562. Management and Outcomes of Patients with Acute HIV Infection in an Expanded Testing and Linkage to Care Program
Session: Poster Abstract Session: HIV: Linkage to Care and Viral Suppression in the Care Cascade
Thursday, October 4, 2018
Room: S Poster Hall
Background: Persons with acute HIV infection have high viral loads and are highly infectious compared to 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 (2016-17) 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 6 sites (5 acute care hospitals/emergency departments, 1 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.

Moira C. McNulty, MD1, Jessica Schmitt, LCSW1, Eleanor Friedman, PhD1, Bijou Hunt, MA2, Audra Tobin, BSPH3, Anjana Bairavi Maheswaran, MPH4, Janet Lin, MD, MPH4, Richard Novak, MD4, Beverly Sha, MD5, Arthur Moswin, MD6, Breon Rose, MA7, David Pitrak, MD, FIDSA1 and Nancy Glick, MD8, (1)Section of Infectious Diseases and Global Health, University of Chicago Medicine, Chicago, IL, (2)Sinai Health System, Chicago, IL, (3)Infectious Diseases, Mount Sinai Hospital, Chicago, IL, (4)University of Illinois at Chicago, Chicago, IL, (5)Rush University Medical Center; Division of Infectious Diseases, Chicago, IL, (6)Michael Reese Research and Education Foundation, Chicago, IL, (7)Friend Family Health Center, Chicago, IL, (8)Infectious Diseases, SINAI HEALTH SYSTEM, Chicago, IL

Disclosures:

M. C. McNulty, None

J. Schmitt, None

E. Friedman, None

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 .

A. Moswin, None

B. Rose, None

D. Pitrak, Gilead: Grant Investigator , Grant recipient and Research grant .

N. Glick, Gilead: Grant Investigator and Scientific Advisor , Grant recipient .

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