CROI 2016 Abstract eBook

Abstract Listing

Poster Abstracts

920 Depression Increases the Risk of Mortality in a Large Cohort of HIV-Infected Adults Angela Bengtson 1 ; BrianW. Pence 1 ; Heidi M. Crane 2 ; Katerina A. Christopoulos 3 ; Amy D. Heine 1 ;W. C. Mathew 4 ; Matthew Mimiaga 5 ; Richard Moore 6 ; Sonia Napravnik 1 ; Conall M. O’Cleirigh 7 ; Michael J. Mugavero 8 1 Univ of North Carolina at Chapel Hill, Chapel Hill, NC, USA; 2 Univ of Washington, Seattle, WA, USA; 3 Univ of California San Francisco, San Francisco, CA, USA; 4 Univ of California San Diego, San Diego, CA, USA; 5 Brown Univ Sch of PH, Providence, RI, USA; 6 Johns Hopkins Univ, Baltimore, MD, USA; 7 Massachusetts General Hosp, Boston, MA, USA; 8 Univ of Alabama at Birmingham, Birmingham, AL, USA Background: Depression affects 20-30% of HIV-infected adults and contributes to suboptimal antiretroviral therapy (ART) adherence and ability to maintain viral suppression. Reduced ART adherence and viral suppression associated with depression may lead to an increased risk of mortality. Depression may also independently predict an increased risk of mortality. However, the relationship between depression and mortality remains understudied in large, representative clinical cohorts of adults in HIV care. Methods: We estimated the association between depression and all-cause mortality using data from CNICS, a cohort of over 30,000 HIV-infected adults engaged in HIV care across 8 sites in the United States. CNICS collects comprehensive HIV clinical information on ART use, adherence, HIV-related labs and clinical events and vital status. Depression information in CNICS is collected by self-report using the Patient Health Questionnaire-9 (PHQ-9) at 7 of the 8 sites. Participants were included in the present analysis if they entered care between October 2004 and November 2014 and had a PHQ-9 measure within 1 year. Vital status was ascertained for all individuals. Participants were followed until death or administrative censoring (May-November 2014, depending on site), whichever date came first. Depression was defined as a PHQ-9 ≥ 10. We used Cox proportional hazards models to estimate the association between depression within 1 year of entering care and time to all-cause mortality. Results: 4,029 adults were included for a total follow-up of 10,242 person years. Nearly a third of adults (n=1,246, 31%) met the definition for depression during their first year after enrollment. Overall, 122 (3%) of participants died during the follow-up period. Depression increased the hazard of mortality by 68% (HR 1.68; 95% CI 1.09, 2.59), after adjustment for site, gender, race/ethnicity, HIV acquisition risk group and age, alcohol dependence, panic disorder, ART status and adherence, viral load, and CD4 count at enrollment. Conclusions: Depression increased the hazard of mortality among HIV-infected adults in care even after adjustment for adherence, CD4 count, viral suppression at enrollment and a number of other clinical and demographic factors. Interventions to improve depression treatment and reduce depression are urgently needed to reduce the risk of mortality among HIV-infected persons. 921 HIV Prevalence and Risk Factors in MenWho Have Sex With Men in Bamako, Mali Maria Lahuerta 1 ; Padmaja Patnaik 1 ; NouhoumTelly 2 ; Justin Knox 1 ;Tako Ballo 3 ; Adama N’dir 4 ; BouyaguiTraore 3 ; Seydou Doumbia 2 ; Avi Hakim 5 1 ICAP at Columbia Univ, New York, NY, USA; 2 ICER Mali, Bamako, Mali; 3 Cellule Sectorielle de Lutte contre le Sida, Ministere de la Sante, Bamako, Mali; 4 CDC, Bamako, Mali; 5 CDC, Atlanta, GA, USA Background: HIV prevalence in Mali is 1.1% and highest in Bamako where it is 1.6% among men. While the epidemic is concentrated in key populations, no data were available on HIV prevalence and risk-behaviors of men who have sex with men (MSM). Methods: Using respondent driven sampling, we conducted a cross-sectional survey among MSM in Bamako between October 2014 and February 2015. Eligibility criteria included being ≥18 years old, residence in Bamako or its suburbs, and having had sex with another man in the last 6 months. Participants underwent a face-to-face interview and then were counseled and tested for HIV. Weighted data analysis was conducted with RDSAT and SAS. Survey logistic procedures were used to identify factors associated with HIV in multivariate analyses, controlling for age and education. Results: We enrolled 552 MSM of which 550 (99.6%) consented to be tested for HIV. MSM in Bamako were young (65.6%were ≤24 years old) and the majority were educated (47.3% had secondary and 16.4% had university education). One-fourth (24.0%) had unprotected anal intercourse with last sexual partner and 47.1% had tested for HIV in the past 12 months. HIV prevalence among MSM in Bamako was 13.7%. Of the HIV-positive MSM, only 13.3%were already aware of their HIV status. One-third (30.4%) of the newly diagnosed HIV+ thought it was not possible for them to be HIV-positive. Of the 15 participants who already knew they were HIV-positive, 11 had enrolled in care and 9 were on treatment. Factors independently associated with HIV infection included: working as an unskilled laborer (vs. not working; aOR 10.8, 95%CI: 1.6-72.7), age of first male sexual partner >25 years vs. 15-24 years (aOR 10.1, 95%CI:3.8-27.2), being the receptive partner (aOR 48.5, 95%CI:10.6-221.0) or being both receptive and insertive (aOR 7.1, 95%CI:1.8- 27.4) with the last sexual partner, having STD symptoms in the past 12 months (aOR 4.2, 95%CI:1.6-10.9), knowing other HIV-positive MSM (aOR 5.2, 95%CI:1.7-15.9), and inability to access condoms when needed in the past 6 months (aOR 3.5, 95%CI:1.4-8.9). Identifying as female or transgender was protective against HIV infection (aOR 0.3, 95%CI:0.1-1.0). Conclusions: HIV prevalence among MSM in Bamako is 9 times higher than men in general population. Testing and awareness of HIV infection are very low. The results suggest the need for enhanced HIV services targeted for MSM in Bamako to increase HIV testing and expand the availability of free condoms.

Poster Abstracts

922

Stigma, Access to Care, and HIV Among MenWho Sell Sex in Nigeria Trevor A. Crowell 1 ; Babjide Keshinro 2 ; Stefan Baral 3 ; Sheree R. Schwartz 3 ; Rebecca G. Nowak 4 ; Sylvia Adebajo 5 ;William A. Blattner 4 ; Manhattan E. Charurat 4 ; Julie Ake 1 ; for theTRUST/ RV368 Study Group 1 US Military HIV Rsr Prog, Walter Reed Army Inst of Rsr, Silver Spring, MD, USA; 2 Walter Reed Prog - Nigeria, Abuja, Nigeria; 3 Johns Hopkins Bloomberg Sch of PH, Baltimore, MD, USA; 4 Inst of Human Virology, Baltimore, MD, USA; 5 Pop Council Nigeria, Abuja, Nigeria Background: Among men who have sex with men (MSM), men who sell sex to other men (MSS) may be subject to intersectional or compounded stigma that may affect access to healthcare and risk of HIV. The objectives of this study were to characterize stigma, access to care, and prevalence of sexually-transmitted infections (STIs) among MSS in Nigeria.

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CROI 2016