P3.203 Mortality Rates in HIV-1/2 Dual- and Mono-Infected Individuals: A Systematic Review and Meta-Analysis

Abstract

Methods In a prospective study among 2269 HIV-1 infected ARTnaïve women from 7 countries in East and southern Africa, we examined the effect of pregnancy on HIV-1 disease progression. We used random effects models to compare CD4 and plasma viral load changes between pregnant, postpartum and non-pregnant periods (prenatal periods from women who became pregnant and all periods from women who did not become pregnant). Among women who became pregnant, we compared CD4 counts during prenatal, pregnant, and postpartum periods. Results Women contributed 3471 person-years and 475 women became pregnant (7.2% of time was pregnant and 6.8% was postpartum). After accounting for baseline levels, CD4 counts were 67.7 cells/ mm 3 lower (95% CI 55.5-79.9) during pregnant compared to nonpregnant periods and 81.2 cells/mm 3 lower (95% CI 65.3-97.2) during pregnant compared to postpartum periods. After adjustment for baseline viral load, there were small increases in plasma viral load: a 0.05 log 10 increase in pregnant vs. non-pregnant periods (95% CI 0.01-0.10) and a 0.08 log 10 increase in pregnant vs. postpartum periods (95% CI 0.01-0.14). Postpartum CD4 and plasma viral loads were not different from non-pregnant periods (p = 0.1 and p = 0.5). Among women who experienced pregnancy, CD4 counts were 59.6 cells/mm 3 lower (95% CI 35.2-84.0) during pregnant versus prenatal periods and 71.6 cells/ mm 3 lower (95% CI 48.0-95.1) during pregnant versus postpartum periods. Prenatal and postpartum CD4 counts were similar (p = 0.4). Conclusion CD4 count and plasma viral load changes among HIV-1 infected women during pregnancy are not permanent and are likely to return to prenatal levels. Pregnancy was not associated with subsequent disease progression. Background There is evidence of sexual HCV transmission among HIV-positive MSM from the UK and Europe. We estimated HCV seroincidence and its risk factors in a North American population of HIV-positive MSM with no known history of injection drug use. Methods We analysed data from the OHTN Cohort Study, an ongoing cohort of persons in HIV care in Ontario, Canada. Data were obtained from medical charts, interviews, and record linkage with the provincial public health laboratories. We restricted the analysis to 1,534 MSM who: (1) did not report injection drug use; (2) were under follow-up in 2000-2010; and (3) had 2+ HCV antibody tests, of which the first was negative. Person-time commenced at the later of the HCV-negative result or HIV diagnosis and ended at the first HCV+ or last date of follow-up (median 6.1 person-years (PY) of follow-up; sum 9,987PY). Results We observed 51 HCV seroconversions, for an overall incidence of 0.51 per 100PY (CI: 0.39-0.67). Annual incidence varied from 0.16 to 0.89 per 100 PY, with no statistical evidence of a temporal trend. Seroconversion was statistically-significantly associated with acute syphilis infection in the previous 6 months (adjusted hazard ratio = 4.9, CI 1.2-21) and there was a marginally statistically-significant association for men who had no...