994 - Risk for Viral Rebound in the Era of U=U; A CNICS Analysis

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Co-Author(s)

BH

Blake Hansen

Graduate Research Assistant
Brown University
Providence, Rhode Island
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
TL

Tao Liu

Associate Professor
Brown University
Providence, RI
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
LB

Lauri Bazerman

Project Director
The Miriam Hospital
Providence, Rhode Island
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
MD

Mari-Lynn Drainoni

Dr.
Boston University
Boston, Massachusetts
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
FG

Fizza S. Gillani

Assistant Professor
Brown Alpert Medical School, Providence RI, USA
Providence, Rhode Island
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Edward R. Cachay

Professor of Clinical Medicine
University of California, San Diego
San Diego, CA
Disclosure: Gilead (Consultant, Grant/Research Support)Merck Sciences (Grant/Research Support)
KC

Katerina Christopoulos

Associate Professor of Medicine
University of California San Francisco
San Francisco, California
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
HC

Heidi Crane

Professor
University of Washington
Seattle, Washington
Disclosure: ViiV (Grant/Research Support)
MK

Mari Kitahata

Professor
University of Washington
Seattle, WA
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
KM

Kenneth H. Mayer

Professor of Medicine
Harvard Medical School/Fenway Research Institute
Boston, MA
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
RM

Richard Moore

Professor
Johns Hopkins University
Baltimore, MD
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
SN

Sonia Napravnik

Associate Professor
UNC Chapel Hill
Chapel Hill, North Carolina
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Aadia Rana

Associate Professor of Medicine
University of Alabama-Birmingham School of Medicine
Birmingham, AL
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
BR

Benigno Rodriguez

Associate Professor of Medicine
Case Western Reserve University
Cleveland, Ohio
Disclosure: Gilead (Speaker's Bureau)ViiV (Speaker's Bureau)

Presenting Author(s)

Curt Beckwith

Associate Professor of Medicine
Alpert Medical School of Brown University/The Miriam Hospital
Providence, Rhode Island
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Background: The “Undetectable equals Untransmittable (U=U)” HIV prevention campaign is a cornerstone of HIV prevention. However, there are few recommendations to guide patients and providers in U=U implementation and limited data on risk factors for viral rebound among persons eligible for U=U.

Methods: We conducted a retrospective multi-center study using data from the CNICS HIV research network to identify risk factors for viral rebound among persons with established viral suppression [two viral loads (VL) and all VLs of < 200 copies/ul within a one-year period (U=U eligible)]. Demographics, patient-reported outcomes, and longitudinal clinical data from 21,359 persons with HIV were analyzed. To include missing data in the analysis, they were treated as a separate category. The primary outcome of viral rebound was defined as any VL > 200 copies/ul within two years after U=U eligibility. A univariable logistic regression model was conducted to identify predictors of viral rebound. Significant variables (p< 0.05) were included in a multivariable logistic regression model. Predictive values of individual variables were captured by adjusted odds ratios (aORs).

Results: From 2011-2019, 12,150 patients met criteria for U=U eligibility and had two years of follow up data. The median age was 46 (IQR: 38-53); 68% male; 51% were white, 39% black. 1544 (13%) experienced viral rebound during follow-up. Forest plot summaries of univariable and multivariable logistic regression models are in Figures 1&2. In multivariable analysis, Black race (aOR=1.56, p< 0.001); MSM-IDU risk (aOR=1.38, p=0.006); lower QoL score (aOR=1.49, p=0.005); poorer ART adherence (aOR=1.84, p< 0.001); duration of lifetime ART [aOR=1.47 (10+yrs), = 1.37 (5-10 yrs); and = 1.28 (2-5 yrs), p< 0.001]; use of InSTIs after eligibility (aOR=1.60, p< 0.001); current smoker (aOR=1.49, p< 0.001), current amphetamine (aOR=1.83, p< 0.001) or cocaine use (aOR=1.46, p=0.012), were associated with viral rebound. In both analyses, older age was protective against viral rebound.Figure 1. Summary of Univariate Logistic Regression Model

Figure 2. Summary of Multivariable Logistic Regression Model

Conclusion: We identified multiple risk factors for viral rebound among PWH with viral suppression. Further research is needed to identify synergistic risk factors that increase probability of viral rebound to inform optimal implementation of U=U.