CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

Methods: We analyzed data from persons at least 13 years old with HIV diagnosed in 2012–2017 and reported through June 2018. Infections were classified as acute if there was a negative or indeterminate HIV-1 antibody test ≤60 days after the first confirmed positive HIV-1 test, or a negative/ indeterminate antibody test or qualitative HIV-1 nucleic acid test (NAT) ≤180 days before the first positive test, if the first positive test was a NAT or detectable viral load. To accommodate reporting delay, for assessing the trend in detecting AHI, we examined data from 2012–2016. Data from 2015–2017 were used to assess characteristics associated with AHI. Results: From 2012 to 2016, while the annual numbers of HIV diagnoses remained stable, the percentage of those that were classified as acute at diagnosis increased from 1.3% (535 of 40,939) to 4.0% (1,563/39,459); preliminary 2017 data show that 3.9%were AHI (1,484/38,182). Of the 117,465 cases diagnosed during 2015–2017, 4,251 (3.6%) were AHI. AHI was associated with all demographic characteristics examined (P<0.0001). The percentage of persons whose HIV infection was acute at diagnosis was higher among those who were white, Hispanic/Latino, or other race, aged 13-24 years, or had HIV infection attributable to both male-to-male sexual contact and injection drug use or male-to-male sexual contact alone, or when diagnoses were made in emergency departments, STD clinics, or inpatient settings (Table). Conclusion: The increase in the percentage of persons with AHI diagnosed from 2012 to 2017 suggests that implementation of the recommended laboratory HIV testing algorithm has enhanced the ability to identify AHI in surveillance data, although increased testing early in infection may have played a role as well. Health departments should ensure complete and accurate collection of laboratory data and prompt recognition of AHI to prioritize follow-up and optimize opportunities for treatment and prevention.

to urgent PrEP scale-up, efforts to reduce CAI and address STIs are critical for effective HIV prevention in this population. 846 RISK FACTORS FOR HIV INFECTION AMONG MSM IN THE ANRS IPERGAY PrEP TRIAL Marine Pillet 1 , Marine Pillet 1 , Eric Cua 2 , Catherine Capitant 1 , François Raffi 3 , Christian Chidiac 4 , Julie Chas 5 , Cécile Tremblay 6 , Armelle Pasquet 7 , Brigitte Guillon 1 , Bruno Spire 8 , Constance Delaugerre 9 , Laurence Meyer 1 , Guillemette Antoni 1 , Jean-Michel Molina 9 , for the ANRS IPERGAY Study Group 1 INSERM, Villejuif, France, 2 CHU de Nice, Nice, France, 3 CHU de Nantes, Nantes, France, 4 CHU de Lyon, Lyon, France, 5 Tenon Hospital, Paris, France, 6 Centre Hospitalier de l’Université de Montreal, Montreal, QC, Canada, 7 Centre Hospitalier de Tourcoing, Tourcoing, France, 8 INSERM, Marseille, France, 9 Hôpital Saint-Louis, Paris, France Background: In the ANRS IPERGAY trial, on demand pre-exposure prophylaxis (PrEP) has been demonstrated to be highly effective in preventing HIV infection among men who have sex with men (MSM). We aimed to identify MSM who would benefit the most from PrEP by assessing baseline risk factors for HIV infection in this population. Methods: We analyzed baseline data from participants enrolled in the placebo arm of the ANRS IPERGAY trial or infected between pre-enrollment and baseline, and who completed the online questionnaire. We analyzed socio-demographic characteristics, past use of psychoactive substances and sexual behavior as risk factors for HIV infection. HIV incidence rate ratios (RR) were estimated with their 95% Confidence Intervals (CI). Results are reported in the table. Results: 203 MSM were included in this analysis, with a median age of 34 years (IQR: 29-42). Overall, 16 HIV infections occurred during a median follow-up of 9 months (IQR: 5-20). The number of sexual partners in prior 2 months (≥10 vs. <10) and the number of condomless receptive anal sex episodes in prior 12 months (≥6 vs. <6) were associated with a significantly increased risk for HIV infection (RR: 3.1; 95%CI [1.1-9.9] and RR: 3.3; 95%CI [1.2-10.2] respectively), whereas those with mostly insertive sexual practices were at lower risk (RR: 0.1, 95%CI: 0-0.6). A diagnosis of bacterial STI at baseline was not significantly associated with an increased risk. Participants who met casual partners in backrooms/sex-clubs or in private sex-parties were also at increased risk for HIV infection (RR: 3.9; 95%CI [1.1-26.8] and RR: 2.9; 95%CI [1.1-9.5] respectively). The use of ketamine, MDMA, GHB/GBL or drugs for erectile dysfunction in prior 12 months was associated with a significantly increased risk of HIV infection. We found no association with age, education level, having a steady partner, or tobacco, alcohol and cannabis consumption in prior 12 months, but being enrolled in Paris was associated with a significant increased risk of HIV infection (RR: 4.1; 95%CI [1.1-28.3]). Conclusion: MSM who have frequent condomless receptive anal sex, multiple partners met in backrooms/sex-clubs or in private sex-parties, or use drugs for sex should be particularly targeted in prevention programs in particular if they live in an area with a high prevalence of HIV infection.

Poster Abstracts

848 DIAGNOSIS OF HIV INFECTION WITHIN 1 YEAR OF ACQUISITION, US, 2010-2016 Alexandra Balaji , Azfar Siddiqi, Anna S. Johnson, Angela L. Hernandez, Baohua Wu, Riuguang Song CDC, Atlanta, GA, USA Background: Diagnosis of HIV infection soon after acquisition is important for preventing transmission and improving clinical outcomes. Data on time from HIV infection to diagnosis can be used as an indicator of success of testing programs. Methods: We used National HIV Surveillance System data reported through June 2018 to estimate HIV incidence and number of diagnoses among persons with recent infection (<=12months) in each year from 2010-2016 using the CD4 depletion model. We then estimated the probability of receiving a diagnosis within 12 months of HIV infection and assessed trends, using estimated annual percentage change (EAPC), in the probability of receiving a diagnosis within 12 months of infection over a six-year (2010-2015) period. Trends were assessed overall and by age at HIV diagnosis, race/ethnicity, transmission category, and region of residence at diagnosis. Results: During 2010-2015, the overall probability of HIV diagnosis within one year of acquiring infection remained stable between 35.1% and 33.9% (EAPC

847 IMPROVED DETECTION OF ACUTE HIV IN THE UNITED STATES, 2012-2017 Laurie Linley , Richard M. Selik, Kevin P. Delaney, Alexandra M. Oster CDC, Atlanta, GA, USA Background: Timely detection of acute HIV infection (AHI) can lead to earlier treatment and prevent further transmission. In June 2014, CDC recommended use of a laboratory HIV diagnostic testing algorithm that facilitates detecting AHI. We used laboratory data reported to the National HIV Surveillance System to examine trends in and demographic associations with diagnosis of AHI.

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