Accuracy of Self-Reports of HIV Viral Load Status and Risk Factors for Inaccurate Reporting of Viral Suppression Among Racial/Ethnic Minority Persons Living with HIV

Abstract Background Much of the prior research on viral failure (VF) with integrase inhibitor (INSTI) therapy is based on results from trials rather than clinical care settings and little is known about recently approved medications such as dolutegravir (DTG). We compared VF in persons living with HIV (PLWH) who initiated DTG-based vs. other guideline recommended regimens in clinical care across the United States. Methods PLWH from eight CFAR Network of Integrated Clinical Systems (CNICS) sites who started a recommended regimen between August 2013 and August 2016 were included. We compared DTG vs. other INSTI, and vs. darunavir-based (DRV) regimens included in current guidelines for initiating antiretroviral therapy (ART). VF was defined as a viral load of >400 copies/ml >6 months after initiation. We used Cox models adjusting for age, sex, race/ethnicity, hepatitis B, hepatitis C, tuberculosis, HIV risk factor, CD4 count, days since last HIV viral load, and site. PLWH were censored at death, regimen change or loss to follow-up (LTFU) with sensitivity analyses varying LTFU definitions from 0 to 12 months after last activity and including/excluding inverse probability censoring weights based on variables in the main models. Results Among 6636 PLWH who initiated a recommended regimen, a lower proportion on DTG-based regimens experienced VF during follow-up (Figure). The adjusted hazard ratio (HR) for VF for DTG vs. DRV-based regimens was 0.56 (95% confidence interval 0.37–0.86). In sensitivity models, the HR for VF for DTG vs. other INSTI regimens ranged from 0.73 to 1.07 depending on LTFU definitions. The HR for DTG vs. DRV-based regimens ranged from 0.38 to 0.63 depending on LTFU definitions. In sensitivity analyses among the 1,229 PLWH known to be ART-naive at initiation, a similar pattern was found with a lower HR of VF among those who initiated DTG vs. DRV-based regimens (HR 0.25, 95% CI 0.11–0.56). Conclusion The observed rate of VF during follow-up was lower among PLWH initiating DTG-based vs. DRV-based regimens in routine clinical care at sites across the US. Results also demonstrated that different definitions of LTFU can have a large impact on the results and highlight the importance of sensitivity analyses in informing study definitions to minimize bias. Disclosures V. Vannappagari, ViiV Healthcare: Employee and Shareholder, Salary and Stocks; K. Smith, ViiV Healthcare: Employee, Salary; C. Johannes, VIIV: Research Contractor, Research support; B. Calingaert, VIIV: Research Contractor, Research support; C. Saltus, VIIV: Research Contractor, Research grant; J. Eron, VIIV: Scientific Advisor, Consulting fee; M. S. Saag, VIIV: Grant Investigator and Scientific Advisor, Grant recipient; BMS: Grant Investigator and Scientific Advisor, Consulting fee and Grant recipient; Gilead: Grant Investigator and Scientific Advisor, Consulting fee and Research support; Merck: Grant Investigator and Scientific Advisor, Consulting fee and Grant recipient; H. M. Crane, VIIV: Scientific Advisor, Nothing to date but I have been asked to be an advisor so there may be a relationship in the future.

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111. Outcomes Related to COVID-19 Among People Living with HIV: Cohort from a Large Academic Center

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.421 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S184-S184

Author(s):

Michael D Virata ◽

Sheela Shenoi ◽

Joseph B Ladines-Lim ◽

Merceditas Villanueva ◽

Lydia Aoun-Barakat

Keyword(s):

Risk Factors ◽

Viral Suppression ◽

Case Series ◽

Adverse Outcomes ◽

Load Test ◽

Bivariate Analysis ◽

People Living With Hiv ◽

Hiv Viral Load ◽

Academic Center ◽

Living With Hiv

Abstract Background The COVID-19 pandemic has resulted in nearly 8 million cases and close to 500,000 deaths globally. Little is known about risk factors for favorable or adverse outcomes from COVID-19 among people living with HIV (PWH). Small case series have described outcomes for hospitalized PWH with COVID19. Methods This is a retrospective chart review of PWH with confirmed diagnosis of COVID-19 from 2 HIV ambulatory clinics from March 1 to May 31, 2020 in a large urban academic center that serves a substantial proportion of underserved minorities. Data on demographics, clinical characteristics, and outcomes were abstracted using a standardized data collection tool. Bivariate analysis was performed to identify correlates of hospitalization. Results Among the clinic cohort of 1469 PWH, 94 (6.4%) were tested for SARS-CoV-2 and 40 (42.5%) were positive. Fifty-percent were women, 65% were 50 years and older, 65% were black, 65% were former or active smokers, and 40% were active alcohol or substance users. The majority (90%) were on ART and 87.5% had HIV viral suppression (< 50 copies/ml). Among comorbidities, 50% had hypertension, 42.5% chronic lung disease, 42.5% cardiovascular disease (CVD), 40% obesity, 27.5% diabetes (DM), and 20% chronic kidney disease (CKD). Hospitalization occurred in 19 patients (47.5%) and of those, 4 (21%) required escalation of care. The median length of stay was 12 days (IQR5.5–15.5) and there was no inpatient mortality. Among the 12 PWH who had HIV viral load test during hospitalization, 11 (91.7%) maintained viral suppression and none of the 19 patients had ART interruption. Those who were hospitalized were more likely to be >50 years old (p=0.02); have CVD (p=0.003), DM (p=0.01), and CKD (p=0.02); or have multiple comorbidities (p=0.007) compared to those managed as outpatients. Furthermore, incremental numbers of comorbidities were associated with hospitalization (p=0.009). A history of AIDS, black race, obesity, smoking, and substance use disorders were not associated with hospitalization or adverse outcome. Conclusion In this initial and to our knowledge largest cohort in an urban academic center, PWH with COVID-19 had favorable short-term outcomes. The risk factors associated with hospitalization were older age and multiple non-HIV related comorbidities. Disclosures All Authors: No reported disclosures

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Characterizing Substance Use Typologies and Their Association with HIV Viral Load Outcomes: A Latent Class Analysis among Sexual Minority Men Living with HIV

Drug and Alcohol Dependence ◽

10.1016/j.drugalcdep.2021.108928 ◽

2021 ◽

pp. 108928

Author(s):

S.A. Meyers-Pantele ◽

J. Rendina ◽

A. Talan ◽

O. Shalhav ◽

S. Lammert ◽

...

Keyword(s):

Substance Use ◽

Viral Load ◽

Latent Class Analysis ◽

Sexual Minority ◽

Latent Class ◽

Class Analysis ◽

Hiv Viral Load ◽

Sexual Minority Men ◽

Minority Men ◽

Living With Hiv

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Predictors of virological failure among people living with HIV receiving first line antiretroviral treatment in Myanmar: retrospective cohort analysis

AIDS Research and Therapy ◽

10.1186/s12981-021-00336-0 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Anita Mesic ◽

Alexander Spina ◽

Htay Thet Mar ◽

Phone Thit ◽

Tom Decroo ◽

...

Keyword(s):

Viral Load ◽

Virological Failure ◽

Antiretroviral Treatment ◽

People Living With Hiv ◽

First Line ◽

Hiv Viral Load ◽

Loss To Follow Up ◽

History Of ◽

Living With Hiv

Abstract Background Progress toward the global target for 95% virological suppression among those on antiretroviral treatment (ART) is still suboptimal. We describe the viral load (VL) cascade, the incidence of virological failure and associated risk factors among people living with HIV receiving first-line ART in an HIV cohort in Myanmar treated by the Médecins Sans Frontières in collaboration with the Ministry of Health and Sports Myanmar. Methods We conducted a retrospective cohort study, including adult patients with at least one HIV viral load test result and having received of at least 6 months’ standard first-line ART. The incidence rate of virological failure (HIV viral load ≥ 1000 copies/mL) was calculated. Multivariable Cox’s regression was performed to identify risk factors for virological failure. Results We included 25,260 patients with a median age of 33.1 years (interquartile range, IQR 28.0–39.1) and a median observation time of 5.4 years (IQR 3.7–7.9). Virological failure was documented in 3,579 (14.2%) participants, resulting in an overall incidence rate for failure of 2.5 per 100 person-years of follow-up. Among those who had a follow-up viral load result, 1,258 (57.1%) had confirmed virological failure, of which 836 (66.5%) were switched to second-line treatment. An increased hazard for failure was associated with age ≤ 19 years (adjusted hazard ratio, aHR 1.51; 95% confidence intervals, CI 1.20–1.89; p < 0.001), baseline tuberculosis (aHR 1.39; 95% CI 1.14–1.49; p < 0.001), a history of low-level viremia (aHR 1.60; 95% CI 1.42–1.81; p < 0.001), or a history of loss-to-follow-up (aHR 1.24; 95% CI 1.41–1.52; p = 0.041) and being on the same regimen (aHR 1.37; 95% CI 1.07–1.76; p < 0.001). Cumulative appointment delay was not significantly associated with failure after controlling for covariates. Conclusions VL monitoring is an important tool to improve programme outcomes, however limited coverage of VL testing and acting on test results hampers its full potential. In our cohort children and adolescents, PLHIV with history of loss-to-follow-up or those with low-viremia are at the highest risk of virological failure and might require more frequent virological monitoring than is currently recommended.

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Annual and durable HIV retention in care and viral suppression among patients of Peter Ho Clinic, 2013-2017

PLoS ONE ◽

10.1371/journal.pone.0244376 ◽

2020 ◽

Vol 15 (12) ◽

pp. e0244376

Author(s):

Debbie Y. Mohammed ◽

Lisa Marie Koumoulos ◽

Eugene Martin ◽

Jihad Slim

Keyword(s):

Medical Care ◽

Viral Suppression ◽

Virologic Failure ◽

Private Insurance ◽

Retention In Care ◽

P Value ◽

Hiv Viral Load ◽

Cross Sectional ◽

Persons Living With Hiv ◽

Urban Clinic

Objectives To determine rates of annual and durable retention in medical care and viral suppression among patients enrolled in the Peter Ho Clinic, from 2013–2017. Methods This is a retrospective review of medical record data in an urban clinic, located in Newark, New Jersey, a high prevalence area of persons living with HIV. Viral load data were electronically downloaded, in rolling 1-year intervals, in two-month increments, from January 1, 2013 to December 31, 2019. Three teams were established, and every two months, they were provided with an updated list of patients with virologic failure. Retention and viral suppression rates were first calculated for each calendar-year. After patients were determined to be retained/suppressed annually, the proportion of patients with durable retention and viral suppression were calculated in two, three, four, five and six-year periods. Descriptive statistics were used to summarize sample characteristics by retention in care, virologic failure and viral suppression with Pearson Chi-square; p-value <0.05 was statistically significant. Multiple logistic regression models identified patient characteristics associated with retention in medical care, virologic failure and suppression. Results As of December 31, 2017, 1000 (57%) patients were retained in medical care of whom 870 (87%) were suppressed. Between 2013 and 2016, decreases in annual (85% to 77%) and durable retention in care were noted: two-year (72% to 70%) and three-year (63% to 59%) periods. However, increases were noted for 2017, in annual (89%) and durable retention in the two-year period (79%). In the adjusted model, when compared to current patients, retention in care was less likely among patients reengaging in medical care (adjusted Odds Ratio (aOR): 0.77, 95% CI: 0.61–0.98) but more likely among those newly diagnosed from 2014–2017 (aOR: 1.57, 95% CI: 1.08–2.29), compared to those in care since 2013. A higher proportion of patients re-engaging in medical care had virologic failure than current patients (56% vs. 47%, p < 0.0001). As age decreased, virologic failure was more likely (p<0.0001). Between 2013 and 2017, increases in annual (74% to 87%) and durable viral suppression were noted: two-year (59% to 73%) and three-year (49% to 58%) periods. Viral suppression was more likely among patients retained in medical care up to 2017 versus those who were not (aOR: 5.52, 95% CI: 4.08–7.46). Those less likely to be suppressed were 20–29 vs. 60 years or older (aOR: 0.52, 95% CI: 0.28–0.97), had public vs. private insurance (aOR: 0.29, 95% CI: 0.15–0.55) and public vs. private housing (aOR: 0.59, 95% CI: 0.40–0.87). Conclusions Restructuring clinical services at this urban clinic was associated with improved viral suppression. However, concurrent interventions to ensure retention in medical care were not implemented. Both retention in care and viral suppression interventions should be implemented in tandem to achieve an end to the epidemic. Retention in care and viral suppression should be measured longitudinally, instead of cross-sectional yearly evaluations, to capture dynamic changes in these indicators.

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