Speaker Abstracts

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Since the first paediatric AIDS case was reported in 1982, significant strides have been made in the prevention and treatment of perinatally acquired HIV infection. From transmission rates as high as 40% if cumulative in utero, intrapartum and postpartum mother to child HIV transmission (MTCT) are computed in the absence of any intervention, today, with adequate maternal diagnosis and prompt initiation of antiretroviral treatment, HIV MTCT rates are 0.5% or lower. Although the number of cases of paediatric HIV infection declined dramatically in the last 20 years, the decline has not been as steep in resource limited settings, where many infants still become infected. Remaining challenges for elimination of mother to child transmission include the risk of breastfeeding transmission and maternal HIV acquisition during pregnancy or while breastfeeding. Guidelines for prompt initiation of treatment in HIV infected infants have been in place for years and are based on data demonstrating high mortality if treatment is deferred. Early intense antiretroviral treatment relies on prompt identification of infection and requires close follow-up in the first weeks of life. Very early treatment of infants is analogous to treatment of acute HIV infection in older populations and significantly reduces viral reservoir burden. This approach spares damage to the developing immune system and may pave way for functional cure interventions. Nevertheless, early treatment of infant HIV infection is challenging due to diagnostic difficulties and lack of adequate paediatric antiretroviral formulations. The evolution of treatment strategies in perinatal/paediatric HIV infection in the Americas will be reviewed.

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Update on PEP and on its role in the era of PrEP DK Smith Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA In the United States, non-occupational post-exposure prophylaxis (nPEP) is supported to reduce the risk of HIV acquisition in persons with potential HIV exposure. nPEP has clear individual benefits, but is unlikely to significantly reduce new HIV diagnoses at the population level. Making urgent and affordable access to nPEP available remains an issue in the US. Lack of awareness of pre-exposure prophylaxis (PrEP) both by clinicians and underserved populations where high rates of new diagnoses is common. However, as PrEP is being scaledup, awareness and use of nPEP is also increasing because of coverage of interventions in media campaigns and provider education efforts. HIV screening is required before providing either nPEP or PrEP and will identify some persons with unrecognized HIV infection who can be rapidly linked to HIV treatment. Persons who have requested multiple courses of nPEP or whose reported sexual behaviours when assessed for nPEP suggest likely frequent HIV exposures, are excellent candidates for PrEP use. These patients can be easily transitioned at the completion of a 28-day nPEP course to ongoing PrEP use.

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Observational studies with integrase inhibitors and experience with first-line use in Brazil

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The public health response to rising pre-treatment HIV drug resistance levels in Latin America: the case of Mexico Results: From September to December 2017, 2182 participants were recruited from 71 clinics in Mexico. For all regions, PDR to NNRTI was higher than to other drug classes (p < 0.0001). We observed significantly higher levels of NNRTI PDR in the South-West region, including the three poorest states in the country, compared to the reference Centre-South region including Mexico City (p = 0.03). NNRTI PDR was >10% in the Centre-North, North-West, East, South-East and South-West, remaining under this threshold in the Centre-South, North-East and West regions. The proportion of persons re-initiating ART varied significantly by region from 4% to 16%, with higher prevalence in the North-East, West, East, and South-West (compared to the Centre-South, p < 0.01 in all cases). Nevertheless, the proportion of re-initiators did not correlate with NNRTI PDR level by region (r = 0.3, p = 0.5). As expected, PDR levels were significantly higher in re-initiators compared to ART-na€ ıve individuals for all drug classes (p < 0.01 in all cases). Conclusions: High NNRTI PDR levels in several Latin American countries underscore the need for countries to consider using first-line regimens that do not include NNRTIs. Costs and lack of infrastructure hinder consideration of baseline HIVDR screening as a feasible option in many countries. Price and licensing negotiations of drug regimens containing integrase inhibitors are warranted. In large and complex countries such as Mexico, diversification of the response based on regional HIVDR prevalence could be considered.
O12 -TB Diagnosis and Treatment: An Update for the Region O121 New methods for TB diagnosis R López Tuberculosis Prevention, Control and Elimination, Pan American Health Organization (PAHO), Washington DC, USA Tuberculosis (TB) continues to be an important Public Health problem in the Americas with 224,000 notified cases out of 274,000 estimated cases for 2016, leaving a gap of 50,000 cases not detected. Given the infectious nature of the disease, prompt diagnosis and treatment is crucial for the prevention, control and eventual elimination of TB. Until 2007 TB diagnosis was mainly based on smear microscopy and culture. Since then, searching for faster and more sensitive diagnostic tests, multiple new methods based on molecular technologies have emerged and the World Health Organization (WHO) has increased the list of approved methods. Most of them also detect drug resistance to first and second line anti-TB drugs. The main new methods for TB diagnosis will be presented, including the Genotype MTBDRplus, Genotype MTBDRsl and the Gene Xpert MTB/Rif. The latter is the first fully automated PCR system that detects the Mycobacterium tuberculosis and rifampicin-resistance. It provides results in less than two hours. The advantages and disadvantages for the implementation of these methods in low and mid-income countries will be addressed. Other new TB diagnostic methods in the pipeline will also be presented.

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Treatment for drug-resistant TB A Pozniak Chelsea and Westminster Hospital, London, UK Multidrug-resistant (MDR) and extensively drug-resistant tuberculosis (TB) are recent global health issues, which makes tuberculosis a major health challenge. Globalization, health inequalities, competing economic interests and political instability contribute substantially to the spread of drug-resistant strains, which are associated with high rates of morbidity and mortality. Of the 27 countries classified as high burden for MDR-TB, 17 are in low-income and middle-income countries (LMICs). Shorter, all oral and less toxic multidrug combinations are required to improve treatment outcomes in these settings. Suitability for safe coadministration with HIV drugs is also desirable. A range of strategies and several new drugs are currently undergoing advanced clinical evaluations to define their roles in achieving these aims. However, several clinical questions and logistical challenges need to be overcome before these new MDR-TB treatments fulfil their potential. New policy issued by the World Health Organization (WHO) in 2016 to 2017 promotes novel treatment regimens. Scale-up of such treatment options is needed to impact global success rates for drug-resistant TB patients, especially in countries with large burdens.

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First-hand experience from Brazil: lessons learned E Távora Dos Santos-Filho Grupo Pela Vida-RJ, Rio de Janeiro, Brazil This presentation will discuss the following: the Brazilian National Programme for TB Control, the Brazilian Unified Health System, the new treatment guidelines 2011, new diagnostics available, the BRICS TB Research network, community engagement and community advisory boards, and the role of metropolitan councils. According to the World Health Organization's new ranking for TB, Brazil is in the 20th position among TB priorities (high burden country) for sensitive TB, and in 19th position for TB-HIV coinfection with an incidence rate of 32.4/100,000 inhabitants or 67,000 new cases in 2016 (BRAZIL, 2017). The country is considered of low burden for MDR-TB with 1.5% of all TB cases. TB is still the number one killer for those with AIDS in the country, as worldwide. Trend of incidence and prevalence is in a steady decrease since the 1990's and TB policies show clear improvements since early last decade. Efforts to take Brazil out of the high burden countries list has been a governmental priority. Yet, little has been achieved in cooperation between TB and HIV/AIDS programs: TB prophylaxis for people with HIV and aids is much below 10%. The efforts to expand DOTS coverage have also shown poor results before and after the Global Fund TB grant to Brazil (32.9% in 2007Brazil (32.9% in to 35% in 2015. If the governmental TB policies have been inefficient to impact consistently the TB epidemic, a significant raise in public awareness on the epidemic and a relevant social mobilization in tuberculosis was observed. Efforts since 2002 to engage civil society and communities affected in the fight against TB: Forums of TB NGOs, as Metropolitan TB Councils and a Stop TB Partnership. This boosted cooperation.

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Diagnosis and treatment of HIV-positive women with comorbidities M Mantilla Suárez CEPAIN IPS, and Virrey Sol ıs IPS, Bogot a, Colombia Women represent more than half the number of people living with HIV worldwide. Young women between 10 and 24 years of age have twice the risk of HIV infection than men of the same age, and some contraceptive methods, such as medroxyprogesterone injections, have been associated with an increase of more than 40% in the risk of acquiring the virus. However, in our region, probably the biggest concern of women in this age range is not that of acquiring HIV but that of an unwanted pregnancy. The health topics relevant to women living with HIV differ according to age. For young women with HIV infection, contraception, pregnancy and HPV infection are the topics most frequently addressed during consultation. In older women, the topics are menopause, bone mineral disease, cardiovascular risk, neurocognitive disorders and cancer (associated or not with HIV/AIDS). Regarding mental health issues, we found that up to 82% of women present with depressive symptoms, anxiety and/or sleep disorders at some point throughout life. For the treating clinician of a woman living with HIV, it becomes a challenge to control the infection with antiretroviral therapy at each stage of the patient's life. This is because there may be multiple interactions between medical therapies such as contraceptives and hormone therapy with antiretrovirals, and also because of the effects that some antiretrovirals may have in skeletal, nervous and cardiovascular systems.

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ARV safety in pregnancy V Rouzier Integrated Care Center and Research Institution, Les Centres, GHES-KIO, Port-au-Prince, Haiti With the scale-up of antiretroviral therapy (ART) for all HIV-infected individuals, including pregnant women, from the time of HIV diagnosis to lifelong treatment, more and more women worldwide are being exposed to ART during childbearing years, conception, pregnancy and breastfeeding. The use of ART to prevent mother-to-child transmission of HIV has been one of the most successful public health interventions and as we move towards the elimination of maternal-child transmission in many countries, many more women will either conceive on or initiate ART during pregnancy and their infants will be exposed to ART in utero and via breast milk. However, there is a paucity of data from randomized clinical trials on the safety of ART in pregnancy and breastfeeding. This presentation will review the current evidence for the safety of ART in pregnancy and on exposed infants. Strategies for the continued monitoring of old and new ART regimens in pregnancy and breastfeeding which are critical to inform guidelines and clinical practice will also be discussed.

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HIV-infected pregnant adolescents are an extremely vulnerable population: a cohort study of PMTCT outcomes in Haiti MM Deschamps 1 ; V Rouzier 2 ; D Jannat-Khah 3 ; J Bonhomme 4 ; J Pierrot 5 ; L Reif 6 ; JW Pape 1 and M McNairy 6 1 GHESKIO, Port au Prince, Haiti. 2 Paediatrics, GHESKIO, Port au Prince, Haiti. 3 General Internal Medicine, Weill Cornell Medicine, New York, NY, USA. 4 Obstetrics, GHESKIO, Port au Prince, Haiti. 5 Data Management, GHESKIO, Port au Prince, Haiti. 6 Center for Global Health, Weill Cornell Medicine, New York, NY, USA Background: To evaluate HIV+ pregnant adolescent outcomes as compared to youth and adults in the largest prevention of mother-tochild-transmission (PMTCT) programme in Haiti. Materials and methods: Retrospective data from HIV+ pregnant women and their infants enrolled in PMTCT care at GHESKIO from 1999 to 2014 were included. Adolescents included women age 15 to 19, youth were ages 20 to 24, and adults >24 years. Maternal outcomes include enrolment in PMTCT, receipt of antiretrovirals prior to delivery, and maternal retention through delivery. Infant outcomes include infant enrolment in PMTCT, HIV testing and HIV infection. Kaplan Meier methods were used to assess retention in PMTCT care. Results: Among 4665 pregnancies,7.8% (364) were adolescents, 15.8% (739) youth and 76.4% (3562) adults. Adolescents were more likely to be single as compared to adults (62% vs. 25%) and poorer (85% vs. 50% no income) (p < 0.001). Median CD4+ count among adolescents was 582 cells/mm 3 vs. 524 and 476 for youth and adults respectively (p = 0.005). Among all pregnancies, 65% (235/364) of adolescents received antiretroviral medications prior to delivery as compared to 74% (547/739) youth and 76% (2719/3562) adults. Adolescents also were less likely to be retained in PMTCT care through delivery as compared to other age groups, 64% vs. 74% and 76% respectively. A total of 3,218 infants were reported born alive among 3414 women retained through delivery (94%), which did not differ by age group (92 to 95%). Among infants enrolled in PMTCT (total of 3218), 84% (183/217) of infants born to adolescent mothers completed HIV testing as compared to 89% (438/494) and 93% (2334/ 2507) of infants born to youth and adults. The HIV transmission rate ranged from 7.7% in adolescents (14/183), as compared to 5.3% youth (23/438) and adults 5.3% (124/2334). Retention of HIV+ women at 12 months after PMTCT enrolment was significantly lower in adolescents as compared to youth and adults: 72.7% (95% CI 67.6 to 77.2%), 80.4% (95% CI 77.2 to 83.2%) and 83.8% (95% CI 82.5 to 85.0%) respectively (log rank p = 0.0003). Conclusions: Adolescent HIV+ pregnant women have poorer outcomes across the PMTCT care continuum compared to youth and adults. This is an extremely vulnerable population that needs tailored interventions within PMTCT clinics to improve uptake of ART and retention in care.

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Transgender Persons B Braga Cuiab a, Brazil This presentation analyses several aspects of Brazilian transmen and transmasculine people. As a Brazilian transman myself and an activist of the Brazilian Institute of Transmasculine people (IBRAT), I intend to contribute to debate about the relationship among gender relations, masculinities [1], education and healthcare in my home country. Therefore, as an example, among other things, I analysed written messages in on-line diaries produced by transmen, social networks in general, as well as conversations in meetings, such as the First Brazilian National Transmen Conference (1 ENAHT). I/We observed in these narratives a tension between the medical knowledge-power dichotomy, reiterating its truths about what is legitimate for the other, and a movement beyond this subjectifying relationship, revealing the potential of vlogs and/or social networks to create care relations between transmen and transmasculine transgendered Brazilian people. From the analysis of these relations, this presentation aims to produce knowledge in the healthcare field, primarily focused on professionals working in this area who are specialized in care services aimed at transsexuals, as well as in other networks of healthcare. Adolescents are a critical population that is disproportionately impacted by the HIV epidemic. More than 2 million young people adolescents (10 to 19 years) are living with HIV today. Despite efforts to date, they continue to be extremely vulnerable, both socially and economically, to HIV infection. Adolescents with HIV include both those infected perinatally and behaviourally. Perinatally HIV-infected adolescents are healthier than they were a decade or more ago, but they are significantly experienced with antiretroviral therapy, with increased virological resistance and other consequences of extended antiretroviral use. The presentation will discuss some of these challenges. The longer-term impact of exposure to HIV and antiretroviral therapy throughout childhood are becoming apparent, with growing concern over neurocognitive, cardiovascular, renal and bone health. Also, they are at risk for multiple behavioural health risks that require consideration in prevention and healthcare programmes. Among the behavioural health risks, mental health problems are the most prevalent. Mental health problems are likely to interfere with adolescent ability to make decisions about negotiating situations of sexual possibility, or experimentation with substances. Difficulties with adherence to antiretroviral therapy are common during adolescence. Poor treatment knowledge and understanding of the benefits of taking combined antiretroviral therapy may impact adherence. Achieving and maintaining high levels of medication adherence are required to obtain the full benefits of antiretroviral therapy. HIV serostatus disclosure is also an immense challenge for adolescents living with HIV. There is a substantial need for interventions that respond adequately to all these healthcare needs.
O22 -Hepatitis C. New Drugs and What Can We Learn from HIV? O221 New HCV drugs in the region M Nelson Chelsea and Westminster Hospital, London, UK The treatment of hepatitis C has been revolutionized by the advent of direct acting antiviral (DAA) drugs which have permitted combination regimens of highly effective, non-toxic, easy to take agents without the need for interferon. High rates of success have been reported in previously believed difficult to treat populations and many countries are now discussing eradication strategies. Due to the high rates of success observed the pipeline of new agents for the treatment of hepatitis has slowed. Newer regimens aim to be pangenotypic with the possibility of shorter and hence potentially cheaper courses. Examples include Epclusa (sofosbuvir and velpatasvir) and Maviret (glecaprevir and pibentrasvir) the latter combination permitting pangenotypic treatment with 8 weeks of therapy. A triple combination of sofosbuvir-velpatasvir-voxilaprevir has also recently become available. This combination is pangenotypic and available for the treatment of noncirrhotic patients for 8 weeks and importantly for the small number who fail treatment for 12 weeks in those who have previously failed therapy with a DAA-containing regimen. Recent data has also suggested encouraging results with DAAs for the treatment of acute hepatitis C which remains prevalent in men who have sex with men populations and studies are underway with these newer agents to potentially improve outcomes with shorter courses of therapy. DAAs where available are associated with high rates of response in all groups of individuals infected with hepatitis C and newer agents may permit with their very high rates of success and limited drawbacks newer strategies for the treatment of hepatitis C and hopefully eradication of the virus in the relatively near future O222 Home/self-testing: when, to whom? Experience from HIV O Sued Fundaci on Hu esped, Buenos Aires, Argentina In 2016 the World Health Organization (WHO) recommended that HIV self-testing (HIV/ST) should be offered as an additional approach to HIV testing services. Currently, 43 countries have legal norms that allow the use of HIV/ST, while a further 46 countries reported they are working on implementing it. Rational to support HIV/ST is their potential for increased uptake and frequency of testing, in particular among key populations who may not otherwise be tested, thus contributing to the reduction on the gap for achieving the 90/90/90 targets. HIV/ST has the potential to be used with different approaches to maximize results. Evidence suggest that acceptability to HIV/ST is high, that the procedure identifies more HIV-positive individuals as compared to standard testing services and that there is little if any evidence of psychological, medical or social harm. When implementing HIV/ST several themes need to be considered such as behavioural risk compensation, counselling, ability to perform, sensitivity and specificity, perceptions, instruction and supervision, and cost. Furthermore research on how to support linkage to confirmatory testing, prevention, treatment and care services is needed.

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Translating lessons from HIV to hepatitis C JL Santana University of Puerto Rico School of Medicine, San Juan, Puerto Rico HIV management and therapy has been one of the major medical advances which has saved lives in the last 35 years. Hepatitis C (HCV) has recently become a worldwide public health concern due to its capability to increase all-cause liver-related morbidity and mortality as well as increasing health cost budgetary expenditures. There are many similarities between both viruses including the fact that anywhere from 20 to 60% of patients do not know their diagnosis. Both are life-threatening blood-borne viruses that can remain asymptomatic for many years thwarting awareness strategies and increasing the burden of community transmission. At present HCV being a curable disease, the global response is at a juncture where lessons learned from the HIV epidemic should form the template for a fast scaleable and sustainable response in order to curtail the epidemic and possibly eradicate or at least turn the disease into a rare incident manifesting illness. The applications of the lessons learned in strategies like seek, test, treat, retain and even treatment as prevention for selective populations are more than ever necessary as a comprehensive approach to create appropriate response from key policy stakeholders, pharmaceuticals, clinicians, patients and the community. All this implementation needs to be ascertained within a framework of respect, leadership, access to treatment, medication assisted programmes and social behaviour inclusion and expertise to seek and assist vulnerable and high risk groups like men who have sex with men, incarcerated individuals, homeless and people who inject drugs and substance use disorder.

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Risk factors for transmission of hepatitis C virus among the HIV population in Central Mexico: a case-control study 3.9), history of fisting (aOR,4.6;95% CI 1.6 to 13.3), and use of poppers during/before sex (aOR, 2.78; 95% CI 1.2 to 4.59). Self-reported history of herpes genitalis was marginally related to HCV co-infection (aOR,4.7;95% CI .99 to 22.3). Among exposures that were significant only at the univariable analysis in our study were, history of tattoo, unprotected receptive anal intercourse, group sex participation, using and sharing sex toys, rectal bleeding related to sexual intercourse. Other nosocomial exposures, acupuncture and major dental treatment were not related to HCV co-infection. Conclusions: HCV infection in HIV patients in Mexico is associated mostly with risky sexual behaviour among men who have sex with men. History of body-piercing may be a route of transmission in our population. IV drug use is rarely a factor associated with HCV acquisition among HIV patients in central Mexico. Background: Bictegravir, a novel, unboosted INSTI with a high barrier to resistance and low potential for drug interactions, has been co-formulated with the recommended NRTI backbone of emtricitabine and tenofovir alafenamide (B/F/TAF) as a fixed-dose combination (FDC). We report the primary Week (W) 48 efficacy and safety Phase 3 results of switching to B/F/TAF from dolutegravir plus abacavir/lamivudine (DTG+ABC/3TC) or FDC of DTG/ABC/3TC. Materials and methods: HIV-infected adults virologically suppressed on DTG/ABC/3TC or DTG plus ABC/3TC (DTG/ABC/3TC group), with estimated glomerular filtration rate (eGFR) ≥50 ml/min were randomized 1:1 to switch to B/F/TAF (50/200/25 mg) once daily or continue current regimen as DTG/ABC/3TC through week 48 in a double-blinded fashion. Primary endpoint was proportion with HIV-1 RNA ≥50 copies/ml (c/ml) at W48 (FDA snapshot). Non-inferiority was assessed through 95.002% confidence intervals (CI) using a margin of 4%. Secondary endpoints were proportion with HIV-1 RNA <50 copies/ml and safety (adverse events (AEs), laboratory results, bone mineral density (BMD) and renal biomarkers). Results: Five hundred sixty-three participants were randomized and treated (B/F/TAF n = 282, DTG/ABC/3TC n = 281): 11% women, 22% Black, median age 46 yrs (range 20 to 71). At W48, 1.1% switching to B/F/TAF and 0.4% continuing DTG/ABC/3TC had HIV-1 RNA ≥50 c/ml (difference 0.7%; 95% CI -1.0% to 2.8%, p = 0.62), demonstrating noninferiority. At W48, proportion with HIV-1 RNA <50 c/ml was 93.6% on B/F/TAF and 95.0% on DTG/ABC/3TC. No participant developed resistance to any study drug. The most common AEs were upper respiratory tract infection (10% B/F/TAF, 10% DTG/ ABC/3TC), diarrhoea (9%, 5%), nasopharyngitis (7%, 8%) and headache (7%, 7%). Few participants (6 [2%], 2 [1%]) had AEs leading to premature study drug discontinuation. Mean BMD increased similarly in both groups. Percentage changes from baseline in renal biomarkers were similar between treatment groups (Table 1). Lipid parameters were similar between groups with the exception of a small decrease in triglycerides seen in the B/F/TAF group.
Abstract O231- p-values were from the two-sided Wilcoxon rank sum test to compare the 2 treatment groups. * p-values were from the ANOVA model including treatment as a fixed effect.
Conclusions: Switching to B/F/TAF was non-inferior to continuing DTG/ABC/3TC with low rates of W48 virologic failure, high rates of maintained virologic suppression and no resistance. B/F/TAF was well tolerated, with a similar bone and urine protein safety profile to DTG/ ABC/3TC.
O24 -State-of-the-ART O241 Dual therapy therapy strategy. In virologically suppressed patients, NEAT001/ ANRS143 recruited treatment-na€ ıve patients, randomized to DRV/RTV plus either raltegravir (RAL) or FTC/TDF (N = 805). Although similar rates of virologic suppression were observed in the overall population, in patients with HIV-1 RNA >100,000 copies/ml and CD4+ cell counts <200 cells/mm 3 , there was an excess risk of virologic failure for dual vs. triple therapy, and it was associated with resistance. The GARDEL study showed at 48 and 96 weeks non-inferiority (in treatment-na€ ıve adults) of a dual regimen of lopinavir 400 mg/ ritonavir 100 mg plus lamivudine 150 mg, to that of a standard triple therapy of the same boosted PI and lamivudine or emtricitabine plus another NRTI. Non-inferiority was maintained irrespective of baseline viral load and sensitivity analysis used to assess results. Similar results were reported in the ANDES study with Darunavir 800 mg/ritonavir 100 mg in fixed-dose combination plus 3TC, compared to the same PI plus 2 NRTIS. Dual therapies based on lamivudine-dolutegravir are being explored for initial treatment or as simplification of suppressed individuals: Recently the PAD-DLE study and ACTG5252 demonstrated that dolutegravir-lamivudine resulted in potent antiviral activity. GEMINI trials are evaluating the non-inferiority compared to a three drug regimen. The SWORD-studies showed non-inferiority in virologically suppressed patients receiving stable ART with no previous virologic failure when treated with dolutegravir plus rilpivirine dual therapy, compared to ongoing standard ongoing triple-drug. So, dual therapy is emerging as an interesting option for treatment-experienced, virologically suppressed patients and a potential alternative for treatment-na€ ıve patients.

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HIV and new drugs 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. To date, regimens that include a non-nucleoside reverse transcriptase inhibitor (NNRTI), typically efavirenz (EFV) in combination with tenofovir disoproxil fumarate (TDF) and lamivudine (3TC) or emtricitabine (FTC) have been the preferred first-line regimen. However, World Health Organization guidelines are shifting and the US President's Emergency Plan for AIDS Relief is pushing to replace EFV with the integrase strand-transfer inhibitors (INSTIs) dolutegravir over the next 1 to 2 years. Newer drugs that have completed phase 3 trials and are awaiting regulatory approval include the NNRTI doravirine (DOR), and the INSTI bictegravir (BIC). Both drugs will be available single-tablet formulations (DOR/3TC/TDF and BIC/FTC/TAF respectively) that do not require a boosting agent. A challenge to both of these newer regimens is the adverse drug-drug interaction with rifampicin. Several injectable long-acting formulations, including the combination of cabotegravir plus rilpivirine; the novel nucleoside reverse transcriptase translocation inhibitor MK8591, and broadly neutralizing antibodies (bNAbs) may permit administration of ART monthly, quarterly or even less frequently. Such advances may greatly simplify drug administration and increase adherence to ART for many patients. were identified as those with CD4+ T cell counts ≥200 cells/ml, plasma viral load >1000 copies/ml, less than one year of HIV diagnosis, and LAg-Avidity test (Sedia) OD score <1.5 (confirmed by triplicate testing). TDR in RI individuals was assessed from available pol sequences using the Stanford HIVdb tool, considering viruses with a score >15 to efavirenz, nevirapine, any nucleoside reverse transcriptase inhibitor (NRTI), lopinavir, atazanavir, or darunavir as resistant. Results: 24.1% (418/1728) of persons in Guatemala, 28.8% (97/420) in Honduras, 29.2% (827/2829) in Mexico, 30.9% (100/323) in Nicaragua and 49.3% (182/369) in Panama showed evidence of RI. We did not observe significant differences in overall or drug class-specific HIVDR levels between individuals with recent and long-standing infection (LSI) in any country for the complete study period. No significant trends in overall or drug class-specific TDR were observed along the study period in RI individuals, in any country. However, non-nucleoside RT inhibitor (NNRTI) TDR in LSI individuals showed increasing trends in Mexico and Nicaragua (both p = 0.03). NNRTI resistance crossed the 10% threshold in RI individuals in Mexico, Honduras and Nicaragua after 2015. K103N was the most frequent surveillance DR mutation both in RI and LSI individuals in all countries. Mexico showed an increase in K103N frequency in RI in 2015 to 2016 (7.58%) vs. 2011 to 2012 (1.93%, p = 0.002). Conclusions: Our results suggest increasing NNRTI HIVDR trends in some Mesoamerican countries. However, this increase was not specific to RI individuals and was also observed in individuals with LSI. More statistical power may be needed to find possible trends in TDR in RI individuals given the low proportion of the recently diagnosed population they represent in many Mesoamerican countries. The origins of syphilis are contended between two main hypotheses, the Columbian by which it was carried to Europe from the Americas by Columbus' crewmen coinciding with the first reported outbreak; and the pre-Columbian, indicating that venereal syphilis existed in Europe but was unrecognized. Four centuries later in 1905, Schaudinn and Hoffmann identified Treponema pallidum in chancres. Syphilis was, until the late 19th century, often confused with gonorrhoea, whose agent was isolated by Neisser in 1879. Gonorrhoea has been associated to biblical words and to descriptions dating back to 500 BC; it was first addressed as a public health problem in 1256 by Luis IX through his rulings on prostitution in Paris, and in 1611 by a decree of the British parliament. Spirochetes and gonococci, together with Chlamydia trachomatis, discovered by Prowazek in 1907, and the protozoan Trichomonas vaginalis, identified by Donn e in 1836, are the causative agents of sexually transmitted infections for which a cure has been available since almost a century. However, according to the Latin American AMR Surveillance Network (ReLAVRA) high levels of gonococcal resistance to tetracycline, penicillin and ciprofloxacin has been emerging since 2005; and, more recently, extended-spectrum cephalosporin-resistant strains of Neisseria gonorrhoea were isolated. The World Health Organization (WHO) estimated in 2012 a global annual burden of 357 million incident cases of these four curable STIs: 143 due to T. vaginalis, 131 to C. trachomatis, 78 to N. gonorrhoea and 6 to T. pallidum. Of those, an estimated 64 million cases occurred in the Americas. The WHO Global Health Sector Strategy on STI (2016 to 2021) recommends prioritizing the implementation of demonstrated cost-effective interventions, with the ultimate goal of eliminating selected STIs as a public health problem by 2030.

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Syphilis amongst key populations M Kamb Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA Syphilis, caused by the spirochete Treponema pallidum, results in the greatest STI-associated morbidity and mortality outside HIV. Although mainly transmitted sexually, it also can be transmitted vertically during pregnancy. In the Americas, syphilis is endemic in most countries (typically <1% general population prevalence) but has high prevalence in certain key populations, such as sex workers (SW), men who have sex with men (MSM), transgender persons (TG) or migrant workers. Surveillance data are limited in Latin America & the Caribbean (LAC); however, available studies suggest rising syphilis case rates in the Americas. In Brazil, where MSM account for the majority of primary and secondary (P&S) (i.e. new) syphilis cases, case rates in pregnant women have increased each year since 2009. Similarly, in the United States most P&S syphilis occurs in MSM, but case rates in women and heterosexual men have increased each year since 2012. In Barbados, where syphilis was once well-controlled, a continuing outbreak starting in 2011 has predominantly affected men (>70%), with almost half of all cases in HIV-infected persons. A 2015 systematic review of syphilis seropositivity among key populations in LAC found prevalence in MSM was >7.5% in more than half of 35 studies, with highest prevalence in Andean and Southern Cone countries. In five studies in transgender populations, prevalence ranged from 6.5 to 43.3%. In 49 studies among female SWs, half found active syphilis in >5% of women. Syphilis continues to cause significant morbidity in LAC. Better surveillance could improve our understanding of syphilis trends and help support prevention activities.

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Innovation: community-based STI clinic and interventions in San Francisco While there were primary care services available to all San Francisco residents, there were limited specialty services and no specific culturallycompetent services for MSM, sex workers and transgender persons. This presentation will review the steps taken to create sustainable services that are now nearly 20 years old for those at risk groups, as well as outcomes and various measures of impact. Attendees may model the San Francisco experience in increasing culturally-competent and highly effective prevention and clinical sexual health services in their own settings.

MM Deschamps GHESKIO, Port au Prince, Haiti
Objective: To evaluate HIV+ pregnant women and infant outcomes, including syphilis testing, in the largest prevention of mother-to-child transmission (PMTCT) programme in Haiti. Methods: Retrospective data from HIV+ pregnant women and their infants enrolled in PMTCT care at GHESKIO from 1999 to 2014 were included. Maternal outcomes include enrolment in PMTCT, receipt of antiretrovirals (ARV) prior to delivery, syphilis testing and treatment, maternal retention through delivery. Infant outcomes include infant enrolment in PMTCT, HIV testing and infection, Syphilis testing and infection. Four PMTCT programme periods were compared: period 1: mono ARV, period 2, dual ARV, period 3 Option B and period 4, Option B+. Kaplan Meier methods were used to assess retention in PMTCT care. Results: Among 4665 pregnancies, median CD4+ was 494 cells/ll (IQR 328 to 691). At time of enrolment in PMTCT care, 3829 (82%) of pregnant women were tested for syphilis, with 8% of all women positive for syphilis (N = 395). A total of 3500 (75%) women received ARV prior to delivery and 73% (3414/4665) were retained in care through delivery with 22% lost prior to delivery, <1%) died, and (6%) stillbirths/abortions. 94% (3218) of infants born alive enrolled in PMTCT, of whom 2955 (92%) had complete HIV testing with 161 HIV+ infants for a 5.4% HIV transmission rate (9.8%, 4.6%, 5.8% and 3.6% in periods 1 to 4). Retention at 12 months was lower in period option B+ compare to other period. The proportion of women who tested positive for syphilis decreased from 16% (95/601) in period 1 to 8% (68/851) in period 4. Syphilis testing among infants increased from 17% to 91% across period 1 to 4 with 2 of 1682 infants being positive. Conclusion: Despite dramatic reductions in MTCT in Haiti, interventions are needed to improve retention to achieve MTCT elimination of HIV and syphilis.

O321
Pre-Exposure Prophylaxis: from clinical trials to implementation K Mayer Fenway Community Health Center, Boston, MA, USA The efficacy of antiretrovirals for HIV prevention has been demonstrated in animal models and clinical trials of at risk heterosexuals, men who have sex with men, transgender women and people who inject drugs. Tenofovir disiproxil fumarate (TDF) co-formulated with emtricitabine (FTC) taken daily has been approved by the World Health Organization and multiple national normative bodies for anti-HIV pre-exposure prophylaxis (PrEP). TDF/FTC PrEP has been found to be safe and well tolerated, though renal function needs to be monitored regularly, since reversible creatinine elevations can be seen in a small percentage of adherent PrEP users. TDF/FTC can also cause a clinically insignificant reversible decrease in bone mineral density, which may suggest additional monitoring is warranted for patients with pre-existing osteoporosis or osteopenia. PrEP efficacy is directly related to medication adherence, with protective levels approaching 100% among those consistently using daily medication. However, several case reports of PrEP failures have been reported, most often in the setting of initiating PrEP when patients were acutely infected with HIV (i.e. pre-antibody seroconversion). Transmission of multi-drug resistant HIV has also been reported, and one PrEP failure in the setting of adequate protective drug levels has been reported in an individual with multiple daily intimate partners and recurrent rectal sexually transmitted infections (STI). Since PrEP does not protect against bacterial STI, users should be counselled to undergo routine screening and to consider using condoms if STI protection is desired. PrEP demonstration projects are underway in multiple countries in Latin America, but access remains limited for many who could benefit.

O322
HIV prevention: PrEP situation in Latin American countries G Ravasi Pan American Health Organization (PAHO), Washington, DC, USA Current HIV prevention strategies have not been able to curb HIV incidence in Latin America and the Caribbean (LAC); the estimated number of new HIV cases remained stabilized since 2010 (120,000/ year). New infections in adult males increased between 2010 and 2016, and young men (15 to 24) account for one-third of new infections. Except for the Bahamas and Brazil, no country currently offers the complete range of HIV prevention interventions recommended by the World Health Organization (WHO). Nearly all countries provide free condoms to young people, men who have sex with men (MSM), female sex workers and transgender women, in most cases including lubricants. Nevertheless, condom use among MSM in their most recent sexual contact is 63%, highlighting the need for additional prevention tools such as pre-exposure prophylaxis (PrEP). The regional PrEP target for LAC, established in 2015, is 10 pilot projects by 2020. By the end of 2017 the provision of PrEP to key populations in the public sector was still limited to the Bahamas and shortly in Brazil and Barbados. In addition, PrEP was available locally at very small scale through civil society organizations (e.g. Guatemala, Paraguay and the Dominican Republic) and private sector (e.g. Peru, Argentina and Chile). Limited knowledge and awareness in national programmes and civil society, resistance with respect to risk compensation and incidence of sexually transmitted infections, and budget gaps are common barriers. On the other hand, at least nine countries (Chile, the Dominican Republic, Guatemala, Haiti, Jamaica, Mexico, Paraguay, Peru and Colombia) are planning the implementation of demonstration projects in 2018 with various modalities and sources of financing. In addition, most countries have access to WHO prequalified low cost generic, including the PAHO Strategic Fund. The regional target of 10 projects will therefore soon be exceeded.

O323
Pre-Exposure Prophylaxis of HIV in Mexico: adding colour to the prevention palette Mexico has a concentrated HIV/AIDS epidemic. The estimated seroprevalence of HIV in men who have sex with men (MSM) is 17% (95% confidence interval: 16, 18%) [1] and 20% (15, 25%) in transgender women (TGW) [2]; 32% of HIV-seropositive persons are unaware of their serostatus. Estimated HIV related mortality is 4.6 per 100,000 persons [3]. Free antiretroviral treatment is available at 78 public HIV/STD clinics since 2004, but late entry into care remains an important barrier to treatment success; 50% of HIV-seropositive persons enter treatment with ≤200 CD4+ lymphocytes /μl [4], and 59% of them die within 6 months of treatment initiation [5]. Cost-effective combination prevention programmes have increased awareness of HIV serostatus, HIV testing and linkage to care in MSM, but many opportunities still exist to improve the prevention of HIV in Mexico [6]. Preexposure prophylaxis (PrEP), a relatively new component of combination prevention, has exhibit high efficacy to prevent HIV infection in diverse high risk populations and it has been proposed as a mechanism to stimulate HIV testing and counselling and to anticipate detection and linkage to care [7]. We propose a demonstration study to assess the feasibility and acceptability of including PrEP in HIV/STD combination prevention programmes in Mexico. This study is part of a tri-national initiative led by the Evandro Chagas Institute for Infectious Diseases in Brazil. In Mexico, a multi-site, prospective, cohort of 3000 HIV-seronegative persons at high risk of HIV infection will be enrolled and followed between April 2018 to July 2019 at HIV/AIDS -STD clinics and through civil organizations in Mexico City and Jalisco. Participants will be ≥ 16 years of age and include MSM, TGW and heterosexual women whose partners are HIV-seropositive. Eligible individuals will receive a daily oral dose of tenofovir disoproxil fumarate, 300 mg/emtricitabine, 200 mg. A concurrent communication intervention will aim to induce demand for PrEP in the target populations and clinicians. Formative research will assess barriers for health service utilization and opportunities for policy changes favourable to scaling-up PrEP in Mexico.

P O S T E R A B S T R A C T S
Comorbidities and Complications of Disease and/or Treatment Background: Kaposi's sarcoma (KS) is the most frequent AIDS-defining malignancy. In Mexico, non-Hodgkin lymphoma (NHL) and KS cause 25 and 14% of hospital deaths from AIDS. There is little information about the association of antiretroviral therapy (ART) with chemotherapy (CT). The cytotoxic effect of CT on immune recovery may be temporary or lasting. The aim of the study is to determine the dynamics of CD4 lymphocytes in patients with HIV and NHL KS or receiving CT. Materials and methods: Cohort of HIV patients with KS or NHL treated at the Instituto Nacional de Cancerologia (INCan) from January 2008 to December 2012. Three groups: KS without CT, KS with CT and NHL with CT. We analysed demographic data, co-infections, clinical stage, CT and number of cycles, viral load, CD4 and CD8 lymphocytes (before, during and after CT), immune recovery at follow-up and mortality (Figures 1, 2). Results: Seventy-one patients: 40 with KS without CT, 13 KS with CT and 18 NHL with CT. All men. 45 (63%) had less than 200 CD4 at diagnosis. Patients received 2 to 12 cycles of CT. NHL patients had lower CD4 count previous to CT (p = 0.2021) during CT (p = 0.0007) and after CT (0.0033). Immune recovery at follow-up did not differ between groups. Conclusions: CT has a transient effect on immune recovery especially in patients with lymphoma so these patients should be closely monitored.

P002
Renal function in perinatally HIV-1-infected patients Results: Sixty-nine patients who had at least 2 microalbumin/creatinine ratio (MC) measurements separated by one month determined between 2007 and 2015 and for whom viral load (VL), CD4%, CD8%, CD8+CD38+%, CD8+HLA-DR+ and complete demographic data were available were included. Thirteen patients (19%) met pre-set definitions for microalbuminuria (>2 findings of MC >30 mg/g, separated by at least 1 month). Outcomes for the microalbuminuria group (13 patients) were compared to those of the 56 patients who did not meet the definition of microalbuminuria (Table 1)

*NS= Not significant
Conclusions: Approximately 19% of a small cohort of perinatally HIV-1 infected children was found to have microalbuminuria. The microalbuminuria group exhibits marked activation of CD8+ but is not associated with the most common measures of HIV clinical status, CD4% and VL. This significant prevalence of renal affection reinforces the importance of screening for microalbuminuria in perinatally infected HIV children even with well controlled disease to allow timely intervention when needed in an attempt to delay/prevent cardiovascular disease in this patient population.

P003
Frequency and distribution of cardiometabolic comorbidities in clinically stable HIV patients on long-term ARV therapy in Lima-Callao, Peru Background: As access to HAART increases globally, the proportion of chronically treated, clinically stable HIV patients also grows. The aim of this study was to describe the differences in the presentation of the most common comorbidities observed in a population of clinically stable, successfully treated HIV infected adults in a country of limited resources.
Materials and methods: Review of medical records at 5 HIV clinics in Lima-Callao, Peru, for HIV-infected adults attending regular followup visits in January or February 2016. Patients were adults (>21 years), ambulatory, on HIV therapy for >6 months and with no current or recent AIDS-defining condition (within last 6 months).
Records were reviewed to collect information regarding epidemiological, clinical and laboratory characteristics. Results: Three hundred and five cases were identified. Patients were mostly male (73.1%), with a median age of 46.0 years, an average time from diagnosis of 9.41 years, and an average time on HAART of 7.78 years. Most patients were on an NNRTI-based, first line regimen (76.4%). INSTIs were used in only 2.2%. Median CD4 count was 614.2 cells/μl and 90.8% (n = 277) had undetectable viral load. According to our observation, cardiometabolic comorbidities presented 3 patterns in our series: 1. Excess weight and obesity were highly frequent at 41.1, and 11.1% respectively. They appeared to be related to clinical stability and lifestyle of patients, rather than to age, gender, duration or type of ART; 2. Dyslipidaemia, hypertension and diabetes mellitus showed closer association to older age (Table 1) *indicates p ≤ 0.05 and longer duration of ART (with p value of 0.06 to 0.07,°); 3. Cardiovascular disease was observed in a low number of individuals (n = 10, 3.3%). Gender of patients and type of ART (NNRTI-vs. PI-based) did not present differences for distribution of evaluated comorbidities (Table 1). Conclusions: A population of stable, ambulatory HIV infected adults on long-term HAART showed differences in the distribution of metabolic and cardiovascular comorbidities. Dyslipidaemia, diabetes mellitus and hypertension and were more frequent in older age and with longer duration of ART. Cardiovascular disease presented in low frequency in our population. Background: Renal involvement in HIV/AIDS patients, such as acute renal failure (ARF) and chronic kidney failure, is one of the most important age-related non-communicable diseases, even in the era of Highly Active Antiretroviral Therapy (HAART), and is independently associated with morbidity and mortality [1,2]. The aim of this is to describe clinical features, mortality and risk factors for Renal Disease (RD) of HIV/AIDS patients in an Intensive Care Unit (ICU), in a period of 5 years. Materials and methods: This is a descriptive and observational study. Among 658 HIV/AIDS patients admitted in ICU from 2012 to 2017, 204 presented ARF on admission or during hospitalization. Their medical records were reviewed. Univariate analysis was performed to identify factors related to death. We performed descriptive statistics on percentage (%), median (Me), mean (M) and range. A p value of <0.05 was considered significant. Results: The incidence was 31%, 72% were male, Me CD4 was 46 (0 to 1000) cells/ml and 82% had CD4≤200. 32% received HAART. Comorbidities identified were: enolism in 45%, smoking in 40%, previous kidney disease in 20%, high blood pressure in 10.2% and diabetes mellitus in 5.3%. Between risk factors we found: volume depletion in 88%, shock in 68%, sepsis in 61%, hypoalbuminemia in 67%, use of nephrotoxic drugs in 58% and liver failure in 17%. 85% presented ARF on admission. Acute kidney injury (AKI) was classified as stage I in 16%, as AKI stage II 25% and as AKI stage III 59%. M and Me proteinuria were 0.71 g/24 hours (0.5 to 4.39). Renal ultrasound was performed in 56% with hyper echogenic kidneys. 10% was treated with haemodialysis. Overall mortality was 54%, was higher in those who need haemodialysis (81%) than in those who do not require it (46%) with p = 0.004. Conclusions: In our experience the incidence of renal failure is higher than in the literature, with male predominance [2]. The most important risk factor was volume depletion which is preventable and has accessible treatment [2]. In our cohort there was significant difference in mortality between those who need haemodialysis and those who do not. We encourage the early detection of comorbidities and risk factors for early treatment to reduce kidney impact. Background: HIV-infected patients (HIP) who ignore their HIV status or those without viral suppression, may develop Pneumocystis jiroveci pneumonia (PJP) and require admission to an intensive care unit (ICU) [1], with a mortality rate of ICU HIV patients with PJP can still be up to 60%. Our aims are to describe clinical characteristics of patients with proven AIDS-related PJP and determine factors related with mortality. Materials and methods: Among 1122 HIP admitted to ICU of an Infectious Diseases Hospital between 2006 and 2016, 63 had PJP. Clinical features, radiological and laboratory investigations and outcomes were reviewed. Univariate analysis was performed to identify factors related to death. We performed descriptive statistics on percentage (%), median (Me), mean (M) and range. A p value of <0.05 was considered significant. Results: Incidence was 0.056. The M age was 37 (14 to 76) years. 65% were male. 92% cases occurred with cell count CD4 ⁺ less than 100 cells/μl with a Me of 52. 90% did not receive highly active antiretroviral therapy. 75% presented weight loss >10% during the last 6 months, Karnofsky scale > 50 or hypoalbuminemia < 2.6 g/L. 70% presented diffuse bilateral interstitial infiltrates on chest X ray and 10% pneumothorax. 87% presented severe acute hypoxemic respiratory failure on admission, 40% required mechanical ventilation (MV). APACHE II (Acute Physiology and Chronic Health Evaluation II) score ≥13 points in 76% of the patients. Initial treatment was trimethoprim-sulfamethoxazole (and corticosteroids) which should be suspended due to adverse events in 25% (15% granulocytopenia, 5% exanthema and 5% hyperkalaemia), it was replaced by intravenous pentamidine. Overall mortality was 43%. CD4+ <100 cells/μl, respiratory failure, MV and APACHE II ≥13 points was related to mortality (p ˂ 0.05) Conclusion: In our serie MV, severity scores and severe immunosuppression were associated with mortality. Patients with CD4>100 cells survived. Malnutrition was related with mortality but p was not statistically significant. Consider initiate empirical PJP treatment in severe pneumonia in HIP.

P006
Latin American prospective cohort of adult HIV-positive patients (LATINA): factors associated with presenting symptoms at diagnosis Thirteen centres distributed in three countries are currently involved in the project: Argentina (9), Mexico (2), Peru (1) and Colombia (1). Inclusion criteria are: being at least 18 years old and having confirmed VIH diagnosis during year before inclusion. Data are recorded in a web platform. Recruitment started in Jan 1st 2013. The objective of the present analysis is to detect demographic and socio-economic variables associated to patients presenting with symptoms at diagnosis. Logistic regression analysis was performed using SPSS v16Variables are presented with the pertaining summary measure and 95% confidence interval Results: As of October 2017, 1866 patients were included in the cohort. Information on presence of symptoms at diagnosis was available in 1631 subjects (87.16%). Forty-two percent (40 to 45) of these presented with symptoms at diagnosis. Sex, age, race and health-care coverage system were complete in 100% of cases; level of education in 98.07% cases. Transmission mode in 89% of cases and CD4 in 90% of cases. The characteristics of the patient were: Male 82% (84 to 86), Latino race 57% (54 to 59), public healthcare coverage 79% (77 to 81); 23% (21.1 to 24.9) had complete primary education or less. Mean age was 32 years (31.16 to 32.74), median CD4 count at entry was 398 (203 to 574). Results found are presented (Table 1). Conclusions: Results displayed show that almost half of the patients included are detected as HIV positive because of symptoms. This leads to worse prognosis and further spread of the epidemics. Early diagnosis is crucial to stop spread of the epidemics. This is a priority in the current context, where vaccines or cure are not to be expected soon. Strategies should include not only the routine HIV testing but also the active search in the community given the association with lower level of education and public healthcare coverage.

P007
Latin American prospective cohort of adult HIV-positive patients (LATINA): 2017 baseline characteristics update  (2) and Per u (1) and Colombia (1). We present basal information as of October 2017. Inclusion criteria are: HIV diagnosis within previous year and at least 2 prior visits to the site. Data are collected in an online "ad hoc" designed platform and was analysed including until October 2017. Patients are requested to have at least 2 visits per year. Thirteen sites in Argentina (9), Mexico (2), Per u (1) and Colombia (1) are participating. Numeric variables are summarized by means (95% CI) or medians (IQR) according to their statistical distribution. Categorical variables that allow inferential estimates are summarized by percentages and 95% CI (Table). Results: Variables analysed had between 5 and 25% missing data.
Abstract P006- This deserves further exploration in order to assess acceptance of the recommendation amongst our population.

P008
Comorbidities in a sample of HIV-positive adults in Colombia. Sub-analysis of patients younger than 50 years Background: According to UNAIDS 1], by 2015 in Colombia, 150.000 people lived with HIV, and the estimated prevalence in adults from 15 to 49 years old was 0.5%. The significant improvement in the survival of these patients with Antiretroviral Therapy (ART) has meant that currently they have an increase in the life expectancy that approaches the HIV-negative population [2]. Furthermore, the HIV population younger than 50 years has shown an increase in comorbidities which is characteristic of older groups. As the presence of chronic comorbidities should be assessed in this population, we developed a study that was aimed at characterizing a group of adult patients with HIV in Colombia to determine the prevalence of comorbidities and risk factors. The following is a sub-analysis of this study for the population younger than 50 years, where we aimed to characterize HIV diagnosed patients <50 years, attending two HIV care programmes and to describe the most frequent comorbidities among people <50 years with HIV diagnosis that attend two HIV healthcare programmes. Materials and methods: This is a sub-analysis of an observational, retrospective study. Medical records that met the inclusion criteria in two HIV care programmes were selected. Descriptive statistics were performed to summarize the clinical and demographic patient characteristics. Background: Elderly patients with HIV/AIDS in Colombia is in upward trend, this being a population that has greater comorbidities and formulated drugs leading to an increased risk of medicationrelated problems when combined with antiretroviral therapy [1,2]. ). The problems related to medication were found in 63.75% of the population, drug interactions 60.42%, polypharmacy with ARV 52.08% and without ARV 20.83%, potentially inappropriate medication 9.58% and anticholinergic risk score ≥3 2.92%. Patients ≥60 years had a higher frequency of problems related to medication compared to those under 60, but this difference was not statistically significant (73.54% vs. 60.96%, p = 0.092). When comparing the characteristics evaluated between patients under and over 60 years, statistically significant differences were found in the percentage of AIDS defining disease (p = 0.007) and the presence of non-infectious comorbidities (p = 0.01), with a higher frequency in the group of patients with an age ≥60 years.
Conclusions: The elderly population with HIV/AIDS in Medellin, Colombia is diagnosed in advanced stages of their disease and with a high burden of non-infectious comorbidities that may be involved in the high percentage of problems related to the medication found in this study. The impact that this can have on important outcomes must be sought. Background: Real world cohorts (RWC) have demonstrated excellent efficacy of LDV/SOF for 8 weeks in HCV monoinfected patients. Real world effectiveness data of LDV/SOF for 8 weeks in HIV/HCV co-infection is emerging from several multiple single-centre and multicentre prospective and retrospective cohorts. The aim of this study was to describe the effectiveness of the single tablet regimen of LDV/SOF for 8 weeks in HCV genotype (GT) 1 patients with HIV/HCV co-infection in RWC. Materials and methods: In this descriptive analysis, data from two prospective studies, one investigator sponsored and one registrational trial, one prospective RWC, three retrospective RWC of LDV/SOF for 8 weeks in HIV/HCV co-infected patients were compared. RWC were selected based on willingness to participate and had at least 15 HIV/ HCV co-infected patients. The prospective trials include data from Ain et al (investigator sponsored) and Isakov et al (registrational trial). The RWC include the Deutsches Hepatitis C-Register, Madrid Coinfection Registry (Madrid-CoRe),Veterans Affairs HCV Registry, and Slim et al, representing diverse patient populations from Europe and US. Baseline characteristics and efficacy were analysed. Results: The majority of the 294 patients included in this descriptive analysis were GT 1, treatment na€ ıve (TN), non-cirrhotic (NC) and had a HCV viral load < 6 million. The prospective cohorts enrolled 79 patients with the following baseline characteristics: mean age (43 years), male (66%), white (89%) and GT 1a (41%). The RWC studies assessed enrolled 215 patients with the following overall baseline characteristics: mean age (54 years) male (84%), white (82%) and GT 1a (75%) in those that reported demographics. The overall SVR12 from six diverse real world and post-marketing cohorts was 94% (277/294). The individual study results are presented in Table 1.
Conclusion: This analysis of diverse cohorts from the EU and US yielded high SVR rates similar to SVR rates seen in multiple RW monoinfected cohorts and supports the use of 8 weeks of LDV/SOF in TN, NC GT 1 HIV/HCV co-infected patients with a baseline HCV viral load < 6 million.
Abstract P011- Table 1 Conclusions: The strategy of prioritizing HCV treatment for HIV/HCV co-infected people, considering morbidity and mortality of co-infection, plays an important role on HIV/HCV controlbeing crucial for public health response. As Brazil increases access to treatment in this population, this strategy could be implemented by other low-middle income countries. Knowing that new interferon-free therapy has more than 90% of efficacy, the next step is to evaluate the sustained virologic response in HIV/HCV co-infected people in order to offer the most suitable therapy for HIV/HCV co-infection in the country.

P013
Investigation of the increasing number of hepatitis A cases among men in the biggest city in Latin America in 2017 In immunocompromised individuals, the viremia tends to be longer, the viral load tends to be higher, and they may present a greater potential risk of transmission, even with the cessation of clinical presentation [2]. In Brazil, the hepatitis A vaccine is available for children under the age of 5 years and for specific populations, including people living with HIV(PLHIV). Our study aimed to assess the profile of the reported cases and the prevalence of HIV among them. A retrospective observational study was carried out by analysing information from the database of individual notification of hepatitis A cases registered in the National Disease Notification System (SINAN) in the Brazilian State of São Paulo in 2017. We analysed information variables related to gender, age, race, educational level, municipality of residence, suspected source of infection and co-infection with HIV. From the 970 cases reported, 81.5% were men (n = 791). Among them, 74.9% were residents of the capital, 72.3% were between 20 to 39 years old (n = 572), 50.3% (n = 400) white, 50% concluded high school or higher degrees and 16.1% (n = 128) were infected with HIV. Among HIV+ men, 62.5% were white, 51% had concluded high school or higher degrees. 66.1% of the reports did not provide information on the possible source of infection (n = 523); among the notifications that correctly registered this information field, 42% corresponded to the sexual route. The municipalities of São Paulo are among the best-evaluated cities in the national ranking of sanitation, which makes unlikely the association of the sudden increase of cases to water or food contamination. The occurrence of the events coincided with the internationally reported outbreaks, and the individual characteristics of the reported cases in São Paulo strongly suggests the event refers to an outbreak related to sexual transmission between gays and other MSM. The perceived high HIV prevalence reinforces the need for warranting immunization for hepatitis A among PLHIV, and provides strong points of argument to the idea of its expansion to MSM and other vulnerable groups. Background: Although the hepatitis B vaccine began widely used in high-income countries in the 1980s, almost 20 years later it was still rarely used in low-and middle-income countries. The main reasons behind these gaps included limited money for immunization, a lack of the infrastructure needed to carry out effective immunization programs, and a lack of political interest in immunization [1]. It is estimated a HBV prevalence of 2 to 4% in the Caribbean, and for HCV it is around 1.2% in the Latin-American region [2]. In the DR prevalence of both HIV and/or HBV/HCV are higher among GMT persons [3]. Background: In the era of combined antiretroviral treatment (cART), survival rate has increased [1,2]. One quarter of the population with HIV+ in the United States are also co-infected with HCV [3]. When comparing HIV+/HCV co-infected women with HCV-uninfected women, studies have shown that co-infected women are more susceptible to health complications [4,5,6]. In addition, studies have shown a significant difference in mortality in women with HIV+/HCV versus HIV+ alone [7]. Materials and methods: A secondary data analysis was performed using information collected from the Puerto Rican HIV+ women cohort from the University of Puerto Rico Medical Science Campus. SPSS© version 24 and Stata© software's were used. The group of seropositive (HIV+) women (n = 43) was stratified in HIV+/HCV coinfected women (n = 15) and HIV+ mono-infected women (n = 28). Evaluation methods included medical history, neurological exam, viralimmune profiles, neuropsychological tests and others. Descriptive statistics were performed. Conclusions: Although half of the adult WLHIV assisted at our institution had advanced disease at presentation, most of them achieved viral suppression and immune recovery. Multi-morbidity was observed with dyslipidaemia, hypertension, bone and psyquiatric disorders as the most prevalent chronic conditions. Healthcare providers should be aware of a comprehensive approach need for adult HIV-infected women.
Abstract P022- Background: UNAIDS indicated that in 2016 there were 36.7 million people living with a diagnosis of HIV. Women represent 48.5% of this group. In our country, 19.6% are women. It has been shown that women present a greater risk of abandoning antiretroviral treatment [1]. Materials and methods: An observational cross-sectional study, carried out among women patients at the Condesa Clinics between March 2014 and November 2017. All patients had previously been pregnant and had started HAART (high active antiretroviral treatment) at least six months before and possessed complete medical records. Convenience sampling; prevalence, odds ratio, chi 2 and attributable risk were analysed using SPSS21. Results: One hundred and three women HIV patients from the Condesa Specialized Clinic (CSC) and CSC-Iztapalapa. Median age, 24.5 years (SD 5.8). Education: 40% completed middle school. Unpaid employment: 61.2%. 73% have a stable partner. 69% with virologic suppression and 31% with virologic failure. At the moment of failure, the average viral load was 5,169c/ml (range: 316 to 188,910); average CD4 was 381c/μl (range: 70 to 591). On average, 11 months (range: 8 to 60) passed between the start of antiretroviral treatment and failure ( Table 1). The probability of virologic failure in women who experienced domestic violence was 1.9 OR, while among illegal and legal drug users, as well as those receiving antiretroviral treatment with protease inhibitor (IP), the probability of virologic failure was 2.2 OR. 31% of patients participated in a women's support group, and 22% of those who attended had virologic failure compared with 35% among the women who did not participate in the group.
Conclusions: In this study, we observed a high prevalence of virologic failure, while other studies have shown greater vulnerability among women with HIV with less education and higher rates of domestic violence [2]. One study reports a 29% virologic failure rate in women who continue treatment for 12 months postpartum. Identifying the associated factors is useful in developing intervention strategies related to the factors identified in reducing virologic failure. Background: After recommending treatment for all PLHIV in 2013, Brazil has progressively expanded ART's coverage. HIV care cascade, tool for decision and health policy making, represents results of interventions and helps to identify crucial points to qualify healthcare for PLHIV. In 2016, 830,000 PLHIV was estimated in Brazil, of these 694,000 (84%) was diagnosed; 655,000 (79%) was linked to health services; and 563,000 (68%) was retained. Since then, there is a decrease of untreated PLHIV in all ages, however the proportion of PLHIV between 18 and 24 yo without ART is 2.5 times higher compared to PLHIV over 60 years old. One of the challenges of the Brazilian public system is to increase the number of young people with TARV adherence, linked and retained in health services. Materials and methods: A cross-sectional study was carried out to estimate retention and adherence in PLHIV older than 18 years. The results were obtained from data crossing of the Siscel (a national laboratory system that shows individual CD4 count and HIV viral load results) and the Siclom (a national antiretroviral delivery control system), between 2009 and 2017 (first semester). Results: There is a progressive improvement in healthcare linking, retention and adherence of PLHIV aged 18 to 24 years between 2009 and 2017. Despite the poorest adherence proportions, young people demonstrated a considerable improvement in sufficient adherence, rising from 47% in 2009 to 64% in 2016 and lost to follow up from 26% to 15% (Figure 1.) In 2016, approximately 43,000 young people were linked, 78% were retained in health service, 66% were in ART and 57% were suppressed. The proportion of PLHIV (18 to 24 yo) in ART with HIV viral load < 200 copies/ml is lower when compared to the other ages (Figure 2). PLHIV aged 18 and 24 who started ART in 2009, 52% were retained after 12 months, rising to 81% in ART started in 2015. Reduction in retention was observed after 24 months and 5 years after the initiation of ART. After two years, 74% of PLHIV aged 18 to 24 who started ART in 2014 remained retained, and 61% who started ART in 2011 remained retained after five years. Conclusions: Despite the gradual improvement of the indicators analysed in PLHIV aged 18 to 24 years, it is essential to strengthen actions directed to young people, increasing access to health services, to ensure linkage and retention of these young people, directly impacting on quality of life.  [2], the incidence of hospitalization in advanced stages of disease and mortality for HIV/AIDS patients remains significantly high. This represents an urgent need for more efficient preventive and early detection strategies that may lead to reduced advanced presentations of the disease and improved outcomes.
Background: Cardiovascular disease (CVD) is one of the main causes of morbi-mortality in general population worldwide. As lifespan of people living with HIV have improved, prevalence and incidence of CVD is expected to increase in the future. Although there are several risk functions to assess long-term CVD-risk, to our knowledge, there is no such data about transgender women (TW) in our country. We aim to describe 30-year CVD-risk of TW at an HIV/STI clinic in Argentina. Materials and methods: We performed a cross-sectional retrospective study to evaluate CVD-risk among TW at a HIV/STI clinic in Buenos Aires, Argentina, from 2014 to 2017. TW between 20 and 60 years at first visit to the clinic were included. We ascertained demographic characteristics, traditional CVD risk factors, HIV status and use of hormone therapy (HT). Categorical variables were described using absolute and relative frequencies and compared by v2 test or Fisher's exact test according to expected values. Continuous variables were described using medians and interquartile ranges (IQR) and compared by t-test or Mann-Whitney test according to normality of variables. A two-sided p-value of < 0.05 was considered significant. Longterm CVD risk was assessed with Framingham 30-year risk score (30FMS) using body mass index (BMI). Both "hard" (coronary death, myocardial infarction, stroke) and "general" ("hard" + coronary insufficiency, angina, transient ischemic attack, peripheral artery disease and heart failure) CVD risks were analysed as continuous variables. Results: One hundred and eleven TW were eligible for this analysis, 37 (33.3%) were HIV-positive and 44 (39.6%) reported use of HT. Median age was 31 years (IQR 27 to 37). The median 30-year risk of "hard" CVD in TW receiving HT was 0.1 (IQR 0.04 to 0.135) and 0.06 (IQR 0.03 to 0.16) among TW not receiving HT. We found no statistically significant differences in the median 30-year risk of "hard" and "general" CVD in these groups (p-value = 0.3356 and pvalue = 0.2981 respectively). The median 30-year risk of "hard" CVD in HIV-positive TW was 0.05 (IQR 0.03 to 0.08) and 0.1 (IQR 0.03 to 0.17) among negative TW. We found statistically significant differences among these groups (p-value = 0.0311). Conclusions: Our study found lower median 30-year CVD risk among HIV-positive TW. Traditional risk scores do not consider the increased CVD risk of HIV population, this result could be related to this limitation of the score. Regarding use of HT we did not detect differences. However, our study provides new insights about a key population and HIV. Furthermore studies are needed, specially to estimate the complex role of HT and HIV in TW CVD risk. The higher the Gender Identity Stigmatization (GIS), the higher the suicidal ideation (r = 0.57), depression (r = 0.55), and anxiety (r = 0.53) and the lower the quality of life (r = -34). GIS is also associated with maladaptive personality traits (DSM-5): more negative affectivity (r = 0.43), psychoticism (r = 0.39) and detachment (r = 0.36).

P030 First intervention in a gay sauna with rapid tests for HIV infection in the city of C ordoba, Argentina
Approximately half of the sample (48.6%) experience clinical levels of negative affectivity (negative emotions and poor self-concept).
Conclusions: Results of this baseline analysis show that half of TGW initiate treatment with advanced HIV infection and report co-occurrences between GIS and negative psycho-social outcomes. Since these factors might negatively impact in retention and adherence of HIV treatment, it is important to consider multi-component intervention assessing TGW psycho-social needs as standard of care in clinical settings.

P034
Abstract Withdrawn  (88%). There was no association between sexual preference, educational level and drug use with the different outcomes. Previous access to social security was strongly associated to chronic intermittent users (p 0.0017). By now, 7.9% of the patients are LTFU (defined as more than three months without pill collection or >12 months without medical visits), and 3.6% died. Deaths were due to AIDS defining conditions in all cases (Table 1.).
Conclusions: In our sample, late testing represents 70% of all patients with less than 100 CD4+ cell count at first medical visit. However, 1/3 of our sample is comprised of patients with previous diagnosis, who were either never linked to care or not retained. Lack of continuity in care between different healthcare systems seems to be an important factor for ARV/ HIV care discontinuation. Increasing diagnosis strategies might be the first step to improving this continuum; however, more studies to better understand the reasons that explain these different scenarios are needed. Background: Assessing hospitalizations and length of stay among HIV-infected patients provides information on morbidity and healthcare utilization, which are essential to evaluate healthcare provision and project costs. We sought to assess hospitalization rates and length of stay, and risk factors associated with prolonged hospitalization in a cohort of HIV-infected patients from Mexico City. Materials and methods: We assessed hospital admissions of patients with HIV from January 2000 to November 2017 at a tertiary care hospital. We estimated hospitalization incidence and classified hospitalizations in two groups according to length of stay in prolonged (>21 days) or regular stay (<21 days). We compared demographic, clinical and laboratory characteristics at hospitalization using logistic regression models to identify the risk of prolonged stay (PSH) as a function of sex, age, updated CD4 counts and viral suppression (HIV RNA<400 copies/ll), and use of ART. We compared the distribution of reason for hospitalization between groups using X2. Results: There were 3421 patients contributing to 20,397 cumulative years of follow-up. There were 2581 hospitalizations accounting for an incidence of 12.6 hospitalizations per/100patients-year. There were 295 (11.42%) PSH. Patients with PSH had a higher proportion of subjects with CD4 <350 cells/ml (91.6% vs. 83.4%, p < 0.001), fewer patients receiving ART (50.8% vs. 59.9%, p = 0.003), and were more frequently hospitalized due to AIDS-related events (80.0% vs. 69.3%, p=< 0.001) in comparison with regular stay. In patients with regular stay, non-AIDS events were more frequent (6.1% vs. 11.4%, p = 0.006) ( Table 1). The proportion of hospitalizations due to AIDS-related events (70%), and of PHS (11%) did not change over time (see Table 2).

Conclusions:
We observed an incidence of hospitalizations similar to previous reports in Latin America. We also observed that 1 in 10 hospitalizations lasted more than 21 days. We identified that AIDSrelated events were the most frequent cause of hospitalization and this did not change over time. Low CD4 and detectable HIV RNA were the main risk factors associated to prolonged hospital stay. Hospitalization rates associated to advanced HIV disease continue to be high in our setting and this seems to have an impact in length of hospitalization.
Abstract P036-  (42%) received all of them. The most frequently reason for not receiving influenza vaccine was "not wanting to get the vaccine" (25%) and having forgotten to apply it (25%). Overall, attitudes towards vaccines were positive: 90% considered vaccines important for health, 91% regarded vaccines safe or very safe, 85% regarded information about vaccines provided by their physician as reliable or very reliable; and 92% perceived vaccines as a means to protect other members in their community. We identified fear of adverse events (92% of respondents were worried about these) and cost (38% answered cost as an important or very important reason for not applying the prescribed vaccines) as potential barriers for vaccine application.
Conclusions: Vaccine coverage among adults receiving care for HIV in our clinic is suboptimal for influenza, pneumococcal and HBV. While most patients have positive attitudes toward vaccines, forgetting or plainly refusing vaccine applications were the most frequent reasons for not getting immunized. Cost and fear of adverse events are potential barriers for vaccination. Interventions to increase vaccine uptake in our clinic should facilitate access and improve education about adverse events.

P038
HIV clinical monitoring in the southern region of Brazil Background: In Brazil, clinical cascade monitoring was implemented to evaluate HIV policies related to care and treatment. The cascade contributes to assess also the 90-90-90 targets (90% of people living with HIV/AIDS (PLWHA) diagnosed; 90% of diagnosed people on antiretroviral therapy (ART); and 90% of people on ART with suppressed viral load (VL)) adopted in the country. In 2013, the Ministry of Health recommended dispensing ART for all diagnosed HIV+ individuals in order to reach fully suppressed VL and epidemic reduction. However, important hotspots can still be found, mainly in the southern region of the country. This study evaluates the cascade in order to identify the main gaps negatively affecting viral suppression among PLWHA. Materials and methods: Individual case data were obtained from crossing the two official databases related to ART dispensation and laboratory results of CD4, CD8 and VL counts, conducted by the public health system. The data for PLWHA who had at least one VL or CD4 counts or ART dispensation in 2016 were analysed. The cascade phases were estimated: 1. Linked patients (those who had at least one VL or CD4 counts, or ART dispensation); 2. Retention in care (defined as those who had at least two VL or CD4 counts, or had an ART dispensation in the last 100 days of 2016); 3. On ART (defined as having at least one ART dispensation in the last 100 days of 2016); and 4. VL suppression (VL <1000 copies/ml  Background: Up to 2015 Brazil's Ministry of Health (MoH) purchased genotyping tests and distributed them through a national laboratory network (Renageno). This involved the costs of logistical arrangements for kits and samples, laboratory equipment maintenance and continuous human resources training in the laboratory network. However, since 2016 testing has been contracted out to a private-sector laboratory service which includes centralized testing, samples collection in 708 collection points throughout the country and the online release of test results. This study compares the features of these two schemes for acquiring HIV genotyping tests. Materials and methods: Data were collected from the Genotyping Control System (Sisgeno) database from 2015 to 2017 and a comparative analysis of the variables performed.
Results: Under the old system, when the MoH was buying and distributing the kits, public laboratory professionals were responsible for evaluating the test requests to check if they complied with the criteria established in the relevant clinical protocol. This procedure, and its outcomes, lacked necessary rigor and generated unnecessary costs. However, after the outsourced service was hired, the private laboratory rejected all the non-compliant requests, which represented 17% of total requests and generating an approximate saving of US $300,000 to the public purse in 2017 alone. Moreover, the average time of results-release in the old input purchasing system (49 days in 2015) fell to 11 days in 2017, thus optimizing patients´clinical management. Another important advance related to antiretroviral resistance monitoring was the increased number of results released: from 8080 in 2015 to 12,265 in 2017. Finally, the unit value of tests under the new scheme is now 40% less than for those purchased previously by the MoH.

Conclusions:
The study showed that outsourcing genotyping testing offers a number of advantages such as standardized testing, a single laboratory for the MoH to ensure quality control, lower costs overall (e.g. price of reagents, logistics costs), reduced delivery time of test results, and an end to unnecessary testing. The outsourced service approach has also boosted access to testing, thereby enabling patients from all Brazil´s regions to receive equal treatment -an important step forward in Brazil´s efforts to achieve the 90-90-90 goal.

P040
Reduction of errors during the pre-analytical process for the collection of HIV samples in Mexican centres: a pilot study of a new software strategy implementation Background: For more than thirty years our attempts have been focused in access to HIV treatment, diagnosis, prevention, universal care and others. Laboratory testing includes a highly complex process commonly called Total Testing Process (TTP), in which errors remain a big problem for healthcare services quality standards and patient safety. The majority of errors in TTP (68 to 71%) still remain within pre-analytical phase of the process. The purpose of this study was to develop and test a new software strategy for the prevention of errors in pre-analytical phase during the collection of samples. Materials and methods: Based on a previous error monitoring phase during the period between March and July 2017, we identified the errors in the identification of blood samples (for CD4 + count and viral load testing) from four centres in Mexico (at these 4 cities, Queretaro, Reynosa, Tampico and Tlaxcala) that belong to the national HIV programme; then, we developed a brand new software with the design of a comprehensive strategy to assign and automate sample identification (including: training, hardware, fast internet access and label printers if needed.) After implementation, we measured and monitor type and quantity of errors within these centres during August to December 2017. After this period, we analysed the collected data and evaluated the proportion of errors.
Results: The previous monitoring phase mean error variation detected during the identification of samples was 10.23% (range 2.3 to 21.1%, n = 2944 samples); after implementation the strategy on participants centres the rate of error decrees to 7.89%, n = 3086 patients. During this process we identified two error types; in the label tubes ID´s and in the laboratory test request forms (4.35% and 3.54% respectively). When we excluded the data from two centres who decided not to use the software, the proportion of error felt down to 4.77%. The highest proportion of errors that we found was during the printing of labels phase.
Conclusions: This software system implementation strategy showed a 2.41% reduction of error among all centres. One of the centres Tampico, with the highest proportion of error (21.1%) showed a reduction of 13.59%. Even the centre in Tlaxcala, that had the lowest proportion of error (2.32%) before strategy implementation, made a reduction in its proportion error of 0.38%. This software strategy will be extended to other collecting-samples centres to improve the quality of HIV healthcare services.

P041
The 'no-show' patients in HIV clinical care

M Sandoval; M Kundro and M Losso HIV Unit, Hospital General de Agudos JM Ramos Mej ıa, Buenos Aires, Argentina
Background: In the last years, advances in the diagnosis and treatment of people living with HIV have significantly improved survival. However, many patients do not completely benefit due to poor retention in medical care and treatment adherence. Missed clinic visits constitute a healthcare related issue, as they have been associated with worse clinical outcomes among HIV-infected patients. We examined the proportion and factors associated with missed HIV medical visits in a large public hospital in Buenos Aires. Materials and methods: We performed a cross-sectional analysis including all subjects who took an HIV-care appointment during a fivemonth period. "No-show" individuals were defined as those subjects with two or more scheduled HIV care visit that were not cancelled either by the patient or by the clinic for which the patient did not arrive. We collected patient-level data on demographic characteristics, immunological and virological status, and calculated the proportion of missed visits.
Results: A total of 249 patients (17.2%) of 1.449 subjects who scheduled an appointment during the study period missed two or more clinic visits. Overall, median age was 40 years (IQR 32 to 48), 37.8% were female and 10% transgender women. As much as 23.5% of "no-show" HIV-patients interrupted antiretroviral therapy for at least one month in the last year and 26.9% failed to have an undetectable viral load, compared with 12% and 18.5% respectively of patients who did not miss clinic visits. Use of cocaine or marijuana, being transgender women and having a psychiatric disorder were associated with "no-show" visits. In contrast, patients ≥ 50 years, men who have sex with men and having chronic comorbidities (except for psychiatric disorder or disability) were less likely associated with no-show visits. Furthermore, having a formal employment, place of residence (Buenos Aires City vs. suburbs) or level of education were not associated with missed visits in this cohort. Conclusions: Missed HIV visits were common in our cohort and were associated with a higher proportion of patients with detectable viral load and treatment interruptions. Additional knowledge is needed to evaluate barriers to appointment compliance and to establish strategies focused on optimal access to care.

P042
Contribution of SISCEL/SICLOM systems for PLHA monitoring: CTA/environmental dermatology experience/SES/RS in Brazil Currently, monthly identification of positive users, notification of cases, registration in search worksheet (personal data, date of testing, SISCEL/ SICLOM inclusion data) is performed. The telephone contact occurs if the user is not inserted into any system within 6 months.
Results: The success rate of monitoring was not high. In 2014/2015, it was possible to monitor almost exclusively patients inserted in the SAE/ADS itself. People sent to the network were hard to find. Contact with management also did not generate feedback. The inclusion of information systems completely changed the monitoring situation. In 2016, 191 were diagnosed, 61 of which were inserted into SAE / ADS itself and 26 were already undergoing treatment. Thus, 104 patients referred to AB, other SAEs or hospitals were monitored. Of these, 50% were inserted into SISCEL and/or SICLOM within onemonth post-diagnosis; 20% were inserted in up to 2 months; 10% within 3 months; 5% within 6 months; and 2% in more than 6 months. In total, 13% are not in any system, without telephone success. Two patients reported that they were being treated, without proving in any information system. Conclusion: The success of monitoring with the inclusion of search in information systems was evident. It is known that CTA teams generally do not have access to these systems, but the experience of CTA/ADS is indicative of this being a good strategy for continued care efficiency. It draws attention to the short time between diagnosis and insertion in the network, which is positive for patients and motivator for the team, who feels more confident in the bonding effort. Background: The Direction of AIDS and STD performs the planning of purchases and logistics of antiretroviral drugs for public hospitals in the country. The public system covers treatment free of charge for 70% of people living with HIV in Argentina (approximately 50,000 patients). Purchases are made annually and must be planned two years in advance. This circumstance makes it necessary to foresee the consumption of each drug available throughout the country and to think prematurely of the incorporation of new treatments to be able to offer, two years after the planning, updated treatments in relation to the national and international consensus on antiretroviral therapy. From these analyses, significant differences were found in the average cost of treatments per person in the different provinces of the country, so it was decided to carry out this study in order to find the relationship between these values and the consumption of certain antiretroviral drugs. The DSyETS, offers the same vadem ecum to the whole country, and the Argentine society of infectology publishes annually updated antiretroviral treatment consensus, so it seems striking to find great differences in the average cost of treatments per person between different provinces of the country and we suspect that the answer may be in the different degree of updating of the treatments prescribed in these provinces. The objective of this work is then to analyse the degree of updating of antiretroviral prescriptions with respect to the recommendations present in the SADI 2016 to 2017 consensus.

Materials and methods:
The present is an ecological, retrospective and observational study. The analysis was carried out in 6 provinces of the country, where the inclusion criteria were those that carry out medication orders on a bimonthly basis and that comply regularly with ministerial resolution 769/98. The analysis time of the study is from January 2017 to June 2017 and all the variables were calculated within that period. Conclusions: Based on the results of the present study, we can conclude that the provinces present differences in the degree. Background: The risk of anal carcinoma (AC) is 32 to 52-times higher among HIV+ men who have sex with men (MSM) [1,2,3]. Current screening guidelines recommend anal cytology (PAP) every 1-3 years and high resolution anoscopy (HRA) after abnormal PAP findings [2,4].

Non-AIDS Morbidities and Mortality, and Ageing
There is a dearth of data on screening practices and frequency of AC in Mexican adults receiving care for HIV. We aimed to describe the frequency of AC screening-tests in a single HIV-clinic in Mexico City and identify factors associated with being screened during 2010 to 2016. We also estimated the prevalence of anal dysplasia. Materials and methods: We studied HIV+ men receiving care during at least one year between 2010 and 2016 at one HIV-Clinic in Mexico City. We describe the frequency of screening tests (anal PAP or HRA) by patient, and the prevalence of dysplasia. Lesions were classified as: 1. High grade (HG), if PAP reported atypical squamous cells but cannot exclude high-grade (ASC-H), high-grade anal intraepithelial neoplasia (HGAIN), carcinoma "in situ" (Cis) or anal carcinoma (AC); 2. ASCUS, if atypical squamous cells of uncertain significance; and 3.
LGAIN if low grade anal intraepithelial lesion. We retrieved sociodemographic and clinical variables and fit logistic regression models to identify factors associated to the probability of being screened. Background: In 1997, people living with HIV who had social security in Mexico, began to receive HAART, which had significantly reduced mortality in other countries. In 2003, free and universal access to TARAA was adopted as a national public health policy. However, mortality due to HIV/AIDS did not decrease as expected, with important differences between the Mexican states. Strategies to reduce mortality should be focused on specific areas. The Jurisdicciones Sanitarias (JS) are the structures of the State Health Services that must coordinate the execution of the actions of prevention and control of HIV/AIDS. Materials and methods: Information on deaths due to HIV/AIDS was obtained from INEGI. For the calculation of crude and standardized rates, the official population estimates of CONAPO were used. The JoinPoint regression model was used to analyse epidemiological trends.
Results: The magnitude, distribution and trends of HIV/AIDS mortality in Mexico by JS were analysed. The 25 JS with higher rates of HIV/AIDS mortality were identified and their epidemiological trends were analysed. Although they have only 11% of the populations of the country, they account for 28.6% of the total deaths due to HIV/AIDS. They have a standardized mortality rate that is at least twice the national rate, and among them, seven JS have a rate three or more times higher. The highest average annual mortality rates were observed in Tonal a, Chiapas (14.4 per 100,000 inhabitants), Veracruz, Veracruz (14.3 per 100,000), Carmen, Campeche (13.7 per 100,000), Centla, Tabasco (13.5 per 100,000 inhabitants), Cosamaloapan, Veracruz (13.3 per 100,000), Coatzacoalcos, Veracruz (13.3 per 100,000 inhabitants and C ardenas, Tabasco (11.6 per 100,000 inhabitants). These 25 JS are located mainly in coastal areas, tourist sites, migration corridors or border areas of the country (Figure 1). The most recent trend estimated by JoinPoin regression model, shows that in 9/25 JS HIV/AIDS mortality increased, 8/25 decreased and 8/ 25 there was no change. (Table 1).
Background: Elvitegravir (EVG)/cobicistat (COBI)/emtricitabine (FTC)/tenofovir alafenamide (E/C/F/TAF) is approved for use in HIV-1 infected individuals with mild to moderate chronic kidney disease (estimated glomerular filtration [eGFR] 30 to 69 ml/min). Current HIV treatment for individuals with renal failure on haemodialysis (HD) requires complex regimens with multiple pills. This is the first study to evaluate safety, efficacy and pharmacokinetics (PK) of a daily single-  (IQR 387,672), and 22% Hepatitis C Ab positive, and 27% history of diabetes. At W24, 87% (48/55) had HIV-1 RNA <50 c/ml. The other seven participants discontinued due to lack of efficacy (n = 1), AE (n = 2), or other reasons not related to efficacy (n = 4). EVG, COBI and TAF PK were consistent with exposures in normal renal function. As expected, exposures of FTC and TFV (metabolite of TAF), which are renally eliminated, were higher v. historical data in normal renal function (Table). Sixteen (29%) participants had Grade (G) 3 or 4 AEs unrelated to study drug; 6 (11%) participants experienced study drug related AEs (all were G1-2, including nausea in 4). Two participants discontinued E/C/F/TAF due to AEs (allergic pruritis, related; staphylococcal endocarditis, unrelated). The participant with endocarditis died from heart failure after entering hospice. Twenty-four (44%) participants had G3-4 laboratory abnormalities, all of which were present at baseline. Seventy-nine percent of participants felt "much more satisfied" with the STR convenience compared to baseline.
Conclusions: Switching to E/C/F/TAF STR maintained virologic suppression at W24, was well tolerated, and more convenient for adults with ESRD on HD (Table 1).
Abstract P047- Background: DAWNING is a non-inferiority study conducted to compare a protease inhibitor-sparing regimen of DTG+2NRTIs with a current WHO-recommended regimen of LPV/RTV+2NRTIs in HIV-1 infected subjects failing first-line therapy of a non-nucleoside reverse transcriptase inhibitor (NNRTI) + 2 NRTIs (ClinicalTrials.gov: NCT02227238). An Independent Data Monitoring Committee (IDMC) performed periodic reviews of data to protect the ethical and safety interests of subjects. Materials and methods: Adult subjects failing first-line therapy, with HIV-1 RNA ≥400 copies(c)/ml, were randomized (1:1, stratified by Baseline plasma HIV-1 RNA and number of fully active background NRTIs) to 52 weeks of open-label treatment with DTG or LPV/RTV combined with an investigator-selected dual NRTI background, including at least one fully active NRTI. An IDMC review was performed, which included data from 98% (612/627 randomized) of subjects through 24 weeks on therapy. Results: At week 24, 78% of subjects on DTG vs. 69% on LPV/RTV achieved HIV-1 RNA <50 c/ml (adjusted difference 9.6%, 95% CI: 2.7% to 16.4%, p = 0.006 for superiority). The difference was primarily driven by lower rates of Snapshot virologic non-response in the DTG group. The safety profile of DTG+2NRTIs was favourable compared to LPV/RTV+2NRTIs with more drug-related adverse events (AEs) reported in the LPV/RTV group, mainly due to higher rates of gastrointestinal disorders (Table 1). Following review of week 24 data and large subsets of data from Weeks 36 and 48, the IDMC recommended discontinuation of the LPV/RTV arm due to persistent differences in rates of Snapshot virologic non-response and protocoldefined virologic failure (PDVF) favouring the DTG arm.
Abstract P049- Patients with severe medical or psychiatric conditions were excluded from these trials. An assessment of demographics, medical history, concomitant medications, safety and efficacy will be presented.
Results: A total of 940 patients were included in this analysis; a majority (71%) were enrolled in the United States. Across all studies, there was a high prevalence of hypertension (28%), gastro-oesophageal reflux disease (GERD) 16% and hyperlipidaemia (14%). A high proportion had psychiatric comorbidities including depression (37%) and anxiety (20%). Prior or ongoing substance abuse was reported in 17% of patients. These rates were similar to that described in a recent analysis of over 18,000 HIV/HCV co-infected patients in the US (Meyer N et al, ICAAC 2015). In the PHOTON-2 study which was conducted in Europe, a smaller proportion reported both medical and psychiatric comorbidities. Overall SVR rates ranged from 79% to 96% based on the treatment regimen, similar to that observed in HCV monoinfected patients.

Conclusions:
The use of interferon-free DAA regimens has resulted in the ability to successfully treat HIV/HCV co-infected patients with complex comorbidities in clinical trials which can be generalizable to real world practice.

P056
SOF/VEL for 12 weeks results in high SVR12 rates in subjects with negative predictors of response to treatment: an integrated analysis of efficacy from the Astral-1, Astral-2 and Astral-3 studies without compensated cirrhosis (ASTRAL-1, ASTRAL-2, ASTRAL-3). Overall SVR12 rates were >95% across all HCV genotypes. This posthoc analysis assesses efficacy in patients with traditional negative predictors of response. Materials and methods: This was a retrospective analysis of data from 1035 patients treated with SOF/VEL in the Phase 3 ASTRAL-1, ASTRAL-2 and ASTRAL-3 studies. Presence of cirrhosis was determined by histology, blood tests or transient elastography. Viral load and other clinical and laboratory assessments were determined prior to treatment with SOF/VEL. Prior treatment records were source verified and race was self-reported by the patient to the investigator. Results: Overall, 21% of patients had cirrhosis, 74% had HCV RNA 800,000 IU/ml, 28% had prior treatment failure, 12% were ≥65 years old and 6% were black. Table 1 provides SVR12 rates by HCV genotype overall and for each patient subgroup. The overall SVR12 rate was 98% and was ≥96% among all subgroups. In general, SVR12 rates were lower in patients with genotype 3 HCV infection compared with other HCV genotypes but were ≥90% across all subgroups.
Conclusions: The ASTRAL-1, ASTRAL-2 and ASTRAL-3 studies enrolled a diverse patient population that included a significant number of patients with historically negative predictors of response. There was little effect of these factors on the efficacy of treatment with SOF/VEL for 12 weeks in subjects with genotype 1.

P057
Safety and efficacy of treatment with once-daily ledipasvir/ sofosbuvir (90/400 mg) for 12 weeks in genotype 1 HCVinfected patients with severe renal impairment Background: The penitentiary system in Brazil presents serious problems of overpopulation [1]. According to data from the Ministry of Justice in 2016 there were 726,712 inmates. In that same year, in Paran a, the number was 51,700 prisoners, of these around 19,700 in the closed system of imprisonment [2]. The severity of these data are accentuated by the fact that the incarcerated population is considered a high-risk group for sexually transmitted diseases because of the favourable conditions found in prison for the spread of diseases [3]. The objective of this study was to estimate the prevalence of HCV markers and their risk factors in the male prison population of correctional institutions in Paran a, Brazil. Materials and methods: Cross-sectional epidemiologic survey for anti-HCV infection held in 11 male prisons in Paran a in the period of May 2015 to December 2016. The stages of the investigation included counselling, information about intervention, orientation about sexually transmitted infections, informed consent for the data gathering and blood sampling for the anti-HCV test performed in a certified laboratory. Reactive cases of anti-HCV were considered as hepatitis C. Odds ratio and logistic regression were used for data analysis and P-value. Results: 1.192 men were addressed total. 1.133 (95%) were subjected to a diagnosis for the anti-HCV test. The estimated predominance of the infection by HCV from this evaluation onwards was of 2.7% (interval of 95% [CI]: 1.9% to 3.8%), 30 men infected. The integrated analysis identified HIV infection and hepatitis C in two men (estimate predominance of 0.18% (95% CI: 0.0% to 0.42%)). The independent effects of the associated factors for HCV were age over 30 years (OR: 4.03 [1.61 to 10.07]), frequency in the prison system (OR: 2.58 [1.02 to 6.52]) and the use of injectable drugs (OR: 7.32 [3.36 to 15.92]). Conclusions: The prevalence of hepatitis c in the prison population is higher than in the free population; reducing the spread of HCV infection in prisons may occur through investments for anti-HCV screening, early diagnosis that contributes to a better prognosis of the disease and with reflections on the quality of life. Education and health is a practice that should receive investments, since targeting of infected individuals reduces the risk of HCV transmission between prisoners and in the community. Background: Approximately 257 million people are living with hepatitis B virus (HBV) infection. In Brazil, since 1999, there have been detected 212,031 cases, with detection rates varying among the five regions in the country. Hepatitis B vaccinethe main form of HBV controlwas implemented in 1998 in the whole country, gradually expanded to cover age's groups, and became universal in 2016. We aim to investigate the relationship between vaccination coverage and detection rates. Materials and methods: Cross-sectional study of hepatitis B cases registered in Notifiable Diseases Information System in 2016 in Brazil. We calculated detection rates based on demographic data from the Ministry of Health Department of Informatics. Cumulative vaccination coverage data were obtained from the National Immunization Program. We applied Spearman rank correlation to evaluate the relationship between vaccination coverage and detection rates. Results: In 2016, 14,199 cases of hepatitis B were detected, with a detection rate of 6.9 (cases per 100,000 population); the cumulative vaccination coverage for the general population was 56.7%. In the group-aged ≤4 years, and 5 to 14 years, coverage was over 82% and detection rate below 1.8 in all regions. Among youngsters aged 15 to 24 years, the North region had the highest detection rate (6.5), although it also presented the highest vaccination coverage. Among people aged 25 to 29 years, again the North region had the highest vaccination coverage (50.6%). However, the detection rate was the second largest (18.2) in Brazil. Among adults aged ≤ 50 years, coverage was below 26%, and the North region presented the highest detection rate (15.9), followed by the Southeast (14.5) ( Table 1). With the exception of the North region, the correlations between vaccination coverage and detection rates were negative, with p-values < 0.05. Conclusions: Findings indicate that low detection rates among younger people is associated to high vaccination coverage while, especially among adults and the elderly, low vaccination coverage is related to high detection rates. However, there are differences among regions, and the North region of Brazil does not follow this trend. Estimated Abstract P061- Background: Informatics and Communications Technology (ICTs) are valuable tools for information exchange. ICTs can contribute to the technological and scientific development, teaching, and learning and in general to all aspect of modern society. Among ICTs, cell phone technology has the necessary qualities that allow its use in laboratories and in the clinical practice to facilitate the daily work. The aim of this work was to design and develop simple, didactic, dynamic, interactive and flexible Android applications for viral hepatitis diagnosis, research and teaching. Materials and methods: For the development of the applications a flexible methodology with the aim to adapt to new platform changes was use. The Android Studio Programming tool was used for the design and development of the applications. Applications can be executed in devices using Android 4.0 platform or later. Results: It was successfully designed and developed three applications: LabCalc which allows calculation of Polymerase Chain Reaction (PCR) Mixes, reagents dilutions (primers) and evaluation of diagnosis assays; HepText which includes relevant information in regard to the aetiology, diagnosis, clinical and epidemiological aspects of viral hepatitis; and HepDiag which facilitate and aid in the diagnosis of viral hepatitis and include a calculator for prognostic models in liver disease (Child-Pugh and Meld/Peld) as well as serum models for diagnosing liver fibrosis .
Conclusions: The applications LabCalc, HepText and HepDiag were successfully designed and developed. These applications facilitate reagents calculation, the assessment of the analytical performance of in house diagnostics assays standardized in the laboratory, improves the teaching and learning of viral hepatitis and help physicians in the better diagnosis, prognosis and treatment of viral hepatitis.

P064
Emergence of the transmitted resistance of HIV-1 to antiretroviral drugs in Cuban patients during the period 2009-2016 Conclusions: A high genetic diversity of HIV-1 and emergence of resistance transmitted to ARV in untreated population was described.
These results demonstrate the need to continue epidemiological surveillance and search for new therapeutic strategies that contribute to accelerated compliance of worldwide 90-90-90 UNAIDS target.
Virology and Immunology

P065
Plasma cytokines levels in patients with disseminated Kaposi sarcoma with syphilis and infectious AIDS-defining events.
P Volkow 1 ; L Ramon-Luing 2 ; L Ch avez-Gal an 2 ; P Cornejo-Ju arez 1 ; D Vilar-Compte 1 ; R Ocaña-Guzm an 2 and B Islas-Muñoz 1   1 Infectious Diseases, Instituto Nacional de Cancerologia, Mexico City, Mexico. 2 Immunology Laboratory, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico Background: Kaposi sarcoma (KS) is a cytokine-mediated angioproliferative disease. The role of several cytokines in KS co-infected patients has not been described [1,2,3]. Cytokines levels (IL-6, Il-10, IL-1beta and IFN-gamma) were measured in plasma from patients with disseminated KS at baseline, at four and at 12 weeks of followup. Two groups were compared with and without syphilis, and other group with and without infectious AIDS Defining event (IADE). Materials and methods: A prospective and observational study was conducted from October 2015 to November 2017. A complete clinical evaluation and active search of co-infections including laboratory, thorax and abdominal CT-scan, gastrointestinal endoscopy, VDRL, HVB and HVC serology, blood marrow culture and tissue biopsy if needed was performed. All patients with syphilis were treated during the first four-weeks; by 12th week all were on combined antiretroviral therapy as well as on treatment of co-infection. Plasma cytokines levels were measured by ELISA assay. We compared groups using Mann-Whitney test considering p < 0.05 as statistically significant.
Results: Twenty patients were included in this report 35% (n = 5) had syphilis, six (30%) had IADE, 3 (15%) with disseminated Mycobacterium Avium Complex, 2 (10%) with disseminated histoplasmosis and one with Penicillium lung infection. IL-1b was lower to 2 pg/ml in all samples according to a previous report on patients with KS. The median levels of IL-6, IL-10 and IFN-gamma at baseline and at week 12, in patients with and without syphilis, without any co-infection and with IADE are shown (Table 1).
Conclusions: IL-6 in patients with KS and syphilis were significantly lower at baseline. In patients with IADE IL-6 was significantly higher at baseline, decreasing parallel to treatment; contrary IFN-gamma was significantly increased suggesting that IFN-gamma is up-regulated once patients start anti-infectious therapy no related to syphilis infection. KS is a complex disease; co-infections. KS is a complex disease that requires diverse clinical and immunological factors to appear. Co-infections appear to show a different pattern of some of the cytokines studied may play an important role in the pathogenesis of the disease.
Abstract P065- . The comparison of the amino acid sequences of the V3 loop showed differences between the B and non-B subtypes (p = 0.0001). Mutations reported to be associated with Maraviroc resistance were detected in 75.7% of the samples, in positions 11 (6.1%), 13 (49.6%), 25 (6.1%), 316 (7.0%), 323 (11.3%) and 319 (3.5%) of Gp120, particularly in the recombinant forms CRF19_cpx and CRF_BGs. HIV variants that use the CXCR4 co-receptor were associated with more than 10 years of diagnosis, with older individuals, in the AIDS stage, with low CD4 counts and higher viral load levels (p < 0.05).

Conclusions:
The results support the hypothesis previously stated that CRF19_cpx viruses could be more pathogenic and would have limitations for the use of Maraviroc. The high rate of mutations associated to MVC among non-B Cuban subtypes should be further studied.