1. Henry Masur, MD Bethesda, Maryland
CROI Update 2016
Henry Masur, MD
Bethesda, Maryland
FORMATTED: MM/DD/YY
From H Masur, MD, at Washington, DC: April 15, 2016, IAS-USA.

2. Oral Abstract
Estimating the Lifetime Risk of HIV Infection in the United States Kristen Hess et al Abstract 52 CDC

3. Lifetime Risk Term “Lifetime Risk” Data for this study
Used to describe cancer risk more than infection risk
Data for this study
National HIV Surveillance System July 2015
Mortality Data-National Center for Health Statistics
Years
Model characteristics
Complex

4. Lifetime Risk of HIV Diagnosis by Transmission Group

5. Lifetime Risk of HIV Diagnosis by Race/Ethnicity

6. Lifetime Risk of HIV Among MSM by Race/Ethnicity

7. Risk for Acquiring HIV By State++

8. Conclusions Lifetime risk for HIV in the US has decreased
1.29% (2004-5) to 1.05 ( )
Currently 3 million persons (1/96 persons) currently alive will be infected
Large disparities exist among groups
Sex, race/ethnicity, risk group
Groups
Black HIV risk = 7 x whites
MSM risk = 79 x heterosexuals
Highest lifetime risk
Black MSM (1/2)
Thus millions of Americans will continue to acquire HIV infection

9. Viral Suppression in United States
Bradley et al
ABSTRACT 53
CROI 2016

10. Data Base Viral Suppression
2009 – 2013 Medical Monitoring Project (MMP)
23,125 persons: interviews and record abstraction
Viral Suppression
Definition: <200 copies/uL at last test and at all tests in last 12 months

11. Increased HIV Viral Suppression Among US Adults Receiving Medical Care,2009-13 (n=23,125)
Most Recent Viral Load
Bradley et al, CROI 2016, #53

12. Most Recent Viral Load Among US Adults Receiving Medical Care, 2009-13 (n=23,125)
Bradley et al, CROI 2016, #53

13. Women 52% 64% 18-29 year olds 32 51 30-39 year olds 47 63
Sustained Viral Suppression x 12 Months Among US Adults Receiving Medical Care, (n=23,125)
2009
2013
Women
52%
64%
18-29 year olds 32 51
30-39 year olds 47 63
African Americans 49 61
Overall 58 68
Bradley et al, CROI 2016, #53

14. Conclusions
All groups in care are increasingly likely to achieve viral suppression
Young people and non-Hispanic blacks showed the most improvement

15. HCV Outbreak in Indiana Similarities and Differences to HIV
Oral Presentation Sumathi Ramichandran, CDC

16. Networks of HCV Transmission in Rural Indiana
New Cases
312 new HCV cases identified
235 HIV- (75%), 77 HIV positive (25%)
188 new HIV cases identified
HCV sequencing
Multiple different sequences introduced into injection drug users in Indiana since 2010
Long history of transmission unlike HIV
Some patients had multiple genotypes
1a,1b, 3 with many subtypes
One big cluster of 131 patients, 2 other big clusters, 23 total clusters….so far

17. Networks of HCV Transmission in Rural Indiana Summary
Evolving Technology
Developed global hepatitis outbreak surveillance technology to analyze sequence data
HIV vs HCV transmission
Overlap was small between HIV and HCV transmission networks

18. Co-Morbidities
Cancers Associated with Viruses Borges Abstract #160

19. START: Immediate ART Prevents Cancer
HIV+ pts with CD4 >500
randomized to immediate deferred ART
Immediate ART 57% reduction in serious AIDS-related events, non-AIDS events or death
Cancer
Immediate ART group
64% lower risk of cancer
Borges et al, CROI 2016, #160

20. Immediate ART Mainly Prevents Infection-Related Cancers (KS, NHL, Cervical CA)
Infection Related Cancers Infection Unrelated Cancers
Borges et al, CROI 2016, #160

21. Conclusions
For the START Study, while the numbers are low, the reduction in cancers occurred predominantly among virus associated cancers
Effect was not totally related to RNA suppression

22. HCV

23. Liver Histology Metavir
Activity grade
• A0—No activity
• A1—Mild activity
• A2—Moderate activity
• A3—Severe activity
Fibrosis stage
• F0—No fibrosis
• F1—Portal fibrosis without septa
• F2—Portal fibrosis with few septa
• F3—Numerous septa without cirrhosis
• F4—Cirrhosis

24. Non Invasive Tests To Assess HCV Liver Fibrosis
Fibrosure/Fibrotest
Proprietary blood test
Measure:
A2 macroglobulin ALT
Apolipoprotein A1 haptoglobin
GGT total bilirubin
FIB4 (Fibrosis 4 Score)
( Age x AST ) / ( Platelets x sqr ALT )
APRI (AST to Platelet Ratio Index)
AST/AST Upper Limit of Normal /Plat Count

25. Comparison of Fibrotest, Fib4 and APRI to Assess Liver Fibrosis
Thomas A et al. CROI 2016

26. Conclusion No true gold standard Biopsy interpretation
Small sample
Interobserver variability
Fibrosure and Scoring Systems
Results are “similar” but….
Considerable patient to patient variation

27. HCV

28. Interim Sustained Viral Response Rates by Provider Type
Kattakuzhy S et al. CROI 2016

29. Visit Adherence
Kattakuzhy S et al. CROI 2016

30. Conclusions from ASCEND
Many patients with HCV can be managed by providers who do not have formal training in hepatology or infectious diseases
Adherence to visits does not correlate with outcome……as long as the patients pick up their medications