CROI 2017 Abstract e-Book

Abstract eBook

Oral Abstracts

there have been unexpected failures in clinical trials when the issues of archived mutations or duration of virologically suppression have not been taken into account. Based on the results of all these clinical trials we have learnt that the success ART simplification is determined by critical pharmacological, biological and behavioural factors such as potency and the genetic barrier of the new regimen, the presence of archived mutations, duration of virological suppression and patient’s pattern of adherence. With the advent of long-acting antiretrovirals and broadly neutralising antibodies, the interest in ART simplification has been renewed because we now have the types of drugs that would theoretically permit for the first time in HIV therapeutics the use of regimens that do not involve daily dosing of antiretrovirals. 149 TOWARD AN IDEAL ANTIRETROVIRAL REGIMEN FOR THE GLOBAL EPIDEMIC Beatriz Grinsztejn, Oswaldo Cruz Foundation - Fiocruz, Rio de Janeiro, Brazil Currently immediate initiation of antiretroviral therapy (ART) is recommended for all individuals with HIV infection. However, among the 37 million people estimated to live with HIV/AIDS, only 17 million are actively on treatment. Proper utilization of ART among HIV-infected and at risk individuals reduces morbidity, mortality, transmission and acquisition of HIV infection. With its ability to reduce viral reservoirs and preserve immune function, early use of ART is a key component in the care continuum. ART regimen choices are affected by factors such as economic differences between high resource and low- and middle-income countries (LIMC), drug availability, and considerations for use in special populations. Instead of “When to Start?”, we are left refining our answer to the question of “What to Start?”. Ideal ART regimens combine high efficacy, high tolerability, low toxicity, low pill burden, affordability and global availability. The ability to meet these criteria can be challenging in LMIC and in special populations such as pregnant women, infants, children, adolescents and those with tuberculosis or hepatitis co-infections. Transmitted drug resistance patterns among newly-infected individuals must be continuously monitored. With the scale up efforts to achieve 90-90-90 by 2020, similar considerations are needed for those transitioning to second- and third-line treatment regimens. The development of drugs for the treatment of cross-class resistance must remain a priority. Advances in drug formulations and novel compounds, such as two-drug regimens, long- acting compounds, and implantable devices for sustained drug release will further improve the clinical management of HIV prevention and treatment. 150 OVERVIEW OF THE GLOBAL BURDEN OF NONCOMMUNICABLE DISEASES IN HIV INFECTION Pragna Patel, CDC, Atlanta, GA, USA Low- and middle-income countries (LIMCs) are undergoing an ‘epidemiological transition’, in which the burden of non-communicable diseases (NCDs) is rising and mortality will shift from infectious diseases to NCDs. Specifically, cardiovascular disease, diabetes, renal diseases, chronic respiratory diseases, and cancer are becoming more prevalent. In some regions, particularly sub-Saharan Africa, the dual HIV and NCD epidemics will pose challenges as joint burden will have adverse effects on quality of life and will likely increase global inequities. Given the austere clinical infrastructure in many LMICs, innovative models of care delivery are needed to provide comprehensive care in resource-limited settings. This talk will review the currently available evidence and data regarding burden of HIV and NCDs and discuss risk factors and clinical issues particularly relevant to HIV- infected persons. The presentation will also highlight examples of current efforts to integrate HIV and NCD care in LMICs, and discuss priorities for future research. 151 CARDIOVASCULAR DISEASE AMONGST PEOPLE LIVING WITH HIV IN AFRICA Aga Khan, Univ, Nairobi, Kenya Cardiovascular disease (CVD), and particularly atherosclerotic and thrombotic disease, is an emerging concern amongst people living with HIV (PLWHIV) in Africa. Although AIDS defining illnesses still account for majority of admissions to hospital and in critical care areas, the proportion of Non-Communicable diseases (NCDs) is significantly rising. Similarly, in the outpatient setting, cardiovascular (CV) risk factors and evidence of early atherosclerotic diseases have been found to be significant. Since the advent of efficient antiretroviral therapies and the consequent longer patient life span, an increased risk for atherosclerotic and thrombotic diseases has been observed in PLWHIV compared with the general population. The pathophysiology of accelerated atherosclerotic process and in-situ thrombosis are complex and multifactorial. Traditional CV risk factors, often not adequately addressed in HIV treatment and care programmes, uncontrolled viral replication in the untreated and exposure to antiretroviral drugs could all promote athero-thrombotic disease. Thus, despite successful antiviral therapy, numerous studies suggest a role of chronic inflammation, together with immune activation, that could lead to vascular dysfunction and athero-thrombosis. CV risk screening and care is not routinely performed in HIV programmes in Africa. Available CV risk scores also do not include young patients (<40yrs). Moreover, the novel vascular risk factors identified in HIV-related atherosclerosis, such as chronic inflammation, immune activation, and some antiretroviral agents, are not taken into account in the available risk scores. Additionally, CVD in HIV affects both arterial and venous circulation significantly. Cardiovascular prevention in HIV-infected patients presents a new challenge and require new approaches to assess and manage CV risk in HIV and also health system changes to integrate prevention and care for communicable diseases and NCDs. 152 CAN WE LEVERAGE HIV PLATFORMS FOR PREVENTION OF CERVICAL CANCER IN LMICs IN SUB-SAHARAN AFRICA? Doreen Ramogola-Masire, Univ of Botswana-Univ of Pennsylvania Collaboration, Gaborone, Botswana The vertical platform for care delivery set up as part of the emergency response to human immunodeficiency virus (HIV) has been responsible for saving many lives in lowmiddle income countries (LMICs). The unintended consequence of this has been the deterioration of health expenditure for general health infrastructure, especially for other disease entities such as non-communicable diseases (NCDs) including cervical cancer. As a result of the effective treatment for HIV, women live longer and therefore face an increased risk of developing cervical cancer later on in their lives. Cervical cancer is preventable in high income countries where sophisticated, well-functioning systems are in place. Although most of the LMICs in sub-Saharan Africa (sSA) have no access to these systems, most of them have benefited from the global funding for HIV care and treatment. Given new innovative cervical cancer prevention options available, this paper explores ways that LMICs countries in sub-Saharan Africa can leverage their single disease platforms set up for HIV care and treatment for prevention of cervical cancer. 153 MINIMIZING MORBIDITY: INTEGRATING CARE FOR DEPRESSION AND HIV IN LOW-RESOURCE SETTINGS Pamela Collins, NIMH, Bethesda, MD, USA Mental and substance use disorders are highly prevalent and rank among the leading causes of disability worldwide, accounting for nearly 20% of the global burden of disability in 2015. Among these, depressive disorders contribute the greatest burden and are the most prevalent, with an estimated 311 million cases globally in 2015. These are disabling disorders of youth, responsible for a greater percentage of disease burden among 15-49 year olds, thus affecting educational, employment, and relationship functioning. Notably, mental disorders frequently co-occur with HIV, both as risk factors and sequelae of HIV infection. Major depression occurs nearly twice as often among people with HIV infection and is associated with poor adherence to care, lower likelihood of virologic suppression, greater morbidity and mortality. Depression is associated with greater mortality in the initial years after antiretroviral initiation. Whereas access to outpatient mental health services for people with HIV care occurs frequently in wealthy countries, several barriers have impeded mental health care access in low-and middle-income countries (LMICs) with high HIV prevalence. The dearth of mental health human resources and limited investment in mental health in LMICs reduce access to care. As a result, most health professionals do not identify or treat disorders like depression in community care settings. The social stigma associated with psychiatric institutional care creates an additional barrier to seeking mental health care. The treatment landscape for HIV and depression has changed in recent years. Investments in HIV care and treatment have led to a chronic care infrastructure in some LMICs that can be leveraged to manage other potentially chronic, remitting conditions like depression. A growing evidence base for the use of task-shifting to deliver mental health services in LMICs is expanding options for non-specialists to treat depression. Recent trials demonstrate that lay health workers, nurses, and peers can be trained to effectively deliver evidence-based depression care in HIV and non-HIV treatment contexts. In addition, several validation studies show that commonly used assessments for depression can be meaningfully applied in varied contexts among HIV-positive patients. These developments, along with new goals for epidemic control, make the integration of HIV and depression care in LMICs necessary and feasible.

Oral Abstracts

60

CROI 2017