CROI 2015 Program and Abstracts

Abstract Listing

Poster Abstracts

Results: 1490 people were followed for 2710 person-years [median 3 (range 1-17) VL measures per person]. 65 (4%) people experienced virological rebound (rate 2.4/100 pyrs; 95% CI 1.8-3.0). Kaplan-Meier percentages with rebound by 12 and 24 months were 2.0% (95% CI 1.3-2.8) and 4.8% (3.5-6.0). After adjustment for demographic factors, increasing financial hardship, non-employment, non-homeownership, non-university education and lack of supportive network were associated with higher risk of rebound (Table). Although further adjustment for baseline non-adherence did not fully explain the associations, they were attenuated (Table). Sensitivity analysis results were consistent (37 rebounds).

Table: Association between socio-economic factors and virological rebound ( x each socio-economic factor considered in a separate model for all results;* gender/sexual orientation, ethnicity, age and clinic; # self-reported number of times ≥ 2 consecutive days of ART missed in 3 months prior to baseline (0; 1; ≥ 2); ~ per 100 person-years; ^ test for trend; aHR=adjusted Hazard Ratio) Conclusions: Even in this setting with free access to treatment and low rates of virological rebound, we observed a substantial impact of social deprivation on increased risk of rebound among people with initial virological suppression. These associations are likely mediated through non-adherence. Targeted adherence interventions and increased social support for those most at risk should be considered.

TUESDAY, FEBRUARY 24, 2015 Session P-K2 Poster Session

Poster Hall

2:30 pm– 4:00 pm ART: Monitoring and Biomarkers 561 NewMarker of Standard-of-ART Care: Percentage of Time on cART With Suppressed HIV-RNA Kamilla G. Laut 1 ; Leah C. Shepherd 4 ; Court Pedersen 2 ; Jürgen Rockstroh 3 ; Helen Sambatakou 5 ; Dzmitry Paduta 6 ; Jens D. Lundgren 1 ; Amanda Mocroft 4 ; Ole Kirk 1 ; EuroSIDA in EuroCoord 1 on behalf of EuroSIDA in EuroCoord 1 Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; 2 Odense University Hospital, Odense, Denmark; 3 University Hospital Bonn, Bonn, Germany; 4 University College London, London, United Kingdom; 5 Hippokration General Hospital, University of Athens, Athens, Greece; 6 Gomel Regional Centre for Hygiene, Gomel, Belarus Background: A WHO recommended indicator of standard-of-care for ART is proportion of individuals fully suppressed 48 weeks after ART initiation. As this is a measure of short term outcome and ART is required life-long, there is a need to consider whether other indicators are better to evaluate ART treatment programs. We evaluated a novel indicator that captures the percentage of time treated being fully suppressed (%FS) for various ART-related outcomes, in order to establish which degree of %FS is required for optimal outcome. Methods: Follow-up time for patients on cART followed in EuroSIDA after January 2001 and with ≥ 3 VL measurements after baseline was classified for %FS. %FS (HIV- RNA<50copies/mL) was assessed, censoring the first 4 months after initiation or change of cART due to VF, to allow full suppression to occur. Follow-up was until death or last follow-up, and multiple events were allowed (not for TCF or death). %FS was then associated, using Poisson regression adjusted for demographics, HIV- and non-HIV-related risk factors, with following endpoints: Virological Failure (VF) : 2 consecutive HIV-RNA ≥ 500 copies/mL; Triple Class Failure (TCF) : HIV-RNA ≥ 500 copies/mL while on cART including 2 NRTIs, 1 NNRTI or 1 PI(/r); Resistance : any new NRTI, NNRTI or major PI-mutation, Fatal/non-fatal AIDS/non-AIDS events and All-Cause Mortality . Results: 11,980 patients contributed with a median follow-up time of 4.5 [IQR 1.9-7.6] years and 14 [6-24] VL-measurements. 25%were female, median age was 40.9 [35.3-48.1] years, CD4 cell count at baseline 428 [282-605]/mm 3 , and median %FS 93.6 [74.1-100]%. Adjusted incidence rate ratios (aIRRs) tended to increase above 1 for lower %FS for all endpoints evaluated, compared with %FS 90-94% (Fig). The threshold for significantly elevated risk however differed depending on the endpoint evaluated from below 70% (VF aIRR 3.61 [95%CI 2.91-4.47]), to 80% (resistance aIRR 3.01 [1.50-6.02]), to 90% for TCF (aIRR 2.41 [1.10-5.28]) and to 95% for new clinical events aIRR 0.78 [0.62-0.99] and death aIRR 0.66 [0.42-1.02].

Poster Abstracts

361

CROI 2015