CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

939 WITHDRAWN POINT-OF-CARE RECENCY TEST TO MEASURE HIV TRANSMISSION IN KEY POPULATION IN GUATEMALA Carlos Vargas 1 , Sanny Northbrook 2 , Ricardo Mendizabal-Burastero 1 , Sandra Juárez 2 , Amalia Giron-Callejas 1 , Cesar Galindo-Arandi 3 , Lucia Saravia 4 , Salvador Soto 5 , Nasim Farach 2 1 Universidad del Valle de Guatemala, Guatemala City, Guatemala, 2 CDC, Atlanta, GA, USA, 3 Colectivo Amigos contra el Sida, Guatemala City, Guatemala, 4 Fundación Marco Antonio, Guatemala City, Guatemala, 5 Ministry of Health Guatemala, Quetzaltenango, Guatemala Background: Determining the recency of HIV infections, can help meet the UNAIDS target (90% of HIV-positive individuals knowing their status). We present preliminary results of the first point-of-care recency test in key population clinics (VICITS) in Latin America. Methods: Men who have sex with men (MSM) and transgender women (TGW) 18 years and older who were seen at three VICITS (Colectivo-Amigos-Contra-El- Sida CAS, Fundación-Marco-Antonio FMA and Quetzaltenango health centers) in Guatemala, October 2017-July 2018, were invited to participate in the study. Rapid HIV testing was performed on site, followed by HIV-1 Asanté rapid recency test (SEDIA Biosciences) for HIV+ cases. Viral load ≥1,000 copies/mL confirmed recent infections. Reverse algorithmwas used to diagnose syphilis. Sociodemographic data, risk behavior, and biological data were collected using routinely used sentinel surveillance forms and laboratory records. Data were analyzed using Stata 13.0. Results: Of 4,264 MSM and 43 TGW reported during the project period, 3,888 (81%) were from CAS. Overall prevalence was 6.5% (95% CI 5.8-7.3 n=280) for HIV and 9.3% (95% CI 8.5-10.2 n=401) for syphilis. Of 232/280 participants who agreed to take the rapid recency test, 8 (3.4%) were not classifiable and 147 (63.4%) were long term infection. Of the 77 (33.2%) with recent infection, the majority (98%) reported a VL ≥1,000 copies/mL (median 86,400 copies/ ml). Of those with recent infection, the median age was 26 years (interquartile range [IQR] 23-31), 99%were MSM, 61% self-identified as gay and 39% as bisexual, 1% reported sex work in the last 12 months, 8% reported drug use in the last 30 days, and 33% reported a syndromic STI. Highest proportion of recent infections were seen in age groups 40-49 years old (42%) compared to 20-24 years old (39%) (p=.6). Patients receiving control visits at VICITS were less likely to have recent infection compared to first time patients (Odds Ratio 0.39, 95% CI 0.27-0.57). Conclusion: Our results show a high proportion of recent infections among MSM and TGW. This data can help improve prevention interventions targeting key populations in Guatemala and Central America. The use of a point-of-care recency test can help countries allocate resources, evaluate interventions, and adjust programs as needed. 940 WITHDRAWN FIRST USE OF POINT-OF-CARE HIV RECENCY TESTS AS A SURVEILLANCE TOOL IN NICARAGUA Sanny Northbrook 1 , Carlos Vargas 2 , Ricardo Mendizabal-Burastero 2 , Jose Manuel Rodas Hernandez 1 , Andrea A. Kim 3 , Nasim Farach 1 , Aleyda Solorzano 2 , Luz Maria Romero 2 , Bharat S. Parekh 3 1 US CDC Guatemala, Guatemala City, Guatemala, 2 Universidad del Valle de Guatemala, Guatemala City, Guatemala, 3 CDC, Atlanta, GA, USA Background: Routine assessment of transmission dynamics facilitates the universal test-and-treat approach for persons living with HIV (PLHIV) and ensures that interventions target those with highest risk. Rapid recency tests can distinguish recent (on average, in the past 6 months) from non-recent infection, enabling healthcare workers to detect, monitor, and respond to recent infections. We describe the first use of point-of-care recency tests as a surveillance tool in Nicaragua. Methods: From January to July 2018, all persons diagnosed with HIV per the national HIV testing algorithm at 205 public testing sites had blood samples sent to the National Center for Diagnostic and Reference (CNDR) for confirmation. The rapid recency assay for HIV-1 (SEDIA Biosciences) was performed onsite for PLHIV diagnosed at key population clinics and at the CNDR for all other samples. Viral load testing was performed using COBAS Amplicor/Ampliprep HIV 2.0 (Roche Diagnostics) on all samples testing recent to confirm recency of infection (≥1,000 copies/mL). Surveillance variables (age, sex, sexual orientation, and place of residence) were recorded in a database. We conducted univariate analysis to describe characteristics of PLHIV with recent infection (Stata 13.0) and identified areas with statistically significant recent HIV infection (p values

psycho-social issues including perceived stigma. Online promotion of free HIVST may be key to addressing many of these barriers.

Poster Abstracts

938 IMPACT OF EARLY ART INITIATION ON PERFORMANCE OF CROSS- SECTIONAL INCIDENCE ASSAYS Ethan B. Klock 1 , Reinaldo Fernandez 1 , Leigh Anne Eller 2 , George Mwinnyaa 3 , Josphat Kosgei 4 , Hannah Kibuuka 5 , Sorachai Nitayaphan 6 , Richard D. Moore 1 , Merlin L. Robb 2 , Susan H. Eshleman 1 , Oliver Laeyendecker 3 1 Johns Hopkins University School of Medicine, Baltimore, MD, USA, 2 US Military HIV Research Program, Silver Spring, MD, USA, 3 NIAID, Baltimore, MD, USA, 4 KEMRI/ Walter Reed Proj, Kericho, Kenya, 5 Makerere Univ Walter Reed Project, Kampala, Uganda, 6 Armed Forces Research Institute of Medical Sciences in Bangkok, Bangkok, Thailand Background: Antiretroviral treatment (ART) can impact results obtained with assays used for cross-sectional HIV incidence estimation, causing inaccurate HIV incidence estimates. We evaluated the relationship between the timing of ART initiation and the performance of two HIV incidence assays (the Sedia LAg- Avidity assay and the Johns Hopkins modified BioRad-Avidity assay). Methods: We analyzed 302 samples from 55 individuals from, Thailand, Kenya, and Uganda (RV 217, Early Capture HIV Cohort Study). The average number of samples per participant was 5.5 (range 4-7); samples were collected 0.15 to 4.20 years after infection. Participants were assigned to one of three groups: never received ART (N=34); started ART 1-3 years after infection (N=12); started ART <1 year after infection (N=9). Samples were tested using the two assays. LAg- Avidity results from this cohort were compared to results from 17 participants in the Johns Hopkins HIV Cohort who started ART ~10 years after infection. All subjects on ART were virally suppressed. Results: The rate of change for LAg- Avidity values in the first year after infection was 2.77 normalized optical density units (OD-n)/year for those who never started ART, and 2.65 OD-n/year for those who started ART 1-3 years after infection. Most participants (7/9) who started ART ≤1 year after infection, did not exhibit the usual increase in LAg-Avidity values early in infection. The mean decrease in LAg-Avidity values after ART initiation was 0.94 OD-n/year for those who started ART 1-3 years after infection, compared to 0.22 OD-n/year for those who started ART ~10 years after infection (p=0.003). There was no statistically significant difference in BioRad-Avidity values among those who did and did not receive ART (p=0.069). Conclusion: Individuals who started ART 1-3 years after infection had a significantly faster decline in LAg-Avidity values than those who started ART ~10 years after infection. BioRad-Avidity values were not impacted by ART and use of this assay may provide more accurate incidence estimates in populations where ART use is unknown or inconsistent. Individuals who started ART <1 year after infection, (especially those that started ART ≤3 months after infection) had persistently low LAg-Avidity values; this could lead to overestimation of HIV incidence estimates.

CROI 2019 367