CROI 2015 Program and Abstracts

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Poster Abstracts

serology and CD4/CD8 ratio from D0 of HIV suppression (Figure 1: box plot & Pearson’s R). Linear regression analyses using CD8 or CD4/CD8 ratio as dependent variables, and CMV serology, duration of HIV exposure, CD4 nadir and cART regimen as independent variables, confirmed a negative correlation between CMV+ serology and CD4/CD8 ratio after 1, 2 and 3 yrs of cART initiation (p<0.05, <0.001 and <0.001, respectively).

Conclusions: CMV+ serostatus is associated with poorer immunological response to cART initiation compared to CMV- serostatus despite efficient control of HIV replication. Thus, CMV serological status should be taken into account when measuring the effectiveness of antiretroviral therapy on immune restoration. 576 CD4 Response in Treatment-Naïve HIV-2 – Infected Patients: The IeDEAWest Africa Cohort Eric Balestre 1 ; Koumavi K. Ekouevi 2 ; BorisTchounga 2 ; Serge P. Eholié 3 ; Eugène Messou 4 ; Adrien Sawadogo 5 ; RodolpheThiebaut 1 ; MargaretT. May 6 ; Jonathan A. Sterne 6 ; François Dabis 1 1 Univ Bordeaux, ISPED, Centre Inserm U897-Epidemiologie-Biostatistique, Bordeaux, France; 2 Programme PAC-CI, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d’Ivoire; 3 Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d’Ivoire; 4 Centre de Prise en Charge de Recherche et de Formation, Hôpital Yopougon Attié, Abidjan, Côte d’Ivoire; 5 Institut Supérieur des Sciences de la Santé, Université Polytechnique de Bobo-Dioulasso, Bobo-Dioulasso, Burkina Faso; 6 School of Social and Community Medicine, Bristol University, Bristol, United Kingdom Background: Response to antiretroviral therapy (ART) among individuals infected with human immunodeficiency virus type 2 (HIV-2) is poorly understood. We compared the immunological response among patients treated with three nucleoside reverse transcriptase inhibitors (NRTIs) and with protease inhibitor (PI) based regimens. Methods: This prospective cohort study enrolled HIV-2-infected patients within the International epidemiological Database to Evaluate AIDS (IeDEA) collaboration in West Africa. Patients aged >17 years at ART initiation and with an HIV-2 infection confirmed by two or three rapid HIV tests were eligible. Only those patients who initiated ART with three NRTIS or a PI-based regimen were included. The treatment effects on CD4 count were estimated with linear mixed models over 24 months. To address possible informative dropout we performed a sensitivity analysis restricted to patients remaining in care. Results: Of 422 HIV-2-infected patients, 389 (92.2%) were treated with a PI-based regimen and 33 (7.8%) with three NRTIs. Treatment groups were comparable with regard to gender (54.5% female), median age at ART initiation (45.3 years; interquartile range [IQR] 38.3-51.8), clinical stage (17.3% at CDC stage C or WHO stage IV) and median length of follow-up (22.5 months; 4.3-45.6). Baseline median CD4 count was 164 cells/ m l (76-250) in the PI-based regimen group compared to 192 cells/ m l (114-308) in the three NRTIs regimen group (p=0.07). Twenty-four months after starting ART there were 17 deaths in total (4.0%, p=1.00) and 33% of patients were lost to follow-up (p=0.98). CD4 count response to ART was significantly higher for patients with a lower initial CD4 count (p=0.047) and for women (p=0.016). CD4 count recovery at 6 months was lower for patients treated with three NRTIs than for those treated with a PI (-53 cells/ m l; 95% CI -105;-1, p=0.046). This difference was no longer significant at 12 months (-43 cells/ m l; -102;17, p=0.16) and 24 months (+4 cells/ m l; -81;89, p=0.92). The results of the sensitivity analysis restricted to patients remaining in care were similar. Conclusions: In this observational study using African data, PI-containing regimens had similar immunological response than triple NRTI combinations at 12 months. A randomized clinical trial is still required to determine the best initial regimen for treating HIV-2 infection. 2:30 pm– 4:00 pm ART: Mortality 577 Mortality and Retention After 12 Months in a Cohort of Patients InitiatedWith the NewWHO Recommendations in Uganda John Ssali; Juan Gonzalez Perez; Jonathan Ikapule; Lydia Buzaalirwa; Kate Ssamula; Augustine Lubanga; Sulaiman Kawooya; Monday Busuulwa; Penninah Lutung Amor; Michael Wohlfeiler AIDS Healthcare Foundation, Kampala, Uganda Background: The 2013 WHO guidelines recommend to start ART in all individuals with CD count 500 cells/mm 3 or less regardless clinical stage. Evidence for clinical benefit of initiation between 350-500 cells is limited and relies mainly in observational studies from high income countries. Concerns about high risk of defaulting in those patients have also been raised. Here we present data on retention and mortality after 12 months on treatment from a cohort of patients initiated on ART with less than 500 CD4 cells in Uganda as part of a pilot on early ART initiation. Methods: Data from adult patients started on ART between December 2012 and August 2014 in four facilities ran by AIDS Healthcare Foundation in Uganda was included and stratified in three categories according to their baseline CD4 count: 0-200, 201-350 and 351-500 cells. Kaplan Meier estimates of mortality and retention after 12 months on ART were calculated for each group. WEDNESDAY, FEBRUARY 25, 2015 Session P-K4 Poster Session Poster Hall

Poster Abstracts

370

CROI 2015