CROI 2015 Program and Abstracts

Abstract Listing

Poster Abstracts

580 Outcomes of First ART in Latino Populations in North America and Latin America Carina T. Cesar 1 ; Mark J. Giganti 2 ; Bryan E. Shepherd 2 ; Richard Moore 3 ; Keri N. Althoff 3 ; Sonia Napravnik 4 ; Angel M. Mayor 5 ; Catherine Mc Gowan 2 ; Pedro E. Cahn 1 1 Fundacion Huesped, Buenos Aires, Argentina; 2 Vanderbilt University, Nashville, TN, US; 3 Johns Hopkins University, Baltimore, MD, US; 4 University of North Carolina, Chapel Hill, NC, US; 5 Retrovirus Research Center, Bayamon, US Background: HIV outcomes and response to ART may be influenced by viral, host, and environmental factors, and differences in health care setting. The goal of this project was to compare rates of ART failure and mortality between HIV-infected adults in Latin America to those with Latino ethnicity from North America. Methods: ART-naive HIV-infected adults who initiated first ART from 2000 to 2012 at Caribbean, Central and South American Network for HIV (CCASAnet) sites in Argentina, Chile, Honduras, Mexico and Peru were compared to those with Latino ethnicity from North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) sites. Patients were defined as Latino if they had Latin American origin or ancestry by self-report. Cox proportional hazards models compared all-cause mortality between cohorts, accounting for sex, age, AIDS at ART start, nadir CD4, calendar year, and regimen class. Prevalence of VL >400 was compared by negative binomial regression. Results: 6223 ART initiators from CCASAnet and 3250 from NA-ACCORD met inclusion criteria; median follow-up was 3.9 years (interquartile range [IQR] 1.6-6.9) and 2.7 (IQR 1.0-5.5), respectively. ART initiators in CCASAnet were younger (median 35 vs. 37 years), more likely to be female (24% vs. 20%), less likely to have acquired HIV through injection drug use (0.5% vs. 13%), more likely to have AIDS prior to ART start (34% vs. 21%), and more immunosuppressed (median nadir CD4 of 139 vs. 208) compared with NA-ACCORD ART initiators (p<0.01 for all). Nearly 90% of patients started a non-nucleoside reverse transcriptase inhibitor-based regimen in CCASAnet compared to 45% in NA-ACCORD (p<0.01). The most common initial nucleoside backbone was ZDV/3TC in CCASAnet and TDF/FTC in NA-ACCORD (68% and 56%, respectively). Subjects in CCASAnet had a higher adjusted hazard ratio for mortality (1.25, 95% confidence interval [CI]: 1.02-1.54). VL was measured less frequently in CCASAnet than NA-ACCORD (median 1.8 vs. 3.27 measures per person per year), and the percentage of VL measurements that were detectable was higher in CCASAnet (adjusted prevalence ratio=1.34, 95%CI: 1.21-1.50). Funded by NIH 2-U01-AI069923 & U01-AI069918

Poster Abstracts

Figure 1: Crude mortality rates among Latino patients at CCASAnet and NA-ACCORD sites Conclusions: Latinos starting ART in Latin America tended to be more immunosuppressed and to be at higher risk of virologic failure and death than Latinos starting ART in North America. These findings may be due to differences in health care settings, drug combinations prescribed and/or access to care. Further investigation is needed.

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CROI 2015