CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

virologic suppression (81% versus 71%, respectively, p-value <0.001), compared to the self-refill group. Home refill (vs. self-refill) was associated with better survival (adjusted hazard ratio = 0.90 [95% CI: 0.84-0.96], p-value for log-rank test < 0.001) (Figure 1). Conclusion: Home refill is associated with improved clinical, immunological, and virologic outcomes compared to self-refill for HIV-infected adults in this private AIDS programme in South Africa. Home refill offers a promising additional option to the growing ART service delivery models and should facilitate the UNAIDS 90-90-90 targets in LMICs.

in STRs vs 93.9% in MTRs, p=0.284) did not significantly differ between the treatment groups [Fig 1c, 1d]. Conclusion: Among currently recommended ART regimens, STRs and 2-pills QD MTRs showed a similar impact on virological control, a proxy of patient’s adherence. Among INSTI-based regimens, the number of pills/ daily administrations does not seem to influence virological outcome.

Poster Abstracts

511 EFFECTIVENESS OF SINGLE- VS MULTIPLE-TABLET REGIMENS AS 1ST-LINE ART IN ICONA COHORT Annalisa Mondi 1 , Patrizia Lorenzini 1 , Alessandro Tavelli 2 , Alessandro Cozzi- Lepri 3 , Franco Maggiolo 4 , Nicola Gianotti 5 , Daniela Francisci 6 , Chiara Carcieri 7 , Andrea De Vito 8 , Antonio Di Biagio 9 , Antonella D’Arminio Monforte 10 , Andrea Antinori 1 , for the Icona Foundation Study Group 1 Lazzaro Spallanzani National Institute for Infectious Diseases, Rome, Italy, 2 Icona Foundation, Milan, Italy, 3 University College London, London, UK, 4 Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy, 5 San Raffaele Scientific Institute, Milan, Italy, 6 University of Perugia, Perugia, Italy, 7 University of Turin, Turin, Italy, 8 University of Sassari, Sassari, Italy, 9 IRCCS AOU San Martino-IST, Genoa, Italy, 10 University of Milan, Milan, Italy Background: Complexity of antiretroviral therapy (ART) has been associated with adherence and virological control. Single-tablet regimens (STRs) are currently recommended for ART initiation. However, the availability of both new and generic treatment options prompts the need of an updated comparison of STRs vs multiple tablet regimens (MTRs)’ effectiveness as first-line therapy. Methods: All naïve patients (pts), enrolled in Icona cohort, starting ART from 2011 to 2017 with currently recommended STRs or MTRs, were included. MTRs were divided in: MTR1 (2 pills QD) and MTR2 (3 pills QD or BID). Probability of virological failure (VF) [confirmed viral load (VL)>200 cp/mL after 6 months of ART] was estimated by Kaplan-Meier curves according to treatment group. The risk of VF in STRs vs MTRs group was compared by Cox regression analysis. In the subset of patients starting an integrase-inhibitors (INSTI)-based regimen a sensitivity analysis on the main end point of risk of VF and a separate analysis on the chance of achieving virological suppression (VS) [confirmed VL<50cp/mL] were performed. An ITT approach, ignoring treatment changes, was applied. Results: 5,349 pts were included. STRs were started in 2,240 pts and MTRs in 3,109 pts (1,128 pts MTR1; 1,981 pts MTR2). ART was started in: 2011-2013 in 2,098 pts, 2014-2015 in 1,904 pts, 2016-2017 in 1,347 pts (STRs were 22%, 52% and 59% of the regimens, respectively). Regimens were based on: INSTI in 31%, PI/b in 33% and NNRTI in 36% pts, respectively. The 2-year probability of VF was higher in MTR versus STR group (2.9% vs 1.4%, p<0.001). However, after stratifying MTR group by number of pills/administrations, the risk of VF was higher in MTR2 vs STR group (p<0.001), but comparable between MTR1 and STR groups (p=0.442). By multivariable analysis, after controlling for main confounders, MTR2 group was associated to a higher risk of VF compared to STR (aHR=2.69, p=0.012), whereas no differences were observed between MTR1 and STR groups [Fig 1a, 1b]. In pts starting an INSTI-based regimen, the 2-year probability of VF (1.35% in STRs vs 1.27% in MTRs, p=0.708) and of VS (93.3%

512 BETTER VIROLOGICAL OUTCOMES WHEN INITIATING EARLY ART IN THE HPTN 071 (POPART) TRIAL Geoffrey Fatti 1 , Ashraf Grimwood 1 , Jean B. Nachega 2 , Jenna Nelson 2 , Kelsea LaSorda 2 , Gert U. van Zyl 3 , Nelis Grobbelaar 4 , Helen Ayles 5 , Richard Hayes 6 , Nulda Beyers 3 , Sarah Fidler 7 , Peter Bock 8 1 Kheth’Impilo, Cape Town, South Africa, 2 University of Pittsburgh, Pittsburgh, PA, USA, 3 Stellenbosch University, Cape Town, South Africa, 4 Anova Health Institute, Johannesburg, South Africa, 5 London School of Hygiene & Tropical Medicine– Zambia, Lusaka, Zambia, 6 London School of Hygiene & Tropical Medicine, London, UK, 7 Imperial College London, London, UK, 8 Stellenbosch University, Stellenbosch, South Africa Background: There have been concerns about reduced adherence and HIV viral suppression (VS) amongst clinically well HIV-positive people initiating antiretroviral treatment (ART) with high pre-ART CD4 counts. We compared virological outcomes in individuals initiating ART irrespective of CD4 count in the HPTN 071 (PopART) trial in South Africa, in which ART initiation irrespective of CD4 count was offered prior to routine implementation. Methods: This cohort study included adults initiating ART between Jan. 2014–Nov. 2015 at three facilities providing ART irrespective of CD4 count. VS (viral load <400 copies/ml), time to first virological failure (VF) (>1000 copies/ ml) and viral rebound (>400 copies/ml) amongst those achieving VS were compared between individuals in three strata of baseline CD4 count up to 30 months after starting ART, using routine facility data. Results: 1901 participants were included, of whom 477 (25.1%), 1024 (53.9%) and 400 (21.0%) had baseline CD4 counts <200, 200–499 and ≥500 cells/ µL, respectively. Amongst those with baseline CD4 count ≥500 cells/µL, VS was ≥94% at all six-monthly intervals to 30 months. Between months 18–30, the risk of an elevated viral load (>400 copies/ml) was 70% lower amongst those with baseline CD4 count ≥500 cells/µL (3.3%) compared to those with baseline CD4 count 200-499 cell/µL (9.2%), adjusted relative risk (aRR)=0.30 (95% CI: 0.12–0.74, P=0.010); while those with baseline CD4 count <200 cells/ µL had an increased risk (23.4%), aRR=2.40 (95% CI: 1.52–3.79; P<0.0001). The incidence of VF was inversely related to baseline CD4 count, declining from 7.0 per 100 person-years for those with baseline CD4 count <200 cells/µL, to 2.0 for those with CD4 count 200–499 cells/µL to 0.5 for those with CD4 count ≥500 cells/µL (P<0.0001); and after 24 months the cumulative probability of VF was 19.8%, 5.3%, and 0.7% in those same groups, respectively (Figure 1). In multivariable analyses, participants with baseline CD4 count ≥500 cells/µL had

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