1544. Uptake and Virologic Outcomes of One-pill versus Multi-pill Antiretroviral Therapy Among Treatment-naïve Non-perinatally HIV-infected Youth (2006-2014)
Session: Poster Abstract Session: HIV Pediatric and Adolescents
Friday, October 28, 2016
Room: Poster Hall
Background: Youth with HIV often struggle with sustaining adherence to antiretroviral therapy (ART). Decreased pill burden may be associated with better ART adherence and several one pill (1-pill) regimens are recommended for first line ART for youth. We evaluated the factors associated with initiation of 1-pill vs. multi-pill ART and the related virologic outcomes in treatment naïve non-perinatally HIV-infected (nPHIV) youth.

Methods: Retrospective analysis of treatment-naïve nPHIV youth ages 12-24 followed at 19 US HIV clinical sites in the HIV Research Network from 2006-2014. Cox proportional hazards regression was used to assess time to initial virologic suppression (<400 copies/mL) within the first year. Demographic and clinical factors associated with initiation of 1-pill vs. multi-pill ART and virologic suppression 1 year (± 3months) after initiation were assessed using multivariable logistic regression.

Results: Of 1646 treatment-naïve nPHIV youth, 62% initiated 1-pill ART (72% EFV/TDF/FTC), with increasing proportion yearly (47% in 2006 to 78% in 2014). Male gender (AOR 5.63, 95% CI: 3.63-8.74) and CD4 count >200cells/mm3(AOR 1.79, 95% CI: 1.34-2.37) were independently associated with increased likelihood of 1-pill initiation. Adjusting for other factors (sex, race, baseline CD4 and viral load (VL), adult vs. pediatric site, HIV risk) 1-pill ART was associated with increased likelihood of initial viral suppression within 1 year of initiation compared to multi-pill (HR 1.16, 95% CI: 1.03-1.31). For those with VL data at 9-15 months, adjusting for the same factors, use of 1-pill ART was associated with virologic suppression (AOR 1.80, 95%CI 1.28-2.52). A similar proportion in the 1-pill and multi-pill groups did not have VL data 9-15 months after ART initiation (37% and 39% respectively).

Conclusion: Use of 1-pill ART is associated with greater likelihood of initial virologic suppression as well as sustained suppression 1 year after ART initiation. Over 1/3 of nPHIV youth in both groups had no available VL measurements 1 year after ART initiation, suggesting that a significant proportion are sub-optimally engaged in care. Use of 1-pill ART may improve virologic suppression among youth, however, interventions to sustain engagment in care are critical to ultimately improving overall outcomes in this age group.

David Griffith, BS1, Charles Farmer, BS1, Richard Rutstein, MD2, W. Christopher Mathews, MD, MSPH3, Robert Beil, MD4, P. Todd Korthuis, MD, MPH5, Stephen Berry, MD1, Ank E Nijhawan, MD, MPH, MSCS6, Aditya Gaur, MD7, Kelly Gebo, MD, MPH, FIDSA1, Allison Agwu, MD, ScM8 and HIV Research Network, (1)Johns Hopkins University School of Medicine, Baltimore, MD, (2)Children's Hospital of Philadelphia, Philadelphia, PA, (3)University of California at San Diego, San Diego, CA, (4)Montefiore Medical Group, New York, NY, (5)Oregon Health & Sciences University, Portland, OR, (6)University of Texas Southwestern Medical Center, Dallas, TX, (7)St. Jude's Children's Research Hospital, Memphis, TN, (8)Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD

Disclosures:

D. Griffith, None

C. Farmer, None

R. Rutstein, None

W. C. Mathews, None

R. Beil, None

P. T. Korthuis, None

S. Berry, None

A. E. Nijhawan, Gilead: Investigator , Research support

A. Gaur, None

K. Gebo, None

A. Agwu, None

Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.