CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

Results: The baseline cohort included 1060 patients with viral suppression in 2015: 72%male, 28% female; 32% ages 18-44, 68%≥ 45 years; 66%White, 31% Black, and 23% Hispanic. At clinic intake: 19% had unstable housing; 37%with psychiatric illness; 45%men who have sex with men; 19% injection drug use, 43% non-injection drug use; 35% foreign-born. Among the 1060 patients, 834 (79%) had viral suppression, 116 (11%) were non-suppressed, and 110 (10%) had no PVLs, in 2016. Among the 834 with viral suppression in 2016, 683 (82%) had viral suppression, 72 (9%) were non-suppressed, and 79 (9%) had no PVLs, in 2017. In sum, over the two years of follow-up, 683 (64%) maintained suppression, 188 (18%) became non-suppressed, and 189 (18%) had missing PVL data. In the bivariate analysis, younger age (p=0.001) and not being retained in care during 2015 (p=0.01), or during 2016-17 (p=0.02), were associated with non-suppression. In the multivariate analysis, increasing age was negatively associated with non-suppression (OR: 0.973, CI:0.958-0.988). Conclusion: U=U represents a paradigm shift in HIV prevention but requires persistent HIV viral suppression. Among patients with one year of suppression in our clinic, approximately 10% per year became non-suppressed, and suppression couldn’t be confirmed in another 10% per year due to lack of PVL testing. This has important implications for counseling, viral load monitoring, and assuring retention in care when implementing U=U, particularly for young patients who may be at higher risk for non-suppression. 1057 FACTORS ASSOCIATED WITH LACK OF VIRAL SUPPRESSION IN THE YEAR AFTER HIV DIAGNOSIS Bridget M. Whelan 1 , Paul L. Hebert 2 , Kym R. Ahrens 1 , Susan E. Buskin 3 , Matthew R. Golden 3 , Julia C. Dombrowski 3 1 University of Washington, Seattle, WA, USA, 2 VA Health Services Research & Development, Seattle, WA, USA, 3 Public Health–Seattle & King County, Seattle, WA, USA Background: Identifying factors associated with poor HIV care continuum outcomes in the first year after HIV diagnosis could guide care engagement efforts at time of HIV diagnosis. Our objective was to identify factors available in HIV surveillance and partner services (PS) interviews associated with failure to reach viral suppression within one year among newly diagnosed persons living with HIV (PLWH) in Seattle & King County, WA. Methods: We analyzed data from a population-based cohort of individuals newly diagnosed with HIV who received a PS interview in King County, 1/1/2013-6/30/2016. The outcome measure was achievement of viral suppression in a year after HIV diagnosis, defined as ≥1 viral load (VL) <200 copies/mL reported to surveillance <12 months from diagnosis date. Predictor variables included patient demographics, HIV transmission category, and value of first VL from case and laboratory surveillance; housing status, foreign birth, primary language, drug use and engagement in exchange sex from PS interviews. We compared characteristics of persons who did and did not reach suppression using a t-test for continuous variables and Pearson’s chi-squared for categorical variables. We used Poisson regression to calculate relative risks for variables associated with suppression failure and examined time to suppression with Kaplan-Meier survival curves. Results: Of 549 persons diagnosed with HIV and received a PS interview, 69 (13%) did not reach viral suppression within a year. The two groups did not differ by gender, race/ethnicity, transmission category, foreign birth, primary language, drug use, exchange sex, or median VL at the time of first report post-diagnosis. Persons who reported having no plan for HIV care at the time of HIV PS interview (N=72; 13%) were less likely to achieve suppression than those with a plan [RR 1.2 (95% CI: 1.04-1.4], as were persons with unstable housing compared to stable housing (N=81; 15%) [RR 1.2 (95% CI: 1.1-1.4)]. However, the majority (74%) of persons who reported no plan for care or unstable housing reached suppression; 42% of non-suppressed persons had one of these risk factors. In the overall population, 42%were suppressed at 3 months, 73% at 6 months, 84% at 9 months, and 87% at 12 months. Conclusion: PLWH with unstable housing or no plan for HIV care at the time of PS interviewmay benefit from early high-intensity intervention, but close monitoring of viral suppression and early identification of failure may be a more effective public health approach. 1058 THE IMPACT OF “CHURN” ON CUMULATIVE PLASMA HIV BURDEN WITHIN A POPULATION UNDER CARE Michael John Gill , Hartmut B. Krentz

to care of individuals with AHI improved the retention in care and durable viral suppression outcomes compared to those with non-AHI. Methods: For all persons newly diagnosed with HIV during 2013-2017, we defined AHI as 1) a negative antibody test and either a positive HIV RNA or 4th gen HIV Ag/Ab test or negative HIV Ab test within 30 days, or 2) a positive HIV RNA and symptoms specific to AHI. Using the NC Engagement in Care Database for HIV Outreach (NC ECHO), laboratory, drug dispense, and claims data were assessed for AHI and non-AHI patients to determine time to initial viral suppression (VL<200 copies/ml), retention in care (at least one VL <200 copies/ ml between January 2017 and June 2018 or two care visits at least 90 days apart between January 2017 and June 2018), and durable viral suppression (two most recent VLs <200 copies/ml between January 2017 and June 2018). Chi-square analyses were performed to determine if the proportions retained in care and durably virally suppressed differed by AHI vs non-AHI status. We conducted a Kaplan-Meier survival analysis to determine time to viral suppression (time between HIV diagnosis and first VL <200 copies/ml) for both AHI and non-AHI. Results: Between 2013 and 2017, a total of 6,648 (333 AHI; 6,315 non-AHI) persons were diagnosed with HIV in NC. The median time to viral suppression for AHI was 112 days (95% CI: 100-136) compared to 157 days (95% CI: 153-162) for non-AHI (log-rank test p<0.0001). AHI patients were more commonly retained in care compared to non-AHI patients, (80% versus 72% respectively; p=0.002). Durable viral suppression was achieved by 57% of AHI and 49% non-AHI (p=0.01). Conclusion: AHI prioritization as a public health emergency in NC and the subsequent coordinated response between health departments and HIV providers to expedite linkage to care among people with AHI was associated with better retention in care, time to initial viral suppression, and durable viral suppression outcomes.

Poster Abstracts

1056 IMPLEMENTING U=U IN THE HIV CLINIC: CAN WE PREDICT HIV NONSUPPRESSION? Fizza S. Gillani, Su Aung, Joseph Garland, Curt G. Beckwith Brown University, Providence, RI, USA

Background: Persons with an undetectable HIV viral load do not transmit HIV infection through condomless sex, hence the emergence of the “Undetectable equals Untransmissable (U=U)” HIV prevention strategy. We conducted a study to identify predictors of HIV non-suppression among clinic patients with one year of demonstrated HIV suppression to help inform the implementation of U=U. Methods: We analyzed data from the Immunology Center in Providence, RI, first identifying all patients with HIV viral suppression [≥ 1 undetectable (<20 copies/ml) plasma viral load (PVL) and zero detectable (≥ 20 copies/ml) PVLs] in 2015. Among this baseline cohort, we determined the proportion of patients during follow-up years 2016-17 who maintained suppression, had non-suppression [≥ 1 detectable (≥ 20 copies/ml) PVLs], or did not have any PVL data. We conducted bivariate and multivariate logistic regression analyses to identify correlates of non-suppression.

CROI 2019 415