CROI 2019 Abstract eBook
1 Johns Hopkins University, Baltimore, MD, USA, 2 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 3 Southern Alberta Clinic, Calgary, AB, Canada, 4 Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA, 5 University of Washington, Seattle, WA, USA, 6 Kaiser Permanente, Oakland, CA, USA, 7 University of Alabama at Birmingham, Birmingham, AL, USA, 8 Emory University, Atlanta, GA, USA, 9 University of Toronto, Toronto, ON, Canada Background: Time to HIV RNA suppression after antiretroviral therapy (ART) initiation may impact durability of viral suppression. Our objective was to estimate risks of: a) virologic failure; b) low-level viremia (LLV); and c) viral blip by time to suppression among patients enrolled in NA-ACCORD clinical cohorts in 2006–2015. Methods: We followed 14551 new ART initiators aged ≥18 years from suppression (2 consecutive viral loads [VLs] ≤50 copies/mL [cpm]) to unsuppressed VL, death, loss to follow-up, or administrative censoring. Time to suppression was categorized as ≤6, 6–12, or >12 months. Outcomes were: a) virologic failure: 2 consecutive (≤180 days) VLs ≥200 cpm; b) LLV: 2 consecutive (≤270 days) VLs 51–199 cpm; and c) viral blip: 1 VL 51–199 cpm preceded and followed by VL ≤50 cpm (≤270 days between VLs). For each outcome, we estimated cumulative incidence (risk) and risk differences (RD) by time to suppression over 7 years, accounting for death as a competing event. Unsuppressed VL other than the outcome of interest was censored. Inverse probability weights were used to account for informative censoring and confounding by ART anchor drug (NNRTI, PI, InSTI) and other factors. Results: After starting ART, 31% (4575) of patients suppressed in ≤6 months, 41% (5912) in 6–12 months, and 28% (4064) in >12 months. Among patients who suppressed in ≤6 months, we observed 7-year weighted risks of failure, LLV, and blip of 13.7%, 5.8%, and 27.8%, respectively. Corresponding weighted risks were 15.9%, 6.6%, and 28.5% for patients who suppressed in 6–12 months, and 21.5%, 9.2%, and 26.3% for patients who suppressed in >12 months. Patients who suppressed in >12 months had a 7.8% (95% CI: 0.4%, 22.1%) higher risk of failure, 3.4% (95% CI: -1.2%, 11.1%) higher risk of LLV, and similar risk of blip (RD: -1.4%; 95% CI: -8.1%, 7.5%) compared to those who suppressed in ≤6 months. No notable differences in risks of failure, LLV, or blip were observed between patients who suppressed in 6–12 months and those who suppressed in ≤6 months. Conclusion: Suppression >12 months after ART initiation was associated with higher long-term risks of failure and LLV compared to suppression in ≤6 months; there was no association with risk of blip. Investigating whether the relationships between time to suppression and these outcomes are modified by ART regimen is warranted. Identifying barriers to achieving rapid HIV RNA response may be needed to maximize durability of viral suppression and optimize treatment as prevention efforts.
96 FACTORS ASSOCIATED WITH PERSISTENT VIREMIA WITH UNIVERSAL “TEST & TREAT” IN UGANDA Eshan U. Patel 1 , Kate Grabowski 1 , Aaron Tobian 1 , Gertrude Nakigozi 2 , Victor Ssempijja 3 , Joseph Ssekasanvu 4 , Godfrey Kigozi 2 , Fred Nalugoda 2 , Ronald H. Gray 4 , Thomas C. Quinn 3 , David Serwadda 5 , Maria Wawer 4 , Larry W. Chang 1 , Joseph Kagaayi 2 , Steven J. Reynolds 3 1 Johns Hopkins University School of Medicine, Baltimore, MD, USA, 2 Rakai Health Sciences Program, Kalisizo, Uganda, 3 National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA, 4 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 5 Makerere University College of Health Sciences, Kampala, Uganda Background: Beginning in 2013, Uganda implemented universal “test and treat” in high-risk populations, including fishing communities along Lake Victoria. Here, we use population-based data to identify characteristics associated with persistent viremia among HIV-positive individuals in hyperendemic fishing communities during “test and treat” scale-up. Methods: Between November 2011-February 2017, five surveys were conducted in four Ugandan fishing communities (>40% HIV prevalence) as a part of an open cohort of all consenting persons aged 15-49 years. HIV viral loads were assessed among HIV-positive participants at three surveys. The unit of analysis was a person-interval (two consecutive visits). Person-intervals were categorized into four outcomes based on a viral load cutoff of 400 copies/ mL: durable suppression, new/renewed viral suppression, viral rebound, and persistent viremia. Multivariate Poisson regression with generalized estimating equations and robust variance estimators was used to estimate adjusted relative risk ratios (aRRRs) and 95%CIs of persistent HIV viremia versus durable or new/ renewed viral suppression. Results: 3,404 HIV-positive individuals participated in the cohort, including 1,346 participants with viral load data at ≥2 visits (n=1,883 person-intervals). Overall, the prevalence of durable suppression was 50.4% and becoming newly suppressed was 30.3%, while the prevalences of viral rebound and persistent viremia were 2.9% and 16.4%, respectively. Over the study period, the prevalence of population-level durable suppression increased from 29.7% to 67.9%. Younger age (15-29 vs. 40-49 years; aRRR=1.93 [95%CI: 1.27-2.93]), male sex (aRRR=1.87 [95%CI: 1.32-2.65]), and being never married (vs. currently married; aRRR=1.93 [95%CI: 1.39-2.68]) were factors significantly associated with persistent viremia. Younger age and male sex were strongly correlated with high risk sexual behaviors. These findings were consistent in sensitivity analyses restricted to the most recent survey interval. Conclusion: In hyperendemic communities with universal “test and treat”, being young (<30 years), male, and never married were associated with persistent viremia. Young people had higher levels of high-risk sexual behavior suggesting those most likely to have persistent HIV viremia are also most likely to sustain HIV transmission. Programs tailored to men and high risk youth are necessary to reduce HIV transmission in sub-Saharan Africa. 97 VIROLOGIC FAILURE, LOW-LEVEL VIREMIA, AND VIRAL BLIP AFTER HIV RNA SUPPRESSION Jennifer S. Lee 1 , Keri N. Althoff 1 , Elizabeth Humes 1 , Joseph J. Eron 2 , Michael John Gill 3 , Michael A. Horberg 4 , Heidi M. Crane 5 , Mari Kitahata 5 , Michael J. Silverberg 6 , Baligh Yehia 1 , Ellen F. Eaton 7 , Neel R. Gandhi 8 , Anita Rachlis 9 , Richard D. Moore 1 , for the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) of IeDEA
98 FIFTY-PERCENT REDUCTION IN HIV INCIDENCE IN CHOKWE DISTRICT, MOZAMBIQUE, 2014-2017 Duncan A. MacKellar 1 , Robert Nelson 1 , Ricardo Thompson 2 , Isabelle Casavant 3 , Sherri Pals 1 , Ishani Pathmanathan 1 , Judite Cardoso 4 , Dawud Ujamaa 1 , Ernest L. Yufenyuy 1 , Katrina Sleeman 1 , Victor Chivurre 2 , Noela Chicuecue 2 , Keydra Oladapo 3 , Aleny M. Couto 2 , Alfredo Vergara 3 1 CDC, Atlanta, GA, USA, 2 Ministry of Health, Maputo, Mozambique, 3 CDC Mozambique, Maputo, Mozambique, 4 Jhpiego, Maputo, Mozambique Background: Reduction of HIV incidence attributed to increasing coverage of a combination of biomedical interventions (CBI) has not been evaluated in
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