EACS2023: 968 Comparison of rapid ART versus delayed ART in viral load reduction and loss to follow-up in a cohort of naïve migrants living with HIV in a single tertiary care center in Florence, Italy S. Trevisan , G. Gasparro , S.T. Kiros , M. Pozzi , I. Campolmi , R. Paggi , A. Cavallo , A. Farese , M. Meli , G. Sterrantino , A. Bartoloni , F. Lagi University of Florence, Department of Experimental and Clinical Medicine, Florence, Italy, Careggi University Hospital, Infectious and Tropical Diseases Unit, Florence, Italy General data Abstract category: Antiretroviral therapy – observational studies Abstract body Purpose: Evaluate the impact of rapid ART (RA) compared to delayed ART (DA) in viral load reduction after 6 months and in the loss to follow-up (LTFU) in a cohort of migrants living with HIV (MLWH) in a high-income setting. Method: All MLWH naïve were retrospectively enrolled at the Infectious and Tropical Diseases Unit of the Careggi University Hospital from 01/01/2014 to 31/10/2022. Cox's regression identified factors associated with LTFU. The end of the study was the end of follow-up (30/04/2023) or the date of LTFU defined as unreachable, relocation to another center, or death. RA was defined as receiving a prescription for antiretrovirals within seven days of diagnosis. Results: We enrolled 87 MLWH: 20 (22.99%) on RA and 67 (77.01%) on DA (>8 days) (Tab. 1). In the RA group, we observed a higher prevalence of AIDS events (45.00% vs. 10.40%), a higher zenith median (5.34, IQR 5.06-5.74), and a lower nadir median (133, IQR 12-446) (Tab 1). First ART regimens were reported in Fig.1. No significant differences were observed in terms of LTFU rate after 4 years (aHR 0.62, 95%CI 0.12-3.10; p=0.560; Logrank=0.2823) (Fig. 2). Being "out of status" was the only predictor of LTFU (Tab. 2). The median days from the ART initiation to viral load <50 cp/mL was similar: 117 (IQR 42-152) in RA and 98 (IQR 39-201) in DA, p 0.728. After 6 months, 61.20% (n=42) in DA and 70.00% in RA (n=14) obtained a virological suppression (HR 1.13 95%CI 0.61-2.09: p=0.676). Tab 1: Clinical, laboratory, and demographic characteristics of a cohort of naïve migrants living with HIV taken in care at the Infectious and Tropical Diseases Department of Careggi University Hospital from 01/01/2014 to 31/12/2022. ART start > 8 (n=67) Rapid ART 0-7 (n=20) p-value N % [IQR] N % [IQR] GENDER (N, %) MEN WOMEN TRANSGENDER WOMEN AGE IN YEARS AT FIRST VISIT (MEDIAN, IQR) 30 18 19 31 44.78 26.87 28.36 25-42 15 1 4 37 75.00 5.00 20.00 28-55 0.039 0.065 RISK FACTORS (N, %) UNPROTECTED SEX (HETEROSEXUAL) UNPROTECTED SEX (MSM) IVDU & MSM VERTICAL TRANSMISSION TRANSFUSION OTHER/UNKNOWN 31 33 1 0 1 1 46.27 49.25 1.49 0.00 1.49 1.49 3 11 1 0 0 5 15.00 55.00 5.00 0.00 0.00 25.00 0.002 GEOGRAPHIC AREA OF ORIGIN OF MIGRANTS (N, %) SUB-SAHARAN AFRICA LATIN AMERICA ASIA EAST-EUROPE WEST-EUROPE NORTH-AFRICA NORTH AMERICA 10 27 8 15 2 4 1 14.93 40.30 11.94 22.39 2.99 5.97 1.49 2 11 3 2 0 1 1 10.00 55.00 15.00 10.00 0.00 5.00 5.00 0.703 MIGRANT OUT OF STATUS ON FIRST VISIT (N, %) 19 28.40 4 20.00 0.457 SEX WORKING POST-MIGRATION YES NO UNKNOWN 18 28 21 26.87 41.79 31.34 3 7 10 15.00 35.00 50.00 0.275 HBSAG AT FIRST VISIT (N, %) POSITIVE ANTI-HBC AT FIRST VISIT POSITIVE HCV IGG-IGM AT FIRST VISIT (N, %) POSITIVE SYPHILIS DIAGNOSED AT FIRST VISIT (N, %) POSITIVE 5 21 3 16 7.46 31.34 4.48 23.88 3 8 1 3 15.00 40.00 5.00 15.00 0.370 0.748 0.857 0.649 AIDS DIAGNOSIS (N, %) AIDS-TYPE (N, %) * PNEUMOCYSTIS JIROVECII PNEUMONIA WASTING-SYNDROME TUBERCULOSIS KAPOSI SARCOMA CYTOMEGALOVIRUS (DIFFUSE INFECTION or RETINITIS) ATYPICAL MYCOBACTERIOS BACTERIAL PNEUMONIA (2 or 2+ IN A YEAR) 7 3 2 2 0 2 0 1 10.45 42.86 28.57 28.57 0.00 28.57 0.00 14.29 9 3 5 0 1 1 1 2 45.00 33.33 55.56 0.00 11.11 11.11 11.11 22.22 <0.001 - ACUTE INFECTION (N, %) 9 13.43 6 30.00 0.204 ZENITH, Log (MEDIAN, IQR) 4.68 4.07-5.10 5.34 5.06-5.74 0.001 CD4 NADIR (MEDIAN, IQR) 432 208-647 133 12-446 0.001 LOSS AT FOLLOW-UP CAUSES (N, %) TRANSFER TO ANOTHER TREATMENT CENTRE NOT CONTACTABLE PATIENT OTHER 6 11 2 8.96 16.42 2.99 1 2 0 5.00 10.00 0.00 0.839 AVAILABLE GENOTYPE BEFORE THERAPY (N, %) RESISTANCE MUTATIONS (N, %) ** RT (REVERSE TRANSCRIPTASE) PR (PROTEASE INHIBITOR) 55 8 2 82.09 14.55 3.64 18 6 0 90.00 33.33 0.00 0.398 - MLWH WHO REACHED A VL < 50 AFTER ART-START (N, %) YES STILL IN FOLLOW-UP *** NO STILL IN FOLLOW-UP *** 57 46 10 2 85.07 95.83 14.93 4.17 18 15 2 2 90.00 88.24 10.00 11.76 0.575 DAYS FROM ART-START TO VL < 50 (N, IQR) 98 39-201 117 42-152 0.728 *A single migrant living with HIV may have had 2 or 2+ AIDS-defining illnesses; percentages calculated for both groups considering as denominator only MLWH with an AIDS diagnosis **Percentages calculated for both groups considering as denominator only migrants living with HIV with an available genotype ***Percentages calculated for both groups considering as denominator only migrants living with HIV still in follow-up (p=0.263) IQR: Interquartile range; MSM: Males who have Sex with Males; IVDU: Intravenous-Drug User; OUT-OF-STATUS: Including arrived regularly but whose VISA has expired; HBsAg: Hepatitis B surface Antigen; HBcAB: Hepatitis B core Antibody; HCV: Hepatitis C virus; HAV: Hepatitis A virus; AIDS: Acquired Immune Deficiency Syndrome; PI: Protease Inhibitor; NNRTI: Non-Nucleoside Reverse Transcriptase Inhibitor; INSTI: Integrase Strand Transfer Inhibitor; TXF: Tenofovir Disoproxil/Alafenamide Fumarate; XTC: Lamivudine or Emtricitabine; ABC: Abacavir; MLWH: Migrants Living With HIV; VL: Viral Load; FU: Follow-Up Tab 2: Multivariate analysis of predictors of loss at follow-up in a cohort of naïve migrants living with HIV taken in care at the Infectious and Tropical Diseases Department of Careggi University Hospital from 01/01/2014 to 31/12/2022. MULTIVARIATE ANALYSIS Hazard Ratio CI95 p-value RAPID ART 0.62 0.12-3.10 0.560 MIGRANT OUT OF STATUS 3.81 1.13-12.84 0.031 GENDER WOMEN - - - 1 1 1 2 2 1 2 2 2 1 1,2 2 1 2 10
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