EACS2023: 967 Prospective assessment of viral rebound and associated risk factors in people living with HIV after achieving viral suppression in rural Tanzania A. Nyuri , L. Wilson , D. Mnzava , E. Temba , T. Fanuel , T. Byakuzana , S. Masoud , E. Luoga , R. Ndege , G. Mwangoka , D.H Paris , F. Vanobberghen , J. Okuma , M. Weisser Ifakara Health Institute, Biomedical, Morogoro, Tanzania, United Republic of, Ministry of Health, National Aids Control Program, Dar es Salaam, Tanzania, United Republic of, St. Francis Referral Hospital, Ifakara, Morogoro, Tanzania, United Republic of, University of Basel, Basel, Switzerland, Swiss Tropical and Public Health Institute, Allschwil, Switzerland, University Hospital Basel, Division of Infectious Diseases and Hospital Epidemiology, Basel, Switzerland General data Abstract category: Antiretroviral therapy – observational studies Abstract body Purpose: Antiretroviral treatment (ART) has greatly improved the life expectancy of people living with HIV (PLHIV) by suppressing viral replication, preserving immune function, and reducing HIV transmission. This study aimed to assess viral rebound incidence and associated risk factors among PLHIV who had achieved viral suppression. Method: We performed a prospective longitudinal study nested within the Kilombero & Ulanga Antiretroviral Cohort (KIULARCO) in rural Tanzania. We included PLHIV aged ≥15 years, on ART between January 2017 and December 2021 for ≥3 months and achieved first viral suppression (HIV viral load (HVL)<1000 copies/ml). Baseline characteristics were measured at time of first viral suppression. Kaplan-Meier methods were used to determine viral rebound (HVL≥1000 copies/ml) incidences and Cox models were used to identify associated risk factors. Results: Among 1,265 PLHIV, 963(76%) achieved viral suppression within 6 months after ART start, 252(20%) at 18 months, and 50(4%) at ≥24 months. The median age was 38 years(IQR 30–46); majority were female (858(68%)), married/cohabiting(795(63%)),with WHO stage I/II (943(74%)) and CD4 count ≥100 (809(83%))(Table). Viral rebound was detected in (55 (6%))after a median follow-up of 25 months(IQR 13–37) and HVL tests of 3(IQR 2-4). Viral rebound incidences at 12, 24 and 36 months were 1.6%(95%CI 0.9-2.6), 5.6%(95%CI 4.1-7.5) and 7.2%(95%CI 5.5-9.5) respectively. PLHIV aged 15-24 was about 3 times more likely to have a viral rebound compared to those aged ≥45 years(HR=3.72 95%CI 1.22-11.35) (Figure). There was no evidence of an association between viral rebound and other risk factors. Table: Baseline characteristics among PLHIV Patient characteristics Median (IQR) or n(%) (N=1265) Socio-demographic Age (years) [median (IQR)] Age categories (years) [n (%)] 15 – 24 25 – 34 35 - 44 ≥45 37.7 (30.1-45.8) 138 (11%) 376 (30%) 407 (32%) 344 (27%) Gender, [n (%)] Male Female 407 (32%) 858 (68%) Marital Status, [n (%)] Married/Cohabiting Never married Separated/divorced/Widowed 795 (63%) 97 (8%) 373 (29%) Education, [n (%)] None Primary Secondary and above Missing 109 (9%) 994 (79%) 152 (12%) 10 (1%) Occupation, [n (%)] Farmer Non-farmer Missing 1011 (81%) 244 (19%) 10 (1%) Distance of residence from clinic [n (%)] ≤1 Km 2 – <50 Km ≥50 Km Missing 675 (55%) 366 (30%) 180 (15%) 44 (3%) Alcohol consumption [n (%)] No Yes Missing 1019 (82%) 224 (18%) 22 (2%) Clinical Body Mass Index (BMI) (Kg/m ) [median (IQR)] BMI [n (%)] Underweight, <18.5 Normal, 18.5 - <25 Overweight, 25 - <30 Obese, ≥30 Missing 22.5 (20.2-26.1) 137 (11%) 709 (58%) 238 (19%) 140 (11%) 41 (3%) WHO Stage [n (%)] I II III IV Missing 715 (57%) 218 (17%) 228 (18%) 86 (7%) 18 (1%) CD4 count (cells/µl) [n (%)] <100 100 - 349 ≥350 Missing 165 (17%) 435 (45%) 369 (38%) 296 (23%) ART regimen [n (%)] NNRTI (Put here the long form) INSTI/PI 737 (58%) 528 (4%) Tuberculosis [n (%)] Yes No Missing 86 (7%) 1165 (93%) 14 (1%) Year of ART initiation [n (%)] 2017-2018 2019-2021 640 (51%) 625 (49%) IQR: Interquartile range Results are number and percent of those with non-missing data, missing data rows are number and column %. at the first clinical visit virally suppressed (HVL <1000 copies/ml) aged ≥15 years old, with at least 3 months on ART between January 2017 to December 2021 and virally nearest recorded measurement of BMI, CD4 cell count, WHO stage 18 months before to 3 months after baseline. 1 1 1 2,3 2,3 1 1 1,3 1,3,4,5 1 5,4 5,4 5,4 1,5,6 1 2 3 4 5 6 a b 2 b b a b 180 19TH EUROPEAN AIDS CONFERENCE | WARSAW 2023
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