CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

Methods: From 1996 all individuals in the OLVG with a documented hiv seroconversion within 1 year (=PHI) were identified and divided in two groups: immediate cART (initiated < 3 mo. after Dx) versus deferred cART (initiated > 3 mo. after Dx). Differences in outcomes between groups were analysed for the following outcomes: immune recovery at 2, 5, and 10 years after diagnosis (CD4 counts and CD4-CD8 ratios), mortality, AIDS-related events, cardiovascular events and malignancies. Statistical analysis: Fishers Exact, Mann Whitney U test; Kaplan-Meier curves and the log rank test to compare survival curves between groups. Results: A total of 370 patients with PHI were included: 91 initiated cART within 3 months (median 1 mo., IQR 0-2 mo.)(9 interrupted cART temporarily) and 279 initiated cART after 3 months (median 25 mo., IQR 14-44 mo.). Median follow-up was longer for the deferred group (6 yrs (IQR 4-10)) compared with the immediate group (3 yrs (IQR 2-7)) (p<0,001). No significant differences between groups were found in CD4 and CD4/CD8 ratio at 5 years (median 560.0 cells/mm3 vs. 590.0 cells/mm3, p=0.572; median 0.71 vs. 0.62, p=0.084) and 10 years after diagnosis (median 550.0 cells/mm3 vs. 580.0 cells/mm3, p=0.264; median 0.74 vs. 0.66, p=0.329). Outcome rates (and KM curves) did not differ significantly between groups for mortality (2.2% vs. 5.4%, p=0,261), AIDS-related events (5.5% vs. 9.7%, p=0.218) and cardiovascular events (2.2% vs. 4.3%, p=0.532). A total of 25 malignancies (12 AIDS related; 13 non AIDS related) occurred only in the deferred group and differed therefore significantly with the immediate group (0% v. 9,0%, p=0.003) (Figure). Results remained similar when the 9 interrupters in the immediate group were excluded from the analyses. Conclusion: Immediate cART provided no benefits over deferred cART in primary HIV infection for immune recovery, mortality, AIDS-related events, and cardiovascular events. However, immediate cART significantly reduced the risk of AIDS-defining and non-AIDS-defining malignancies in this setting. 471 WITHDRAWN 472 EARLY TREATMENT IS LIKELY MORE IMPORTANT THAN PREVIOUSLY THOUGHT Katherine E. Schlusser 1 , Shweta Sharma 2 , Julia A. Metcalf 3 , Angie N. Pinto 4 , Rika Draenert 5 , Pola de la Torre 6 , Giuseppe Tambussi 7 , James Neaton 2 , Oliver Laeyendecker 8 1 The Johns Hopkins Univ, Baltimore, MD, USA, 2 Univ of Minnesota, Minneapolis, MN, USA, 3 NIAIDs, Bethesda, MD, USA, 4 Kirby Inst, Sydney, Australia, 5 Klinikum der Univ Munich, Munich, Germany, 6 Cooper Univ Hosp, Camden, NJ, USA, 7 Ospedale San Raffaele, Milano, Italy, 8 NIAID, Baltimore, MD, USA Background: The Strategic Timing of Antiretroviral Treatment (START) trial randomized persons with CD4+>500 cells/µL to immediate or deferred antiretroviral treatment (ART). START demonstrated that early ART for HIV is more beneficial than waiting until CD4+ count drops below 350 cells/µL. We examined whether CD4+ count response differed between those recently infected and those infected for a longer duration. Methods: START participants were classified into groups by duration of HIV infection (self-report)/diagnosis (documented) at study entry: 1) recently infected (<6 months) by self- report or recently infected using a multi-assay algorithm (MAA) based on serologic markers of early infection (group 1; n=373); 2) diagnosis date <6 months but recent infection not confirmed by MAA or diagnosis date 6-24 months (group 2; n=2,635); or 3) diagnosis date ≥2 years (group 3; n=1,605). Longitudinal regression was used to compare CD4+ count levels during follow-up for the immediate and deferred ART arms by duration of infection. In the deferred arm, time to CD4+<350 cells/µL or AIDS (threshold for initiating ART) was compared by duration of infection, with and without censoring for ART initiation. Results: At entry, individuals recently infected (group 1) were younger than those in groups 2 and 3 (31 vs 34 vs 40 (years), p<0.001); and more likely to be MSM (75% vs 59% vs 44%, p<0.001). Those recently infected had a higher median baseline viral load than the other two groups (27199 vs 13550 vs 9744 (copies/mL), p<0.001). The mean CD4+ difference (immediate minus deferred) over follow-up was significantly greater for those in the recent infection group compared to the two other groups (230 vs 202 and 171 cells/ µL; p<0.001). Time to CD4+ decline to 350 cells/µL or AIDS was faster among those recently infected compared to those who were not (Figure). Rates for the three groups with ART censoring were 19.7, 16.0, and 11.7 per 100 person-years (p<0.001). Conclusion: Our results demonstrate that the CD4+ count difference over follow up between the immediate and deferred ART arms was greater among those recently infected. Immediate treatment after HIV infection likely has a greater impact than previously thought, as selection into the START trial required individuals to have two CD4s > 500 cell/µL and those enrolled were less likely to be recently infected and more likely to be individuals with decreased pathogenic progression as measured by CD4+ decline.

Poster and Themed Discussion Abstracts

473 ART IN HIV PERSONS WITH PRETREATMENT VIREMIA ≤3000 C/ML: THE START STUDY Irini Sereti 1 , Roy M. Gulick 2 , Sonya Krishnan 1 , Stephen A. Migueles 1 , Adrian Palfreeman 3 , Veronique Touzeau-Römer 4 , Waldo Belloso 5 , Sean Emery 6 , Matthew Law 6

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