CROI 2016 Abstract eBook

Abstract Listing

Poster Abstracts

953

INSTI In-Class Switching on Continued Viral Suppression in the OPERA Cohort Michael B. Wohlfeiler 1 ; Felix Carpio 2 ; Philip Lackey 3 ; Cassidy Henegar 4 ; Jennifer Fusco 4 ; Michele Jonsson Funk 5 ; EdwardVonesh 6 ; Edwin DeJesus 7 ; Gregory Fusco 4 ; Anthony Mills 8 1 AIDS Hlthcare Fndn, Los Angeles, CA, USA; 2 AltaMed Hlth Services, Los Angeles, CA, USA; 3 Carolinas Hlthcare System, Charlotte, NC, USA; 4 Epividian, Inc, Durham, NC, USA; 5 Univ of North Carolina at Chapel Hill, Chapel Hill, NC, USA; 6 Northwestern Univ, Chicago, IL, USA; 7 Orlando Immunology Cntr, Orlando, FL, USA; 8 Anthony Mills, MD, Inc, Palm Springs, CA, USA Background: The US HIV guidelines include within-class switches to simpler and less frequent regimens as a valid reason for changing a regimen. With its low risk of cross- resistance and once daily dosing, clinicians may consider substituting dolutegravir (DTG) for raltegravir (RAL) in an effort to improve adherence and durability. Clinical trials have evaluated INSTI intra-class switching, however, real-world assessments of stable RAL to DTG switching is currently lacking. This study tested the hypothesis that patients stably suppressed on RAL and switched to DTG would not significantly differ in risk of virologic failure from patients who continued on RAL. Methods: Using the OPERA longitudinal database, individuals who initiated RAL after their first prospectively-collected visit were identified. Additionally, they were required to have RAL as their first INSTI regimen and achieve stable suppression (2 consecutive VL<75 copies/mL at least 90 days but not more than 365 days apart). Patients on RAL were followed from the time they first achieved stable suppression with a subset of these being followed after a switch to DTG while still stable. The primary outcome was time to virologic failure (VL>200 copies/mL). DTG-switch to RAL-continuation was compared by estimating hazard ratios (HR) with propensity score adjusted Cox proportional hazards models. Results: Out of 64,759 HIV+ individuals in OPERA, RAL had been prescribed to 9,677 patients. Of 2,755 eligible stable-suppressed patients taking RAL, 229 (8%) switched to DTG, after a median (IQR) of 1,202 (693, 1763) days on RAL. Those continuing RAL and switching to DTG were followed for a median (IQR) of 616 (275,1164) and 337 (145, 564) days, respectively. No difference in risk of virologic failure was observed for patients switching to DTG compared to those continuing on RAL (weighted HR: 0.74, 95% CI: 0.38, 1.42). In sensitivity analyses, findings were robust to alternative definitions of stable-suppression. Conclusions: Within-class switching from RAL to DTG was found to be equally successful at maintaining stable viral suppression as compared to continuing on RAL in both crude and adjusted models as well as in sensitivity analyses.

Poster Abstracts

954 The Validity of Self-Reported ART Use in Persons LivingWith HIV in Rakai, Uganda Mary K. Grabowski 1 ; Joseph Kagaayi 2 ; Ronald H. Gray 3 ; Oliver Laeyendecker 4 ;William Clarke 5 ; Steven J. Reynolds 4 ; Maria J.Wawer 3 ; David Serwadda 6 ;Thomas C. Quinn 5 ; Aaron A. Tobian 5 1 Johns Hopkins Univ, Baltimore, MD, USA; 2 Rakai Hlth Scis Prog, Entebbe, Uganda; 3 Johns Hopkins Bloomberg Sch of PH, Baltimore, MD, USA; 4 NIH, Bethesda, MD, USA; 5 Johns Hopkins Univ Sch of Med, Baltimore, MD, USA; 6 Makerere Univ Schoool of PH, Kampala, Uganda Background: Despite massive rollout of antiretroviral therapy (ART) across Sub-Saharan Africa, little is known about the validity of self-reported ART use in the general population outside of clinical trial settings. Methods: We compared self-reported ART use and non-use to a validated lab assay in 558 participants (n=337 women, 221 men) in the Rakai Community Cohort Study, who were surveyed between September 2011 and December 2011 in rural Rakai District, Uganda. The study population included 302 participants (54%) from an HIV endemic (>40% prevalence) fishing community on Lake Victoria. ART use was assessed using liquid chromatography-tandemmass spectrometry (API 4000 Triple Quadruple Mass Analyzer) which

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CROI 2016