CROI 2019 Abstract eBook
107 IMPACT OF PrEP ON DRUG RESISTANCE AND ACUTE HIV INFECTION, NEW YORK CITY, 2015-2017 Kavita Misra , Jamie Huang, Demetre C. Daskalakis, Chi-Chi Udeagu New York City Department of Health and Mental Hygiene, Long Island City, NY, USA Background: A major concern for PrEP use is possible induction of drug resistance by prescribing PrEP to persons with undiagnosed HIV infection. Such persons may not have been screened appropriately for HIV or may have been screened during the window period between HIV exposure and infection. However, no data are available to determine the frequency of this phenomenon. Methods: Using data from cases assigned for partner services from November 2015 to August 2017, we examined the viral resistance profile of recently diagnosed persons (< 12 months) in New York City (NYC) with a recent history of PrEP use to determine rates of mutations to PrEP component medications: emtricitabine (3TC) (M184I/V/IV/MV) and tenofovir disoproxil fumarate (TDF) (K65R). We compared acute HIV infection (AHI), negative NAAT, and prevalence of viral resistance in pre-diagnosis PrEP users and those with no PrEP use (never-users). Results: In this period, 95 (3%) out of 3,721 persons with a recent HIV diagnosis assigned for partner services had a report of pre-diagnosis PrEP use. Median duration of PrEP exposure before diagnosis was 3 months (IQR=7). Pre- diagnosis PrEP users were more likely than never-users to have a negative NAAT pre-diagnosis (33% vs 4%, p<0.0001), and were more likely to be diagnosed with AHI (33% vs 9%, p<0.0001). Genotypes were available for 75% of pre- diagnosis PrEP users and 62% of never-users. M184I/V/IV/MV was significantly more prevalent among pre-diagnosis PrEP users than never-users (26% vs 2%, p-value <0.0001). K65R mutations were found in 4 persons; none were pre- diagnosis PrEP users. Conclusion: In a study of recently HIV diagnosed people from NYC, persons with a history of pre-diagnosis PrEP use were significantly more likely to have resistance mutations to 3TC. There were no signature TDF mutations (K65R) detected among pre-diagnosis PrEP users. In addition, persons with a history of PrEP were significantly more likely to have AHI leading to diagnosis. The latter may be due to an effect of the PrEP or the possibility that persons receiving PrEP are more likely to be receiving health care more regularly. Only one-third of pre- diagnosis PrEP users had evidence of a negative NAAT. Our findings stress the importance of screening regularly to reduce the likelihood of PrEP start during undetected HIV infection in order to reduce the risk of inducing drug resistance. 108 THE CURRENT STATUS OF LATENCY REVERSING AGENTS Carine M. Van Lint , Université Libre de Bruxelles, Brussels, Belgium Combination antiretroviral therapy (cART) successfully prolongs the life of HIV+ patients, prevents the development of AIDS and substantially reduces the risk of HIV-1 transmission. However, cART is not curative and patients must adhere to a life-long cART regimen, leading to a new set of complications and making of HIV a chronic disease. Indeed, cessation of cART invariably leads to a rapid rebound of the virus in most patients. HIV-1 persistence is notably due to the existence
106 PERSISTENCE WITH HIV PREEXPOSURE PROPHYLAXIS IN THE UNITED STATES, 2012-2016 Ya-Lin A. Huang , Guoyu Tao, Dawn K. Smith, Karen W. Hoover CDC, Atlanta, GA, USA Background: Daily oral preexposure prophylaxis (PrEP) with Truvada is highly effective in preventing HIV infection with adherence to daily dosing and persistence with PrEP during periods of HIV risk. We estimated persistence and associated factors among a cohort of PrEP users with commercial health insurance. Methods: Using data from the IBM® MarketScan® Research Databases, we created a cohort of PrEP users aged 18-64 years who initiated PrEP between 1/1/2012 and 12/31/2016. We restricted our analysis to persons continuously enrolled in their health plans for at least 6 months prior to and 6 months after their initial PrEP prescription. We monitored each person’s medication fill persistence, defined as time from the initial PrEP prescription fill until there was a gap in prescription fills >30 days. Patients were considered nonpersistent if they did not refill within 30 days after exhausting PrEP medications from previous fills. We used Kaplan-Meier time-to-event methods to estimate the proportion of PrEP users who persisted with PrEP at 6 and 12 months after initiation. We censored patients if they disenrolled from insurance or were diagnosed with HIV prior to nonpersistence. We conducted Cox proportional hazards models for nonpersistence adjusting for sex, age, urbanicity, and region. Results: In our cohort of 7,250 commercially insured PrEP users, 98.2%were male, and 10.6%were aged 18-24 years. During the study period, after initiation 74.8% of PrEP users persisted for 6 months, and 55.7% for 12 months. The median persistence was 14.5 months (95% CI=13.9-15.0), but was significantly shorter for female PrEP users (6.9 months; 95% CI=4.7-11.6) and for users aged 18-24 years (8.6 months; 95% CI=7.4-9.3). After adjusting for other factors, we found that PrEP users who were female, young, and resided in rural area were less likely to be persistent users. The Kaplan-Meier curves of PrEP persistence stratified by age group demonstrated that PrEP persistence increased with age. Only 36.6% of the users aged 18-24 years persisted for 12 months, compared to 65.3% aged 55-64 years. (Figure) Conclusion: More than half of commercially insured persons who initiated PrEP persisted with it for 12 months. However, women and young users persisted with PrEP for shorter times than men or older adults. We were not able to assess reasons for PrEP nonpersistence. A better understanding of patient factors for nonpersistence is important to support PrEP use for persons who might benefit from it during periods of risk.
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