Paris, France, 8 CHU de Clermont-Ferrand, Clermont-Ferrand, France, 9 Hospices Civils de Lyon, Lyon, France, 10 CHU Hôtel-Dieu, Nantes, France, 11 Centre Hospitalier de Tourcoing, Tourcoing, France, 12 CHU de Reims, Reims, France Background: Antiretroviral therapy (ART) has reduced the risk of Kaposi Sarcoma (KS). However, the current incidence of KS remains under reported in HIV-infected people. We analyzed the data of a large French multicenter cohort to estimate KS incidence between 2010 and 2015 and to describe patient’s characteristics at diagnosis. Methods: We performed a retrospective study using longitudinal data from the DAT’AIDS cohort from 01/2010 to 12/2015. KS cases were identified using ICD-10 codes. For incidence assessment, prevalent KS cases (occurring within 30 days after cohort enrollment) were excluded. Demographic, immunologic, and therapeutic characteristics were collected at the time of KS diagnosis. Results: Among the 44 642 HIV infected people followed-up in the DAT’AIDS cohort during the study period (median age 43 [36-50] years, 69.7%male), 209 patients developed KS, of which 130 were incident KS cases. The KS incidence [95%CI] among 41 744 patients without history of cancer accounting for 167 848.7 person-years (PY) was 77.5 [65.2-92.0]/105 PY, 106.1 [88.8- 126.8]/105 PY in males and 16.7 [8.7-32.1]/105 PY in females. At the time of KS diagnosis, 48 (23%) patients were receiving ART for less than 6 months (median CD4: 227[79; 290]), 55 (26%) for at least 6 months (median CD4: 252 [53; 469]) and 105 (50%) were not receiving ART (median CD4: 112 [36 ; 219]) of which 41 patients had a concomitant HIV diagnosis (median CD4: 41 [25 ; 160]). Patients’ characteristics are presented in table according to both ART exposure for at least 6 months and HIV viral load (VL). Conclusion: In a resource-rich setting with high ART coverage, KS incidence remained high in recent years. Though such rates usually reflected a late HIV diagnosis and/or care access, KS also occurred despite prolonged ART exposure and/or controlled of HIV viremia in a quarter of cases. Multiplying the opportunity of HIV screening among the key populations to avoid useless delays to care should result in substantial reduction of KS incidence. We need to better define factors associated of KS in patients under ART and controlled viremia.

274 ANTIRETROVIRAL THERAPY AND KAPOSI SARCOMA TRENDS AND OUTCOMES IN LATIN AMERICA

Jessica L. Castilho 1 , Ahra Kim 1 , Cathy Jenkins 1 , Beatriz Grinsztejn 2 , Eduardo Gotuzzo 3 , Valeria I. Fink 4 , Denis Padgett 5 , Pablo F. Belaunzaran-Zamudio 6 , Brenda Crabtree-Ramírez 6 , Juliana Netto 2 , Claudia P. Cortes 7 , Alexandre Grangeiro 8 , Bryan E. Shepherd 1 , Catherine McGowan 1 , for the Caribbean, Central and South America network for HIV epidemiology (CCASAnet) 1 Vanderbilt University, Nashville, TN, USA, 2 Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro. Brazil, 3 Universidad Peruana Cayetano Heredia, Lima, Peru, 4 Fundación Huésped, Buenos Aires, Argentina, 5 Instituto Hondureño de Seguridad Social, Tegucigalpa, Honduras, 6 Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico, 7 Fundación Arriarán, Santiago, Chile, 8 Universidad de São Paulo, São Paulo, Brazil Background: Kaposi sarcoma (KS) remains the most frequent malignancy in persons living with HIV (PLWH) in Latin America, though little is known of KS epidemiology in the region. We examined KS trends and outcomes from Latin American clinical sites in the era of increased access to antiretroviral therapy (ART). Methods: Cohorts in Brazil, Peru, Mexico, Honduras, and Chile contributed clinical data of PLWH ≥16 years old and KS outcomes from 2000-2017. As KS is often an HIV-presenting diagnosis, we included diagnoses ≤60 days before or at any time after clinic entry. KS incidence by calendar year and cumulative incidence, accounting for death and loss to follow-up as competing risks, were calculated. Patient characteristics associated with KS diagnosis before/at or after ART initiation and the association of mortality after KS with timing of ART relative to KS diagnosis were examined using stratified Cox regression. Results: Of 22,166 PLWH, 414 had incident KS, including 202 diagnoses in ART-naïve and 212 diagnoses in ART-experienced patients. In total, 45% of PLWH and 50% of KS cases were from Brazil. From 2000-2017, the incidence of KS significantly decreased from 78.1 to 0.3 per 1,000 person-years. Among those who developed KS before ART, the median time from clinic entry to KS was 29 days (interquartile range [IQR]: 1-162) and the median time from KS to ART was 20 days [10-36]. Among those who developed KS after ART, the median time to KS was 4.6 years [2.3-8.3] from ART. Risk of KS was significantly increased in persons with low CD4 cell counts and among men who reported sex with men (MSM) for both pre- and post-ART cohorts (p trend <0.05, each). Among PLWH with KS, those with KS before ART initiation had decreased risk of mortality (Figure, logrank test p=0.08). In analyses accounting for country, HIV sexual risk factor, age, CD4 cell count, viral load, and calendar year, KS diagnosis before ART was associated with a 38% decreased risk of mortality (adjusted hazard ratio [aHR] = 0.62 [95% confidence interval: 0.38-1.02]). Low CD4 cell count (p trend =0.01) and heterosexual HIV risk among women (aHR =2.62 [1.27-5.39] vs. MSM) were also associated with mortality risk after KS.

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CROI 2019