CROI 2015 Program and Abstracts

Abstract Listing

Poster Abstracts

Conclusions: For persons in whom CD4 counts were available, there has been a gradual, sustained increase in median CD4 counts at presentation to HIV care in Kampala, Uganda from 2005 to 2013; however, a substantial proportion (20%) still present with advanced AIDS and CD4<100. In light of the current ART start guidelines, more effort is required to ensure eligible patients enroll into care. 574 Implications of Poor CD4 Recovery During HIV Suppressive ART in Sub-Saharan Africa Marieke E. de Pundert 1 ;Tamara Sonia Boender 1 ; Raph L. Hamers 1 ; Kim Sigaloff 1 ; Cissy M. Kityo 2 ; Alani S. Akanmu 3 ; MaureenWellington 4 ;Tobias F. Rinke deWIt 1 ; Pascale Ondoa 1 Pan African Studies to Evaluate Resistance (PASER) studygroup 1 Amsterdam Institute for Global Health and Development, Brasschaat, Belgium; 2 Joint Clinical Research Centre Kampala, Kampala, Uganda; 3 Lagos University Teaching Hospital, Lagos, Nigeria; 4 Newlands Clinic, Harare, Zimbabwe Background: Achieving undetectable plasma viral load (VL) on antiretroviral therapy (ART) is not always accompanied by the recovery of CD4 count. This study evaluates determinants, clinical outcomes and time trends of poor CD4 recovery in patients receiving suppressive ART in the Pan-African Studies to Evaluate Resistance Monitoring (PASER-M) cohort. Methods: In 2585 patients with pre-ART CD4<200 cells/ m L VL<50 RNA c/mL, poor CD4 recovery was defined as CD4<200 or gain <100 cells/ m L at month 12, and CD4<350 or gain <100 cells/ m L at month 24. Determinants were assessed using logistic regression. Clinical outcome beyond 12 months was assessed using logistic regression and Kaplan- Meier analysis. Positive predictive value (PPV) was used to determine the (change in) predictive capacity of CD4 count to identify virological failure using WHO-recommended immunological criteria, at month 12, 24 and 36. Results: At month 12, risk factors were older age ≥ 40 (OR=2.38, 95%CI1.45-3.90), nevirapine (OR=1.52, 95% CI1.05-2.22), and lower pre-ART CD4 count per 50 cells/ m L stage (OR=0.65, 95%CI 0.59-0.72). At month 24, these factors were male sex (OR=1.61, 95%CI1.12-2.31), AIDS at ART initiation (OR=0.46, CI 95%0.25-0.84), and poor CD4 recovery at month 12 (OR=9.45, CI95% 6.33-14.10). Determinants of persistent poor CD4 recovery, at both month 12 and 24, were older age (OR=3.90, CI95%1.45-10.49), lower pre-ART CD4 count (OR=0.74, CI95%0.63-0.87) and AIDS at ART initiation (OR=0.36, CI95%0.15-0.89). Poor CD4 recovery at month 12 was associated with a significantly higher risk of HIV- related mortality between month 12 and 24 (OR=3.78, CI95%1.26-11.41). Proportions of poor CD4 recovery remained stable during the follow-up period (between 12.8 and 19.8%), with persistently low predictive capacity of WHO-defined immunological criteria on virological failure throughout the observation period (PPV= 16%, 34% and 37% at month 12, 24 and 36). Conclusions: Early ART initiation prevents the occurrence of adverse clinical outcomes in the face of undetectable VL. Proportions of poor CD4 recovery do not decrease over time, suggesting that risk factors for poor CD4 recovery that were not present at baseline may emerge in the course of the treatment. Routine VL monitoring is warranted to reliably identify virological failure during early and long-term response to ART. CD4 count might carry important information on clinical outcome during suppressive ART. 575 Better CD4/CD8 Restoration in First-Line HIV-Infected CMV-Seronegative Patients Isabelle Poizot-Martin 1 ; Clotilde Allavena 2 ; Claudine Duvivier 3 ; Carla E. Cano 1 ; Francine Guillouet de Salvador 4 ; David Rey 5 ; Lise Cuzin 6 ; Antoine Cheret 7 ; Bruno Hoen 8 On behalf of the Dat’AIDS Group 1 Aix-Marseille Univ, APHM Hôpital Sainte-Marguerite, Marseille, France; 2 CHU Hotel Dieu, Nantes, France; 3 APHP–Hopital Necker–Université Paris Descartes–IHU Imagine, Paris, France; 4 CHU Archet 1, Nice, France; 5 Hôpitaux Universitaires Strasbourg, Strasbourg, France; 6 Regional Coordination for HIV, Toulouse, France; 7 Hospital Tourcoing, Tourcoing, France; 8 University Medical Center of Guadeloupe, Guadeloupe, France; 9 The Dat’AIDS Group, Nice, France Background: CMV-infection is highly prevalent among HIV-infected patients. We investigated its impact on immune reconstitution in HIV-infected patients receiving their first cART. Methods: From the French multicenter Dat’AIDS cohort, we selected patients who initiated a first cART between 2002 and 2009, maintained an undetectable plasma viral load (pVL) for at least 12 months with the same cART regimen and had a known CMV serostatus. T-cell immunophenotyping was performed before cART initiation (pre-cART), at the first undetectable pVL (D0), and every 6 months during 3 yrs. Results: 5,688 patients initiated a first cART during the study period, 503 of whom fulfilled the selection criteria (74%male, median age 43 yrs, 15.5% CDC stage C), distributed in 444(88.3%) CMV+ and 69 CMV -. Median CD4 nadir (222/mm3) and exposure to first-line cART (32.3 months) were not different by CMV status. Chronic hepatitis C (HCV-PCR+) was equally prevalent (5.2%) in CMV+ and CMV- patients. Median follow-up was shorter in CMV+(1[0.2;3.4] yrs) than in CMV- (3.4[0.3;8.4]yrs, p<0.05). Both groups had similar median pre-cART CD4 (250[162;319]/mm3) and pre-cART CD8 (772[530;1123]/mm3) values. After 3 yrs, CD4 reconstitution was comparable between the groups, while absolute and differential CD8 cell counts were higher in CMV+ (816[583;1017] vs. 615[383;849]/mm3 in CMV-, p<0.001). Bivariate analysis revealed a negative correlation between CMV+

Poster Abstracts

369

CROI 2015