CROI 2015 Program and Abstracts

Abstract Listing

Poster Abstracts

Conclusions: Even small delays in switch to second line ART was associated with increased virologic failure and increased death on second line among patients with low CD4 counts on first line. 572 Rapid Progression Hinders the Recovery of CD4 + T Cells Following Initiation of cART Inma Jarrin On behalf of the CASCADE Collaboration within EUROCOORD Instituto de Salud Carlos III, Madrid, Spain Background: We aimed to compare trends in CD4+ T-cell recovery after combination antiretroviral therapy (cART) initiation and proportion of patients achieving optimal CD4+ T-cell restoration (counts ≥ 500 cells/ m l) after 12, 36 and 60 months of viral suppression between rapid (RP) and non-rapid progressors (non-RP). Methods: We included HIV-1 seroconverters (SC) from CASCADE who initiated cART from naïve and achieved viral suppression within the first 6 months. Individuals were classified as RP if they experienced ≥ 1 CD4+<200 cells/ m l within 12 months from SC before cART initiation, non-RP if not. We used piecewise linear mixed-models (slopes changes at months 1 and 18) to model trends in CD4+ T-cell counts and logistic regression to calculate Odds Ratios for optimal restoration. Models were adjusted for sex, risk group, geographical origin, age and HIV-RNA at cART initiation. To compare RP and non-RP with the same baseline CD4+ T-cell count, we applied a post-estimation adjustment procedure to the results of the multivariate linear mixed model and we also fitted multivariate logistic regression models which included an adjustment for CD4+ T-cell count at cART (<100, 100-199, ≥ 200) initiation. Results: Of 4,197 individuals, 307 (7.3%) were classified as RP. Median CD4+ T-cell count profiles are shown in Figure 1. Comparison of RP and non-RP with the same baseline CD4+ T-cell count showed that RP experienced a faster CD4+ T-cell increase than non-RP in the first month [difference (95% CI) in mean CD4+ T-cell increase/month (square root scale): 1.87 (1.65; 2.10)], slightly slower increases in months 1-18 [-0.05 (-0.06; -0.03)] and no significant differences in 18-60 [0.001 (-0.010; 0.012)]. Percentage of patients achieving an optimal restoration was significantly lower in RP than non-RP at months 12 (29.0 versus 64.2%) and 36 (46.3% versus 73.2%) but not at month 60 (70.2% versus 72.3%), differences that disappeared after comparing patients with the same CD4+ T-cell count at start of cART: OR (95% CI) 0.79 (0.54; 1.15), 0.79 (0.34; 1.83) and 1.61 (0.58; 4.45) at months 12, 36 and 60, respectively.

Poster Abstracts

Conclusions: Although RP experience faster initial increases of CD4+ T-cell counts that non-RP on suppressive therapy, they are less likely to achieve optimal CD4+ T-cell restoration during the first 36 months after cART, mainly due to their lower CD4+ T-cell counts at cART initiation. 573 Increase in CD4 Counts at Presentation to ART Care Among Urban HIV Clinics in Uganda ELIZABETH K. NALINTYA 1 ; Agnes N. Kiragga 1 ; Edison Katunguka 2 ; HenryW. Nabeta 1 ; Joanita Kigozi 1 ;Yukari Manabe 4 ; David R. Boulware 2 ; Jon Kaplan 3 ; David B. Meya 1 1 Infectious Diseases Institute, Kampala Uganda, Kampala, Uganda; 2 University of Minnesota, Minneapolis, MN, US; 3 CDC Center for Global Health, Division of Global AIDS/HIV, Atlanta, GA, US; 4 Johns Hopkins University, Baltimore, MD, US Background: In resource-limited settings, the increased availability of HIV testing services, scale-up of antiretroviral therapy (ART), and revised ART initiation guidelines has led to increased accessibility to HIV care. We hypothesized that HIV-infected persons are seeking care earlier compared with the era of initial ART roll-out in sub-Saharan Africa. We investigated the median CD4 count at presentation to care and the proportion presenting with CD4 counts <100 cells/ m L from 2005 to 2013. Methods: Data on CD4 counts at enrollment in care were obtained from 8 urban municipal clinics in Kampala District (KCCA clinics) where HIV care services are supported by PEPFAR and the Infectious Disease Institute (IDI) in Uganda. Multiple linear regression examined associations with CD4 count by year. Results were adjusted for clinic site with robust standard errors to account for clustering. Results: A total of 59327 HIV-infected persons were registered for care in the KCCA clinics in 2005 – 2013, of whom 21895 (36.9%) had documented CD4 results at entry into care. Of these, 73%were women; median age was 32 years (Interquartile range: 26, 39). The median CD4 count increased steadily through the study period from 168 cells/ m L in 2005 to 263 cells/ m L in 2013 (Figure 1). Overall, there was a 20% reduction in the proportion of people presenting with CD4 <100 cells/ m L from 24.7% in 2005 to 20.2% in 2013 (P<0.001). During the study period, a greater proportion of men (35.6%) presented with CD4<100 than women (24.3%, P<0.001). After adjusting for age, gender, and clinic site, the mean increase in CD4 count at presentation per year was 6.0 cells/ m L per year (95%CI: 1.0 to 12.0 cells/ m L per year).

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CROI 2015