1422. Acute HIV infection (AHI): Trained Service Linkage Workers and 4th Generation Assay Significantly Shorten Time to Antiretroviral Therapy Initiation.
Session: Poster Abstract Session: HIV: Rapid ART Initiation
Friday, October 6, 2017
Room: Poster Hall CD
Background:Identification and early initiation of antiretroviral therapy (ART) during acute HIV infection (AHI) can preserve the immune system, reduce HIV reservoir size, and prevent transmission. We aimed to characterize patients with symptomatic AHI and their linkage/retention to care in a county clinic.

Methods: Retrospective chart review of 60 patients diagnosed with AHI from 7/2012 to 4/2017 at two county hospitals emergency departments in Houston, TX. We compared the interval between diagnosis and initiation of ART before and after implementation of an AHI protocol in 11/2014 comprised of trained service linkage workers and use of the 4th generation Ag/Ab combination assay as newly recommended by the CDC in 6/2014. AHI was defined as 1) detectable HIV RNA or reactive 4th generation Ag/Ab combination assay with non-reactive HIV-1 antibody, 2) reactive 3rd generation Ab assay and negative/indeterminate Western blot (WB), or 3) positive WB that is negative for p31 band. CDC and DHHS definitions were used for linkage to and retention to care respectively. 

Results: 10 patients were diagnosed prior to AHI protocol (25-month period) and 50 after (31-month period). 92% established care with 78% retention. Median age 34 years (IQR 25-42), with 78% men, 58% Hispanic, 36% Black non-Hispanic, 50% men having sex with men. Presenting symptoms include fever 78%, chills 47%, malaise/fatigue 47%, nausea 38%, sore throat 37%, and headache 37%. Physical exam findings include rash 20%, pharyngeal edema/erythema 14%, cervical lymphadenopathy 8%, and thrush 7%. Baseline median CD4+ T cell count was 205 cells/µl (IQR 123-350), median HIV RNA 4.75 x 106 copies/mL (IQR 1.1-10.0 x 106). 56% had leukopenia, 47% thrombocytopenia, 37% syphilis, 12% aseptic meningitis and 8% K103N mutation. Median time to ART initiation decreased from 17 days (IQR 11.75-23.5) to 7 days (IQR 4.0-13.25) after protocol implementation (p=0.011).

Conclusion: Employing trained service linkage workers and the new CDC testing algorithm significantly decreased time to initiating ART, which may improve long-term outcomes in these patients. However, 14% of patients were lost to follow-up, highlighting the need for a strategy to maintain engagement of care.

Daniel Smith, M.D.1, Qianmiao Gao, BS2, Hongyu Miao, MS, PhD.2, Oswaldo Gutierrez, B.A3, Cecilio Martinez, B.S4, Karen Vigil, MD5, Netanya S. Utay, MD6 and Roberto Arduino, MD7, (1)Internal Medicine, University of Texas McGovern Medical School at Houston, Houston, TX, (2)The University of Texas School of Public Health, Houston, TX, (3)Ryan White Medical Case Management, Harris Health, Houston, TX, (4)Ryan White Case Management, Harris Health, Houston, TX, (5)The University of Texas Health Science Center at Houston, Houston, TX, (6)Department of Internal Medicine, Division of Infectious Diseases, University of Texas Medical Branch, Galveston, TX, (7)Internal Medicine/Infectious Diseases, The University of Texas Health Science Center at Houston, Houston, TX

Disclosures:

D. Smith, None

Q. Gao, None

H. Miao, None

O. Gutierrez, None

C. Martinez, None

K. Vigil, None

N. S. Utay, None

R. Arduino, None

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