CROI 2015 Program and Abstracts

Abstract Listing

Poster Abstracts

Results: During the 10 year study period, 6031 ART naive HIV1 infected adults initiated 3TC or FTC with TDF and either EFV (N=3878), NVP (N=862) or boosted PI (N=1291). Week 48 virological failure rates on 3TC compared to FTC were 10.8% and 3.6%with EFV (adjusted odds ratio (aOR):1.78, 95% confidence interval (95%CI):1.11-2.84), 27.0% and 11.0% with NVP (aOR: 2.09, 95%CI:1.25-3.52) and 5.3% and 4.7%with boosted PI (aOR: 1.44, 95%CI:0.51-4.03). Analysis by ITT and propensity score adjusted models gave similar results. The adjusted hazard-ratio on virological failure at week 240 using 3TC instead of FTC was 2.35 (95%CI:1.61-3.42) with EFV, 2.01 (95%CI:1.36-2.98) with NVP and 1.21 (95%CI:0.58- 2.52) with boosted PI. The time to virological suppression <400 c/mL within 48 weeks and the time to virological failure after HIV-1 RNA <400 c/mL were not significantly influenced (P>0.05) by including either 3TC or FTC in EFV, NVP or boosted PI containing regimens. Conclusions: The use of FTC as part of NNRTI containing regimens was associated with better virological responses. These findings are relevant for settings with extensive 3TC use and for including generic 3TC in cART. 567 Prevalence and Risk Factors of Multiple Micronutrient Deficiencies Pre- and Post-ART Rupak Shivakoti 1 ; Parul Christian 2 ; Nikhil Gupte 1 ; Cecilia Kanyama 3 ; Sima Berendes 4 ; Javier Lama 5 ; Richard Semba 1 ;Thomas Campbell 6 ; Amita Gupta 1 NWCS 319 and PEARLS StudyTeam 1 Johns Hopkins University School of Medicine, Baltimore, MD, US; 2 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, US; 3 University of North Carolina Project–Malawi, Lilongwe, Malawi; 4 Malawi College of Medicine-Johns Hopkins University Research Project, Blantyre, Malawi; 5 Asociacion Civil Impacta Salud y Educacion, Lima, Peru; 6 University of Colorado School of Medicine, Aurora, CO, US Background: Micronutrient deficiencies pose a special risk among immune suppressed HIV-infected adults resulting in an accelerated disease progression even when on antiretroviral therapy (ART). The objective of this study was to describe the prevalence and risk factors of multiple micronutrient deficiencies among ART-naïve HIV-infected adults from 9 countries and to test the hypothesis that micronutrient deficiencies are reduced 48 weeks post-ART initiation. Methods: A random sub-cohort (n=270) stratified by country was selected from the ACTG PEARLS clinical trial (n=1571 ART-naïve, HIV-infected adults). We measured pre-ART serum concentrations of vitamins A, B 6 , B 12 , D (25-hydroxyvitamin), E, carotenoids, ferritin, soluble transferrin receptor, and selenium in 221-2 individuals with some losses of samples during export and processing. Prevalence and risk factors (using logistic regression) of single and multiple ( ≥ 3) micronutrient deficiencies were determined using defined serum concentration cutoffs. All micronutrients, except for vitamin B 6 , vitamin B 12 , and iron markers were also measured at 48 weeks post-ART. We assessed mean changes in micronutrient concentrations from pre-ART to week 48 post-ART using multivariable random effects models. Results: Of 222 participants, 13.9%, 29.2%, 24.5% and 32.4% had 0, 1, 2 and multiple deficiencies, respectively. Pre-ART prevalence was the highest for single deficiencies of selenium (53.2%), vitamin D (42.4%), and B 6 (37.3%) with 12.1% having concurrent deficiencies of all three micronutrients. Independent risk factors for multiple micronutrient deficiencies were high inflammation and being from Brazil, India, Malawi, Peru, South Africa, Thailand and Zimbabwe relative to Haiti. In multivariable models adjusting for baseline micronutrient concentrations, gender, age, country, treatment arm, body mass index (BMI), CD4 count and viral load, mean concentrations of all the micronutrients (except vitamin D due to EFV treatment) increased (p<0.001) 48 weeks post-ART, but with minimal changes in deficiency status ( Table 1 ).

Poster Abstracts

Conclusions: Single and multiple micronutrient deficiencies are common among HIV-infected adults pre-ART initiation but vary widely between countries. Importantly, despite changes in mean concentrations of micronutrients, prevalence of individual deficiencies remains largely unchanged after 48 weeks on ART. Our results suggest that ART alone is not sufficient to improve micronutrient deficiency. 568 Detection of HIV RNA and DNA in Anal Swabs of HIV Infected Men Having Sex With Men Julian Storim 1 ; Jens Verheyen 1 ; EvaWolff 1 ; Lewin Eisele 1 ; JeremiasWohlschläger 2 ; Peter-Michael Rath 1 ; Evelyn Heintschel von Heinegg 1 ; Dirk Schadendorf 1 ; Stefan Esser 1 1 University Hospital Essen, University Duisburg-Essen, Essen, Germany; 2 University Hospital Essen, Essen, Germany Background: Unprotected anal intercourse is high-risk behavior for acquiring HIV-infection. The transmission risk depends on plasma viral loads and concomitant sexual transmitted infections (STI). However, the effect of STI and antiretroviral therapy (ART) on the detection of HIV in the anal tract has not been scrutinized in detail. Methods: 110 HIV-positive MSM, were recruited for proctological consultation at the outpatient center of the University Hospital Essen between November 2013 and February 2014. High-resolution anoscopy was performed and anal swabs were tested for N.gonorrhoeae (N.G.)-DNA, C.trachomatis (C.T.)-DNA, HPV genotypes, HI -RNA and integrated HIV DNA. Subsequently, these results were correlated with serological syphilis assays and HIV plasma viral loads (VL). Statistical analysis was performed using the Fisher’s exact test. Results: Anal condylomata acuminata were observed in 31 patients and bacterial STIs were diagnosed in 18 patients, of whom 7 patients had multiple bacterial STIs (N.G.: n=9, C.T.: n=12, T.P.: n=4). The majority of patients (89/110) carried at least one high-risk(HR)-HPV and 59 patients at least one low-risk(LR)-HPV. Bacterial STIs were associated with the presence of lymphocytes (p<0.01) and histiocytes (p<0.01) in cytological swabs. HIV-1 RNA was detected in 15 (14%) and integrated HIV DNA in 14 (13%) of 110 anal swabs. By comparing patients with ART and plasma HIV VL below the detection limit (n=88) with treatment-naïve (n=10) and patients with detectable viral loads with ART (n=12), the detection of anal HIV RNA and DNA were significantly correlated with HIV plasma VL above the detection limit (VL <40copies(c)/ml: 2/88 (RNA+) and 7/88 (DNA+) vs. VL >=40c/ ml: 13/22 (RNA+) and 7/22 (DNA+), p<0.001 and p<0.01, respectively). Of note, also in ART-treated patients with plasma HIV-RNA <40c/ml anal HIV RNA (n=2) and DNA (n=7) could be detected. Coinfection with bacterial STI was diagnosed in 3 of these 7 ART-treated patients with detectable anal HIV DNA. All of the remaining four patients without bacterial STI and with HIV plasma RNA <40 (4/74) carried three or more HR-HPV (<2 HR-HPV: 0/57 vs >3 HR-HPV: 4/17, p<0.01). Conclusions: The detection of either HIV-1 RNA or DNA in anal swabs of MSM correlates with the HIV plasma VL and the coinfection with multiple HR-HPV. However, even anal swabs from ART-treated MSM with HIV plasma VL below the detection-limit could in part be tested positive for HIV-1 RNA and DNA.

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CROI 2015