1267. Contribution of Acute Infection to the Community Viral Load of an HIV Care Program

Abstract

BackgroundIndividuals with acute HIV infection (AHI) are a priority for public health due to higher viral loads and greater risk of transmission. Despite potential clinical and public health benefits, rapid or immediate ART can be resource-intensive, with programmatic implications. We measured the contribution of AHI to our programs community viral load (VL) to inform our expanded testing and linkage to care program.MethodsWe calculated the contribution to the community VL for 3 HIV-positive groups from January 1, 2016 to September 1, 2018; (1) AHI (p24 antigen-positive, negative or indeterminate supplemental antibody testing), (2) new diagnoses (ND), and (3) existing diagnoses (ED). Persons who were AHI or ND were ART naïve at first VL. The contribution of each group to community VL was calculated at the first and second VL assays. Group contributions were characterized as (1) percentage of the total HIV-positive population, and (2) group contribution to community VL.Results217 persons tested positive for HIV and had an initial VL, and 69 persons linked to our program had a second VL. Time intervals between first and second VL measurements were similar between groups (Kruskal–Wallis P = 0.55). Initial VL medians were significantly different by group (Kruskal–Wallis P < 0.001), partly due to the large number of ED in care and virally suppressed ( <200 copies/mL) at first VL (n = 82). AHI contributed the fewest persons to the HIV-positive population (7.8%), but contributed the most to first VL (58.6%). ART reduced VL for all groups. The median time from diagnosis to treatment for AHI was 5.5 days (IQR 4–21). Due to both natural decay and ART, AHI contributed the least to total VL load at second assay (5.6%). Using previously published data on treated and untreated VL decay, a delay in ART of 15 days would resulted in an estimated VL of 17,721 copies/mL (95% confidence interval (537- 53,576) vs. the estimated VL with ART, 131 copies/mL (95% CI 5–294), a 135-fold increase in AHI VL.ConclusionPatients with AHI are small proportion of our cohort compared with ND and ED, but account for the greatest portion of our community VL. These data quantifies the benefit of rapid initiation of ART for AHI to reduce community VL, a priority for prevention efforts. Disclosures All authors: No reported disclosures.