CROI 2017 Abstract e-Book

Abstract eBook

Oral Abstracts

Results: Eighty of 96 enrolled children, completed the study (Table 1: clinical data) 31% and 9% of children were <12 months at enrolment and PK 3 respectively. TB therapy was started first in 73% children. A 1-compartment PK model with 1st-order absorption and elimination, with allometric scaling to adjust for weight, best fitted the data. No age effect was identified. The percentage (95% CI) of M-PK C0 levels below target was 7.6% (0.4% to 16.2%) for superboosting during rifampicin co-treatment, versus 8.8% (0.6% to 19.8%) without rifampicin. The median value of their difference 1.1% (95%CI 6.9% to 3.2%), confirmed the non-inferiority of LPV exposure during super-boosting with rifampicin to standard LPV/r without rifampicin. Three deaths were unrelated to study treatments. One case of jaundice and elevated liver enzymes occurred, treatment was interrupted but not considered associated with the medication. No electrocardiograph abnormalities occurred. 82% of children had a VL<=”” div=””> Conclusion: Super-boosting is safe and effective for TB/HIV co-treated children.

Oral Abstracts

30 HIV INCIDENCE, PREVALENCE, AND UNDIAGNOSED INFECTIONS IN MEN WHO HAVE SEX WITH MEN Sonia Singh , Ruiguang Song, Anna S. Johnson, Eugene McCray, Irene Hall CDC, Atlanta, GA, USA

Background: Gay, bisexual, and other men who have sex with men (MSM) represent approximately 2% of the United States population, yet they represent 67% of persons with HIV diagnoses in 2014. There are differences in HIV diagnoses by race/ethnicity and age, but few data are available on incidence and prevalence. We estimated HIV incidence, prevalence and percent of undiagnosed infections among MSM to better guide prevention efforts. Methods: Data from the National HIV Surveillance System on HIV diagnoses among MSM and the first CD4 test result after diagnosis were used to estimate HIV incidence, prevalence and the percentage of undiagnosed infection by racial/ethnic and age groups for 2008-2014 using a method based on a well-characterized CD4 depletion model. Results: Estimated annual HIV infections among Hispanic/Latino MSM increased from 6,100 in 2008 (95% confidence interval [CI]: 5,800, 6,500) to 7,200 (95% CI: 6,200, 8,300) in 2014, but decreased among black and white MSM, from 10,100 (95% CI: 9,600, 10,600) to 10,000 (95% CI: 8,800, 11,200) and 8,900 (95% CI: 8,500, 9,300) to 7,400 (95% CI: 6,600, 8,300), respectively. HIV prevalence increased for all racial/ethnic groups from 2008-2014. In 2014, the percentage of undiagnosed infections among black, Hispanic/Latino and white MSM were 20.4% (95% CI: 18.5%, 22.2%), 20.9% (95% CI: 18.6%, 23.1%) and 12.5% (95% CI: 11.0%, 14.0%), respectively. The percentage of undiagnosed infections decreased for all racial/ethnic groups from 2008-2014. Among MSM 13-24 years old, the estimated annual number of HIV infections (9,400 in 2008 to 7,700 in 2014) decreased (p<0.05), and prevalence decreased after 2010 (2010, 57,000; 2014, 48,000). Among MSM 25-34 years old, both the estimated annual number of HIV infections (7,100 in 2008 to 9,700 in 2014) and prevalence (84,300 in 2008 to 128,000 in 2014) increased (p<0.05). The percentage of undiagnosed infections decreased for MSM 13-24 years old (70.1% in 2008 to 52.0% in 2014) and 25-34 years old (32.3% in 2008 to 30.1% in 2014)(p<0.05). Conclusion: Decreases in HIV infections among black, white, and young (13-24 year old) MSM are encouraging, but there was an increase in HIV incidence among Hispanic/Latino MSM and MSM 25-34 years old from 2008-2014. Though there were decreases in undiagnosed HIV infections for all race/ethnic groups, expansion of HIV testing and treatment, particularly among Hispanic/Latino and MSM 13-24 and 25-34 years old, are needed to achieve the goals of the National HIV/AIDS Strategy. 31 VIRAL-LOAD DYNAMICS AMONG PERSONS WITH DIAGNOSED HIV: UNITED STATES, 2014 Nicole Crepaz 1 , Tian Tang 2 , Gary Marks 1 , Irene Hall 1 1 CDC, Atlanta, GA, USA, 2 ICF Intl, Atlanta, GA, USA Background: The most common measure of viral suppression (VS) in clinical and surveillance studies is the most recent viral load (VL) < 200 copies/mL in past 12 months. This single-value measure does not capture the VL dynamics over time. We examined durable VS, never virally suppressed, and change in VS status to offer new types of metrics that help us better understand VS patterns. Methods: We used data from the National HIV Surveillance System reported from 33 jurisdictions among persons aged ≥ 13 years with HIV infection diagnosed by year-end 2013 and alive at year-end 2014. We calculated the percentage of HIV-diagnosed persons whose last VL was <200 copies/mL in 2014 and the percentage of HIV-diagnosed persons who had durable VS (all VLs < 200 copies/mL) in 2014. Among persons who had at least 2 VLs in 2014 (indication of being in HIV care), we calculated the percentage of persons never virally suppressed (all VLs > 200 copies/mL) and created 4 groups based on the first and last VLs in 2014: both suppressed, first unsuppressed and last suppressed (improved), first suppressed and last unsuppressed (worsen), and both unsuppressed. Results: Of 630,965 persons with diagnosed HIV, 361,665 (57.3%) had the last VL suppressed and 316,442 (50.2%) had durable VS in 2014 (relative difference: 14.3%). Among 339,515 persons in HIV care, 28,782 (8.5%) persons never had suppressed VLs in 2014. The breakdown of change in VS status indicates that 75.4% had first and last VL suppressed, 10.5% improved, 4.2%worsened, and 9.9% had first and last unsuppressed. The percent “never suppressed” was higher among females than males (11.1% vs. 7.7%). Among race/ ethnic groups, blacks/African Americans had the highest percentage of persons in HIV care never virally suppressed (see Table). This racial/ethnic disparity was observed in men who have sex with men (MSM), injection drug use (IDU) for both sexes, MSM/IDU, heterosexual contact for both sexes, and other transmission category. Conclusion: Using single VL measures overestimated by 14.3% relative difference of HIV-diagnosed persons with durable VS. Half of HIV-diagnosed persons had durable VS in 2014. Among patients in HIV care, more showed improving than worsening VS status, yet 8.5% never had a suppressed VL within a 12-month period and racial/ethnic disparities were observed in this outcome. Targeted clinical interventions are needed to help patients achieve and maintain durable VS.

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CROI 2017