1. 17th European AIDS Conference (EACS)
November 6-9, 2019 in Basel, Switzerland
Faculty
Jose Ignacio Bernardino, Madrid, Spain
Pedro Cahn, Buenos-Aires, Argentina
François Raffi, Nantes, France
Our institutional partners

2. Next ARV-Trials.com webinars
CROI, Boston
AIDS, San Francisco
8th-11th March 2020
6th-10th July 2020

3. EACS GUIDELINES ART initiation Prefererred Initial TB ART regimens
Switch in
suppressed
Pregnant women
/conception TB

4. ART is recommended in all adults with HIV infection, irrespective of CD4 counts
ART is recommended irrespective of the CD4 count. In certain situations (i.e. lower CD4 count or pregnancy) there is a greater urgency to start ART immediately
Whether rapid, possibly same-day ART start is proposed to newly diagnosed persons or awaited until complementary assessments depends on the setting and medical circumstances, medical indications to start ART more urgently and risk of loss from care. To reduce loss to follow-up between diagnosis and ART initiation, structural barriers delaying the process should be addressed

5. Initial combination regimen for ART-naïve Adult HIV-positive Persons
Before selecting an ART regimen, it is critical to review:
If a woman wishes to conceive (see Table)
If a woman is pregnant (see Table)
If the person has an OI (see Table)
If the person has TB (see Table)
If the person has potential treatment limiting comorbidities: see Comorbidity section, dose adjustment for renal and liver impairment
If the person is treated with other medications: d-d-i
If the person has swallowing difficulties

6. Recommended regimens 2 NRTIs + INSTI (preferred) ABC/3TC + DTG
HLA 5701 negative
HBsAg negative
TAF/FTC or TDF/FTC or TDF/3TC + DTG
TAF/FTC/BIC
TAF/FTC or TDF/FTC or TDF/3TC + RAL qd or bid
1 NRTI + INSTI
DTG + 3TC
HBs Ag negative
HIV-VL < c/ml
CD4 count > 200 cells/ml
2 NRTIs + NNRTI
TAF/FTC or TDF/FTC or TDF/3TC + DOR
TDF/3TC/DOR
TAF/FTC or TDF/FTC or TDF/3TC + RPV
TAF/FTC/RPV
TDF/FTC/RPV
HIV-VL < c/ml
Not on proton pump inhibitor
With food
2 NRTIs + PI/r or PI/c
TAF/FTC or TDF/FTC or TDF/3TC + DRV/r or DRV/r
TAF/FTC/DRV/c

7. Switch strategies for virologically suppressed persons
INDICATIONS
Documented toxicity  
Prevention of long-term toxicity.  
Avoidance of drug-drug interactions  
Planned pregnancy or women wishing to conceive
Women who become Pregnant on ART
Ageing and/or co-morbidity with a possible negative impact of drug(s) in current regimen, e.g. on CVD risk, metabolic parameters.
Simplification: to reduce pill burden, adjust food restrictions, improve adherence and reduce monitoring needs.
Protection from HBV infection or reactivation by including tenofovir in the regimen
Regimen fortification: Increasing the genetic barrier of a regimen in order to prevent resistance (e.g. in persons with reduced adherence)
Cost reduction: switching to the generic form of their current regimen, if available.
PRINCIPLES
In case of prior virologic failures, with or without evidence of resistance, switches have to be planned especially carefully when they result in a lower genetic resistance barrier of the regimen.
A PI/r or PI/c may only be switched to unboosted ATV, an NNRTI, RAL and EVG if full activity of the 2 NRTIs in the new regimen can be assumed based on resistance data, ARV history before switching
Due to the higher genetic barrier of DTG and BIC it is currently unclear if a switch to DTG- or BIC-based regimens also requires full activity of 2 NRTIs in the combination
Proviral DNA genotyping may be useful in persons with multiple virological failures, unavailable resistance history or low-level viremia at the time of switch. Results ought to be taken cautiously as proviral DNA genotype may not detect previous resistance mutations and can also detect clinically irrelevant mutations. Therefore, routine proviral DNA genotyping is currently not recommended

8. Dual therapies supported by large randomized clinical trials or meta-analysis
DTG + RPV
3TC + DTG
3TC + (DRV/r or DRV/c)
3TC + (ATV/r or ATV/c)
In clinical trials these strategies have not been associated with more virological rebounds than triple therapy. There were a few cases of resistance development on DTG + RPV
Dual therapy options supported only by small trials
DRV/b + RPV
In persons with suppression of HIV-VL < 50 copies/mL for the past 6 months these dual therapy strategies should only be given if there is a) no historical resistance and b) absence of chronic HBV co-infection
TDF ou TAF should not be discontinued in persons with chronic HBV
Not recommended : monotherapy with a boosted PI, with DTG….

9. Scenarios for Pregnant Women or Women who Wish to Conceive
1. Women planning to be pregnant or becoming pregnant while already on ART
Maintain ART, unless taking not recommended drugs
2. Women becoming pregnant while ART-naïve
Starting ART as soon as possible is highly recommended
3. Women whose follow-up starts late in the 2ndor in the 3rd trimester
Start ART immediately and consider RAL or DTG as the preferred choice to obtain rapid VL decline and to ensure the HIV-VL is undetectable by the time of delivery
4. Women whose HIV-VL is not undetectable at 3rd trimester
Perform resistance testing and consider changing to or adding INSTI (RAL or DTG) if not on this class to obtain rapid VL decline
5. Women whose HIV-VL is >50 c/mL at W34-36 of pregnancy
Elective cesarean section to be planned at W38
6. Women diagnosed with HIV in labour
See to section “labour and breastfeeding”
ARV Drugs not Recommended in Women who Wish to Conceive
DTG. Reason : Higher risk of neural tube defects if used preconception. Should be switched to another drug
ARV Drugs Not Recommended in Women who become pregnant while on ART :
TAF ; RAL QD ; BIC ; DOR. Reason : Insufficient data
DTG. Reason : Higher risk of neural tube defects if used during periconception
EVG/c, ATV/c, DRV/c. Reason : lower levels during pregnancy

10. Antiretroviral regimen for ART Naïve Pregnant Women
Recommended regimens
2 NRTIs + INSTI (preferred)
ABC/3TC + DTG
ABC/3TC/DTG
Initiate after 8 weeks of pregnancy
HLA 5701 negative
HBsAg negative
TDF/FTC or TDF/3TC + DTG
TDF/FTC or TDF/3TC + RAL 400 mg bid
2 NRTIs + PI/r
TDF/FTC or TDF/3TC + DRV/r 600 mg/100 mg bid
With food

11. ART in TB/HIV Co-infection
Suggested timing of ART initiation in TB/HIV co-infection according to CD4 count
< 50 cells/µL: As soon as TB treatment is tolerated and wherever possible within 2 weeks
≥ 50 cells/µL: Can be deferred up to 8 weeks of TB treatment, especially when there are difficulties with drug-drug interactions, adherence and toxicities 
Prophylactic prednisone for 4 weeks at the time of ART initiation (prednisone 40 mg/day for 14 days, then 20 mg/day for 14 days) can prevent paradoxical TB-associated IRIS in persons with CD4 <100 cells/µL receiving anti-TB treatment
Corticosteroids should be considered for treatment of symptomatic IRIS, with dosages and duration tailored according to response

12. Antiretroviral regimens in TB/HIV Co-infection
Main requirements
Additional guidance (footnotes)
Recommended regimens with rifampicin
2 NRTIs + NNRTI
TDF/FTC or TDF/3TC + EFV TDF/FTC/EFV
At bed time or 2 hours before diner
I (tenofovir salts)
II (EFV : suicidality. HIV2 or HIV-1 group 0)
ABC/3TC + EFV
HLA 5701 negative
HBsAg negative
HIV-VL < c/ml
III (ABC : HLA5701)
Alternative regimens with rifampicin
2 NRTIs + INSTI
TDF/FTC or TDF/3TC + DTG bid
IV (DTG : dosing)
TDF/FTC or TDF/3TC + RAL bid
V (RAL : dosing)
ABC/3TC + RAL bid

13. ARV strategies 2DR in naive HIV reservoir, GEMINI semen
DTG in HIV-2
2DR in naive
GEMINI
(additional data)
HIV reservoir,
semen
2DR in switch
TANGO (DTG/3TC)
SIMPL’HIV (DTG/FTC)
RPV + DRV/c
2 DR
Real-life
data
VACH cohort
Meta-analysis
M184V
History
DTG/3TC
ART-PRO
ARV
strategies
TDF/FTC
maintenance

14. Proportion of Participants with TND by Visit: Snapshot analysis
GEMINI
Low level viremia
Proportion of Participants with TND by Visit: Snapshot analysis 20 40 60 80 90 4 24 72 96
Proportion of subjects 8 12 16 36 48 84
Weeks 70 50 30 10
DTG + 3TC
DTG + TDF/FTC
Underwood M, EACS 2019, Abs. PS8/2

15. GEMINI
Proportion of Participants with TND by Visit according to baseline HIV RNA and CD4
Analysis
Subgroup
DTG + 3TC n/N (%)
DTG + TDF/FTC n/N (%)
Treatment diff. (95% CI)
 Snapshot
Overall
474/716 (66)
484/717 (68)
-1,5 (-6.3 ; 3.2)
<
400/576 (69)
405/564 (72)
-2.4 (-7.6 ; 2.9)
>
74/140 (53)
79/153 (52)
1.2 (-10.2 ; 12.7)
 Observed
474/616 (77)
484/642 (75)
1,2 (-3.4 ; 5.8)
400/499 (80)
405/510 (79)
0.7 (-4.2 ; 5.7)
74/117 (63)
79/132 (60)
3.4 (-8.7 ; 15.5)
Snapshot
CD4≤200
27/ 63 (43)
32/ 55 (58)
-15.3 (-33.2, 2.5)
CD4>200
447/653 (68)
452/662 (68)
0.2 ( -4.9, 5.2)
Observed
27/ 43 (63)
32/ 48 (67)
-3.9 (-23.5, 15.8)
447/573 (78)
452/594 (76)
1.9 ( -2.9, 6.7)
Underwood M, EACS 2019, Abs. PS8/2

16. TANGO
RCT in virologically suppressed adults : switch to DTG/3TC vs continuation of TAF-containing 3DR = non-inferiority at W48
DTG/3TC
n/N (%)
TAF-Based Regimen
Overall population
344/369 (93,2)
346/372 (93,0)
Adjusted difference and 95% CI
0,2 (-3,4 ; 3,9)
Age (years)
< 35
35 - < 50
> 50
118/130 (90,8)
153/160 (95,6)
73/79 (92,4)
109/119 (91,6)
151/161 (93,8)
86/92 (93,5)
Gender
Female
Male
21/25 (84,0)
323/344 (93,9)
27/33 (81,8)
319/339 (94,1)
Baseline Third Agent Class
INSTI
NNRTI PI
268/289 (92,7)
49/51 (96,1)
27/29 (93,1)
276/296 (93,2)
42/48 (87,5)
28/28 (100)
Baseline CD4+
(cells/mm3)
< 350
> 350
31/35 (88,6)
313/334 (93,7)
29/30 (96,7)
317/342 (92,7)
Van Wyk J, EACS 2019, Abs. PS7/2

17. SIMPL’HIV RCT: DTG + FTC vs continuation cART
187 adults, HIV RNA < 50 c/mL
Non-inferiority of DTG + FTC compared to standard 3DR cART (with INSTI = 66%) at W48
HIV RNA < 100 c/mL 93.5% vs 94.7%
HIV RNA < 50 c/mL 90.3% vs 91.5%
Virologic failure
DTG + FTC, N = 1 (W48) : 67 c/mL, confirmed 65/80 c/mL (no RAM)
Triple cART, N = 2 (ABC/3TC/DTG W6, TDF/FTC + DTG W48)
AE leading to withdrawal : 1 in each group
Sculier D, EACS 2019, Abs. PS8/3

18. PROBE 2 RCT: RPV + DRV/c vs continuation cART
160 adults, HIV RNA < 50 c/mL, HBs Ag neg
Non-inferiority of the RPV+DRV/c 2DR compared to standard 3DR cART at W48
HIV RNA > 50 c/mL 0% vs 3.7%
HIV RNA < 50 c/mL 91.3% vs 93.8%
Good lipidic profile
Maggiolo F, EACS 2019, Abs. PS7/1

19. VACH Cohort Multicenter, Spanish cohort
All patients switching to INSTI-based ART (N = 5,047) or to a 2DR (N = 617) of DTG+RPV or DTG+3TC between 05/ /2019 2DR : older,more experienced but higher proportion virologically suppressed at switch
Time to treatment failure (virological failure, immunologic failure or disease progression )
HR :2.334 (p=0.003)
discontinuations due to VF (HR=2.236, p=0.024)
95% CI
INSTI-based TT
DTG-based 2DC 1 2 3
0,25
0,50
0,75
Years from switch to current regimen
Probability of remaining free of treatment failure
Kaplan-meier survival estimates
Limitations :
retrospective
mean number of virologic failure : 1.5 2DR vs 1.1 3DR (p< )
limited number with > 2 y FU
Teira R, EACS 2019, Abs. PS8/5

20. Meta-analysis
Risk of failure in dual therapy versus triple therapy in naïve HIV-patients: a meta-analysis
15 studies meet inclusion criteria allowing a meta-analysis on 5,606 patients
At 48 weeks and 96 weeks, no difference between 2DR and control group was observed in RR of regimen and virological failures and adverse drug reaction leading to discontinuation of regimen
RR of treatment failure by dual-therapy at 48 weeks
INI-based = 1.07 (95%CI: ),
PI-based = 0.70 (95%CI: )
INI+PI = 1.52 (95%CI: )
Russo A, EACS 2019, Abs. PS8/4

21. TRULIGHT RCT, open-label
223 adults, stable triple TDF/FTC containing ART, HIV RNA < 50 c/mL, cellular HIV DNA < 2.7 log c/106 PBMC, CD4 nadir > 150/mm3
Randomisation 1:1, TDF/FTC vs continuation cART
Non-inferiority of TDF/FTC 2DR compared to cART at W48
HIV RNA < 50 c/mL 90.5% vs 88.5%
HIV RNA > 50 c/mL 2% vs 5%
2 virologic failure on triple cART
6 virologic failure on TDF/FTC (emergence M184V, N = 1, emergence K65R, N = 1)
Prazuck T, EACS 2019, Abs. BPD1/5

22. DTG in HIV-2 Phase 2, open-label study
30 ARV-naïve HIV-2 infected patients
DTG/ABC/3TC or DTG + TDF/FTC
W48 outcomes
All 17 viremic patients at baseline had HIV RNA < 40 c/mL
CD4 : + 95/mm3 (95% CI : 28 – 163)
CD4/CD8 ratio :
1 discontinuation for AE (insomnia, anxiety and memory disturbance)
Pacheco P, EACS 2019, Abs. PS 7/3

23. ART-PRO Historical M184V/I, N = 21 No historical M184V/I, N = 20
Inclusion
CD4> 350 cel/µl and VL < 50 copies/ml for 12 months (1 blip allowed)
Stable ART for 3 months
FTC or 3TC in past/present treatment
INSTI naive
Exclusion
M184V/I or K65R in baseline proviral DNA Sanger genotype
HBAgS+
Pregnant/women wishing to conceive
Groupe WITHOUT historical M184V/I o K65R (n = 20)
Group WITH historical M184V/I o K65R (n = 21)
Day 1 Switch to DTG+3TC
Screening* Peripheral blood proviral DNA Sanger genotype W4 W8
W12
W24
W36
W48
W64, 80, 96, 112, 128
W144
Primary endpoint at week 48: proportion of participants with HIV-1 RNA <50 c/mL (ITT-E FDA Snapshot)
Historical M184V/I, N = 21
No historical M184V/I, N = 20
CD4/mm3 nadir/current, median
160 / 705
259 / 647
Duration of suppressed HIV RNA, median years
9.8
7.5
Baseline ART including 3TC ou FTC, %
42.9 (n = 9)
95 (n = 19)
M184V in proviral DNA Sanger genotype, %
9,5 (n = 2)
M184V/I detected by NGS in proviral DNA, %
> 1%
> 5%
> 20%
95.2
De Miguel Buckley R, EACS 2019, Abs. PS7/5

24. Virologic outcomes through week 48 (FDA snapshot)
ART-PRO
Virologic outcomes through week 48 (FDA snapshot)
At week 48, 92.7% (38/41) of paticipants maintained HIV-RNA VL < 50 c/ml
ITT-e population
Per protocol population
Per protocal population: 2 patients excluded from analysis
18/21
20/20
18/19
85.7%
100%
94.7%
Discontinuations: 1 AE 2 protocol violation
Historical 3TC-resistance group
Historical 3TC-resistance group
NO VIROLOGIC FAILURE
De Miguel Buckley R, EACS 2019, Abs. PS7/5

25. DOLUPRIM
19 men with PHI (4 Fiebig II, 5 F-III, 1 F-IV, 4 F-V and 5 F-VI)
DTG + TDF/FTC
Outcome : achievement of first HIV RNA < 20 c/mL in blood and < 60 c/mL in semen
Blood Plasma
Seminal Plasma
6.5
4.5
p < 0,0001
At W48 : HIV RNA < LOQ : 84% in blood,
93% in semen
Median time to HIV RNA
< LOQ :
- Blood = 24 weeks
- Semen = 8 weeks
Ghosn J, EACS 2019, Abs. PS7/4

26. Comorbidities Hepatic Steatosis Comorbidity workshop DTG during
pregnancy
Weight gain
Comorbidity
workshop
Hepatic
Steatosis
INSTI effect
an adipose tissue

27. ADVANCE Mean change in weight (kg) to Week 96
MEN
WOMEN
+6 kg
+3 kg
+1 kg
n =
Mean weight change (kg)
TAF/FTC+DTG
TDF/FTC+DTG
TDF/FTC/EFV
+9 kg
+5 kg
+3 kg
n =
Mean weight change (kg)
TAF/FTC+DTG
TDF/FTC+DTG
TDF/FTC/EFV
McCann K, EACS 2019, Abs. PS3/3

28. ADVANCE Factors associated with obesity and weight gain
After multivariable analysis, associated factors were:
Treatment-emergent obesity:
TAF/FTC+DTG, baseline CD4+ count, baseline VL, and baseline BMI
When baseline BMI was excluded the following predictors were also significant:
Female sex, South African nationality, and employment status
> 10% increase in body weigh:
TAF/FTC+DTG, baseline CD4+ count, baseline VL, female sex, age, and baseline weight
McCann K, EACS 2019, Abs. PS3/3

29. Weight gain on INSTI Pooled analysis, 8 RCT in naïve PLHIV * * ** *
0,5 1
1,5 2
2,5 3
3,5 4 12 24 36 48 60 72 84 96
Weeks
4,5
Female
Male * *
Black
Non-Black 12 24 36 48 60 72 84 96
Weeks
0,5 1
1,5 2
2,5 3
3,5 4
4,5 5 1 2 4 6 12 24 36 48 60 72 84 96 5 3
Weeks
108
Black Female
Black Male
Non-Black Female
Non-Black Male ** *
Sax P, Clin Infect dis. Oct 2019

30. Weight gain on INSTI * * * * * * * * * * * * * 0,5 1 1,5 2 2,5 3 3,5 4
0,5 1
1,5 2
2,5 3
3,5 4
INSTI PI
NNRTI 12 24 36 48 60 72 84 96
Weeks
* * *
0,5 1
1,5 2
2,5 3
3,5 4
RPV
EFV 12 24 36 48 60 72 84 96
Weeks *
4,5 1 2 4 6
BIC
DTG
EVG/c 12 24 36 48 60 72 84 96 5 3
Weeks *
* *
* * *
* * * 1 2 4 12 24 36 48 60 72 84 96 5 3
TAF
ABC
TDF
AZT
Weeks
Sax P, Clin Infect dis. Oct 2019

31. Weight gain Naive patients Switch in suppressed patients Weight gain
DTG associated with weight gain
TAF associated with weight gain
No significant chnge in weight DOR vs EFV 1st line (Orkin C Abs. PS 3/2)
Switch in suppressed patients
INI not associated with weight gain
Swiss Cohor [PS3/5] : modest increase after switch to DTG
AGEhIV Coghort [PS3/6]) : noweight increase after switch to INSTI
Women
Black
EFV
TDF PI
DTG
or BIC
Treatment naïve
Weight
gain
loss

32. INSTI and adipose tissue
Non-infected macaques treated with INSTI (RAL/TDF/FTC = 4, RAL/TDF/FTC = 1)
 sub-cutaneous and visceral adipose tissue +  adipogenic markers
ART treated obese patients (14 with INSTI [ 10 DTG] vs 5 without INSTI)
 fibrosis (SACT & VAT) + adipocyte hypertrophy and dysfunction
In vitro models of human adipose Stem Cells and adipocytes
Fibrosis
 adipocyte differentiation
Triglycerides accumulation
Adicocyte dysfunction and insulin resistance ( adiponectin)
DTG have a greater effect than RAL
These effects could explain weight gain : cardiometabolic consequences ?
Gorwood J, EACS 2019, Abs. PS3/4

33. Antiretroviral Pregnancy Registry
Pregnancy and neonatal outcomes in infants with periconception and prenatal exposure to DTG through 2019
N = 650
Periconception exposure : 53%
Periconception
N = 357
1st trimester after 8 weeks
N = 67
1nd-3rd trimester
N = 243
Stillbirths
1.4%
1.5%
1.2%
Spontaneous abortions
6.7%
3.0%
Induced abortions
4.5%
0.4%
Defects per live births
3.2%
3.8%
NTD : 1/312 = 0.30%
No increased risk of overall birth defects with DTG use
Vannapagari V, EACS 2019, Abs. PS1/2

34. NAFLD, a marker of frailty
Cross-sectional study, 707 PLWH
Evolutive NAFLD = liver steatosis + significant liver fibrosis or cirrhosis (stage ≥F2) = 10.2%
Association of evolutive NAFLD with co-morbidities
Evolutive NAFLD OR
IQR p
Depression
1.78
0.07
Neurocognitive impairment
5.08
< 0.01
Vitamin D insufficiency
1.94
0.01
Obesity
8.06
Hypertension
1.59
0.08
Type 2 diabetes
3.28
CVD
0.85
0.78
CKD
0.71
0.32
COPD
1.32
0.62
Osteoporosis
0.37
Dyslipidemia
0.92
0.8
Cancer
1.36
0.34
Milic C, EACS 2019, Abs. 12/7

35. Prevention
PrEP
TASP
ChemSex
HSIL

36. Late 2013, France  initiation of cART irrespective of CD4
Full cohort
MSM cohort
Late 2013, France  initiation of cART irrespective of CD4
Longitudinal study : epidemiology of primary HIV infection (PHI) and/or recent HIV infection (CD4 ≥ 500 at diagnosis (PRHI) between 2007 and 2017 in Dat’AIDS cohort ( pts)
The 2nd and 3rd targets were reached in 2014 and 2013, respectively
240
200
160
120
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
New PHI
Before +10 news cases per years, each year
Breakpoint : july 2012
After -25 news cases per years, each year
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
240
200
160
120
New PHI
Before +12 news cases per years, each year
After -24 news cases per years, each year
Breakpoint : june 2012
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
300
400
500
600
700
New PHRI
Before +22 news cases per years, each year
After -62 news cases per years, each year
Breakpoint : January 2013
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
New PHRI
Before +21 news cases per years, each year
After -48 news cases per years, each year
Breakpoint : January 2013
700
600
500
400
300
Le Guillou A, EACS 2017, abs. PS9/4

37. Open-Label Prospective Cohort Study in the Paris Region
PREVENIR
Open-Label Prospective Cohort Study in the Paris Region
TDF/FTC
Daily
On Demand
HIV-negative high risk adults (99% MSM)
Inconsistent Condom use
eGFR > 50 mL/mn
HbS Ag negative if On Demand
Show 15% reduction in new HIV diagnoses among MSM in the Paris Region
May 3rd 2017
May 31st 2020
N = 3,057
Participants opted for either Daily or On Demand PrEP and could switch regimen
PrEP discontinuation = stopping PrEP or missing the last 2 FU visits: 32% (95% CI: 29-35) at M30
HR (95% CI)
Age (years) (vs ≥ 40)
[18-25[ ; [25-30[; [30-40[
2.46 ( ) ; 1.9 ( ) ; 1.4 ( )
Country of birth other than France
Other
1.23 ( )
Education (vs Upper diploma)
< High school
1.66 ( )
Regular sexual partner (vs No)
Yes
0.88 ( )
N UAI last 4 weeks
0.99 ( )
Already on PrEP at enrolment (vs Yes) No
1.85 ( )
Counselling (vs Accepted)
Not offered or Offered but not accepted ns
Costagliola D, EACS 2017; abs. PS11/1

38. ChemSex in MSM in EuropeUK
Spain
Greece
Italy
Total
Number
544
534
449
173
1 700
Age (years) (median, IQR)
40 (32-49)
40 (34-47)
36 (32-42)
40 (32-47)
39 (32-47)
Recreational drug use, 12m, n (%)
278 (51 %)
239 (45 %)
167 (37 %)
57 (33 %)
741 (44 %)
ChemSex, 12m, n (%)
174 (32 %)
117 (22 %)
84 (19 %)
21 (12 %)
396 (23 %)
SlamSex, 12m, n (%)
69 (13 %)
15 (2,8 %)
22 (4,9 %)
1 (0,6 %)
107 (6,3 %)
Unwanted side effects, n (%)
70 (40 %)
51 (44 %)
35 (42 %)
6 (29 %)
162 (41 %)
Drug withdrawal (%)
49 (28 %)
31 (26 %)
6 (7,1 %)
0 (0 %)
86 (22 %)
Overdose, n (%)
11 (6,3 %)
8 (6,8 %)
9 (11 %)
1 (4,8 %)
29 (7,3 %)
Non-consensual sex, n (%)
16 (9,2 %)
5 (4,3 %)
5 (6,0 %)
2 (9,5 %)
28 (7,1 %)
Negative effect on work, n (%)
58 (33 %)
11 (13 %)
5 (24 %)
105 (27 %)
Negative effect on friends/family, n (%)
50 (29 %)
34 (29 %)
13 (15 %)
4 (19 %)
101 (26 %)
Negative effect on relationships, n (%)
53 (30 %)
41 (35 %)
16 (19 %)
116 (29 %)
Lconway K, EACS 2017, abs. PS9/6

39. Natural history of anal high grade squamous intraepithelial lesions in HIV positive and HIV negative gay and bisexual men
Study of the Prevention of Anal Cancer, Sydney, Australia
Prospective, 3-year, cohort study conducted
617 GBM (35.7% HIV+) aged ≥ 35 years, median age 49 years
Anal high grade squamous intraepithelial lesions (HSIL) diagnosed on cytology and/or high-resolution-anoscopy-guided-biopsy at baseline and at 3 annual visits
124 incident HSIL cases over person-years of FU (11.3 [95%CI ] per 100PY)
Univariate predictors of higher HSIL incidence :
age< 45 years (HR 1.64, 95% CI )
HIV-positivity (HR 1.43, 95% CI )
prior SIL diagnosis (p-trend< 0.001)
HPV16 DNA detection (HR 3.39, )
Over PYFU, 153 HSIL cleared (clearance 22.0 [95% CI ] per 100PY)
Predictors of HSIL clearance
age< 45 years (HR 1.52, )
anal intraepithelial neoplasia (AIN)2 rather than AIN3 (HR 1.79, )
smaller lesions (HR 1.62, )
lack of persistent HPV16 (HR 1.72, )
There was one progression to cancer (incidence [95% CI ] per 100 PY)
Templeton DJ, EACS 2017, abs. PS6/1