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562. Management and Outcomes of Patients With Acute HIV Infection in an Expanded Testing and Linkage to Care Program

Abstract Background Persons with acute HIV infection have high viral loads and are highly infectious compared with those with chronic infection. Rapid linkage to care and initiation of therapy, facilitated by new testing algorithms, allows for immunologic preservation and rapid virologic control, which benefits the individual and decreases transmission events. Methods We analyzed testing data (2016–2017) from the xTLC Program, a collaborative effort between 13 healthcare centers on the South and West sides of Chicago. For acute HIV infections, we assessed linkage to care, initiation of antiretroviral therapy (ART) and viral suppression across sites. Results Of 334 new HIV diagnoses in xTLC, 33 (9.9%) had acute infection across six sites (five acute care hospitals/emergency departments, one clinic). Baseline viral load (VL) was 2.19 million copies/mL (IQR 0.47–5.00) and baseline CD4 count was 440.5/µL (IQR 287.5–568.5). Table 1 shows care continuum outcomes for patients with acute HIV infection. Table 1: Care Continuum Outcomes for Acute HIV Infections Diagnosed Through X-TLC Site (N) Days to Linkage* (IQR) Days to ART* (IQR) Days to ≥2 Log Reduction in VL* (IQR) Days to VL ≤ 200* (IQR) Retained in Care** (%) Virally Suppressed (%) A (1) 27 (27–27) 9 (9–9) 55 (55–55) 55 (55–55) 1 (100.0) 1 (100.0) B (6) 11 (6–58) 21.5 (7–58) 48 (34–62) 132.5 (48–321) 4 (66.7) 4 (100.0) C (2) 39 (39–39) 53 (53–53) 95 (95–95) 162 (162–162) 1 (50.0) 1 (100.0) D (4) 3.5 (1.5–4.5) 4 (3–6) 31 (29–33) 31 (29–33) 3 (75.0) 3 (100.0) E (14) 8.5 (4–18) 5.5 (4–21) 55 (47–131) 124 (55–162) 10 (71.4) 10 (100.0) F (6) 14 (13–21) 25.5 (23–34) 92.5 (62–471) 329.5 (186–643) 4 (66.7) 4 (100.0) Total (33) 11 (5–19.5) 15 (5–27) 58.5 (42–117) 131 (54–188) 23 (69.7) 23 (100.0) *Median. **Currently in care. Conclusion Patients with acute HIV infection can be successfully managed in existing programs for HIV screening and linkage to care. The xTLC program had a high linkage to care rate, timely initiation of ART, and relatively quick reduction in viral loads. Our outcomes approach those seen for intensive immediate therapy programs, but without additional costs beyond those of the xTLC program. This will likely create similar public health benefits as dedicated programs for rapid initiation of therapy. Disclosures B. Hunt, Gilead: supported by Gilead FOCUS grant, Salary. A. Tobin, Gilead: supported by Gilead FOCUS grant, Salary. A. B. Maheswaran, Gilead: supported by Gilead FOCUS grant, Salary. J. Lin, Gilead: Grant Investigator, Grant recipient. R. Novak, Gilead: Scientific Advisor, Consulting fee. Viiv: Scientific Advisor, Consulting fee. Theratech: Scientific Advisor, Consulting fee. B. Sha, Gilead Sciences: Grant Investigator and Investigator, Grant recipient and Research grant. Viiv Healthcare: Investigator, Research grant. D. Pitrak, Gilead: Grant Investigator, Grant recipient and Research grant. N. Glick, Gilead: Grant Investigator and Scientific Advisor, Grant recipient


Background.
There is a paucity of data on factors associated with viral suppression in representative populations of HIV-positive MSM in low-middle income country (LMIC) settings. We characterized factors associated with viral suppression among a community-recruited sample of MSM across India with a particular focus on depression, alcohol use and recreational drug use.
Methods. Of 10,024 MSM recruited using respondent-driven sampling (RDS) from 10 Indian cities between August 2016 and April /2017, 1,460 were HIV-positive and eligible for ART. Alcohol dependence was defined as AUDIT score ≥15; severe depression as PHQ-9 score ≥15; recreational drug use included both injection and non-injection use of drugs common in India, excluding marijuana. Prevalence ratios (aPrR) were obtained using multivariable Poisson regression incorporating RDS2 weights and accounting for clustering by site.
Results. Median age was 37 years, 34.1% had at least high school education and 66.0% reported monthly income >$115. Prevalence of viral suppression among HIV+ ART eligible MSM was 66.2% overall, ranging from 35.2% in Bhopal to 76.1% in Madurai with no regional trends. Prevalence of severe depression was 4.0%, alcohol dependence 66.3% and recreational drug use 9.5%. Viral suppression was significantly more common among those who were older and had higher treatment literacy. In analyses that adjusted for these factors and sexual identity, those who reported drug use and had evidence of severe depression had a significantly lower likelihood of being virally suppressed (aPrR 0.38; [95% CI: 0.16-0.89]) than those with neither (P-value for interaction = 0.05). Similarly, compared with those who used neither alcohol nor drugs, those using both had a lower prevalence of viral suppression (aPrR: 0.61; [95% CI: 0.40-0.94]) although the interaction did not achieve statistical significance (P = 0.07).
Conclusion. In this population of MSM in an LMIC, recreational drug use appeared to be a key barrier to achieving viral suppression. Moreover, the impact of drug use was greater in the context of co-occurring severe depression or co-occurring alcohol dependence. It is critical that HIV programming in India and other resource-limited settings incorporate interventions to address these conditions in differentiated care models to maximize viral suppression.
Disclosures. All authors: No reported disclosures. Methods. We analyzed testing data (2016-2017) from the xTLC Program, a collaborative effort between 13 healthcare centers on the South and West sides of Chicago. For acute HIV infections, we assessed linkage to care, initiation of antiretroviral therapy (ART) and viral suppression across sites.

Management and Outcomes of Patients With Acute HIV Infection in an
Results. Of 334 new HIV diagnoses in xTLC, 33 (9.9%) had acute infection across six sites (five acute care hospitals/emergency departments, one clinic). Baseline viral load (VL) was 2.19 million copies/mL (IQR 0.47-5.00) and baseline CD4 count was 440.5/µL (IQR 287.5-568.5). Table 1 shows care continuum outcomes for patients with acute HIV infection.

Conclusion.
Patients with acute HIV infection can be successfully managed in existing programs for HIV screening and linkage to care. The xTLC program had a high linkage to care rate, timely initiation of ART, and relatively quick reduction in viral loads. Our outcomes approach those seen for intensive immediate therapy programs, but without additional costs beyond those of the xTLC program. This will likely create similar public health benefits as dedicated programs for rapid initiation of therapy. Background. The Bronx was one of the first counties in the United States to describe HIV infection, and with over 29,000 PLWH remains an epicenter of the epidemic and a major driver of US outcomes. The Bronx epidemic was historically most among minorities, with heterosexual (HSP) and IDU risk factors predominating, and poor outcomes along the care cascade. The Bronx epidemic is changing, and multiple efforts have been made to address the high needs of PLWH in the area. Up to date data would be enlightening.
Methods. We identified those age ≥18 newly diagnosed with HIV at Montefiore Medical Center, Bronx, New York in 2013 and 2016. Retrospective review was undertaken of all cases for up to 1 year after diagnosis, including demographics, clinical data, and outcomes along the care cascade. We used univariate, multivariate logistic and cox regression models to identify factors associated with linkage to HIV care (LTC), retention in care (RIC), ART prescribing, and viral load suppression (VLS).
Conclusion. The Bronx HIV epidemic has changed dramatically, reflecting new demographics and effective approaches to testing and care across the HIV care cascade. Most of the historical disparities associated with poor outcomes have been eliminated in newly diagnosed PLWH at Montefiore. These findings hold great promise for the future epidemic in the Bronx-and across the US-if the gains can be maintained and replicated.
Disclosures. All authors: No reported disclosures.