CROI 2019 Abstract eBook

Abstract eBook

Oral Abstracts

found in 14.3% ARV+ve and 20.0% ARV-ve samples (p=0.311), while dual NNRTI and NRTI resistance occurred in 40% ARV+ve and 2.1% ARV–ve samples (p< 0.001). Among those who were ARV-ve but self-reported daily ARV use (ARV defaulters; n=41), 75.6% had DRM; 56.4%with NNRTI-only resistance, 14.3%with dual NNRTI and NRTI resistance. There were no significant age and sex differences among either NNRTI-only resistant and dual NNRTI and NRTI resistant samples. Conclusion: These findings demonstrate high proportions of DRM among virally unsuppressed HIV-infected persons in South Africa. While these results include treatment defaulters, potential pretreatment HIVDR levels are concerning. Programmatic implications include stronger adherence support to reduce ARV defaulting, and strengthened first line ART regimens by including integrase strand transfer inhibitors (INSTIs) as a part of first line treatment. These findings support the national transition to include Dolutegravir as part of first-line ART in South Africa.

1 Epicentre, Cape Town, South Africa, 2 MSF, Nairobi, Kenya, 3 Médecins Sans Frontières, Kinshasa, Congo, The Democratic Republic of the, 4 KEMRI–Centre for Global Health Research, Kisumu, Kenya, 5 MSF, Cape Town, South Africa, 6 MSF, Paris, France, 7 Epicentre, Paris, France Background: In sub-Saharan Africa, an increasing number of patients hospitalized with advanced HIV are ART-experienced and mortality among them is extremely high during and after hospitalization. In patients on first-line ART with an elevated viral load (VL≥1000 copies/ml), WHO recommends a switch to 2nd line conditional on a 2nd elevated VL three months after the 1st one and enhanced adherence counseling, regardless of CD4 level and hospitalization status. To assess if patients may benefit from a faster switch to 2nd line, we measured rates of ARV drug resistance (DR) among ART- experienced hospitalized patients. There were previously no data available on HIV DR among these patients. Methods: A cross-sectional survey was implemented between September 2017 and April 2018 in two hospitals supported by MSF in Kinshasa (KS), Democratic Republic of Congo, and Homa Bay (HB), a rural area in Kenya. Hospitalized people living with HIV (PLWH) aged 15 years and above receiving first-line ART for at least 6 months and with CD4<350 cells/µL were invited to participate. CD4 count, VL and resistance genotype were done at inclusion. Resistance was defined as any major (intermediate/high, Stanford HIVdb) NRTI or NNRTI DR. A regimen-specific genotypic sensitivity score (sGSS) was calculated (maximum score 3, fully susceptible regimen). Results: In total, 305 participants were included after a median time of 5.3 years [IQR:2.5-10.3] on ART in KS (77%-TDF/3TC/EFV,8%-ABC/3TC/EFV) and 4.0 years [IQR:1.8-8.9] in HB (71%-TDF/3TC/EFV,11%-AZT/3TC/NVP). 69% (KS) and 54% (HB) were female, and the median age was 38 [31-48] and 40 [32-48] years. The median CD4 was 69 cells/µL [IQR:29-134] and 135 cells/µL [IQR:46- 255] in KS and HB, respectively and 70% in KS and 37% in HB had a VL≥1,000 cp/mL. Among those with CD4<50 cells/µL, 87% and 84% had a VL≥1,000 cp/ mL in KS and HB. Of those with VL≥1000cp/mL, 73% had dual-class DR in both sites, with 73% on an ineffective regimen (sGSS<2) in KS, and 74% in HB. Age, low CD4 count and suboptimal self-reported adherence were associated with treatment failure (VL≥1000cp/mL and Dual-class DR) in HB and with low CD4 (CD4<50 cells/µL) in KS. Conclusion: A high proportion of PLWH hospitalized with advanced disease and on first-line ART were resistant to their ARV treatment in each site. A fast switch to 2nd line ART after one single elevated VL or CD4<50 cells/µL should be immediately recommended to accelerate immune reconstitution and improve outcomes among those patients. Sizulu Moyo 1 , Gillian Hunt 2 , Zuma Khangelani 1 , Nompumelelo P. Zungu 1 , Edmore Marinda 1 , Musa Mabaso 1 , Karidia Diallo 3 , Cheryl Dietrich 3 , Thomas Rehle 4 1 Human Sciences Research Council, Pretoria, South Africa, 2 National Institute for Communicable Diseases, Johannesburg, South Africa, 3 US CDC Pretoria, Pretoria, South Africa, 4 University of Cape Town, Cape Town, South Africa Background: South Africa’s antiretroviral treatment (ART) programme is the largest globally with >4 million HIV-infected persons receiving standardized treatment regimens. Monitoring levels of HIV drug resistance (HIVDR) is a priority activity for the country. HIVDR testing was included for the first time in the 5th national HIV household survey conducted in 2017. Methods: Multi-stage stratified cross-sectional random sampling was used to select households for participation nationally. Dried blood spots were tested to determine HIV status, estimated recency of infection, exposure to antiretroviral drugs (ARVs), and HIVDR in addition to behavioral data from all household members who agreed to participate. HIVDR testing was conducted on HIV-positive samples with viral load ≥1000 copies/ml using next generation sequencing methodologies. Results: Of 1107 HIV positive samples from virally unsuppressed participants, 697 (63%) were successfully amplified by polymerase chain reaction and sequenced. Drug resistant mutations (DRM) were identified in 27.4% (95% CI 22.8-32.6) of samples: 18.9%(95% CI 14.8-23.8) had resistance to non- nucleoside reverse transcriptase inhibitors (NNRTIs) only, 7.8% (95% CI 5.6-10.9) had dual resistance to NNRTIs and nucleoside reverse transcriptase inhibitors(NRTIs), and 0.5% (95% CI 0.1-2.1) had resistance to second-line regimens that include protease inhibitors (PIs),NNRTIs, and NRTIs). Table 1 shows HIVDR by exposure to ARVs, sex, and age. NNRTI-only resistance was

Oral Abstracts

153 DURATION OF INFECTIOUSNESS AMONG PERSONS WITH HIV DIAGNOSED DURING 2012-2016 Nicole Crepaz , Riuguang Song, Irene Hall CDC, Atlanta, GA, USA Background: HIV treatment as prevention succeeds by reducing the duration of infectiousness (i.e., time from infection to diagnosis and from diagnosis to viral suppression). HIV testing and linkage to care efforts have been intensified over the years for promoting early HIV diagnosis and early treatment to achieve viral suppression. To evaluate the progress, we examined the time from infection to diagnosis (I-to-D) and from diagnosis to first viral suppression (D-to-VS). Methods: We analyzed data from the National HIV Surveillance System reported through June 2018 from 27 U.S. jurisdictions with complete laboratory reporting. The analyses include persons with HIV infection (PwH) diagnosed at age => 13 years during 2012-2016, whose address at the time of HIV diagnosis was in one of the 27 jurisdictions, and had CD4 and viral load tests after HIV diagnosis. The I-to-D duration was estimated based on the CD4-depletion model. The D-to-VS duration was calculated based on viral load tests. Viral suppression was defined as <200 copies/mL. We censored viral load data at the time of death or by June 30, 2018. The median time and interquartile range for both durations were examined by year when HIV diagnosis occurred, sex, age at HIV diagnosis, race/ethnicity, and transmission category. Results: Approximately 22,000 PwH per year met the inclusion criteria. The I-to-D duration shortened from 43 months for PwH diagnosed in 2012 to 39 months for PwH diagnosed in 2016 (9.3%). The D-to-VS duration shortened from 8 months for PwH diagnosed in 2012 to 5 months for PwH diagnosed in 2016 (37.5%). Both durations shortened in all sex, age, race/ethnicity, and transmission category. Younger age groups (13-24 and 25-34 years) had shorter I-to-D durations but had longer D-to-VS durations, compared to older groups (35 and older, see Table). Among race/ethnicity groups, Hispanics/Latinos had the longest I-to-D duration (47 months) and blacks had the longest D-to-VS duration (7 months). Among transmission categories, male heterosexuals had the longest I-to-D duration (70 months) and men who have sex with men and inject drugs had the longest D-to-VS duration (8 months). Conclusion: Our findings show the success of promoting early HIV diagnosis and early treatment as evidenced by the shortened duration of infectiousness over time. Delayed HIV diagnoses continue to be substantial. Targeted and intensified HIV testing and care efforts are needed to address group differences in I-to-D and D-to-VS durations.

152 HIV DRUG RESISTANCE IN SOUTH AFRICA: RESULTS FROM A POPULATION-BASED HOUSEHOLD SURVEY

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CROI 2019