Speaker Abstracts

Supplement HIV & Hepa s in the Americas 4–6 April 2019, Bogotá, Colombia Oral Abstracts O11 – Keynote Lectures 1 O12 – HIV in HPV 1 O13 – Keynote Lecture 2 O21 – Keynote Lectures and GHESKIO Oral Papers 2 O22 – HIV and Ageing 4 O23 – Key Topics in Hepatitis 5 O31 – Public Health HIV Programmes of Latin America and the Caribbean Moving Beyond NNRTI-Based First-Line Regimens 7 O32 – Barriers and Facilitators to Early Treatment and PrEP Implementation in the Region 8 Poster Abstracts Co-Morbidi es and Complica ons of Disease, Non-AIDS Morbidity and Cancers 10 HIV and Adolescents, Children and Women 14 HIV and Hepa s Co-Infec on, and Tuberculosis 17 HIV and Vulnerable Popula ons 19 Models of Care/Scale Up of Treatment 27 Opportunis c Infec ons 32 Treatment, Preven on, Strategies and Outcomes 33 Viral Hepa s 45 Virology and Immunology 47 Author Index 49

Human papillomavirus (HPV)-related cancers, including cervical, anal and oropharyngeal cancer, occur more frequently in individuals living with HIV infection than in the general population. Strategies for prevention among individuals with HIV infection include HPV vaccination, cervical cancer and anal cancer screening programmes, and early initiation of antiretroviral therapy (ART). HPV vaccination is not yet optimally used as a preventive vaccine; a stronger and more persistent effort is needed to increase vaccination rates and combat anti-vaccine stigma. Much of Latin America relies on cytology-based methods for cervical cancer screening; however, primary HPV-based screening is gaining acceptance worldwide. Although anal cancer screening is not recommended by all authorities, there is at least some evidence that screening and treatment of anal high-grade squamous intraepithelial lesions may prevent progression to cancer. However, more definitive evidence is needed. More data is needed on the epidemiology of HPV-related oropharyngeal cancer in Latin America and prevention modalities are urgently needed. Early initiation of ART reduces the risk of infection-related cancers, with some evidence of benefit in preventing HPV-associated cancer in individuals with HIV infection. Latin America and the Caribbean (LAC) is a region with a wide heterogeneity and fragmentation at the regional and local level. Access to care is unequal, and this, in the HIV field has a direct impact on people's chances to receive appropriate counselling and access to a combination prevention package, which includes timely testing and access to ARV therapy. Albeit in paper access to testing and treatment is free in all LAC countries, in real life key populations are frequently set aside due to a complex array of factors, including poverty, social injustice, stigma, discrimination, migration, bad governance, inefficiency and corruption. Most (but not all) countries in the region have adopted the World Health Organization recommendation regarding the immediate universal offer of HAART initiation. Uptake of integrase inhibitors in first-line is slow and limited to a reduced number of countries. While access to plasma viral load testing has expanded, access to baseline resistance testing is still limited to a few countries. Efavirenz is still used as first-line anchor drug, notwithstanding the increasing resistance rate to NNRTIs. Cost of medicines consumes at least one third of the national health budget in most countries. The Pan American Health Organization Strategic Fund is a regional mechanism for pooled procurement of medicines, including antiretrovirals, but a minority of countries take advantage of this tool. Apart from Argentina, Brazil, Chile, Colombia, Mexico and Uruguay, HIV programmes focused on key populations are too dependent on donor funding, which threatens their sustainability. The region has made good progress but we still have a long way to go. Worldwide, tuberculosis (TB) remains the leading cause of mortality among people living with HIV (PLWH); accounting for about one third of deaths. TB incidence and outcomes are extremely related to other development determinants such as expenditure per capita, sanitation facilities and life expectancy at birth. According to UNAIDS, by 2016 TB was responsible for 4800 deaths in the Latin American region and 1000 deaths in the Caribbean. From the clinical perspective, many challenges remain in the TB/HIV field; including screening and management of latent tuberculosis infection (LTBI), atypical clinical presentations, multidrug resistant TB, duration of anti-TB treatment in PLWH, concomitant use of antiretroviral therapy (ART) with anti-TB agents and immune reconstitution inflammatory syndrome related to TB. Recent evidence has proven that the use of preventive isoniazid as treatment for LTBI has an effect on mortality among PLWH, a similar effect has been observed in studies assessing early ART initiation after TB diagnosis and treatment. Another major issue has been the coadministration of anti-TB treatment and ART in low-and middle-income countries with restricted access to rifabutin and integrase inhibitors. Efavirenz is still the first option in this group of patients, although available data show that raltegravir and twice daily dolutegravir might represent a safe and effective option for this population. Advocacy to strengthen health policies and programmes to improve availability of adequate treatments and diagnostic tools are undoubtedly needed in our region in order to tackle this important public health challenge.

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Substantial declines in HIV, syphilis, genital ulcers and urethral discharge over two decades, with recent increases in sexually transmitted infection (STI) prevalence in an STI clinic in urban Haiti the STI clinic, HIV and syphilis testing were offered to all patients. Patients were tested for HIV with two rapid tests, in accordance with World Health Organization guidelines. They were classified as testing positive for syphilis if they had a positive treponemal or non-treponemal test. Results: A total of 102,724 (81,913 female, 20,811 male) visits were included in the study, with 782 (498 female, 284 male) visits occurring in 1995, and 11,293 (9060 female, 2233 male) occurring in 2015. HIV prevalence declined over time (p < 0.001). In females, the proportion of patients testing positive for HIV declined from 19% in 1995 to 5% in 2015, and in males, it declined from 32% to 6% over this time period. Syphilis prevalence declined from 1995 to 2012, and then increased in both females and males from 2012 to 2015. In females, the proportion of patients testing positive for syphilis decreased from 11% in 1995 to 3% in 2012, and then increased to 8% in 2015 (p < 0.001). In males, it decreased from 29% in 1995 to 5% in 2012, and then increased to 13% in 2015 (p < 0.001). Genital ulcer disease declined throughout the study period, from 19% in males and 3% in females in 1995 to 0.8% in males and 0.2% in females in 2015 (p < 0.001). The prevalence of urethral discharge decreased in males from 22% in 1995 to 18% in 2012, but then increased to 57% in 2015 (p = 0.04) ( Figure 1). Conclusion: The proportion of patients testing positive for HIV, syphilis, genital ulcer disease and urethral discharge at presentation to an STI clinic in urban Haiti decreased from 1995 to 2012. We attribute this decline to the scale-up in access to comprehensive HIV and STI prevention and treatment services, and massive national information programmes about safer sexual practices. However, the proportion of patients testing positive for syphilis and urethral discharge (in males) has increased in recent years, coincident with an increasing economic crisis in Haiti. Additional efforts are needed to prevent a resurgence of STIs and HIV in Haiti. Objective: To define the intrinsic factors associated with lost to follow-up of HIV-positive patients in order to address the issues and achieve significant reductions in patient disengagement.
Methods: Retrospective review of data collected as part of routine clinical care was performed from HIV-positive patients tested at GHESKIO from January 2014 to October 2018. Data on patients are recorded in an electronic database by doctors and nurses. Patient's information is recorded at each visit into a file which is entered into the computer system. Patients retained in care were defined as those actively receiving antiretroviral (ART) at the GHESKIO clinic and patients defined as lost follow-up (LTFU) are those not returning for HIV services for at least one month after their last expected appointment date during study period. Data of patients who remained in care and received ART were compared with those who did not return for HIV services to determine characteristics associated with LTFU. Abstracted data included, gender, age, education level, income, sociodemographic profile, ART treatment, last CD4 count and viral load. Chi-square analyses were used to determine predictors of LTFU. Using a threshold of p < 0.1, we conducted a multivariate regression analysis to determine independent predictors of LTFU. Results: During the study period, there were 10,672 patients visiting the site with 4265 LTUP (42%) and 497 deaths and 646 transfer to other sites. The median time before LTFU was: seven months (interquartile range: one to ninteen month): of the 4265 (13 %) came once. Majority, 2006 (47%) of the LTFU occur within the first six months with an incidence rate of 356 per 1000-person years. Factors associated with becoming LTFU included: young age female (20 to 29 years); adjusted hazard ratio (aHR): 2.05, 95% CI: 1.78 to 2.37, p = 0.0001; no education (aHR) 1.94, 95% CI: 1.51 to 2.48, p = 0.0001; with low income (aHR) 1.27, 95% CI: 1.03 to 1.57; p = 0.0001; detectable viral load at last visit (VL) (aHR) 2.51, 95% CI: 2.15 to 2.92, p < 0.0001; low BMI (<18.5) (aHR) 3.70, 95% CI: 2.92 to 4.69, p < 0.0001. Patients that previously had irregular visit records had a higher risk (aHR): 0.62, 95% CI: 0.26 to 0.40, p = 0.0001 of becoming LTFU than those that had not. Conclusion: Despite dramatic reduction in HIV prevalence in Haiti, the incidence rate of LTFU is high; mainly within the first six months. Intensify measures to improve quality and condition of life must be prioritised in patients with limited resources that are at increased risk of becoming lost to follow-up [1][2][3][4].
The advent and global rollout of triple-drug combination antiretroviral therapy (ART) for the treatment of HIV infection has resulted in a dramatic reduction in morbidity and mortality from this disease worldwide. Despite the availability of once-daily single-tablet regimens, the need for daily administration poses a burden for many patients. The development of long-acting formulations, including the combination of cabotegravir plus rilpivirine; the novel nucleoside reverse transcriptase translocation inhibitor MK8591; the investigational HIV capsid inhibitor GS-CA2; and broadly neutralising antibodies (bNAbs) permit administration of ART weekly, monthly, quarterly or even less frequently. Such advances may greatly simplify drug administration and increase adherence to ART for many patients. According to press releases, the phase 3 trials of injectable cabotegravir plus rilpivirine have met their non-inferiority endpoint; results will be presented formally at CROI in early March, 2019. Although long-acting formulations may improve the efficacy of antiretroviral therapy or pre-exposure prophylaxis in persons who have difficulty adhering to daily oral regimens, the very long terminal half-life of these agents carries the risk of drug resistance, particularly in HIV-infected persons, who discontinue treatment. Research towards an HIV cure or a treatment that could lead to durable drug-free remission remains a high priority for clinicians, investigators and patients. Current efforts at eradicating HIV infection or inducing long-term ART-free remission include activation of HIV transcription in latently infected CD4+ T cells; enhancing HIV-specific immunity in order to target and destroy cells harbouring latent infectious proviruses; and cell-based therapies using genetically modified CD4+ T cells or haematopoietic stem cells. Several exploratory human pilot studies are underway with each of these approaches, but none have borne fruit to date. The difficulty of quantifying the HIV reservoir, the uncertain safety of the experimental treatments under study, and the need to balance the risk of these interventions against the generally well-tolerated and proven efficacy of long-term ART remain significant challenges.
O22 -HIV and Ageing O221 HIV and ageing: a role for inflammation? P Hunt University of California San Francisco, San Francisco, CA, USA While HIV-infected individuals with access to modern antiretroviral therapy (ART) have experienced a dramatic improvement in life expectancy, they remain at higher risk than the general population for morbidity and mortality, particularly from non-AIDS complications typically associated with ageing. While lifestyle factors (e.g. smoking, drug use, obesity, etc.) as well as ART toxicities likely play a role, it is now well recognised that abnormal immune activation and inflammation persist in many ART-suppressed individualsindependent of lifestyle factorsand that the extent of these immunologic defects strongly predicts morbidity and mortality from non-AIDS conditions. While the inflammatory state can be attenuated by early ART initiation, it may persist even in individuals who start ART at high CD4+ T-cell counts, but appears to predict a narrower set of infectious and neoplastic morbidities in this setting. Multiple causes of the persistent inflammatory state in treated HIV infection have been proposed including HIV persistence, microbial translocation, CMV and other prevalent coinfections. While earlier initiation of ART appears to be beneficial in reducing the inflammatory state and in reducing some morbidities, and some commonly used medications with anti-inflammatory properties (e.g. statins) are being studied in clinical outcomes trials, there is a clear need for effective interventions to reverse persistent immune activation in this setting. These issues will become increasingly important as the HIV epidemic gets older, particularly in resource-limited settings, where the vast majority of HIV-infected individuals live. Long-term survival of treated people living with HIV (PLWH) currently approaches that of the general population, with cofactors modulating individual outcomes. This reality, coupled with an increasing age at seroconversion, has resulted in ageing of the PLWH population. In resource-rich countries most PLWH are older than 50 and this proportion will continue to increase. Similar trends occur in most other parts of the world. This profound impact of cART is however associated with sobering clinical realities. The profile of ageing PLWH resembles that of the general population about five to ten years older. In addition to the earlier occurrence of common age-related conditions, multimorbidity has also increased. This is associated with polypharmacy and its complications. Furthermore, other common geriatric syndromes also impact this younger population. These conditions are challenging to evaluate and manage, and include impaired mobility and falls, sensory complaints, age-related body composition changes, impaired cognition and frailty. Frailty is relevant as it increases other serious health outcomes. Frailty is a state of increased vulnerability to biologic and environmental stressors, with reduced ability to maintain homeostasis. In the general population, a simple and reliable test for frailty in the clinic remains elusive, although several are used in research settings. The investigation of common determinants of frailty in both the geriatric and PLWH populations, including immune-senescence, chronic inflammation, epigenetics and mitochondriopathy, will improve prevention and management and provide insight into the described discordance between chronologic and biologic age. While research investigates whether PLWH represent a model of accelerated versus accentuated ageing, evaluation of predictors of successful ageing in PLWH is ongoing. Emerging insights into psychological and physical resilience will contribute to both increased lifespan and improved healthspan for PLWH. about its accuracy have arisen recently. The aim of this study was to evaluate the prevalence of fragility fractures (FF) and associated factors in a cohort of adult WLHIV receiving care at our institution. Material and methods: A retrospective, observational study including WLHIV over 50 years old attending an HIV reference centre in Buenos Aires, Argentina from 1997 to 2017 was performed. Clinical, laboratory and demographic data were reviewed assessing the prevalence of common comorbidities, including low BMD measured by DXA scan, and FF defined as events evidenced by imaging techniques that occurred spontaneously or by low-level trauma. FR assessment was performed using modified-FRAX®. Information was collected in an ad hoc database and t-test, chi-square, Fisher exact or mid-P tests, and maximum likelihood odds ratio were used as appropriate. Variables with p < 0.15 were included in a multiple regression model.
Results: Two hundred and fifty patients were included. Demographic and clinic characteristics are shown in Table 1. The prevalence of low BMD was 67% (88/132 women) and FF 6.4% (18 events in 16 patients). Factors associated with FF according to multiple regression model were: increased age (p = 0.007), HCV coinfection (p = 0.001), increased modified-FRAX score for hip fracture (p = 0.002) and major osteoporotic fracture (p < 0.001). Those patients with FF showed a 75th percentile in current hip and major osteoporotic fracture scores of 1.1 and 5.6, respectively; and patients without FF showed a 75th percentile for each scores of 1.2 and 4.7 respectively (Figure 1). Taking into account the latest percentiles as cutoff values, scores for hip fracture ≥1.2 or major osteoporotic fracture ≥4.7 were associated with a significantly higher likelihood of FF with an OR: 6.7 (95% CI: 1.9 to 29.4, p < 0.01) and OR: 11.9 (95% CI: 3.1 to 67.2, p < 0.001) respectively. Conclusions: Risk factors for FF found in this study were similar to those previously described in the literature, highlighting the impact of HCV coinfection. Despite known modified-FRAX® limitations, we believe that a new cutoff could be more accurate for risk prediction and deserve further investigation in a prospective study. The investigation of normal liver enzyme in patients infected with HIV can be as challenging as it is for a patient negative for any hepatotropic virus. In the absence of alcohol abuse, we have to keep in mind the possibility of drug-induced liver injury (DILI), especially in patients with polipharmacy and cART. Non-alcoholic fatty liver disease (NAFLD) is increasingly recognised as an important aetiologic factor of chronic liver disease in the HIV-infected population. As NAFLD can coexist with other liver diseases, it can be also responsible for a faster progression of fibrosis towards cirrhosis. The term NAFLD includes a wide spectrum of liver disease, from simple steatosis to steatohepatitis with different grades of fibrosis, including cirrhosis. NAFLD is also recognised as an important risk factor for the development of hepatocellular carcinoma, independent of the presence of cirrhosis. The prevalence of NAFLD is extremely variable depending on the geographical area, probably due to different diet behaviour in the different continents. Overall, the prevalence is estimated to be around 25% in the general population. In the HIV-infected population, prevalence is described to range from 13% to 73%, with this wide variation probably due to the different methods for fatty liver assessment. Although up to now, only life style modification is effective in the management of this NAFLD, several drugs are under investigation, including antifibrotic drugs, with interesting results in this disease, who is becoming the leading aetiology in the liver transplant list in several countries.

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Hepatitis C eradication: is it for real in this day and age of economic constriction? treated patients. Theoretically, both scientifically and mathematically, eradication of the disease is feasible but will require great efforts to diagnose patients who are unaware of their infection as well as real commitment from the sociopolitical and cultural arena to achieve this goal allocating the required resources. We are nevertheless in a historic junction in modern medicine where the feasibility of eradicating a global disease is being contemplated and might be possible with simple tools of prevention, linkage to care and curative oral treatment. Unfortunately, hepatitis C is still not considered in many countries a public health priority despite great efforts by many scientific and health regulatory agencies including the World Health Organization. In addition, there has been no iconic figure identified who can raise the emotional passion of collective political and community awareness as we have seen with other chronic and terminal illnesses such as HIV and cancer. Individuals as well as the civil society need to thrive with determination, partnerships, collaboration and advocacy to build and sustain support for these efforts. Upfront fair and just negotiations with government-pharmaceutical leverage needs to be played in order to lower the price even further of these highly effective medications. We can and we must as individuals within the civil society stimulate the collective awareness in order to screen, identify and diagnose at risk individuals so we can sensitise politicians, key stakeholders and opinion leaders to the reality of response that a secure initial investment will help save many lives and will bear long-term benefits to the society as a whole. Strong and sustained political, community advocacy in conjunction with people living with the disease is needed in order to build and support effective measures. If this is to happen in our lifetimes, the time for action needs to wait no longer.
Background: In Brazil, hepatitis E (HEV) is rare, with a prevalence ranging from 1% to 12.9% in healthy subjects. It is known that in patients with chronic hepatitis C (HCV), hepatic lesions may be exacerbated by coinfection with hepatitis A virus (HAV) or hepatitis B virus (HBV) [1]. However, few studies have evaluated HCV coinfection with HEV. Therefore, we evaluated the impact of HEV infection on the disease severity of chronic HCV infection. The aims were to determine the prevalence of HEV infection among patients with chronic HCV, assessing the impact of coinfection on liver disease severity and to evaluate histological characteristics to HEV infection in HCV-HEV coinfected patients. Materials and methods: A observational and cross-sectional study was performed. Samples were collected from 2013 to 2016. Inclusion criteria were consecutive chronic HCV adults; na€ ıve for HCV treatment. An exclusion criteria was HBV or HIV infection. HEV serology was performed with IgG and IgM antibody assays (ELISA, Mikrogen, Germany) and, HEV RNA by QIAamp® MinElute® Virus Spin (Qiagen, United States of America). Liver histology was analysed with a 1:2 pairing of monoinfected and coinfected patients. Results: Anti-HEV IgG was positive in 22/181 (12.0%) patients, anti-HEV IgM was positive in 3/181 (1.6%) patients and real-time HEV RNA was positive in 9/181 (4.9%) patients. When comparing patients with and without HEV coinfection, we observed a significant difference in the following laboratory parameters: APRI score (p = 0.013), albumin (p = 0.01), total bilirubin (p = 0.007), platelets (p < 0.001) and INR (p = 0.032). In addition, HEV-positive cases also had a higher severity of liver disease in the following clinical parameters: fibrosis ≥3 vs. ≤2 (p = 0.001), oesophageal varices (p = 0.007), ascites (p = 0.010) and CHILD-PUGH score (p = 0.036). Of the 96 patients who underwent liver biopsy, 11 had a positive serological marker for HEV (Table 1). We then performed a 1:2 match for age, gender, HCV genotype and grade of liver fibrosis. No particular histological abnormality could be attributed in HEV coinfection when compared to HCV monoinfected patients.

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Experience with dolutegravir in first-line treatment in Brazil: the first 100,000 patients adopted two strategies to offer DTG without major changes in its annual budget: price negotiation and reorganisation of the drug portfolio, including withdraw of obsolete drugs and major switch to the new regimens. Thus, MoH-B offers the best HIV therapy available nowadays, maintaining the sustainability of universal access to ARV.

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ART and sexual and reproductive health of women living with HIV: challenges and opportunities R Zash Reproductive Health, Harvard University Center for AIDS Research, Cambridge, MA, USA Paediatric HIV infections have been dramatically reduced because of the scale-up of antiretroviral treatment (ART) among all adults, including pregnant women. Now, the magnitude of ART exposures in pregnancy in countries with high HIV prevalence outweighs that seen for any other drug in history. An increasing proportion of women start ART prior to conception, leading to more ART exposures in the first trimester when the foetus is most vulnerable to teratogens. Despite the magnitude of ART exposures, data on the safety of ART in pregnancy has lagged behind. Recent data from Botswana suggests a potential increased risk of neural tube defects with dolutegravir (DTG) exposure from conception. This signal has put country programmes, healthcare providers and women living with HIV in a difficult position with regard to HIV treatment decisions. This presentation will review recent data on ART safety in pregnancy, highlight knowledge gaps and discuss how to compare pregnancy safety data from varied settings. Despite the challenges presented by the Botswana findings, there is also now an opportunity to address reproductive health of HIVinfected women more broadly. This includes improving access to contraception and family planning, creating models for individualised HIV treatment decisions in lower resource settings and expanding surveillance to more efficiently gather pregnancy safety data on new antiretroviral medications.

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The role of civil society in the evolving HIV treatment programmes: lessons learned and recommendations J Hourcade Bellocq Buenos Aires, Argentina During the first darker decade of the epidemic, civil society (CS) organised a movement to fight stigma and discrimination, putting pressure on governments and scientist to find a cure or a treatment, including proper resource allocations. With highly effective treatment, the CS moved into treatment access advocacy and literacy, supporting adherence. One of the key stakeholders in the creation of the Global Fund (GF) and its architecture were the CS including people living with HIV (PLWH) movement and this resulted in a scale-up to 17 million people on antiretroviral therapies (ARVs). Today, CS and PLWH are critical in replenishing the GF and in discussing a proper allocation. Under the new global funding for health trends, the investment of Official Development Assistance is moving away from middle-income countries where most of the people live, jeopardising some of the gains of the grant investments. The introduction of ARV-based prevention and the evidence Undetectable=Untransmittable (U=U) changes the landscape of the response. The role that CS and PLWH could play campaigning on U=U will significantly decrease stigma, discrimination and criminalisation of HIV transmission, that is a massive incentive for more people to come forward for HIV testing. PrEP requires accessing a diverse and heterogeneous population that is out of the reach of CS. The primary challenge is how to build demand on potential users and pressure on decision-makers for funding PrEP access. CS needs to rethink itself and to create a new narrative around the current response that we need. There are lessons to be learned, but it will not be enough.  Abstract P001- Figure 1. HIV mortality in M exico from 1990 to 2017 by sex.
Abstract P002- Conclusions: PLLV following virological suppression is common. In our cohort, most of them are with protease inhibitors. It is well known that PLLV can be due to problems in adherence. It is common in our centre to work in adherence with these patients. 12% progressed to VF and the only factor associated was polypharmacy. On the other hand, CKD is associated with still having detectable viraemia. It is important to evaluate in the future the influence of adherence improvement, reduction of polypharmacy as well as the impact of PI in these patients.

P004
AIDS-related death in Uruguay: high proportion in patients not retained in HIV care Conclusions: High proportion of patients who died due to AIDS before the linkage and follow-up in the health system demonstrates the need to adopt proven strategies to improve access and continuity of care. In addition, the strategies must be adequate for the conditions of social vulnerability of this population.
Abstract P004- Table 1. Distribution of deaths in "cascade of continuum of HIV care," AIDS-related deaths versus non-AIDS-related deaths Step at death  [1]. In the general population, it is estimated that the prevalence of dyslipidaemia exceeds 30% [2,3]. People living with HIV (PLWHIV) have increased cardiovascular risk associated with chronic inflammation, immune dysfunction and antivirals [4]. Dyslipidaemia is becoming more prevalent due to the increase in life expectancy and other risk factors in PLWHIV [5]. The purpose of the present study was to evaluate the frequency of dyslipidaemia in Mexican mestizo HIV patients receiving antiretroviral treatment in a Mexican secondary healthcare facility. Materials and methods: A cross-sectional study was carried out. Clinical records of patients over 18 years of age who had a complete lipid profile and at least six months of continuous antiretroviral treatment were evaluated. Dyslipidaemia was defined as cholesterol level ≥200 mg/dL, triglycerides ≥150 mg/dL, LDL-C ≥115 mg/dL or HDL-C <40 mg/dL [6]. Variables are expressed in median and range, bivariate analysis was performed using c2 and p < 0.05 was considered statistically significant.
Results: A total of 183 patients were included. The median age was 38 years (20 to 72). Out of 183 patients, 88.5% were male, and 80.3% met at least one criterion for dyslipidaemia. The most frequent disorder was hypertriglyceridaemia (60.7%), with a median 214 mg/dL (37 to 713 mg/dL) followed by low HDL-C levels (49.7%), median 42 mg/dL (25 to 179 mg/dL), hypercholesterolaemia (31.7%), median 183 mg/dL (86 to 381 mg/dL) and high concentrations of LDL-C (30.6%), median 101 mg/dL (4 to 362 mg/dL). On the bivariate analysis there was a tendency for hypercholesterolaemia in patients receiving protease inhibitors; however, it was not statistically significant in this study. Conclusions: Higher triglyceride values and decrease in HDL-C were the most commonly encountered disorders. There appears to be an association between the use of protease inhibitors with hypercholesterolaemia; however, it was not statistically significant in this study group. Limitations of the study were the size of the sample and other factors that can cause dyslipidaemia that have not been taken into account. Due to a higher life expectancy of PLWHIV and the cardiovascular risk it represents, it is necessary to implement measurements to identify and control dyslipidaemia and to adjust the antiretroviral drugs associated with this disorder. The results obtained are similar to other series performed in Latin American patients. Currently there are no local guidelines or consensus on the control and treatment of dyslipidaemia in PLWHIV. Background: Bictegravir (BIC, B), a novel, unboosted integrase strand transfer inhibitor (INSTI) with a high barrier to resistance and low potential for drug interactions, has been coformulated with the recommended NRTI backbone of emtricitabine (F, FTC) and tenofovir alafenamide (TAF) (B/F/TAF) into a once-daily (QD), single-tablet regimen (STR). We report pharmacokinetics (PK), safety and efficacy in children who switched from a stable antiretroviral regimen to B/F/TAF. Materials and methods: We conducted a prospective, single-arm, open-label, 2-part, 48-week (W) clinical trial to evaluate switching to the adult formulation of B/F/TAF (50/200/25 mg) QD in virologically suppressed children (6 to <12 years) weighing ≥25 kg. Intensive PK was evaluated at W2 or W4. PK parameters were compared to B/F/TAFtreated adults to confirm BIC dose. Adverse events (AE), laboratory tests and HIV-1 RNA were assessed. We report follow-up data through W12.
Results: Twenty-five children were enrolled; median (range) age 10 (6 to 11) years, median (range) weight 28.4 (25.0 to 39.0) kg, 52% female, 64% Black, median CD4 count 928 cells/lL. BIC AUC tau was similar, C max 77% higher, and C tau 22% lower in children ≥25 kg than adults. BIC C tau was well above protein adjusted effective concentration for wild-type virus (162 ng/mL) in all children. FTC and TAF exposures were within safe and efficacious ranges of adults ( We designed a differentiated model of HIV care to improve retention and adherence among pregnant adolescents in Haiti designed to target stigma, social isolation and lengthy clinic visits. Materials and methods: Community cohort care groups pregnant teens in groups of~15 peers who meet monthly in the same group for integrated clinical care and counselling. Groups occur in a community setting. From 1 February 2018 to 31 August 2018, HIV-infected pregnant adolescents (10 to 24 years) were invited to participate. A PMTCT nurse led each group session including assessment for ART adherence, ANC care, medication dispensation and facilitated peer group counselling. Retention at six months was defined as being alive with a visit between five and seven months; viral suppression was defined as <1000 copies/mL. Retention was compared between cohort care participants and pregnant teens receiving standard care at the PTMCT clinic 1999 to 2014. Results: Twenty-eight adolescents participated with a median age of 21 years (IQR 20 to 22) and of whom 7% (2/28) were ART na€ ıve, and among those on ART, 58% (15/26) had viral suppression at enrolment. In cohort care, 100% of adolescents initiated ART and 89% (25/28) were retained in care at six months compared to 71% initiating ART Abstract P009- Table 1 Parameters are presented as arithmetic mean (%CV); GLSM, geometric least-squares mean a n = 25 from intensive PK substudy in current cohort of children (6 to <12 years) weighing ≥26 kg b ; From population PK modelling (BIC, n = 1193) or pooled intensive PK (FTC and TAF, n = 74 to 77) data from 4 Phase 3 Studies in HIV-infected adults Statistical comparisons of the PK parameters in children (test) versus adults from Phase 3 studies (reference) were made using GLSM rations and associated 90% confidence intervals (CI) with PK equivalence boundary of 70% to 143%. and 71% retention in standard care. In cohort care, 4% (1/28) of pregnant teen mothers died and 7% (2/28) were lost. At six months, 85% (23/27) were virally suppressed. A total of 88% (22/25) deliveries were reported born alive among 100% (25/25) teen mothers retained through delivery; 52% of deliveries were assisted by a health professional. The median number of prenatal and postnatal visits per adolescent mother enrolled in cohort care was 3 (IQR 2 to 5) and 5 (IQR 3 to 6) respectively. Conclusions: PTMCT cohort care for HIV-infected pregnant adolescents plays a critical role in decreasing social isolation, increasing patient knowledge and increasing patient outcomes among Haitian teen mothers.

P011
The HIV continuum of care among recently diagnosed adolescents in two large clinics in Mexico City Background: Women receiving care for HIV infection in Mexico disengage from medical services, and interrupt treatment more frequently than men, but little is known about the barriers for women to access clinical services, continue in care, and adhere to ART. We describe potential barriers to access HIV-care services among women receiving care in Mexico; and compare characteristics of women that interrupted ART with those that never did. Methods: A cross-sectional study was conducted. We enrolled women in care in three centres located in geographically and culturally diverse regions (Mexico City, Cuernavaca and Oaxaca) during 2018. We collected data on individual, family, socio-economic, physical and gender-role characteristics, and compared these between those that self-reported interrupting ART with those never withdrawing ART. Results: We interviewed 164 women (85 in Mexico City, 41 in Oaxaca and 38 in Cuernavaca). The median age was 43 years (range 12 to 87) and most (n = 135, 85%) had been diagnosed before 2013. Women in Oaxaca were younger (32, 12 to 72 years) and more frequently diagnosed in 2017 to 2018 (31/41, 76%). Most women were receiving ART (135/164, 82%). A higher proportion were housewives (68% in Oaxaca and 46% elsewhere). Only 45 (24%) live in a household with a monthly income higher than 200 USD, and in Oaxaca, most women depended on their partners´income (78% vs. 28%). A higher proportion of women in Oaxaca had children (85% vs. 68%); live more than 4 hours away from their clinic (56% vs. 18%) and spent more to get to the clinic (54 USD vs. 14 USD each visit). The frequency of self-reported treatment interruption was similar across centres (20%). The most frequent cited reasons for treatment interruption were: adverse effects (32%) and related to depression (26%). Women that interrupted treatment were younger (44 vs. 41 years), and more frequently single (42% vs. 25%). They had a lower education level (79% had <9 years of school vs. 54%), and more likely to have a child (84.2% vs. 63%), or a child with HIV (25% vs. 12%). They were also more likely to be economically dependent from their partners (37% vs. 26%) or the single contributor to family income (32% vs. 17%) and lived outside the urban area where they receive care (60% vs. 45%).
Conclusions: In this small sample of women receiving care for HIV infection in three different regions in Mexico, we observed that a high proportion of women self-report treatment interruptions. A diverse set of individual (age, education), family situation (partnerships status), socio-economic (family and individual income), gender roles (having children, being economically dependent) and geographic factors (distance) appear to negatively impact the ability of women to adhere to ART over prolonged periods of time.

P013
Effectiveness of a protocol for reduction of HIV vertical transmission in Colombia Background: Preventing vertical HIV transmission is one of the major goals in HIV programmes around the world. This study was made to evaluate the effectiveness of the World Health Organization (WHO) protocol for prevention of vertical HIV transmission. Materials and methods: A retrospective descriptive analysis of a cohort of pregnant women diagnosed with HIV infection who attended an HIV programme located in Bogot a Colombia between January 2009 and December 2018 is presented. The primary outcome was perinatal HIV transmission, other variables in study were: gestational age, current and previous antiretroviral (ARV) regimens, viral load of newborn, initial and last HIV viral load plus CD4 count. Results: Data from 152 pregnant women were recollected, although 14 patients were excluded by incomplete data; the majority were diagnosed during first trimester of gestation (24), followed by 41 and 21 diagnosed in second and third trimester respectively. The most preferred ARV regimen was: zidovudine/lamivudine associated with lopinavir/ritonavir. Raltegravir was used in high-risk cases (third trimester at diagnosis, recent infection; Figure 1). There were no serious adverse effects related to ARV. In the newborn group, all received prophylaxis: 117 of them with zidovudine for 42 days and less than 10% received dual therapy with zidovudine plus nevirapine. The mean HIV viral load at the beginning of treatment in the mothers was 16727 copies/mL, and pre-cesarea the mean viral load was 45.6 copies/mL. The newborn's follow-up indicate the absence of HIV perinatal infection in all of them. Conclusions: For the mothers, ARV was safe and effective. WHO protocol guarantees the effectiveness in terms of reducing HIV vertical transmission.

L Arevalo HIV Program, Centro de Expertos para Atencion Integral CEPAIN IPS, Bogot a, Colombia
Introduction: In the context of violence in HIV, consequences are implicated in all areas for women, which include the loss of social support, social rejection, abandonment and violation of confidentiality. This descriptive exploratory qualitative study focused on the perceptions of HIV women, who have been victims of intimate partner violence to apprehend about the phenomenon and its clarification from their experience. Materials and methods: Participants were women attended in an HIV care centre in Bogot a, and identified as victims of intimate partner violence; group interviews were conducted with a number of two to four people, a total of thirteen women participated. In the analysis of the obtained data, units, categories and patterns were formed, in order to explain contexts, situations, facts and phenomena that establish links between categories, and the relationships between them. Results: It was found manifestations mainly of physical violence, the majority of women interviewed relate situations that have different triggers but all end in a forceful imposition of their partners in blows, or the use of forceful objects. It is followed by verbal violence and psychological violence, which leads to an intense and continuous humiliation, threats of violence, control, disapproval, contempt and/or threat of abandonment. In the moment that they were asked if they considered that the diagnosis of HIV had been a factor in the occurrence of intimate partner violence, only in some cases it was explicitly recognised that HIV increased various types of violence. However, although the majority of women established that there was no direct relationship of partner violence with the diagnosis, in the development of their stories some women narrated situations of violence than corresponded to a correlation with living with the infection. The data were segmented by group of informants and subjects, the process of generating categories was mainly abductive, considering prior categories constructed in the light of the referential framework and at the same time an inductive analysis based on the categories that were emerging from the interviews ( Figure 1). Conclusions: Intimate partner violence has multiple causes such as cultural, social, personal, and relationship factors; if personal variables can be intervened, it is possible to break the circle of violence established by disparate power relations that still persist in our society. The accompaniment that we can give as health personnel is essential to guide and give tools to women and empower them when they are victims of violence. Background: Concurrent treatment of tuberculosis (TB) and HIV is challenging owing to drug interactions, overlapping toxicities and immune reconstitution inflammatory syndrome (IRIS). The efficacy and safety of dolutegravir (DTG) in adults with HIV/TB coinfection were assessed. Materials and methods: INSPIRING (NCT02178592) is a phase 3b, non-comparative, active control, randomised, open-label study in HIV-1-infected adults' na€ ıve to antiretroviral therapy (CD4+ 350 cells/µL) with drug-sensitive TB. Participants on rifampicin-based TB treatment ≤8 weeks were randomised (3:2) to receive DTG (50 mg twice daily during and two-week post-TB therapy, followed by 50 mg once daily) or efavirenz (EFV; 600 mg once daily), with two nucleoside reverse transcriptase inhibitors (NRTIs) for 52 weeks. The week 48 primary endpoint was the proportion of DTG participants with plasma HIV-1-RNA <50 c/mL (responders) using the FDA Snapshot algorithm (intent-to-treat-exposed (ITT-E) population). An independent committee adjudicated IRIS episodes. The study was not powered to show a difference between arms; no formal statistical hypothesis was tested. Results: Participants were randomised to DTG (n = 69) or EFV (n = 44). The median baseline HIV-1-RNA and CD4+ counts were 5.10 log10 c/mL and 208 cells/µL for DTG and 5.24 log10 c/mL and 202 cells/µL for EFV. The proportions of week 48 responders (ITT-E) were 52/69 (75%; 95% confidence interval (CI): 65 to 86) for DTG and 36/44 (82%; 95% CI: 70 to 93) for EFV. The DTG non-response rate was primarily driven by non-treatment-related discontinuations: 11 participants (16%) for DTG and 3 (7%) for EFV discontinued due to non-treatment-related reasons while suppressed (mainly loss to follow-up). There were two protocol-defined virologic failures (PDVFs) and no treatment-emergent resistance-associated mutations (RAMs) for DTG and 1 PDVF in EFV with NRTI and non-NRTI RAMs. Week 48 median CD4+ increases were 220 cells/µL (interquartile range (IQR): 111, 271) for DTG and 190 cells/µL (IQR: 104, 252) for EFV. TB treatment success was 61/69 (88%) and 39/44 (89%) in DTG and EFV respectively. Two EFV participants discontinued due to adverse events. TB-associated IRIS rates were low (DTG, n = 4 (6%); EFV, n = 4 (9%)). No participants discontinued due to IRIS or liver events. Median DTG trough concentrations during twice-daily dosing with rifampicin were similar to that with once-daily DTG without rifampicin. Conclusion: DTG is effective and well tolerated in HIV/TB coinfected adults receiving rifampicin-based TB treatment. Background: Globally, 2.7 million people are coinfected with HIV and HBV. Little is known regarding the prevalence and genotype distribution of HBV in HIV-infected subjects in the Mesoamerican region. As the HBV epidemic evolves, it is important to understand the dynamics of HIV/HBV coinfection in the region. In this study, we analyse HBV prevalence, genotype distribution and treatment resistance prevalence in six countries of the Mesoamerican region. Materials and methods: HIV-infected antiretroviral treatment-na€ ıve persons were enrolled after written informed consent, as part of a multicentre study evaluating HIV pretreatment drug resistance and HBV coinfection in Mesoamerica. Participants were selected by convenience sampling from key HIV clinics and research centres in the region. Serology for HBsAg was performed for all participants and HBV was genotyped using an in-house amplification method in those testing positive. HBV sequences were reviewed for quality and a consensus was generated for each participant. Treatment resistance was evaluated with a web-based application. For genotyping consensus, sequences for each participant were compared phylogenetically to reference HBV sequences from NCBI using MEGA, PhyML and BEAST. Results: In total, 8503 patients were surveyed; 441 (5.19 %) were HBsAg positive. HBV prevalence by country was: Belize 8.7% (n = 139), Panama 6.5% (n = 611), Mexico 6.2% (n = 4111), Honduras 5.0% (n = 1489), Nicaragua 3.6% (n = 392) and Guatemala 2.6% (n = 1761). The median age was 33.5 years, and the most prevalent risk factor was heterosexual transmission (32.7% of all cases), followed by MSM (23.5%), and bisexual (4.9%). Genotype H was identified in 40.6% of amplified samples, followed by genotypes F (26.2%), A (26.2%), G (6.4%) and D (0.5%). Genotype A was the most frequent genotype in Belize and Panama; genotypes H and F in Guatemala and Mexico; Honduras and Nicaragua had equal distribution of the three genotypes. Phylogenetic analysis showed evidence of region-specific clades, suggesting that subgenotypes may evolve as the virus migrates between countries. Major drug mutations to lamivudine and telbivudine were observed in 17 (8%) of the sequences, and to entecavir in 19 (9%). Conclusions: Overall, HBV coinfection in persons living with HIV in Mesoamerica was under the global prevalence of 7.4% (except for Belize), but over 4%, suggesting middle to high prevalence in the region. Sexual transmission, including heterosexual, remains the leading risk factor for coinfection, warranting focused interventions. Overall, drug resistance prevalence approached 10% for most drugs, underscoring the importance of baseline drug resistance tests and warranting continuous surveillance. Background: Several reports from randomised clinical trials and reallife settings have shown that direct-acting antiviral (DAA) therapy for chronic HCV infection in HIV/HCV-coinfected patients yield high response rates in both scenarios. We evaluated the efficacy and safety of these regimens in a private and ambulatory clinical facility. Materials and methods: Retrospective study assessing all HIV/HCVcoinfected patients underwent HCV treatment with a DAA regimen in routine clinical practice from an ambulatory care centre in Buenos Aires, Argentina, between January 2016 and September 2018. Demographic features, liver fibrosis status, DAA use, adverse events, and sustained virological response 12 weeks after the end of therapy (SVR12) were included in an ad hoc data base to be analysed. Results: One hundred and three HIV/HCV-coinfected patients were enrolled in the study (male 70%; median age (range): 48 years (35 to 74)). All patients were on antiretroviral treatment, 81.5% of them had undetectable HIV-1 viral load, and 99% had <200 copies/mL. The median CD4 count (range) was 672/mm 3 (48 to 1276), HCV genotype 1: 89%, cirrhosis: 43.9%, pegylated interferon and ribavirin experienced 38.8%. In terms of DAA use, 53.4% received daclatasvir + sofosbuvir, 40.8% ledipasvir/sofosbuvir, 2.9% paritaprevir/ritonavir/ombitasvir + dasabuvir, 1.9% elbasvir/grazoprevir and 1% sofosbuvir/velpatasvir. Out of 103 patients, 88 ended their DAA therapy and 83 of them reached the time to perform the HCV viral load 12 weeks after the end of therapy. The SVR12 was 98.8% (95% CI: 93.5 to 99.8). Four patients reported grade 1/2 adverse events (3.9%) that were mild and transient. Only one patient (0.9%) had a serious adverse event related to ledipasvir/sofosbuvir that led to its discontinuation. Conclusions: Treatment of HIV/HCV-coinfected patients for chronic HCV infection with different DAA combinations in a real-life setting led to high rates of SVR12 similar to those previously described in literature, and the occurrence of adverse events was low. Our results should be encouraging to expand the DAA treatments in the HIV/ HCV-coinfected population in order to control HCV infection. Background: Co-infection with HIV, hepatitis B and C virus has important implications especially when considering treatment and prognosis. Since the transmission route of these viruses is shared, co-infection is not uncommon. HIV has been shown to increase the persistence of HCV and HBV and the risk of hepatocellular carcinoma. According to CENSIDA in Nuevo Le on, our state, 3402 persons live with HIV, but the co-infection with other viruses has not been studied. In 2018, the Mexican consensus on the treatment of HCV was updated to include for the first time the use of direct-acting antivirals. Thus, we consider that it has become critically important to establish the local prevalence of these infections for physicians to know the burden of the disease and establish protocols in their clinics to adapt to newly available treatments. Materials and methods: The Hospital Universitario Dr. Jos e Eleuterio Gonz alez is a 500-bed teaching hospital in Nuevo Le on, Mexico. We aimed to report the seroprevalence of HCV antibodies and HBV surface antigen in the population living with and without HIV that receives medical attention at our institution. A retrospective review of medical and electronic charts was done looking for HIV, HCV and HBV diagnosis, especially looking for co-infections. Demographic information was also obtained including age, year of infection diagnosis, and gender among others. Results: From 1 January 2013 through to 31 December 2018, 888 persons were diagnosed with HIV infection. They were all tested for HBV and HCV. HCVAb was positive in 4.6% (41/888) of the studied population, while HBsAg was positive in 2.3% (21/888). When compared with the total of positive tests, the +HCVAb/+HIVAg-Ab represented 9.5% (41/431) of all the reactive HCVAb tests. The +HBvsAg/+HIVAg-Ab on the other hand was 22.8% of the total HBV infections (chronic and acute). Conclusions: We cannot establish the prevalence since viral loads to confirm infections and rule out false positive tests have not yet been obtained. Nevertheless, it is very alarming that more than a fifth of the new HBV diagnosis are being done in HIV-infected people. We realise a bias in our results since all our HIV-infected patients are being tested both for HCV and HBV. We conclude that the preventive measures for hepatitis should be reinforced including HBV vaccination and early detection of HBV must be sought in HIV new diagnosis. Background: Currently, the global leading cause of death among people living with HIV is tuberculosis (TB) [1]. Without appropriate treatment, 28% to 53% is at risk of dying, and this risk increases to 65% to 94% among those who are coinfected with HIV [2]. Material and methods: A retrospective cohort study to obtain prevalence, incidence, mortality rate and percentage cure among incarcerated patients living with HIV/TB was performed. We used as a diagnostic method for TB: chest X-ray, basiloscopy, culture and GeneXpert in expectoration and/or gastric juice. Inclusion criteria: (1) incarcerated, male patients infected with HIV and (2)   Background: Hepatitis C (HCV) and HIV coinfection is associated with accelerated hepatic fibrosis progression, higher rates of liver decompensation and death when compared to HCV monoinfection. In past years, patients with HCV/HIV coinfection were considered "hard to cure. " Direct-acting antivirals (DAA) have changed dramatically this landscape. We analysed a cohort of HIV-HCV-coinfected patients who received specific HCV treatment with elbasvir/grazoprevir (EBR/GZR). Methods and aim: A retrospective analysis of HIV/HCV-coinfected patients treated with EBR/GZR in several care centres in Buenos Aires, Argentina between February 2017 and August 2018 was carried out to assess the outcomes of EBR/GZR in coinfected patients in a real-life setting. Results: Twelve coinfected patients were treated during the study period: 11/12 were male. The average age was 50 years. 7/12 had a genotype (G) 1 infection (G1b: 4/7); 3/12 had a G4 and 2/12 had a G3 infection. Only 25% presented extra hepatic manifestations. 7/12 had a viral load higher than 800.000 IU/mL, 10/12 were treatment experienced (3/10 had received DAA as a previous regimen). 8/12 had advanced liver fibrosis (4/8 had cirrhosis). Among cirrhotic patients average MELD score was 7 points. 9/12 received Ribavirin (RBV) and all G3 patients received EBR/GZR+ Sofosbuvir (SOF) per label indication. Data regarding HIV viral loads and CD4 count were collected. Neither viral load nor CD4 count had an impact in sustained virologic response (SVR12). All patients were under antiretroviral treatment and all achieved SVR12 and only 1 patient presented mild asthenia. Conclusions: The combination EBR/GZR was effective and safe in a real-life setting in this cohort of coinfected patients.

P021
Venezuela: the perfect storm: resurging epidemics, a broken health system, and lack of reliable data M Torres 1 and A Nieves 2 1 ICASO, Toronto, Canada. 2

ACCSI & RVG+, Caracas, Venezuela
Background: There is an unprecedented humanitarian emergency in Venezuela. In 2018, the GDP plummeted by 17% and inflation rates soared to 1,698,488% (record). Economic collapse and wide spread corruption have made accessing food and life-saving medicines impossible. The humanitarian crisis in Venezuela was created by the government that refuses to publish epidemiological data and censors and disciplines those who attempt to do so. For the government, the "absence" of data translates into the absence of a crisis. Their widely documented (IACHR, 2018) refusal to accept foreign "aid" (including medications) supports their denial of any crisis, yet clearly constitutes a violation of the basic human rights of their citizens. Materials and methods: To document the humanitarian and health emergency in Venezuela, ICASO and ACCSI have performed quarterly rapid assessments since September 2017. They include desk reviews along with targeted key informant interviews of PLHIV and other diseases, doctors, advocates, academics and UN representatives. Results: The information collected has been used to influence decision-making processes of regional and international organisations (Global Fund, UNAIDS, PAHO, IACH) with respect to responding to the crisis in Venezuela. These reviews clearly demonstrate that Venezuela is experiencing several epidemics simultaneously (HIV, malaria, diphtheria, measles, TB and hepatitis), painting a picture of widespread suffering and death that the international community is now recognising and slowly trying to respond to. For example, the number of AIDSrelated deaths in the country has risen by nearly three quarters since 2011 and the widespread stock out of ARVs has resulted in viral suppression of 7% for HIV (UNAIDS, 2018), heightening fears of widespread resistance to a host of ARVs. In malaria, by 2017, the country had the world's worst malaria performance, having 80% of the estimated malaria-related deaths in the region of the Americas. Conclusions: Venezuela is a case study of the many ways in which international donor policies, based on widely applied generic metrics and standard data collection methods have failed to address a burgeoning crisis in the country and the region. This, combined with the lack of "official" data and the denial of the crisis by the Venezuelan government have created the perfect storm; a humanitarian crisis punctuated with resurgent epidemics that Latin America has never seen. But NGOs have demonstrated that they can respond, not only by providing direct relief, but by gathering the voice from the ground and rigorously collecting, analysing and sharing data that informs decision-making.

P022
National study: prevalence of HIV, hepatitis B and C, syphilis and tuberculosis in people deprived of liberty in federal prisons in Argentina Background: One of the sanitarian policies implemented by the Ministry of Health of Argentina in the last decade was the improvement of the health conditions and access to care for imprisoned people. For this reason, between 2015 and 2017, a nationwide study was conducted to determine the prevalence of HIV, syphilis, hepatitis B and C and tuberculosis in federal prisons in Argentina, within the framework of the "justice with health, health convention to include" [1]. Materials and methods: An observational cross-sectional study was designed based on a representative sample of the universe of 10300 imprisoned people in federal prisons. Extractions were made to study HIV (fourth generation ELISA), HBV (HBsAg and Anti-HBc), hepatitis C (HCV) and syphilis (VDRL confirmed by TF-PA). Samples were taken from those who had TB-related symptoms to perform a baciloscopy. All the people who accepted to know their serology received pre-and postcounselling. A self-administered survey was conducted on sexual practices, care history and drug use. The fieldwork was carried out in 2016. The study was approved by a bioethics committee and was supported by UNAIDS, PAHO, UNODC and the Federal Penitentiary Service. Results: In total, 2181 blood samples were taken and 2277 surveys were carried out in six federal prisons (89% men, 10% women and 1% transgender). All estimates and prevalence values presented here were adjusted based on prison population structure, through sample weights (taking in account 6 variables). The weighted prevalence of HIV was 2.7% (CI: 2.4% to 3%); syphilis 6.8% (5.8% to 7.7%); positive HBsAg was 0.51% (0.37% to 0.65%); positive Anti-HBc and negative HBsAg was 6.1% (5.5% to 6.5%); HCV was 3.3% (3% to 3.6%). In one case, baciloscopy was positive, so a TB prevalence was 29.6 9 100000. More than 85% of the people tested received their results [2]. Conclusions: The findings demonstrate the high prevalence of the infections studied in the prison population and reinforce the need to develop interventions that facilitate access to prevention, diagnosis and care in this population. Federal prisons have 15% of the total number of people imprisoned in Argentina [3]. It is possible that the prevalence of the infections studied may be higher in the rest of the provincial prisons. With regard to the development of an articulated investigation with the management, the process of preparation and the development of the work of field allowed to weave new nets and to strengthen some that already existed, something that must be sustained in the time.  [1]. It was observed that hospitals and primary healthcare are ideal places for their implementation because they facilitate referrals to other services [2]. Most of the CAs offered the attention in non-traditional hours benefiting the target population [3]. The benefits most demanded by the population were: hormone, HIV-STI test, proctology and health control. The DSyETS made technical and financial support to CSOs and health teams for the creation of CA (Table 1). Results: The promotion activities of the CA are fundamental for its installation and it is highly recommended to be carried out by members of the collectives, since they know the circuits and codes of the potential beneficiaries [2]. Many CAs have achieved their sustainability thanks to political decisions made by local authorities, promoting changes in the schedule of professionals and including rented promoters. Over a total of 5509 people seen in the CAs, 2353 were gay men, 3 men who have sex with men, 900 transgender women, 119 transgender men, 467 lesbian women, 1465 heterosexual (both men and women) and 202 sexual workers (non-transgender). Conclusions: By 2018, Argentina has 44 CAs. The promulgation of the Gender Identity National Law (26.743) had a strong impact on people's access to health resources and, in this sense, there is much to be done, being the health sector with the main responsibility for generating this opening and new offers [2].    is a PLHIV trained to help others who share their HIV status, to overcome barriers that arise in medical care. With that goal, we created, "Positivos para Positivos" (PPP), a peers group for supporting PLHIV with recent diagnosis of HIV infection. Our objective was to compare adherence and laboratory parameters in recently HIV-diagnosed PLHIV as they were accompanied or not by members of PPP. Material and methods: A team of physicians, social workers and psychologists selected adherent PLHIV with undetectable plasmatic HIV viral load (VL), assisted in our centre, and offered them to integrate PPP. Those who accepted were trained by the team. Recent diagnosis was defined when the first positive test was performed ≤6 months before the first consultation. Each PLHIV with recent diagnosis were offered contact with a member of PPP. If they agreed, two PPP members were designated for their accompaniment. Recently diagnosed PLHIV with at least one appointment with a PPP member constituted the "study group. " The "control group" was constituted by PLHIV who refused to contact and by those who were not offered (for any reason). Medical care to both groups was identical. The analysed variables were: deaths in every group; proportion of PLHIV with optimal clinical control (≥3 visits to the office during follow-up); proportion of PLHIV who started HAART; pharmacy refill rate; unstructured HAART interruptions (≥3 consecutive months without pharmacy refill); CD4 evolution; proportion of PLHIV lost to follow-up (≥6 consecutive months without contact with the healthcare system); proportion of PLHIV with good laboratory control (≥1 blood collection during follow-up); proportion of PLHIV who achieved undetectable VL; proportion of PLHIV who increased >50 CD4/mm 3 at the end of the follow-up. Categorical variables were analysed by 2 9 2 tables and chi-square (EpiInfo 7.2.2.6). Results: In total, 127 PLHIV met the inclusion criteria. The "study group" had more advanced disease. Otherwise, both groups were similar. The results are shown in Table 1.     Methods: This is a descriptive study, epidemiological data about HIV/ AIDS in immigrant patients as well as immunological and virological data were used. Results: Treatment was started in 321 immigrant patients with HIV infection between 2016 and 2018, 82% were Venezuelans, and 89% were male. 42% have university studies, 51% are homosexual and 31% are bisexual. 53% of patients had a diagnosis time of five years or less. 25% were symptomatic at the time of diagnosis. 60% was diagnosed in a routine consultation. The route of transmission was sexual in all cases. 25% had AIDS stage at the time of diagnosis in their country of origin. 42% of patients had CD4 greater than 500, 60% of patients had undetectable viral load and 11% were in AIDS stage at the time of entering the Peruvian health system. 69% had received treatment in their country and 18% had a history of having abandoned treatment. 71% of patients who started treatment in the Peruvian health system started with non-nucleoside analogues. Conclusions: The increase in the immigrant population with HIV infection in Peru is mainly from Venezuela. This increase is mainly of MSM population, with higher education and with good response to antiretroviral treatment. The response capacity of the Peruvian health system must be evaluated to ensure the sustainability of the treatment in this group of patients.  Background: Travestis and transgender women, in search of signs of corporal femininity, resort to different technologies for body modification, such as hormones [1]. Due to characteristics of frequent access denial to health services, the use of these hormones occurs, mainly, by self-medication [1]. They are considered a key population due to high HIV prevalence found in Brazil and worldwide [2]. Therefore, discussing other aspects of health, such as access to inputs and healthcare services are part of the concept of HIV combination prevention, under its structural approaches. This study aims to describe the selfreported prevalence of hormone use by travestis and transgender women in the Brazilian Federal District. Materials and methods: A cross-sectional study with RDS sampling, containing a KAP questionnaire, carried out with travestis and transgender women over 18 years of age, with some relationship to the Brazilian Federal District and never having participated in the study. The statistical analysis used 95% confidence intervals. Estimated prevalence used the RDS-II estimator. All analyses were performed in programme R, version 3.4.4 using the RDS package [3]. Results: We analysed information from 201 participants. The study had a young sample, with a median age of 24 years. The overall prevalence of continuous hormone use was 64.5%. The most used formulation was the one that combines oestrogen and progesterone (86.2%), in the injectable (75.1%) and oral (66%) forms respectively. A great part (84%) of the participants got the hormones directly in the pharmacies, without medical prescription. The guidance on use of these medicines came from other travestis and transgender women in 41% of the cases. Satisfaction with the use of hormones was high (over 70%), as well as the side-effects felt (in 63% of cases). Discontinuation of hormone use in the event of side-effects was the attitude taken by a great part of the respondents (43%). Conclusions: This study demonstrated the reality of great rates of self-medication indicating poor access to healthcare services, reflected in high rates of side-effects, discontinuation of use and receipt of technical information only from peers. Related to the structural approaches to HIV combination prevention, these kind of studies about access are very important because they can be considered a proxy to access of these persons, suggesting a lack of access to HIV inputs and healthcare services as well. More studies to confirm this hypothesis are fundamental.  Background: The prevalence and incidence of cardiovascular disease (CVD) are expected to increase among people living with HIV as their lifespan improves in South America due to accessibility to new treatment regimes [1]. Transgender women (TW) have unique characteristics, thus, CVD risk factors in this group may differ from general population. The short lifespan of TW in Argentina, estimated around 40 years, constitutes a major challenge to use most of CVD risk scores. We aim to assess the impact of non-traditional CVD risk factors in TW with the Framingham 30-year risk score at their first visit to an HIV/STI clinic in Buenos Aires, Argentina.

References
Methods: We performed a cross-sectional study to analyse non-traditional CVD risk factors and evaluate their possible association with intermediate/high 30-year CVD risk among TW at an HIV/STI clinic in Buenos Aires, Argentina, from 2014 to 2017. TW between 20 and 60 years at their first visit to the clinic were included. We evaluated CVD risk assessed with the Framingham 30-year score as our outcome [2]. As independent variables, we evaluated HIV status, cocaine use and hormone therapy (HT). CVD risk was analysed as a dichotomic variable (low-risk vs. intermediate/high-risk). Finally, a logistic regressions analysis was performed to investigate the effect of these non-traditional CVD risk factors on our outcome. Results: One hundred and eleven TW were eligible for this analysis, 37 (33.3%) were HIV positive, 44 (39.6%) reported use of HT and 52 (46.8%) reported use of inhaled cocaine. The median age was 31 years (IQR 27 to 37). 80 patients (71.43%) were found to have low CVD risk. According to our model, cocaine use and HT use were not significantly associated with high CVD risk (OR 0.92 p = 0.853 and OR 0.58 p = 0.25 respectively). Moreover, HIV was associated with lower odds of having intermediate/high CVD risk, being these results statistically significant (OR 0.23 p = 0.026). Conclusion: Well-known non-traditional CVD risk factors such as HIV infection and cocaine use were not associated with increased odds of having high CVD risk. Moreover, patients with HIV seemed to have lower odds of intermediate/high CVD risk according to our analysis. Traditional CVD risk functions are not accurate tools to establish CVD risk among people living with HIV [3]. Our study shows that this risk function might be even less accurate for assessing this outcome among the transgender population in our setting. More studies in this population need to be done in order to find better tools for measuring CVD risk more accurately. Background: HIV-2 infections predominate in the West African region but the presence of the virus has been identified in other parts of the world [1]. In the Dominican Republic, trans population has an elevated prevalence of HIV infection (3.9% to 6.9%) compared with general population [2]. Not all antiretrovirals developed for HIV-1 treatment are equally effective in HIV-2 infection, and limited data exist on the efficacy of new ARV on HIV-2 [3,4]. The objective of this study was to further characterise the presence of HIV-2 in transwomen populations living with HIV in the Dominican Republic. Methods: Serological analysis to identify HIV-2 antibodies by PCR and Multispotin previously confirmed HIV-positive samples of transwomen volunteers. Socio-demographic determinants were linked with serological data and statistical analyses were used to assess risk determinants of HIV-2 infection. Results: A total of 110 participants were evaluated for the presence of HIV-2 serum antibody. We found the presence of HIV-2 as a coinfection with HIV-1 in 5.45% (n = 6) of participants. Single infection with HIV-2 was not found. Geographical origin of participants with confirmed co-infections was located near the border with Haiti. No correlation was found with alcohol consumption and condom use. All positive results were returned and positive cases were enrolled in care for HIV infection in their localities (Table 1).  Figure 1). Conclusions: HIV infection among prisoners is a critic health problem which requires a proactive attitude by the medical staff to improve the epidemiological situation in prisons. In SSF, the immediate aim to achieve is being able to carry out a greater number of tests for HIV, which implies an active information campaign to make prisoners aware of the problem and their possibilities of treatment.  behaviours. The preliminary effects of this intervention, which is named Gay Poz Sex (GPS), were evaluated in terms of acceptability, appropriateness, and the psychosocial and HIV sexual risk behaviour outcomes. Method: Two HIV-positive peer counsellors administered six 2-hour counselling sessions to 11 HIV-positive gay men living in Cali, Colombia. A pre-post study without control groups was designed to assess effects of the intervention on depression, loneliness, self-efficacy of condom negotiation and on condom-less anal sex (CAS). The paired ttest and McNemar's test were used to assess the effects at the end of the intervention and three months later. Semi-structured interviews with participants on intervention acceptability, effectiveness and appropriateness were also assessed after three months of the intervention.
Results: A total of 7 of the 11 eligible participants finished the GPS intervention and completed the follow-up. We observed a reduction in CAS (any partner) from 83% at baseline to 46% at the three-month follow-up. After three months, a significant increase was found in condom use and negotiation (p = 0.01), and there was a decrease in the depression score (p = 0.07). Participants perceived the programme to be acceptable and highly appropriate. Favourable responses were mainly related to 1) the relevant nature of information, 2) a chance to discuss sex in a non-judgemental place, 3) a well-designed intervention, and 4) helping to make positive changes in their sexual life and decrease risky sexual behaviours (i.e. drug use and the use of Internet dating sites).
Conclusions: This work was done to fill an important gap in prevention of HIV transmission and acquisition in gay men who are HIV positive and living in Colombia. The findings provide preliminary evidence that a counselling intervention led by peers may offer an efficient way to concurrently reduce CAS, increase negotiation for condoms, and mental health problems in HIV-positive gay men. These results favour GPS as an intervention to reduce the transmission of HIV in Colombia.

P037
A pilot study of a prevention programme for Latino gay men in Canada: results in terms of effectiveness  Background: In Brazil, we noted that HIV and syphilis in young people is increasing, then although the prevention strategies adopted in our country, we still observe that in this kind of population exist a low-risk perception and testing, that are facts that induces a late access to treatment [1]. According to the period 2006 to 2015 epidemiologic data showed triple the numbers of cases in 15 to 19 years old age group and double in 20 to 24 years old age group [2]. Aiming contribute to sexually transmitted diseases (STD) prevention between college students, an extension project named "ISTeja Prevenido" begun at the State University of Western Paran a -Unioeste, Cascavel Campus.

Materials and methods:
The college students who participated in the State Meeting of Youth Leadership in STD Prevention, AIDS and Viral Hepatitis, promoted by the Secretary of State for Health, begun the project by holding weekly meetings to discuss strategies to improve the STD prevention within the student college at Unioeste. Those activities include: creation of communicating ways, like social medias to share information with academic ways, condom distribution, educate activities and testing campaign, than this last one, the college students of the project were training by the Specialized Center for Parasitic Infectious Diseases (CEDIP) of Municipal Secretary of Health in Cascavel/PR. Results: The project created communicating ways elaborating a Facebook page (https://www.facebook.com/coletivoistejaprevenido/) and an Instagram account (@istejaprevenido) to spread educate content and divulgate all project actions. Condoms distribution is a consoled strategy in health services, hence little disseminated out that ambiences. However, a strategy adopted in this project was distributed during congresses and letters, and a continuing way was leave custom boxes containing condoms, in bathrooms in university. To discuss this theme, were performed two educative activities, one of them was the Talk Show and another one was a conversation wheel, that made it possible to clarify doubts and discuss themes, like STD transmission, humanisation in health services and preconceptions related HIV. Lastly, two testing campaigns were done inside the university that made it possible to identify HIV and syphilis cases. Conclusions: In 2018, 4946 condoms were distributed, 196 college students participated in our educational actions and 261 quick tests were performed. The development of this project evidences that the participation of own young people in realisation of those kind of prevention actions, made the dialogue more easily and encouraged the comportment change. A total of 575 (69.2%) self-reported reasons for missing the clinic appointment were obtained. The most frequently cited were: "forgetting or confusing the time of the appointment" (18.6%), "overlapping with work schedules" (18.2%) and "health problems" (9.7%). Fourteen per cent of patients answered that they did not remember why they missed the appointment. Conclusions: We identified some frequent factors that caused patients to miss appointments. Patients who underused HIV care had Abstract P042- Figure 1. PLHIV in treatment gap, Brazil, July 2016 to January 2019.

Models of
Background: Delays in HIV diagnosis and enrolment in care have been persistent barriers to achieve the 90-90-90 WHO goals to end the HIV/AIDS epidemic as a public health problem by 2030 in Latin America. Between 38% and 45% of patients in our region enrol in care with advanced HIV disease (CD4 counts <200 cells/lL) driving steadily high HIV-mortality rates in Latin America. Moreover, more than 60% present late to care (CD4 < 350 cells/lL). Our goal is to describe the presentation to care among centres from the HIV Latin American Workshop from 2013 to 2017. Material and methods: We performed an ecological analysis using collected data from 31 centres in 10 Latin American countries. Data were organised in 12 strata of age and sex, 4 strata of CD4 cells (<200, 200 to 349, 350 to 499, >499 cells/lL) and 5 strata of calendar-year of enrolment (2013 to 2017). We defined "timely presentation" (TP) as CD4 > 499 cells/lL, late presentation (LP) as CD4 count <350 cells/lL and advanced HIV disease (AIDS) as <200 cells/lL, all at enrolment. We used contingency tables and random effect (strata, centre and country) logistic models to observe trends over time of these conditions. We explored covariables associated to AIDS at enrolment and reported crude and adjusted odd ratios (OR). In sensitivity analysis, we considered weights based on the expected fraction of people analysed in respect to the total population receiving care by country using distributional assumptions. Results: We analysed data of 34,679 (7.4%) people of an estimate of 470,165. During 2013 to 2017, LP decreased from 60.7% to 52% and AIDS at enrolment from 37.1% to 28.4%, with important heterogeneity by country and age group (Table 1 and Figure 1). TP increased from 21.4% to 27.7% (p < 0.05). In multivariate analysis, covariables associated to decreased risk of AIDS at enrolment were: younger age, female gender (OR 0.91, 95% CI: 0.85 to 0.97), enrolment in centres with private funding (OR 0.54, 95% CI: 0.32 to 0.92) and being enrolled in care in recent years (2016 to 2017). Heterogeneity for AIDS between countries was around 1%, while between centres close to 6%.

Conclusions:
We reported a large observational study showing that AIDS and LP at enrolment in care decreased in recent years in Latin America, but heterogeneity in trends across countries is large with important differences by age group and source of funding. Nevertheless, LP is still an important problem in most countries of our region with consequences in HIV transmission, morbidity and mortality.   Background: A fundamental factor in the HIV management has been to achieve the adherence to antiretroviral treatment, whose failure brings consequences produced by the increase in morbidity and mortality. The aim of this study is to determine the prevalence of nonadherence, and to evaluate the effectiveness of the follow-up area of an HIV care centre; this area is responsible for recovering non-attendant patients (those without physician consultations in a period of more than six months and/or who do not make the claim of medicines in the following month in the Centre).

Materials and methods:
A cross-sectional retrospective study was developed in the CEPAIN HIV programme care at Bogot a, Colombia. The databases of patients not attending to the HIV programme in the period 2015 to 2017 were reviewed, with subsequent review of clinical histories.
Results: During the period from 2015 to 2017, the programme had 4551 patients, follow-ups were performed in 555 patients who were identified as patients who left the programme or were inactive due to absences of more than six months. 2015 started with 134 patients, 2016 detected 214 and 2017 141 patients (Figure 1), this implies a lost-to-care of antiretroviral treatment in 3.17%, 4.68% and 4.55% for each year. It was identified that the discontinuation rate is higher in women than in men, since for every 100 women registered 5.3 do not return on average in the three years, while for every 100 men, 4.4 leave the programme (Figure 1). The Engaged-in-Care with the intervention of the follow-up group was 88.8%, 64.0% and 63.8% for those years, the average time between diagnosis and the abandonment of patients who do not return is 5.4 years 95% CI (4.7 to 6.0).

Conclusion:
The factors associated with non-adherence have been widely described, but the effectiveness of the intervention is associated with having a work team aimed at identifying factors that may lead to abandonment and establishing concerted, educational and individual actions with the patient that facilitate their re-entry and guarantee the continuity of the services and ensure that the patient understands the risk of non-adherence.

P048
Impact of supervised antiretroviral therapy in patients with HIV who have no adherence to therapy and are with detectable viral load Background: Therapeutic adherence is a key factor to ensure the sustainability of the health system and ensure adequate virological suppression in patients with HIV; however, there are patients who do not have adequate adherence to ART, which leads to a risk of opportunistic infections and antiretroviral drug resistance. For patients who have tuberculosis, a strategy of daily medication dispensation is designed, which leads to better clinical outcomes. Our centre sees approximately 8000 patients with HIV in Colombia each month, and of these the great majority is in the capital city Bogot a. We have patients who, despite being educated by the support group (psychologist, social worker, pharmacist, doctor and nurse), cannot improve their adherence. Therefore, an attempt was made to extrapolate the tuberculosis strategy and we discharged the antiretroviral drug for nonadherent patients, daily, weekly or twice a month and then we evaluated the results of the intervention. Materials and methods: A descriptive study of supervised therapy and its impact on patients without adherence to ART who present with virological failure, in the period from January to November 2018 in a HIV care centre was performed. Forty-seven patients were included who entered in the supervised therapy programme which was dispensed by the pharmacy service daily, weekly or twice a month, the storage of the ART was done in individual boxes labelled for each patient. With face-to-face and telephone follow-ups. Viral load monitoring was carried out at two months and finally six months after the intervention. Results: Of the 47 patients who underwent supervised therapy, 20 patients remained non-adherent despite the supervised therapy, 6 patients despite being fully adherent had virological failure defined as HIV viral load >200 copies/mL after six months of adjustment of adherence, and 21 patients managed to have control of the viral load (<200 copies/mL) after six months considering how therapeutic success ( Figure 1).

Conclusions:
The supervised therapy in non-adherent HIV patients, carries to 45% of patients who achieve virological suppression below 200 copies/mL. We consider it to be a highly recommended strategy and intervention to avoid resistance to antiretroviral drugs and, consequently, a lower probability of hospitalisations and opportunistic infections.  Table 1 shows the results. For the three years reported, the median age was similar, and gender was predominantly masculine. Baseline CD4+ cell count showed a gradual increase and there was a decreasing proportion of patients presenting with clinical stage IV at initiation. Access to ART improved: time between HIV diagnosis and initiation of ART, and time between initiation of care at V ıa Libre and initiation of ART, showed a decreasing trend for each evaluated year. Significant early (<3 months) ART toxicity, leading to a modification or interruption of HAART was higher in 2005 and 2011, in comparison to 2016. Treatment regimens were always predominantly NNRTI based (98.9% to 99.1%). In 2016, use of zidovudine was clearly diminished. Complications associated to progression of disease or immune reconstitution inflammatory syndrome (IRIS), observed within three months of initiation of ART, were higher in 2005 and less frequent in following years. This included early mortality cases (n = 5), which were observed only in 2005.
Abstract P050- Conclusions: Since launch of the HIV treatment programme by the Peruvian Ministry of Health in 2004, we have observed ART initiation over the following years with higher CD4 count, a higher proportion of clinically stable patients, shorter time to initiation since diagnosis, and a lower proportion of early complications. This progress reflects changes in criteria to start of treatment and improvements in access, but still needs to get much closer to current international goals. Background and objective: In order to control the HIV epidemic, it is essential to intensify early diagnosis, as a strategy to reduce late presentation to 10% [1]. Previous reports in Latin America found percentages between 38% and 45% of late presentation with advanced disease (CD4 T lymphocytes <200 cells/lL), and an additional 23% with late presentation (CD4 T lymphocytes: 200 to 350 cells/lL) [2].
Conclusions: Understanding local data and associated factors helps develop public surveillance programmes by providing targeted intervention, focusing on people at high risk [3]. HIV testing should be intensified, stigma should be reduced, the benefits of treatment should be made known and retention should be improved in consultation. Background: Histoplasmosis is an endemic mycosis considered worldwide as an orphan disease [1], which has a very variable clinical presentation and usually is disseminated in the population with HIV/AIDS [2]. Knowing that clinical suspicion and early treatment are important for a successful outcome and there is usually a delay in diagnosis, there is a need to identify early signs and symptoms associated with the definitive diagnosis of disseminated histoplasmosis. Materials and methods: Retrospective cohort study that included patients diagnosed with HIV/AIDS and suspicion of disseminated histoplasmosis in a population attended in a reference hospital in Pereira, Colombia, between January 2015 and May 2018. Clinical and laboratory variables were taken and univariate, bivariate and multivariate analyses were performed to determine the characteristics associated with the diagnosis of disseminated histoplasmosis. Results: Of 147 patients with HIV and clinical suspicion of histoplasmosis, who underwent antigenuria for histoplasma, 37 had positive antigenuria and 110 negative antigenuria. 75.5% were male, 78.9% came from urban areas, 53% had HIV recently diagnosed, while 47% were diagnosed during hospitalisation. The mean haemoglobin was 9.8 mg/dL; CD4 count with a median of 55 cells/mL and viral load of 258.727 copies/mL. The most common clinical manifestations were constitutional symptoms 89.1%, fever 71.4% and weight loss 82.3%. The most common abnormal tests were the presence of anaemia 89.1%, lymphopenia 82.9% and lactate dehydrogenase elevation 44.9%. Other infections were present in 70%, of which the most common was tuberculosis in 69.9%. Of the total population, 69.4% received antifungal therapy and 25.2% died in the hospital. In the bivariate analysis, the conditions associated with the diagnosis of disseminated histoplasmosis were leukocytosis (p = 0.001), thrombocytopenia (p = 0.001), elevated alkaline phosphatase (p = 0.03), AST/ ALT ratio (p = 0.002) and lactate dehydrogenase elevation (p = 0.11). In a logistic regression analysis, the conditions associated were the elevation of alkaline phosphatase (p = 0.015) and lactate dehydrogenase elevation (p = 0.035), and in a Poison regression analysis the conditions associated with the diagnosis were lactate dehydrogenase elevation (p = 0.001). Conclusions: The behaviour of histoplasmosis in our population establishes some differences with the behaviour reported in studies from other regions [3], such as less skin involvement and lymphadenopathy, but with greater haematological manifestations. The adequate analysis of these clinical and laboratory findings can facilitate decision-making to suspect the presence of disseminated histoplasmosis in patients with HIV/AIDS in our region. According to the high mortality found in this population, new studies are required to determine the factors associated with mortality.

P054
Study of tuberculosis cases registered among prisoners in South Santa Fe, Argentina Background: It is widely known that certain infections, such as tuberculosis (TB), present much higher health impact among imprisoned people than in general population. Thus, WHO reported the TB prevalence for prisoners is 100 times higher than in the general population [1]. Several factors, like socio-economically disadvantages or overcrowding in prisons, lead this particularly vulnerable population to a critic condition with an increased risk to their health. Materials and methods: The present work studied TB cases notified among prisoners of the six centres of detention of South Santa Fe region (SSF), Argentina; where 4250 people (4145 men and 105 women) have been imprisoned during the analysis period (January 2017 to May 2018). TB diagnosis and treatment is systematically controlled by the medical staff of the prison units. Results: During the studied period, 35 cases of TB (0.8% of studied population) were notified, being 25 (71.4%) pulmonary TB; 21 (84.0%) presented positive bacilloscopies, with an average of 2 + + at the diagnosis; 90.0% were new cases or relapses and 3 (8.6%) presented also HIV infection. This number of TB cases would represent an estimated notification rate of 823.5 cases per 100,000 persons, which is much higher than the TB notification rate for the corresponding population in the same area (16.1 per 100,000 inhabitants). Only one case was classified as multiresistant TB. Among the treated patients, a 67.0% presented negative bacilloscopies after two months of treatment. A 77.1% of the treated patients reached the cured/completed treatment condition, with a mean of 7.75 months (Figure 1). Conclusions: TB infection among prisoners is a critic health problem which requires a proactive attitude by the medical staff to improve the epidemiological situation in prisons. In SSF, the immediate aim to achieve is carry out an active information campaign to make prisoners aware of the problem and their possibilities of treatment and cure. Background: DAWNING is a non-inferiority study comparing dolutegravir (DTG) + two nucleoside reverse transcriptase inhibitors (NRTIs) with lopinavir/ritonavir (LPV/r) + two NRTIs in HIV-1-infected adults failing first-line therapy (HIV-1 RNA ≥400 c/mL) of a non-NRTI (NNRTI) + 2 NRTIs. Materials and methods: Participants were randomised (1:1, stratified by screening HIV-1 RNA and number of fully active NRTIs) to 52 weeks of open-label treatment with DTG or LPV/r + two investigator-selected NRTIs, including ≥1 fully active NRTI based on screening resistance testing. The primary endpoint was the proportion of participants with HIV-1 RNA <50 c/mL at Wk48 (Snapshot algorithm). Post hoc efficacy analyses were performed based on baseline NRTI resistance profile and NRTI use in the second-line background regimen (BR). Results: Of 624 participants randomised and treated, 499 (80%) received <2 active NRTIs at baseline. Overall, 84% (261/312) of participants on DTG versus 70% (219/312) on LPV/r achieved HIV-1 RNA<50 c/mL at Wk8 (adjusted difference 13.8%; 95% confidence interval (CI): 7.3 to 20.3; p < 0.001 for superiority). This difference was consistent regardless of the use of<2 or 2 fully active NRTIs in the BR. NRTI resistance was present in 561 participants (90%) at baseline, M184V/I (alone or plus additional NRTI resistance-associated mutations (RAMs)) in 513 (82%), K65R in 187 (30%), and ≥1 thymidine analogue mutations (TAMs) in 152 participants (24%). Of participants with M184V/I alone or plus ≥1 NRTI RAMs, 430 participants (84%) took lamivudine (3TC) or emtricitabine (FTC) as part of their BR. Tenofovir disoproxil fumarate (TDF) was included in the BR in the presence of K65R in 15 participants while 86 participants with ≥ 1 TAMs took zidovudine (AZT). Among participants receiving 3TC or FTC in the presence of M184V/I, 85% (187/220) on DTG versus 72% (152/210) on LPV/r had HIV-1 RNA <50 c/mL at Wk48 (difference 12.6%; 95% CI: 4.9 to 20.3). High responses were also observed in the DTG arm, when AZT or TDF were included in the BR in the presence of TAMs or K65R, respectively; however, participant numbers in these subgroups were small (Table 1). Conclusion: In DAWNING, response rates were high in participants receiving DTG + 2 NRTIs, regardless of pre-existing resistance to one of the NRTIs in the BR, including in participants using 3TC or FTC in the presence of M184V/I. In World Health Organization interim guidance on HIV treatment, DTG + 2 NRTIs is now recommended second-line therapy for patients failing an NNRTI-based regimen.

Results:
The studies randomised and exposed 1024 participants (DTG+RPV 513; CAR 511). Efficacy and key safety for the ES and LS DTG+RPV groups are shown in Table 1 Background: Compared with tenofovir disoproxil fumarate (TDF), tenofovir alafenamide (TAF) has been associated with improvement in markers of renal dysfunction in individual randomised trials; however the comparative incidence of clinically significant renal events remains unclear. We used a pooled data approach to increase the person-years of drug exposure analysed, maximising our ability to detect differences in clinically significant outcomes. Materials and methods: We pooled clinical renal safety data across 26 treatment na€ ıve and antiretroviral switch studies in order to compare the incidence of proximal renal tubulopathy (PRT) and discontinuation due to renal adverse events (AEs) between participants taking TAF-containing regimens versus those taking TDF-containing regimens. We performed secondary analyses from seven large randomised studies (two treatment-na€ ıve and five switch studies) to compare incidence of renal AEs, treatment-emergent proteinuria, changes in serum creatinine, creatinine clearance, and urinary biomarkers (albumin, beta-2-microglobulin and retinol binding protein to creatinine ratios). Results: Our integrated analysis included 9322 adults and children with HIV (n = 6360 TAF, n = 2962 TDF) with exposure of 12,519 person-years to TAF and 5947 to TDF. There were no cases of PRT in participants receiving TAF versus 10 cases in those receiving TDF (p < 0.001), and fewer individuals on TAF (3/6360) versus TDF (14/ 2962) (p < 0.001) discontinued due to a renal AE. Participants initiating TAF-versus TDF-based regimens had more favourable changes in renal biomarkers through 96 weeks of therapy. Conclusion: These pooled data from 26 studies, with over 12,500 person-years of follow-up in children and adults, support the comparative renal safety of TAF over TDF. Background: Treatment with once-daily E/C/F/TAF in HIV-1-infected therapy-na€ ıve patients was shown to be effective and safe through 144 weeks in two randomised, double-blinded trials, which excluded participants whose HIV-1 harboured the M184V and/or M184I mutation. Materials and methods: This ongoing, prospective open-label, single arm, multicentre, 48-week trial is evaluating the efficacy and safety of switching suppressed participants to E/C/F/TAF from a stable regimen (≥6 months) of a third agent plus either F/tenofovir disoproxil fumarate or abacavir/lamivudine. Participants had a historical genotype report showing M184V and/or M184I and no evidence of previous virologic failure (VF) or resistance to boosted PIs or INSTIs. At screening, HIV-1 RNA <50 c/mL was required as well as the absence of additional NRTI or PI resistance mutations based on sequencing of integrated HIV DNA (GenoSure Archive, Monogram Biosciences). The primary objective is to evaluate the efficacy of switching to E/C/F/ TAF in maintaining HIV-1 RNA <50 c/mL at Week 12 using pure virologic response (PVR). Participants with discontinuation or missing values were considered responders if they never had HIV-1 RNA >50 c/ mL at 2 consecutive visits and the last HIV-1 RNA was <50 c/mL. This report presents the Week 24 data. Results: Thirty-seven participants were enrolled and switched to E/C/ F/TAF. The mean age was 50 years (range 22 to 76), 73% White, 19% Black, 22% women, median CD4 count 724 cells/lL and 100% HIV-RNA <50 c/mL at baseline. Through Week 24, all 37 participants (100%) had HIV-1 RNA <50 c/mL based on PVR. Three participants who discontinued prior to Week 24 with last recorded HIV-1 RNA <50 c/mL were not considered VF. Four serious adverse events occurred (none were study drug-related): one each of squamous cell carcinoma, acute kidney injury (with poorly controlled hypertension and diabetes), transient proteinuria (resolved on study drug) and pulmonary embolism. Twenty-two per cent (8/37) of participants experienced a study drug-related AE (grade 1 or 2); one participant discontinued due to grade 2 muscle spasms (Table 1).
Conclusions: E/C/F/TAF offers an effective, well-tolerated switch option for patients with pre-existing M184V and/or M184I mutations. These data on continued virologic suppression despite resistance are encouraging though longer term data are needed. Background: Despite it can be prevented by currently available safe and effective vaccine, hepatitis B infection is still a major health problem which affects approximately 257 million people around the world and, in 2015, caused 887000 deaths [1]. This could be explained by low immunisation coverages and lack of vaccination programmes for population at risk. According to many investigations among hard to reach populations, a better acceptability would improve vaccination coverage when prevention programmes are included in clinics specialised in sexually transmitted infections (STD) [2][3][4]. In Peru, core hepatitis B antibody seroprevalence has been estimated in 22.3% among men who have sex with men (MSM), in contrast among general population reaches 5% [5]. We think that prevention and vaccination programmes tailored for MSM and transgender women (TW) should be implemented in Peru. Conclusions: Compared to the published data of the whole integrated analysis, the Puerto Rican patients presented some differences in terms of genotype distribution (lower prevalence of GT3 infection) and high virologic response rates across all GT (100% vs. 98% global analysis). Puerto Rico sub-analysis demonstrates comparable tolerability profile and 100% of efficacy. The small sample size could be a limitation, but the data still shows an interesting profile of the Puerto Rico experience in the treatment of chronic hepatitis C.

P076
Case-control study to identify risk features associated to anti-HCV serology reagent in prisoners in the state of Paran a, Brazil Background: The prison system in Paran a, Brazil presents serious problems related to the increasing number of prisoners [1] and becomes more intense in the control of the hepatitis C virus (HCV) due to the fact that the incarcerated population is considered a high-risk group for contagious diseases because of the favourable conditions found in prison for spreading these morbidities [2,3]. The objective of this study was to identify features associated with HCV infection among male prisoners in the prison system (correctional institutions) of Paran a, Brazil. Materials and methods: This is a case-control study (27 cases and 54 controls) with men arrested in 11 penitentiaries in Paran a, Brazil, where the information was obtained through the application of a questionnaire in a cross-sectional epidemiological survey for anti-HCV infection in the period from May 2015 to December 2016. Eligible men were recruited after the positive result for anti-HCV. The selection of the cases and controls considered the result of the serology by an enzyme-linked immunosorbent assay, following the manufacturer's instructions, matched by age, location of the penitentiary and time in prison. Odds ratio (OR) and 95% confidence interval (CI) were estimated using binary logistic regression analysis to identify the predicting factors of the variable to be explained. Results: The participants' mean age was 39 years, and the prevalence was predominantly among individuals over 30 years of age. The logistic regression analysis showed that the main significant risk factor for the acquisition of HCV infection was the use of injectable drugs (OR = 4.00; 95% CI, 1.41 to 11.35; p < 0.001).
Conclusions: This is the first case-control study reported with male prisoners in the closed prison system of Paran a, Brazil. This study provides evidence that HCV infection is associated with drug use by this population. This information is pivotal for tailoring prevention programmes and guiding specific socioeducational measures that aim to reduce or prevent HCV transmission within the prison setting.

P077
The opportune diagnosis of hepatitis C, an option to prevent vertical transmission and follow-up on births of infected mothers E Silva Cabrera; A S anchez Guti errez; T Licourt Otero and A Arteaga Yera Centro de Inmunoensayo, Programas Nacionales de Salud, La Habana, Cuba Background: The hepatitis C virus (HCV) is a known cause of chronic liver disease in adults, but its importance in pregnant women and children is underestimated. It is thought that at present the main route of acquiring HCV in children is vertical transmission. However, it is very likely that more than half of infected infants are not diagnosed since mothers are not evaluated during pregnancy and newborns are asymptomatic after delivery. The objective of the work is to deepen the convenience of introducing the prenatal screening to HCV. Materials and methods: Studies of the state-of-the-art and the behaviour of the disease in Cuba were carried out. Results: Screening in pregnant women or women of reproductive age with an interest in getting pregnant is not common practice in most countries; however, HCV transmission risk is estimated as 4% to 8% among mothers without HIV infection and as 17% to 25% among mothers with HIV infection. reported annually, positivity in blood banks in 2017 was 1.1% and epidemiological surveillance was 3.5%. Cirrhosis and other chronic diseases of the liver ranked ninth in mortality in the country. Conclusions: HCV positivity in blood donors and in epidemiological research, as well as mortality by cirrhosis and other liver diseases, suggest that hepatitis is not a solved issue in Cuba. So, we believe that opportune diagnosis of the infection and the new treatment regimens could be a realistic strategy to eradicate the vertical transmission of HCV in the future and reduce the consequences of a virus infection in young adults.
Virology and Immunology Background: Initiating cART as early as possible following HIV infection to limit the size of the viral reservoir and improve disease prognosis has been widely recommended. However, some cases of seroreversion after very early antiretroviral therapy have been reported which has important implications for the safety of blood product and organ and tissue donation, among other settings. Here, we assessed the presence of HIV antibodies among individuals initiating cART during acute/early HIV infection in a cohort of Argentinean seroconverters.
Methods: Twenty-four recently diagnosed subjects were enrolled as part of the Grupo Argentino de Seroconversion study group. Baseline samples were obtained at a median of 60 days post-presumed date of infection. Regular diagnosis algorithm was performed to confirm infection. After subjects initiated cART, samples were obtained at six-month intervals and up to 54 months' post-cART. Fourth-generation ELISA, rapid tests (RT) and Western Blot (WBs) were performed.
Results: All 24 subjects included in this study had serologically confirmed HIV infection at baseline with detectable viral load. Post-cART, all subjects showed reactive RTs and fourth-generation ELISAs with elevated sample-to-positive ratios at all time points. In the WBs, different longitudinal patterns were observed: some individuals showed the same numbers of bands along time (compared to baseline); others showed an increasing number of bands while others showed a decreasing number of bands along time. It was observed that 50% of early-treated subjects, that is those who started cART early (<120 days' post-infection), showed, compared to the baseline WB, less WB bands or the same number of bands but with decreasing intensity, than those who delayed the start of treatment after acquiring infection (>120 days post-infection). Moreover, one subject turned from one positive WB at baseline (5 bands: gp160/gp120/gp41/p24/ p17) to an indeterminate state by 24 months' post-cART (only the gp160/gp120 band). Within the same group, 22.2% showed the same and 27.8% showed an increasing number of bands. However, these proportions were 20%, 40% and 40%, respectively, in the delayedtreated subjects.
Conclusions: Evidence of partial seroreversion was found in the studied cohort. The rate of reversion was higher within subjects who received cART at very early times post-infection and might become even more frequent with more prolonged time on suppressive cART. This phenomena, in addition to the delayed seroconversion seen among individuals receiving PrEP and the seropositivity produced by new HIV vaccines among individuals without infection, might challenge our current HIV diagnosis algorithms. Further research is warranted in the context of Test and Treat strategy and Combined Prevention paradigm.

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Surveillance of HIV pretreatment resistance in Cuban patients according to WHO recommendations