CROI 2016 Abstract eBook

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Poster Abstracts

Results: Across sites, 1071 individuals presented for testing and were found to be HIV-infected and ART-eligible over the study period. Of those, 360 (33.6%) did not return to collect their CD4 results within 6 weeks of testing (Median CD4: 194 cells/mm 3 ). Among those who returned, 500 (70.3%) were enrolled in the prospective cohort. Median age at testing was 35 years-old, of whom 62.6%were women, 57.2%were unemployed, and 75.6% had not completed high school. Median CD4 was 244 cells/mm 3 . We found a 6.6% (n=33) refusal rate at baseline. Multivariable analyses showed fatalismwas associated with ART refusal at baseline (AOR: 1.16, p=0.02). Additional exploratory stratified analyses found that high social support attenuated the association of fatalismwith ART refusal ( Table 1 ). After three months, 77.8% (n=389) of participants were retained. Of those, 1.3% (n=5) died in 3 months prior to ART initiation, and 14.9% (n=58) reported no ART initiation by 3 months post-VCT. Conclusions: Among over 1000 HIV-infected, ART-eligible individuals presenting for VCT at 2 sites in RSA, one-third did not return for their CD4 count. Of the 500 ART-eligible individuals enrolled in our cohort, nearly 7% initially refused ART at baseline. Among those tracked for 3 months, 16% (n=63) died or had yet to initiate ART. Future interventions should be designed to focus on decreasing gaps in pre-ART care, and addressing fatalistic beliefs by optimizing social support.

1015 6-Year Retention and Immunological Response to ART by Gender: IeDEAWest Africa Thierry Tiendrebeogo 1 ; Juan Burgos-Soto 1 ; Eugene Messou 2 ; AristophaneTanon 3 ;Vivian Kwaghue 4 ; Marcel Zannou 5 ; Albert Minga 6 ; Nathalie De Rekeneire 1 ; Francois Dabis 7 ; Renaud Becquet 1 1 INSERM U897, Bordeaux, France; 2 CePReF, ACONDA, Abidjan, Côte d’Ivoire; 3 CHU de Treichville, Abidjan, Côte d’Ivoire; 4 Univ of Abuja Teaching Hosp, Abuja, Nigeria; 5 Cntr de Prise en Charge des Personnes Vivant Avec le VIH, CHNU, Cotonou, Benin; 6 Cntr Médical de Suivi de Donneurs de Sang /CNTS/PRIMO-CI, Abidjan, Côte d’Ivoire; 7 INSERM U897, ISPED, Univ de Bordeaux, Bordeaux, France Background: Gender differences were previously reported in sub-Saharan Africa for retention and immunological response to antiretroviral therapy (ART), but follow up was usually limited to the first 2-3 years after ART initiation. West Africa is among the regions of the world with the least well-performing ART programs. We evaluated gender differences on retention and immunological response in the 6 years following ART initiation in West African adults. Methods: We included all the patients of the IeDEA West Africa collaboration who initiated ART between 2002 and 2014 and had a baseline T-CD4+ lymphocyte measurement. A logistic regression analysis assessed the risk of no follow-up after ART initiation; survival analyses with Cox models assessed the risk of 6-year retention failure (defined as either dead or lost-to-follow-up). Year 2-3 and 5-6 were pooled to comply with proportional hazards assumption. The evolution of the immunological response by gender was investigated by linear mixed models. Results: A total of 49,677 patients (66.2%women) contributed 197,953 person-years of follow-up after ART initiation in 16 clinics in 9 countries. At ART initiation men were older than women (median age 40.8 years vs. 34.0 years) and had a lower median CD4 count (140/μl vs. 184/μl). Being male was associated with an increased risk of no follow-up after starting treatment (4.2% vs. 3.3%, adjusted OR (aOR) = 1.22, 95% CI =[1.12; 1.33] and with an increased retention failure probability over the first 4 years of follow-up: 17.2% vs. 13.1%, adjusted HR (aHR) =1.22, CI=[1.17; 1.28] in Year 1; 9.6% vs. 7.3%, aHR=1.11, CI=[1.05; 1.18] in Y2-3; 8.4% vs. 6.4%, aHR=1.15, CI=[1.04; 1.28] in Y4. Retention failure did not differ by gender in Y5-6 (6.7% vs. 5.8%, aHR=0.95 [0.87; 1.04]). The evolution of the immunological response was similar in men and women during the 4 first months of follow- up. Frommonth 5 up to month 72, women had a better immunological response than men, allowing them to reach the 500 CD4 threshold by 54 months on average, while this was never reached for men by 72 months (Figure1). Conclusions: In the West African context, a better retention and immunological response are achieved by women in comparison to men for long periods of follow up after ART initiation. This difference on retention may disappear from the fifth year following ART initiation. Interventions targeting gender-related factors need to be tailored to improve HIV care programs’ effectiveness as soon as possible after ART initiation.

Poster Abstracts

433

CROI 2016