Speaker Abstracts

O133–Figure 1. Comparison of the probability of the 10-year survival since 50 yo cohort enrolment by group (<50 vs ≥50 yo) in patients younger than 65 at end of follow-up, adjusted for site, gender, route of transmission, time since diagnosis to art, CD4 count at 50 and age. Abstracts of the HIV & Hepatitis in the Americas 2017 Congress Journal of the International AIDS Society 2017, 20 (Suppl 2) Speaker Abstracts

In 2008, the District of Columbia (DC) Department of Health and the NIH launched the DC Partnership for HIV/AIDS Progress, a collaborative research initiative designed to decrease the rate of new HIV infections in the city, improve the health of district residents living with HIV infection, and strengthen the city's response to the HIV/AIDS epidemic. This programme was developed to address the high level of incident HIV infections in the city using state of the art research as the tool. The initial focus was to determine the true status of disease burden in the city. To accomplish this, we created the DC Cohort, which has now collected longitudinal clinical data from approximately 8000 consented HIV-infected outpatients receiving care at 13 treatment clinics in DC. Additionally, through the HIV Prevention Trials Network, a series of clinical trials brought the current state of the art prevention research to the city residents. Combined with public health campaigns aimed at educating city residents, the city has vastly improved treatment coverage and has reduced HIV incidence. In addition, the programme has been seeking ways to better understand HIV/HCV co-infection and has sought to expand HCV treatment options for this population. Through a number of clinical studies we demonstrated how sustained HCV suppression could be reliably obtained in this co-infected population. Further we found that HCV treatment was a gateway for reaching what many public health officials believed was the most difficult population to identify and engagedually infected people. Further work has focused on defining how best to deliver HCV treatment. The ASCEND study, launched in 2015, examined whether primary care physicians and other healthcare providers, such as nurse practitioners and physician assistants, can use a new antiviral therapy as effectively as specialist physicians to treat people with HCV infection. Validation of this task shifting provides an important piece of information as we advance our plans for HCV eradication.

O112
Towards and HIV cure: a clinician's perspective Steven G. Deeks University of California, San Francisco, CA, USA Given the challenge of delivering complex, expensive and potentially harmful antiretroviral therapy (ART) on a global level, there is intense interest in the development of short-term, well-tolerated regimens that will either fully eradicate all HIV (a "cure") or durable prevent HIV replication in absence of any therapy (a "remission"). Recent heroic interventions such as hematopoietic stem cell transplant suggest that dramatic reductions in the reservoir size can be achieved, but that complete eradication will be challenging. Also, failure to eradicate on HIV is associated with risk of delayed rebounds in viremia, which can have detrimental effects to the HIV-infected person and his or her partners.
Most experts agree that a remission will be easier to achieve than a complete cure. Enthusiasm for this approach is supported by observations made in "elite" controllers and perhaps the rare and still controversial post-treatment controllers. Observations from these studies suggest that a sustained remission will likely require a low reservoir size and a potent and durable HIV-specific immune response. Enthusiasm for a remission is also being driven by success using immunotherapies to reduce and control cancer cells. Cancer and HIV persistence share a number of similarities. In each case, a rare population of cells with the capacity to cause harm becomes established in difficult to reach tissues. The local environment in each case is reshaped to prevent immune mechanisms from clearing the diseased cell. Specifically, a chronic inflammatory environment stimulates and immunosuppressive response and therapies that target these immune pathways have either been very successful (in cancer) or now entering the clinic (in HIV disease). These interventions have the potential to enable successful repurposing of preventative vaccines into the HIV cure arena. Efforts to cure or durably control HIV are now entering an era of experimental medicine in which the agenda will be increasingly driven by studies performed in non-human primates and early proof-of-concept clinical studies. Recent progress in these studies will be summarized. A pathway towards testing of viable combination regimens that have the chance to achieve a durable remission will also be discussed.

O122 HIV/AIDS guidelines on cARTthe Brazilian perspective
Adele Schwartz Benzaken Brazil AIDS Programme, Rio de Janeiro, Brazil Brazil has recently incorporated dolutegravir (DTG) in both first and third line ART regimens in the Brazilian Unified Health System (SUS). Darunavir use was also extended as a preferable protease inhibitors (PI) in the second line, alongside its use in the third line. TDF/3TC/DTG is the preferable scheme for people living with HIV/AIDS (PLWHA) starting in 2017. TDF/3TC/EFZ is chosen for pregnant women and TB-HIV co-infection, without criteria of severity. PLWHA with tuberculosis can undergo TDF/ 3TC/RAL scheme whenever one of the conditions are presented: CD4 <100 cells/mm 3 , concomitant opportunistic infection, need of hospitalization/serious illness or disseminated TB. Regimens containing EFV are the initial choice for cART in cases of intolerance or whenever DTG is contraindicated. The safe use of ABC is corroborated by the incorporation in the SUS of the HLA B*5701 test. For the PI, ATV is the preferred one, followed by DRV and LPV, all boosted with ritonavir. The innovation is that DRV, previously administered to PLWHA with multiple ARV schemes exposures, can be used in the second line regimens. The Brazilian policy on cART poses challenges still to be solved: (i) the use of raltegravir for late presenter pregnant women living with HIV/AIDS, (ii) drug switch (phase out of nevirapine, fosamprenavir, indinavir, lopinavir and saquinavir) and (iii) new paediatric formulations (DTG). Implementing these guidelines and policies takes into account national budget and new ART, considering cost in the long run and its sustainability as a public health policy.

O123 ARV guidelines in Argentina
Carlos Zala HIV/AIDS Programme, Buenos Aires, Argentina Antiretroviral therapy in Argentina is free of charge to all eligible HIV infected individuals seeking for HIV care. According to current local guidelines, ARV treatment should be offered to subjects with a confirmed HIV infection regardless their CD4 T cell count. As of December 2016, approximately 50,000 PLWH were receiving ARVs through the National Programme. An additional 20,000 were being covered by the social security and private sector. At the three healthcare sectors, there are ARVs available within the four mayor drug classes, including generics drugs of nucleosides, nonnucleosides and protease inhibitors. The choice of an initial regimen is requested at the Programme by a registered physician within the available options recommended by the Argentinean Society of Infectious Diseases. Accordingly, an NNRTI, or boosted ritonavir protease inhibitor, or integrase inhibitor in combination with two analogue nucleosides are within the available regimens. A national wide survey has recently showed an increase number of primary HIV resistance, mainly to the NNRTIs. Figures close to the 10% prompted to the HIV/AIDS Programme to make available resistance testing prior to initiation of ARV therapy to subjects willing to start an efavirenz based regimen. The need of implementing timely results of resistance testing to newly HIV infected individuals across the country imposes a formidable challenge to the healthcare system. In this scenario, widely access to affordable new drugs, that is integrase inhibitors, should be considered.

O131
Treatment of hepatitis C: "where are we now?" Mário Guimarães Pessoa University of São Paulo School of Medicine, São Paulo, SP, Brazil In this lecture, we are going to talk about the management of patients with chronic HCV infection in this new era of highly effective direct-acting antivirals (DAAs). We came from a time of SVR rates of around 60% in the former difficult to treat genotype 1 patients with a poor tolerance to interferon treatment, to achieving a cure in more than 95% of them with few adverse events, with only 12 weeks of treatment in the majority of patients. Patients naïve to treatment with mild fibrosis and low viral load can even be treated with a shorten regimen of 8 weeks. Genotype 3 HCV infection is now the more difficult to cure, especially in patients with cirrhosis, but new combinations of DAAs are under development and we had the opportunity to see very good preliminary results in this population presented at the last AASLD meeting. Most of Latinamerican countries are prioritizing treatment only for patients with advanced liver disease, for budgetary reasons, but we expect in the near future to see more and more patients achieving the cure of this life-threatening infection, before becoming at high risk of hepatocellular carcinoma.

O132
Retreatment of patients failing AAD therapy in Spain in a real life setting: updated results from the HEPCREsp GEHEP004 cohort Introduction and aims: To describe the virological characteristics of patients failing approved DAA regimens in ithe HCVREsp-GEHEP004 Cohort in Spain, how they have being retreated and how were efficacy rates of retreatment. Methods: HCVREsp-GEHEP004 is a prospective multicentre cohort enrolling HCV infected patients treated with IFN-free DAA regimens at discretion of the investigators. Population-based sequencing of HCV NS3, NS5A and NS5B genes was performed. After receiving a comprehensive resistance interpretation report, the retreatment regimen was chosen. Results: HCVREsp includes 5521 patients treated with DAAs across Spain. Data of 277 failing patients (GT-1a (n = 96), Gt-1b (n = 81), GT-3a (n = 60), GT-4a (n = 9), GT-4d (n = 31)) are shown. Patients had failed SOF/SIM (18.8%), SOF/DCV (18.4%), SOF/LDV (42.2%) or paritaprevir/ombitasvir ± dasabuvir (15.2%). Patients failing SOF/SIM developed RASs in NS3 in 74% of the GT1a infected patients and 52% of the GT1b, being RASs in position 168 the most prevalent. To date, 41/53 patients failing SOF/SIM have been retreated, 39 with Harvoni and 25 have reached 12 weeks post end of treatment: 22 patients (88%) have achieved SVR12. Almost all the patients failing SOF/DCV showed NS5A RASs, being Y93H highly prevalent in  and ; to date, 22/48 patients failing SOF/DCV have been retreated, 11 have reached 12 weeks post end of treatment: 7 patients (58%) have achieved SVR12. Patients treated with SOF/LDV also showed a high prevalence of Y93H at failure, especially , in contrast to GT-3a infected patients (only 11.7% prevalence); of note, three GT-4 patients failing SOF/LDV harboured S282T. To date, 52/112 patients failing SOF/LDV have been retreated, 42% with SOF/SIM, 21 have reached 12 weeks post end of treatment: 18 patients (86%) have achieved SVR12. Most patients treated with 2D/3D developed RASs, and 14.2% showed RASs against the three drugs; almost a half of the patients failing 3D/2D (7/16) have been retreated. Conclusions: Genotype 1a and 1b patients failing DAAs in Spain harbour a high prevalence of RASs, especially in NS5A. Genotype 3 patients failing SOF/LDV are less prone to develop NS5A RASs than SOF/DCV failures. Retreatment of Sof/DCV failing patients was more difficult than SOF/LDV or SOF/SIM, with lower rates of SVR12. Resistance testing may help to guide the retreatment option.

O133
Increased age-adjusted mortality and incidence of non-AIDS defining events among people living with HIV enrolled after 50yo and aging in care in Latin America. A CCASAnet cohort study Introduction: The proportion of people living with HIV (PLWH) older than 50 years is increasing in our region. The growth of this population will increase demands on healthcare systems as comorbidities are expected to rise. This study aims to quantify the frequency of non-AIDS associated comorbidities (NADEs) amongst aging people receiving care for HIV in CCASAnet centres between 2000 and 2015. We also explored whether the incidence of NADEs differs by age at enrolment (<50 years old (yo) and ≥50 yo) in patients of similar age. Methods: We selected HIV-infected adults between 50 yo and 65 yo receiving care in CCASAnet cohort centres between 2000 and 2015. We divided participants in two groups based on age at enrolment in care (<50 and ≥50 yo). We compared mortality between both groups and estimated the frequency of NADEs (cardio-and cerebro-vascular diseases, type 2 Diabetes mellitus "DM2," hypertension and non-AIDS-related neoplasias) in each group using Kaplan-Meier (KM) curves. We used inverse probability weights techniques and stratification by age-group to adjust for confounders and selection bias. We adjusted by gender, route of transmission, time since diagnosis to art, CD4 count at 50 and age. Results: 4788 patients over 50 years from seven Latin American countries were included. People enrolled in care ≥50 yo (n = 2010, 42%) had a significantly higher crude and adjusted mortality than those <50 yo at enrolment (n = 2788, 58%) ( Figure 1). Follow-up information on clinical events was collected for only 2937 patients. Amongst those, there was a higher incidence of DM2, cardiovascular events and non-AIDS-related neoplasias in people enrolled ≥50 yo when compared with those enrolled <50 yo ( Figure 2). A high number of diabetes and other events were diagnosed right after enrolment in care in patients enrolled after 50 yo. Conclusions: PLWH enrolled in care in CCASAnet sites after 50 yo have an increased age-adjusted mortality, and incidence of NADEs than those reaching 50 yo in care. In addition to prevalent comorbidities at 50 yo or at enrolment in care after 50 yo, a large proportion of PLWH receiving care in our sites develop chronic NADE while in care. Higher incidence of Non AIDS related morbidity in patients enrolled after 50 yo may reflect a lack of clinical care in this population and the need of planning provision for complex, primary care for adults living with HIV older than 50 yo in our region.

O142
The 90s in the Americas: treatment Pedro Cahn Fundación Huésped, Buenos Aires, Argentina The number of persons on antiretroviral treatment in Latin America and the Caribbean continues to increase, reaching an estimated 1.1 million persons at the end of 2016. This indicates that 55% (47-64%) of all persons living with HIV in LAC are receiving lifesaving treatment. In addition, the percentage of all children living with HIV (0-14 years) on ART is estimated to be 64% (54-76%). Pregnant women receiving ARVS to prevent MTCT, represent 88% (77-95%) of the PW living with HIV. Countries in the region have adhered to the 90-90-90 targets. An additional target of reducing late diagnosis (<200 CD4 cells/mm 3 ) below 10% amongst newly diagnosed individuals was also included. Unfortunately, 35% of new cases were diagnosed late in the course of the infection. In 2013, 79% of patients on first-line were being prescribed a WHO-recommended regimen (preferred or alternative). In 2013, 31% of patients on first-line were using the WHO preferred EFV-based regimen. What are the obstacles to reach the third 90? Of course being far behind the first two nineties is the main issue. Socioeconomic context is not favourable at all, as unemployment is raising in many countries, which implies losing the social security protection. Also housing deficits, malnutrition and cost of surface transportation to the clinics conspire against appropriate and timely periodic visits, and so adherence is at risk. Temporary stock-outs still happen in some countries, with obvious consequences. Last but not least, resistance rates, particularly related to NNRTIs, are as high as 15% in some areas, which highlight the need of obtaining baseline genotypes before first ART start and/or the substitution of efavirenz by drugs with high genetic barrier, like boosted-PIs or dolutegravir.

O143
The 90s in the Americas: retention in care/adherence Carlos Beltran Latin American HIV Workshop Study Group, AIDS, Santiago, Chile According to last numbers released by UNAIDS 18.2 million of 36.7 million HIV infected people are on ART, 1.1 million of them in Latin America. This is far below the two first 90-90-90 goals to achieve 81% of all HIV infected people on ART. Testing and linkage/retention are the main gaps in fighting the epidemic, being both essential to reduce HIV transmission and prevent HIV-related morbidity and mortality. Many factors contribute to poor linkage and poor rates of enrolment in care in Latin America such as patient and sociocultural factors as well as economic and health system barriers. Poor linkage to care after diagnosis has been partially blamed for high rates of late presentation to ART in some countries. Comprehensive services including home-based testing and immediate ART initiation, integration and decentralization of healthcare provision, task shifting to trained health-care workers and lay providers to face up human resource constraints and to provide services outside the office setting and even financial incentives for patients along with social and family support and reduction of stigma and discrimination have been proposed to improve linkage to care. Prompt ART initiation and active and continuing patient education for adherence optimization as well as proactive monitoring of adherence are critical in the setting of treatment as prevention goals and to prevent resistance to ARV drugs. The above-mentioned interventions to promote linkage are also crucial for adherence, along with simplicity and safety of ARV drugs and especially quality and fluency of patient-healthcare provider relationship. Some concerns have been raised recently on adherence of adolescents and young adults who initiated ART in good health and with high CD4 counts. New strategies such as communication technologies and financial incentives may be used to increase adherence in particular settings. Linkage and retention in care require appropriate and trained healthcare teams as well as maintenance of drugs and monitoring tests supply chain. Heterogeneity in availability of this resources and even stock outs episodes are observed in the region. Ending the epidemic in Latin America will take a combination of political will, national policies, strategic planning, resources mobilization and novel, comprehensive and standardized interventions to improve testing, care and treatment.

O144
The 90s in the Americas: prioritization of treatmentis it necessary?
Mauro Schechter Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil In 2014 the UNAIDS launched the 90-90-90 initiative, with a view to help end the AIDS epidemic. Its ambitious goals were that, by 2020, 90% of all people living with HIV would know their serostatus, 90% of all people diagnosed with HIV would be receiving antiretroviral therapy (ART), and 90% of all those on ART would be virally suppressed. Irrespective of the capacity of individual countries to achieve these goals, this initiative provided useful metrics for national programmes to monitor their progress towards universal access to treatment. Optimization of limited and often scarce material and human resources is of paramount importance to achieve the UNAIDS goals. Thus, targeted testing through knowledge of local characteristics of the epidemic and of key affected populations, strengthening of referral systems, identification of patients in more urgent need of care, and improvement of acceptance, adherence and retention in care are some of the issues that need to be addressed in order to achieve the UNAIDS targets.

O211
The second decade: cashing in on evolving capacities for better outcomes Linda-Gail Bekker The Desmond Tutu HIV Centre, Cape Town, South Africa The African continent is currently undergoing a youth bulge. It is estimated that by 2030, one in every four individuals will be African, the vast majority of them under the age of 35 years (You et al., 2014). However, over 40% of all new HIV infections occur amongst youth and 85% of young people living with HIV live in Sub-Saharan Africa (Idele et al., 2014). Adolescents and young adults are at increased risk of HIV infection due to the many developmental, psychological, social and structural transitions that take place in this period of the life course, yet engaging and retaining adolescents actively in healthcare promotion and provision is challenging in every setting worldwide. Adolescent girls and young women (AGYW) are particularly effected and in South Africa young women are 4-6-fold more likely to be HIV infected than their male counterparts. Huge success in ARV treatment worldwide has allowed more people to live productive lives with HIV and initiation of treatment early has shown to significantly reduce transmission. The Adolescent population, however, struggles to cope with an HIV diagnosis and often gains that are made during paediatric treatment may be lost in adolescence. To tackle the challenges of care and treatment as well as primary and secondary prevention in this critical age group, we desperately need integrated and tailored programmes that are adolescent-friendly and that incorporate biomedical, structural and social interventions. In Latin America, PrEP should be offered to populations with higher HIV prevalence: men who have sex with men (MSM) and transgender women (TGW). The largest gap in the region's HIV care continuum is between those living with HIV and those who are unaware of their status. Therefore, it is expected that a high proportion of MSM and TGW who seek PrEP test positive in the baseline serology. In order to bring these newly diagnosed individuals to virologic suppression a test-and-treat strategy with proper linkage-to-care is necessary. PrEP programmes should collaborate with diagnostic and counselling services and with HIV care facilities. This could impact HIV incidence not only by offering antiretrovirals to high-risk negative individuals but alsoand maybe even moreby contributing in diagnosing and linking to care previously undiagnosed HIV-positive individuals (treatment as prevention). Diagnosis algorithm should incorporate new point-of-care technologies capable of identifying acute HIV infections. PrEP programmes should develop specific strategies for hard-to-reach populations and their comorbid behavioural disorders that may interfere with PrEP adherence. Furthermore, linking PrEP users to combination prevention services could reduce the risk of acquiring HIV through counselling, condom distribution, STD diagnosis and treatment services, harm reduction and substance use programmes, mental health services and also through interventions that address socioeconomic and other structural factors that influence HIV transmission. In order to achieve all the potential benefits of PrEP, strong leadership is needed from the public health, behavioural and social sciences fields both in implementation and in research projects.

O314
Treatments for hepatitis C through the Brazilian Unified Health System (SUS) MoH will have provided 50204 treatments for 12-week and 24week course of treatment by the end of March 2017. The preliminary analysis of treatment effectiveness in Brazil showed that patients with hepatitis C genotype 1 achieved a cure rate of 97%. Based on results of real life clinical studies demonstrating the low effectiveness of 12-week course of treatment for hepatitis C genotype 3 with cirrhosis, the MoH extended the treatment period for 24 weeks for these patients. Recently, the MoH introduced the 4drug combination of ombitavir, veruprevir, ritonavir and dasabuvir in SUS. Toward the elimination of hepatitis C as a public health threat by 2030, the Department of STI, HIV/AIDS and Viral Hepatitis in the MoH will submit the revised Guidelines for hepatitis C and coinfections for approval by the National Commission and through public consultation in March 2017.

O323
Efficacy and safety of switching to EVG/COBI/FTC/TAF in virologically suppressed women Introduction: The integrase inhibitor regimen (elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate [E/C/F/TDF]) demonstrated superior efficacy when compared to a protease inhibitor regimen (atazanavir boosted by ritonavir [ATV/r] plus F/ TDF) in 575 treatment naïve women at week (W) 48. We now report the safety and efficacy of subsequent switching to E/C/F/ tenofovir alafenamide (TAF) versus remaining on ATV/r + F/TDF. Methods: After completing the initial randomized, blinded 48-week trial, women on ATV/r + F/TDF were randomized 3:1 to receive open label E/C/F/TAF versus remaining on their current regimen. Viral suppression (HIV-1 RNA <50 and <20 copies [c]/mL) by FDA snapshot analysis, pre-defined bone and renal safety and tolerability endpoints 48 weeks after switch are reported. Women who become pregnant while on study are given the option to continue study drug. Results: 212 HIV-infected, virologically suppressed women were randomized (E/C/F/TAF n = 159, ATV/r + F/TDF n = 53). Virologic suppression (<50 c/mL) was maintained in 94.3% on E/C/F/TAF versus 86.8% on ATV/r + F/TDF (weighted difference: 7.5%; 95% CI: −1.2% to 19.4%), with virologic failure in 1.9%, 3.8%, respectively. More women on E/C/F/TAF achieved <20 c/ mL at W48 compared to ATV/r + F/TDF (84.9% vs 71.7%, weighted difference: 13.2% [−0.0% to 27.5%], p = 0.041). No treatment emergent resistance was detected in either study group. Mean % increase in BMD was higher in the TAF group for both lumbar spine and total hip (Table 1). Multiple markers of renal safety were improved for participants randomized to TAF (Table 1). No cases of proximal renal tubulopathy were reported. Participants on TAF had greater increases in lipids (Table 1), with no difference in TC:HDL ratio (Table 1). Nineteen women became pregnant during the switch study, 13 E/C/F/TAF and 6 ATV/r + F/TDF and three normal infants have been delivered in each group to date. Conclusions: These data demonstrate that women who switch to an integrase inhibitor + TAF-based regimen maintain high levels of virologic suppression with improvement in BMD and renal function biomarkers, as compared with those remaining on their ritonavir boosted atazanavir + TDF-based regimen.

O324
Significant efficacy and long-term safety difference with TAF-based STR in naïve adults Several questions remain to be answered. We still do not know how efficient the new therapies are in the "real world" for these patients and whether expanded treatment will be sufficient to reduce transmission. Can mathematical models be transposed to real life? On the other hand, the benefits of treatment as a preventive measure in this case are reduced by the risk of reinfection. In order to optimize the benefits of treatment as prevention in HCV, it is essential to improve diagnosis and adherence as well as extending coverage of treatment, working on improving the cost of drugs, and modifying restrictions based on the stage of hepatic disease and the use of drugs to have access to treatment. Some trials are ongoing; we are close to finding out whether we are capable of reaching our goal.

O332
New ART strategies and the future of ART Introduction: The large number of antiretroviral drugs available allows multiple combinations, many of these combinations have similar efficacy. The goal of antiretroviral therapy (ART) is to reduce viral load to undetectable levels, below 50 copies/mL, however, these goals are not always achieved due to toxicity, poor adherence to treatment, potency and pharmacokinetic interactions. These are the reasons for changing regimes to maintain effectiveness [1]. Studies in the United States, reported a median duration of ART regimens of 11.8 months and 2.6 years [2]. The objective of this study was to assess the duration of the various combinations of drugs used for the initiation of antiretroviral treatment in naïve patients.
Methods: This study was a cohort retrospective observational study that included all patients with HIV infection who initiated HIV treatment at 138 HIV care clinics in Mexico between 2006 and 2015. The clinics included are part of the Mexico Ministry of Health. Patient information is routinely collected in the "Antiretroviral Management, Logistic and Surveillance System" (SALVAR in Spanish). It was considered a regiment change cessation of therapy by substitution or interruption of either drug or the entire therapy. The KM analysis was used.
Results: A total of 62,156 patients were included. The median baseline CD4 cell count was 362 cells/μL and 69% had an initial ART regimen that was non-nucleoside reverse transcriptase inhibitors (NNRTI) based. 20% used protease inhibitor (IP). The average duration of the first treatment was 5.9 years ( Figure 1). It was observed that NNRTI-based regimens had a significantly longer median duration of 7.3 years than regimens based on PI 3.2 years or that they only included nucleoside reverse transcriptase inhibitor (NRTI) one year (p < 0.05) ( Figure 2).

Conclusions:
The regimen based on NNRTI showed a significantly longer duration than the rest. The median duration was longer than reported in other studies. It is possible that NNRTI regimens have fewer adverse effects in relation to IP based regimens. In Mexico, the antiretroviral management guidelines include the use of regimens with NNRTI as the preferred regimen in patients initiating ART. The duration of regimen based on Integrase Inhibitor (II) was short, because it is a recent treatment in Mexico.
phosphatases inhibitors (PTPi) may enhance the activity of IFN, by delaying the inactivation of the cascade induced by the cytokine. The effect of PTPi on HIV replication has not been described. with IFN-α (10 UI/mL) enhanced the anti-HIV-1 effect of IFN-α 4-5-fold compared to using IFN-α alone. As expected, this effect was inversely proportional to HIV-1 input. The ratio of STAT1 phosphorylated/non-phosphorylated was increased two fold when the combination PTPi/IFN was used.
Conclusions: Our results suggest that IFN activity is modulated by the use of PTPi, producing a reduction in the effective concentration of IFN required. The mechanism associated with the enhancement of IFN activity could be related with an inhibition of tyrosine phosphatases that regulate the cascade of the interferon response, which could lead to a prolongation of the IFN signal, however further studies will be needed to verify these results, including the mechanism of action (e.g. inhibition of tyrosine phosphatases that regulate the cascade of the interferon response) and the potential use of these combinations to inhibit HIV-1 replication in vivo.

P003
The prognosis of HIV/AIDS patients in intensive care rate (90-100%), the highest have a 100% mortality rate. A score of 8 or more points identifies patients at high risk of adverse prognosis, with a sensitivity of 80%, specificity of 78% and positive predictive value of 77% and negative of 80%. A significant association was found between score and mortality. The receiver operating characteristic (ROC) curve shows the cut off point for this score, where it achieves the highest sensitivity and specificity (8 points). The area under the curve has an acceptable discrimination value (0.8664711 (0.8366941-0.8962480)) ( Figure 1). Conclusions: Admission of an HIV/AIDS patient to IC should be made taking into account several prognostic factors and not on an isolated basis. We believe that the achievement of a score does not replace clinical judgment at all in conjunction with the patient's decision. The prognostic score presented is easy to perform using accessible variables and has utility to identify patients at high risk of death. We encourage your use.

P004
Clinical characteristics and long-term monitoring of a cohort of HIV/AIDS patients admitted in intensive care Introduction: Intensive care (IC) admission of patients with HIV/ AIDS, prior to the era of highly active antiretroviral therapy (HAART) was controversial and discussed, many centres now report an improvement in HIV/AIDS survival [1,2]. There are studies of clinical characteristics, admission, reason for IC entry and shortterm prognosis. Few papers describe long-term follow-up of an HIV/AIDS cohort. This study describes the clinical characteristics and long-term follow-up of HIV/AIDS patients admitted to IC. Conclusions: Our case series provides evidence that the severity of the acute event influences mortality, and are also statistically significant other variables such as the HIV/AIDS stage and the pathology that determined its entry. Intra-IC mortality was higher than the literature. In the long-term follow-up, variables such as nutritional status, immunological status and HAART have significance, mentioned in different publications [3,4]. The low mortality at three years of follow-up, shows as a chronic disease, influenced by the presence of HAART (p significant).

Introduction:
The HIV Colombian group (VIHCOL) comprises 17 HIV care centres located in 10 Colombian cities, which provide outpatient medical care to people living with HIV/AIDS. In this current study, we aimed to determine the prevalence of co-infection of hepatitis B, hepatitis C, syphilis and tuberculosis amongst a large cohort of HIV-positive patients in Colombia.

Methods:
We conducted a multicentre retrospective study between January 2014 and December 2015 in 17 HIV care centres located in 10 Colombian cities. HIV-infected patients over 15 years of age receiving medical care in the participating institutions were included. Prevalence rates for HBV (either HBsAg, anti-HBs or anti-HBc), HCV (anti-HCV), syphilis (non-treponemal and treponemal tests) and latent tuberculosis (TST ≥5 mm) were obtained and analysed by age, sex and health system affiliation. History of active tuberculosis was also recorded.
Conclusions: Hepatitis B co-infection rate was high, while hepatitis C co-infection rate was lower compared to general population. We found statistically significant differences between health system affiliation plans for hepatitis B, syphilis and latent TB.

P006
Symptoms, psychosocial and treatment-related variables amongst patients with virologic failure into two first-line antiretroviral therapy investigated the frequency of symptoms associated with depression, self-reported psychosocial and treatment-related factors, in a sample of patients with failure to the first line of HAART [1][2][3][4].
Methods: A descriptive, cross-sectional study, with a non-probabilistic sample of 50 patients. Patients were evaluated by the mental health department after the documentation of virological failure. All patients were evaluated using the Beck Depression Inventory second edition (BDI-II) and Medical Outcomes Study Short Form-36 (SF-36). Using the World Health Organization suggested criteria, we asked the patients to self-report the adverse effects of the treatment that resulted in low adherence and also to report stressful life events that took place during the three months prior to the time of the evaluation (Tables 1 and 2) [5].
Conclusions: In this study, we showed that participants in LAT1 had a higher frequency of neuropsychiatric symptoms that could be related to sleep deprivation secondary to treatment use, in comparison with LAT2. This evidence suggests the importance of periodic assessment of mental health of patients initiating HAART and monitoring side effects to antiretrovirals. This would ultimately reduce the number of treatment failures and may help to develop of interventions that facilitate reinsertion to daily activities. Introduction: Historically treatment of HIV and HCV co-infection has always been a concern due to the poorer response to anti-HCV therapy compared to mono-infected and to the worsened fibrosis progression in the presence of HIV. Currently Brazil includes HIV co-infection for treatment regardless of the degree of hepatic fibrosis and prioritizes these patients to receive a treatment regimen compatible with their antiretroviral therapy. The DAAs allow co-infected to be treated like HCV mono-infected patients, calling into question whether these patients should be considered a special population any longer. Clinical and epidemiological profile as well as response evaluation to treatment of hepatitis C/HIV coinfected patients are described in this article.

Methods:
We enrolled all co-infected patients under treatment from December 2015 to June 2016 at a co-infection clinic at Hospital das Clínicas of the State University of Campinas-São Paulo. The patients received sofosbuvir + daclatasvir with or without ribavirin, after antiretrovirals interactions were managed. Demographic, clinical and laboratory parameters were retrospectively analysed in medical records.
Results: 50 patients were enrolled, GT1a (66%), GT1b (16%), GT3 (8.3%), GT4(2%). 88% were male and 74% were white. The mean age was 49,6, mean baseline HCV RNA was 6.3 log10 UI/mL, mean baseline CD4 was 704 cells/μL, 66% were classified as C3. 56% had cirrhosis, 41% underwent ARV switch. There were three patients who did not follow-up, one because of reclusion, another one because of collateral effects of the new ARV prescribed. As a partial result, we obtained 76% of SVR4 and 62% of SVR12, while eight patients are still completing SVR with non-detectable PCR Abstract P006- Table 2. Frequencies and differences in selfreported side effects and stressful life events for each line antiretroviral therapy Line antiretroviral therapy Self-reported side effects Yes Not Yes Not Chi square = 3.324**p < 0.05
Conclusions: The SVR rates after treatment with DAAs of coinfected patients are comparable to the rates of mono-infected. The whole scenario begs the question if there still is a particular subset of population. But although we may not have the same concerns as before, the co-infected patients have different features regarding SVR. The DAAs should be checked for interactions, including with antiretroviral therapy. The need to change ART may lead to side effects and non-adherence. Co-infected patients will still be considered a particular group because of risk exposure and reinfection possibility. Furthermore, we have little options so far for re-treatment. Introduction: Approximately 10% of the HIV-infected population worldwide is infected with hepatitis B virus (HBV) [1]. HIV increases the risk of cirrhosis and end-stage liver disease in HBV co-infection. In Central America, the adult hepatitis B prevalence rate is below 2% [2]. Absent data on Honduras, HBV prevalence rates in El Salvador and Guatemala, Honduras' neighbours, are 1.0 and 0.5, respectively [3]. The rate for people co-infected with HIV and HBV is unknown. Siempre Unidos, the only non-governmental organisation authorized by Honduras' government to provide antiretroviral medications, operates two clinics providing HIV education, testing and treatment.

P008
Patients are primarily of low income and educational levels and live in urban or semi-rural settings. Our aim was to test our HIV patients for hepatitis B and assure treatment for all who were co-infected.  Figure 1) and most of the cases were in men (62.6%). Heterosexual exposure amongst elder men (73.4%) was predominant when compared to the general population (51.2%). Most of the cases amongst the elderly (50.4%) was amongst whites, while in the general population we verified a higher proportion of cases (50.1%) amongst blacks. The proportion of HIV/AIDS cases in illiterate senior citizens was 6.9%, while in the general population it was 2.9%. The majority of them started ART with CD4 <200 (Table 1). According to data from the PCAP 2013 [1], the proportion of illiteracy (or low schooling) amongst the elderly may lead to late diagnosis, which corroborates the finding that a greater proportion of elderly individuals have a late ART initiation, with CD4 <200. Despite this, we observed an increasing distribution of ARV for individuals over 50 years, indicating that this population has a good adherence to ART. Conclusions: The aging process involves complex issues regarding sexuality that influences the vulnerability of elder people. In the light of increased AIDS detection rates found amongst this population, it is important to expand access to information regarding HIV/ AIDS prevention, and also to encourage the dialogue about sexuality and sexual health problems people aged 50 and over may Abstract P012- HIV AND TUBERCULOSIS

P014 HIV and tuberculosis incarcerated patients in Mexico City between 2013 and 2016
increases to 65-94% amongst those who are co-infected with HIV [2]. In 2010, the estimated incidence of pulmonary TB amongst inmates in Mexico was 34 times greater than that of the general population (473.9 cases per 100 thousand persons) [3]. Methods: Retrospective cohort study to obtain prevalence, incidence, mortality rate and percentage cure amongst incarcerated patients living with HIV/TB. We used as a diagnostic method for tuberculosis: chest X-ray, basiloscopy, culture and GeneXpert in expectoration and/or gastric juice. Introduction: Patients receiving antiretroviral therapy who need the initiation of rifampin-based anti-tuberculosis treatment (anti-TB) represent a management challenge due to unfavourable drugdrug interactions and the risk of loss of HIV control. There is no solid data on the best ART switch strategy in these patients. Our objective was to describe the ART switch recommended by a national peer-advisory board (CORESAR) to practitioners caring for HIV-TB co-infected patients, to investigate the determinants of the choice of the switch modality and to assess the virologic outcomes of the diverse switch strategies. Methods: We conducted a nationwide, HIV clinic-based, cohort study in Mexico. Inclusion criteria were: adults under ART with newly diagnosed TB and requiring the start of anti-TB, whose physician had received therapeutic advice, by a panel of experts, regarding the switch of ART to minimize pharmacologic interactions. The primary end-point was the incidence of HIV viremia control (persistent plasma HIV-RNA levels of <200 copies/mL) during anti-TB. Noncompleters were considered as therapeutic failure. Results: Fifty-six patients were assessed. ART regimens at TB diagnosis were: 2 NRTI + PI (32 patients), 2 NRTI + NNRTI (20 patients) and other regimen (4 patients Conclusions: In patients already receiving ART and initiating anti-TB a switch to RAL (or to NN) may be an adequate strategy, particularly amongst those with favourable viral control history. Conversely, contention with only NRTI could be an acceptable alternative for drugheavily exposed individuals. Our results ought to be interpreted with caution as they were generated through an observational survey.
Abstract P014- Figure 3. CD4 count at Diagnosis.  Figure 1). However, there are significant differences in the distribution of mortality in the regions of the country. In 2015, the Mexican States of Veracruz (4.14 per 100,000 women), Colima Introduction: There is no consensus on gender differences in clinical outcomes of HIV-infected patients. Immunologic, virologic and survival data for patients receiving antiretroviral therapy (ART) show an inconsistent presence and direction of a gender gap. Gender and sexual behaviour-based outcomes analysis is lacking in Guatemala, which has largely sexual transmission of HIV. We examine outcomes of HIV-positive Guatemalans receiving ART over a 9-year period. Introduction: In 2015, Cuba was the first country in the world to eliminate mother-to-child transmission of HIV. Early diagnosis of HIV in pregnant women and the systematic monitoring of virological response to highly active antiretroviral therapy (HAART) during the gestational period are fundamental premises in the prevention of HIV vertical transmission. The objective of the present study was to analyse the behaviour of the virological response in HIV-1 seropositive pregnant women in Cuba during the period 2015-2016. Methods: The study included 74 HIV-1 seropositive pregnant women during the period 2015-2016, who were assessed for HIV-1 plasma viral load (VL) during the three trimesters of pregnancy using the Cobas Ampliprep/Cobas Taqman 48 technology. The viral RNA was isolated from 28 pregnant women with elevated VL and used as target to amplify the protease and reverse transcriptase regions of the HIV-1 pol gene. PCR products were sequenced and the generated data used to determine the subtype and resistance of HIV-1 to ARV according to HIVdb v6.1.1. Results: Between three and five months after initiation of HAART, 50% of pregnant women had undetectable VL, 12.2% had values between 100 and 1000 copies/mL and 37.8% pregnant women above 1000 copies/mL. The predominant viral variants in the group of pregnant women who were assigned the HIV-1 resistance profile to antiretrovirals were subtype B (21.4%) and CRF20, 23, 24_BG (17.9%). The 17.8% (5/28) had any mutation associated with ARV resistance; 7.1% (2/28) to nucleoside reverse transcriptase inhibitors and non-nucleoside reverse transcriptase inhibitors (NNRTI) combinations; 3.6% (1/ 28) to the NNRTI and 7.1% (2/28) to the protease inhibitors. The antiretroviral drugs with high resistance were 3TC, AZT, NVP and EFV. Conclusions: The systematic monitoring of the virological response in HIV-positive pregnant women allowed the optimization of HAART and contributed to the sustainability of the prevention of mother-to-child transmission of HIV.

P021
Switching from TDF to TAF in HIV-infected adults with low BMD: a pooled analysis Introduction: Switching from tenofovir disoproxil fumarate (TDF) to tenofovir alafenamide (TAF) represent an important treatment strategy to improve bone health in HIV-infected individuals with low bone mineral density (BMD), but this has not been specifically investigated.
Methods: This analysis consisted of pooled data from two prospective phase 3 studies (studies 109 and 112) of HIV suppressed adults on a TDF-based regimen switching to elvitegravir, cobicistat and emtricitabine (E/C/F) co-formulated with TAF. In adults with clinically significant low BMD by dual energy X-ray absorptiometry (Tscore ≤ −2.0 at the lumbar spine, femoral neck, or total hip) at baseline (BL), we assessed percentage change in BMD and T-score at the lumbar spine and total hip and change in proportion with osteoporosis (T-score ≤−2.5 at any site) at weeks (W) 96. Logistic regression was used to determine BL predictors of a clinically significant improvement (≥ 5% increase) in lumbar spine and total hip BMD, adjusted for age, race, sex and BL BMD. Results: Of the 1117 enrolled who switched from TDF to TAF, 214 (19%) had clinically significant low BMD at BL (median age 46 years, 85% male, 63% White, 26% smokers) with 43% (93/ 214) osteoporosis. The BL median (interquartile range: Q1, Q3) T-score (lowest of any 3 sites) was −2.4 (−2.8, −2.2). At the spine, the median (Q1, Q3) % BMD change at W96 was 2.53% (0.22%, 5.31%) and T-score change was 0.19 (0.02, 0.42) (p < 0.001). At total hip, BMD change at W96 was 2.39% (0.72%, 4.18%) and T-score change was 0.14 (0.04, 0.24) (all p < 0.001). Of the 86 with BL osteoporosis and W96 BMD data, 23% no longer met criteria for osteoporosis at W96. Of 214 with low BMD, 24% and 15% had a clinically significant BMD increase at the spine and total hip, respectively. In multivariable analysis, BL factors associated with clinically significant BMD increase at W96 were higher fraction excretion of phosphate (FEPO4 ≥ 10%) for the hip and higher BMI (≥30 kg/m 2 ) and procollagen type 1 N-terminal propeptide (P1NP >1.85 log10 ng/mL) levels for spine. Conclusions: HIV-infected individuals with clinically significant low BMD on a TDF-based regimen who switched to E/C/F/TAF experience a~2.5% BMD increase over 96 weeks and a reversion from osteoporosis in approximately 1/4 of patients. Baseline urinary phosphate wasting and high bone turnover may identify TDF-treated HIV-infected patients with low BMD who may benefit the most from a switch to TAF.

P022
HIV care cascade in transgender women: Mexico facing the challenge 1 Condesa Specialized Clinic, Mexico City, Mexico. 2 Condesa-Iztapalapa Specialised Clinic, Mexico City, Mexico. 3

HIV/AIDS Mexico City Program, Mexico City, Mexico
Introduction: Transgender women (TGW) are a vulnerable group for HIV infection and are 34-49 times more likely to be infected than the general population. Furthermore they receive little to no care at health services which makes it difficult for them to receive an early or timely diagnosis [1,2]. It is estimated that TGW with HIV have higher ART treatment failure rates than other groups due to poor adherence. HIV prevalence in TGW is approximately 19.1% globally [3], even though there are very few studies published. A few studies report that 77% of TGW with HIV receive medical care, only 65% receive ART and 44% have an undetectable viral load [4]. The Condesa Specialized Clinic has a health service tailored for transgender persons since 2009, offering free mental health assessments, hormone therapy and HIV/STI diagnosis and treatment. Methods: Describe the HIV care cascade of TGW. An administrative and care database of the Center for Transgender Services was used to obtain follow-up information and the viral load information was obtained from SALVAR, the national HIV treatment database. Results: There are 1669 patients registered at the Center for Transgender Services from September 2009 through January 2017. Of these 1358 (81.3%) are TGW and 311 (18.6%) are Transgender men. All patients receive sex reassignment counselling and are offered voluntary HIV, syphilis, hepatitis B and C tests, but not all patients agree to the tests. 78% (n = 1069) of TGW agreed to get tested for HIV, of which 32.8% (n = 351) received a positive result and 87% (n = 304) of these receive ART. Only 274 (78%) receive HIV care at our clinic, the rest receive HIV care in other health institutions. Of the 274 patients, 86% (n = 235) receive ART and 83% (n = 227) have an undetectable viral load (Figure 1). Conclusions: HIV prevalence in TGW that receive care in our clinic is much higher than the reported in the international literature since the Center for Transgender Services is located inside the HIV clinic. Unfortunately not all patients agree to HIV testing thus it is not possible to diagnose everyone. Is probable that the retention and virologic suppression in our patients id higher compared to other provides due to the fact that the hormone therapy services may very well be an incentive for controlling the HIV epidemic in this population group.
we collected peripheral blood samples for HIV, syphilis, hepatitis B and C. Results: A total of 311 samples and epidemiological data were collected. Compared with the general population (−1%) the HIV frequency in trans-populations was 17.8-38.5%; syphilis was 23.5-55.5%; hepatitis B was 1.6-5.8%; and for hepatitis C was 0.03-3.8% ( Figure 1) Early sexual intercourse, risk behaviours and violence were detected in higher levels. Conclusions: Despite many efforts in the fight against HIV, disparities in STIs frequencies are still observed amongst trans-populations. This is influenced by a poor access to formal employment, illiteracy, lower access to health services and provision of population-specific services. Integrated services and comprehensive care for trans-populations will impact the reduction of HIV/STIs infections.
Introduction: The HIV Colombian group (VIHCOL) comprises 17 HIV care centres located in 10 Colombian cities, which provide outpatient medical care to people living with HIV/AIDS. Here, we aimed to analyse the features of clinical presentation, diagnosis, treatment and virologic success amongst patients 50 years and older. Methods: We conducted a multicentre retrospective study between 2013 and 2015 in 17 HIV care centres from 10 Colombian cities. HIV-infected patients over 15 years of age receiving medical care in the participating institutions were included. We compared two patient groups: those ≥50 yo and those 15-49 yo, in terms of immune status at admission, first antiretroviral treatment (fART) and virologic success (viral load <50 copies/mL) at one year. Results: A total of 128 (11.5%), 251 (14.4%) and 372 (13.4%) patients ≥50 yo were diagnosed with HIV in 2013, 2014 and 2015, respectively. The proportion of patients ≥50 yo with a baseline CD4 count <200 and <350 cells/µL were 32. 8% and 63.3% in 2013‚ 42.2% and 63.7% in 2014 and 36% and 59.7% in 2015, respectively. Frequency of EFV as part of fART in patients ≥50 yo progressively increased: 45.5% in 2013, 60.2% in 2014 and 69.6% in 2015. ZDV/3TC was the most frequent NRTI-based combination ART in 2013 (36.4%) and 2015 (57.5%), in contrast to TDF/XTC in 2014 (39.1%). Virologic success rates for patients ≥50 yo on ART were 80.5%‚ 80.2% and 80.4% in each study year, respectively (p < 0.001 when compared to patients <50 yo) In contrast to patients <50 yo, patients ≥50 yo had more frequently a late immune presentation but achieved a significantly higher virologic suppression (p < 0.05). Conclusions: HIV diagnosis and access to ART occurred later in HIV population ≥50 yo, but this patient group had a better treatment response. Strategies for an early identification of this age group are encouraged. Conclusions: It is necessary to strengthen the diagnosis of HIV in prison settings to achieve the goals set by the WHO 90-90-90 initiative. Linkage and retention in medical care is covered in this model (HIV Programme in Prisons), alongside working with improving adherence to HAART in order to increase the levels of undetectability. The model of supervised daily dosage has given partial effective results given that the ARV is provided daily but it does not guarantee that the patients swallow the pills. With the implementation of new strategies (accompaniment and timely information) we are overcoming the problem of how to link 100% of patients to ambulatory care once they obtain their freedom. The HIV Programme in Prisons of Mexico City is effective and can be replicated in different penitentiary systems in other states and countries, but not in the general population. 1. Gras, A. N., Badial, H. F. y González, R. A. (2013). Salud pública, VIH/SIDA y derechos humanos en los centros de reclusión. Revista de derechos humanosdfensor. Número 8 -Agosto 2013, pp. 13-21. Introduction: Brazil has the fourth biggest penitentiary population in the world, with an average occupation rate of 161% at the facilities. The registered growth in the period of 2000-2014 was on average 7% per year, an amount 10 times bigger than the Brazilian population growth, 94% of the quota being male [1,2]. Populations deprived of freedom are considered high-risk for sexually transmitted diseases, due to the favourable conditions encountered in prison for the propagation of diseases [3,4].The State of Paraná presents the fifth biggest jail population in Brazil accounting for 4.61% of that population and has tried over the years to develop health attention policies to the convicted within the National Health Plan at the Penitentiary System (PNSSP) [5]. The main goal of this study was to estimate the predominance of HIV markers within the male jail population at the prison system in the State of Paraná. Methods: Cross-sectional epidemiologic survey for HIV infection held in nine male prisons in Paraná in the period of May 2015 to December 2016. The State of Paraná presents 23 closed system male correctional facilities, with a jail population of 16,657 men incarcerated in closed system. 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 HIV test performed in a certified laboratory. The ELISA test was used as a criteria for HIV with the confirmation through a positive Western Blot test. The data analysis was based in the predominance with confidence intervals estimates. Results: In total, 1192 men were addressed, 1133 (95%) were subjected to a diagnosis for the HIV test. The estimated predomi- Conclusions: Infectious and contagious diseases tracking and investigation in the penitentiary system that promote knowledge, contribute directly to the adoption of effective disease control measures, for diseases such as HIV, in the freedom deprived population, as well as the feasibility maintenance of an egress individual able to work and socially capable of integrating himself in society. Introduction: The pooled HIV prevalence was 19.1% in 11,066 transgender women (TGW) worldwide [1]. It is known as the suboptimal adherence of ART in this group [2]. TWG have lower percentage of ART adherence compared to non-transgender men (78.4% vs 87.4%) and viral suppression (50.8% vs 61.4%). Optimal HT adherence is associated with adherence to ART [3]. Objective: Correlation of the viral load amongst HIV-positive TGW on ART with optimal HT or TWG on ART without HT. Methods: The information was taken from the clinic data base and the SALVAR database. The viral load and serum hormones were taken before HT and last visit at least three year after initiating HT. Adequate HT is evaluated by serum hormonal concentrations (E2 = 50-200 pg/mL, total testosterone <0.5 ng/mL). In our protocol, the viral load must be undetectable (<40 copies) before HT they were classified in groups for E2 serum concentrations (>200, 200-50 and <50 pg/mL) and for testosterone serum concentrations (>0.5 and <0.5 ng/mL). Results: A total of 272 TGW with ART, 60.6% of TGW (n = 165) with HT and 39.4% (n = 107) without HT. Of the TGW with hormonal therapy 90.9% (n = 150) have undetectable viral load and 10.1% (n = 15) have detectable viral load. 103 TWG without HT were consider for analysis 4 TGW were excluded. TGW without HT 66% (n = 68) have undetectable viral load and 34% (n = 35) detectable viral load. Of the Group with HT 85 patients had hormonal serum concentrations, 93% (n = 79) have undetectable viral loads and 7% (n = 6) have detectable viral load. 45.56% TWG (n = 36) had optimal HT (E2 50-200 pg/mL) 5.06% (n = 4) were above optimal treatment and 49.36% (n = 39) were below optimal treatment. The testosterone concentrations 69.4% (n = 59) were on optimal hormone concentrations (0.5 ng/mL).

P027 Correlation between optimal hormonal therapy and viral load amongst transgender women with HIV infection
Conclusions: Viral loads are undetectable on the 90.9% TGW on TH versus 66% without HT, in our clinic the HT is free of charge with endocrinologists, this can be encouragement for optimal adherence of ART. The majority E2 concentrations 49.36% were below optimal treatment and testosterone serum 30.5% were suboptimal. This can be explained that in part of previous year the clinic did not have supply of HT. Just 5% were overmedicated. The Attention model of our clinic can be an example of positive influence of incentives on TGW for optimal adherence. Introduction: Peer dialogues influence the adoption of behavioural changes to reduce the risk of HIV infection. By intervening experimentally in the community to change risk behaviour patterns, it may be possible to promote widespread reductions in HIV risk practices within a population [1]. Methods: The intervention identified and trained young age range 18-26 people who are reliably identified as leaders amongst one of these key populationsgay men and MSM, transgender people (transvestites and transsexual women), drug users and harm reducers and sex workersin all five regions of Brazil to act as multipliers of behavioural changes for their peers, in relation to HIV. We also include young people living with HIV, considering that it is important that these young people share the experience of living with HIV with other young people in greater vulnerability and risk [2]. Results: 140 young people from the key populations were trained in the 5 Brazilian regions. The proportions of the key populations trained in this intervention were 41.9% homosexuals and MSM, 14.5% harm reduction or drug users, 8% transgender people, 6% sex workers and 15% young people living with HIV. Approximately 70% of young trained in this intervention have already developed some activity to multiply the information about prevention and behavioural practices to reduce HIV infection in their respective territories and communities, promoting knowledge about combination prevention and changes related to sexual practices and behaviours. Introduction: Retention in care plays a critical role in achieving viral suppression and has a recognized impact on public health. Men who have sex with men (MSM) and transgender women are key vulnerable populations, however, recent research suggest they constitute a minority of HIV-infected adults in care. We aimed to examine the proportion and factors associated with retention in care in MSM and transgender women newly diagnosed with HIV. Methods: We performed a retrospective study including all adult patients (≥18 years) self-identified as MSM or transgender with a new HIV diagnosis from 2002 to 2014 in a public hospital in Buenos Aires. We evaluated demographic characteristics, immunological status at diagnosis and proportion of linkage and retention in care for both groups. Individuals who visited at least once a healthcare professional for HIV after diagnosis were considered to be linked. Retention in care was defined as two or more visits separated for ≥90 days in the first year after diagnosis. Logistic regression was used to identify factors associated with retention in care. Results: A total of 1239 patients were tested positive for HIV during the study period, of whom 314 (25.34%) were self-identified as MSM and 108 (8.71%) as transgender women. Compared with MSM, transgender patients had similar CD4+ counts at diagnosis (364 vs 386 cells/μL) and years of education (10 vs 12 years). Only a minority of subjects (4.5% of transgender women and 17% of MSM) had social insurance. A high proportion of MSM and transgender individuals were linked within three months of diagnosis (94.8% vs 95.2%), however only 40.3% of transgender and 61% of MSM met the retention criteria. The odds of being retained in care were higher for MSM than for transgender patients [OR 2.3;]. Cocaine abuse, CD4+ cell count at diagnosis, years of education, social insurance, country of origin (Argentina vs others) and place of residence (Buenos Aires city vs others) were not associated with retention in care in this cohort. Conclusions: Our results suggest that there is a need to improve interventions to retain both of these key populations in care with special emphasis on transgender patients.

Advisory, AHF Argentina, Argentina
Introduction: According to the UNAIDS report of 2015, the prevalence of HIV in the general population of Panama is 0.4%. However, in the adult population (>19 years) it is 0.7%, and there are even higher prevalence reports in indigenous populations (Kuna Yala and Ngäbe Buglé) prior to the mentioned report. Therefore, a study on HIV prevalence in the Ngäbe Buglé population from different Panamanian districts was carried out. Methods: Between 15 February 2016 and 15 August 2016 determinations of anti-HIV antibodies were performed in Ngäbe Buglé individuals from 10 different districts of the Republic of Panama through a rapid test previously validated in panamanian population (Alere Determine™ HIV1/2). Counselling was given to all people and for positive cases established the appropriate referral. The information was collected in an ad hoc database. Chi 2 -test, Student's t-test or Fisher's exact test and maximum likelihood odds ratio were used as appropriate.
Results: Determinations were made in 698 people. Mean age (±SD): 33.6 (±13.7) years; Gender distribution: female 55.7%, male 44.3%. It was the first HIV test for 509 people (73%). Thirty four out of 309 men (11%) reported having sex with men. No data on injecting drug use were collected. There were 20 HIV positive results. Prevalence: 2.86% (95%CI: 1.81-4.33). Amongst the positive cases, 85% were tested for HIV for the first time. Although the prevalence was higher in men than women, the difference was not significant (3.56% vs 2.31%, p = 0.14). No significant differences were found in relation to age. In men who had sex with men, the prevalence was 11.8% (95% CI: 4.7-26.2), showing a significantly greater probability of a positive result with an OR: 5.37 (95% CI: 1.46-16.35; p = 0.01). Conclusions: The HIV prevalence observed in this population was seven times higher than the prevalence reported for the general population of Panama. Cultural or vulnerability issues could explain this finding, and a study assessing these factors should be carried out in order to establish risk reduction strategies in the Ngäbe Buglé population. Introduction: Approximately 11,000 people are incarcerated in the federal prison system in Argentina. The estimated HIV prevalence in this population is around 3%. It is important to evaluate de cascade of care in this population to maximize virologic control, improve survival rates and quality of life. The Ezeiza prison is the biggest prison in the country with 1800 inmates. Prison inmates that are diagnosed with HIV infection are evaluated monthly with our Infectious Diseases Unit at Hospital Penitenciario Central 1, inside Ezeiza prison. Methods: Cross-sectional retrospective study of HIV positive prisoners in the Complejo Penitenciario Federal 1 at Ezeiza, Argentina. Criteria for inclusion: all HIV infected prisoners who were receiving medical care at our Infectious Diseases Unit during December 2016 were included in the final analysis. During 2016 several strategies were implemented in order to meet WHO 90-90-90 goals: voluntary HIV testing was offered to inmates when they entered the prison, HAART treatment was initiated at first visit with the ID specialist, every HIV inmate was evaluated at least once a month, local HIV treatment guidelines were followed. Data were obtained from an electronic database of medical records. All statistical analysis was undertaken using Statistics SPSS. Results: On 31 December 2016, a total of 62 HIV positive inmates remained incarcerated (>90% of the total estimated cases in this federal prison): 100% male. Median age: 37 (min 21-max 74). Average CD4 count of 427 cell/mL (min 59-max 1120). Eighteen out of 62 inmates (29.03%) were co-infected with hepatitis C, and a total of 5 inmates (8.06%) had TB in the past. Sixty-two inmates (100%) were linked and retained to healthcare, 61 inmates (98.38%) received HAART. There were 48 inmates with more than four months of HAART; amongst them, 43 had viral loads results. 40 (93%) were under virology control with a viral load of <200 copies/mm 3 and 38 (88.37%) were undetectable with VL <40 copies/mm 3 . NNRTIs were used in 34 inmates (54.84%), PIs in 25 inmates (40.32%) and INSTIs in 3 inmates (4.84%). Conclusions: Two of the 90-90-90 goals were meet in this model. It is necessary to strengthen HIV diagnosis in prison settings particularly when entering the prison system. Monthly medical visits and rapid HAART implementation are crucial to meet undetectable viral loads in this population. This study aims to investigate the profile of HIV/AIDS treatment for Chilean women according to their ethnicity in the region of La Araucanía-Chile. Methods: Cross sectional study based on 161 women living with HIV who were attended at the Hospital from 1 January 2006 to 1 August 2016; 38 were Mapuche and 123 non-Mapuche; 78% of women lived with their sexual partner. Median age for the group was 34.8 yo . 80.1% had less than 12 years of education and their average income was U$98 monthly. Most women were housewives (47.5%) and non-qualified workers (19.8%). We used descriptive analysis to associate clinical variables such CD4, AIDSrelated disease and reason for testing to sociocultural variables such as ethnicity (Mapuche, non-Mapuche), education, disclosure HIV status and partner HIV positive. We defined advanced disease with a CD4 <200 cels/mm; and very advanced disease with <100 cells/mm. Results: Women do not perform the test spontaneously. Reasons for testing HIV are: HIV-positive partner (39.5% Mapuche, 41.1% non Mapuche); diagnosis made in health centres (34.2% Mapuche, 25.8% non-Mapuche), and during pregnancy (21.1% Mapuche, 19.4% non-Mapuche). Fifty per cent of women access first consultation with less than 234 cells/mm. Mapuche access to healthcare system with a very advanced disease 35.1% (CD4 <100 cells/mm and in stage C 39.5%), versus non-Mapuche: 23.6% and 30.1%, respectively (p = 0.52). Mapuche with 12 years of study access to care with more advanced disease (39%) than non-Mapuche (17%) (p = 0.05). 47.8% of Mapuche housewives had very advanced disease compared to non-Mapuche (18.9%) (p = 0.01). Access to care with very advanced disease is independently of family HIV disclosure status. 47.8% of Mapuche women with HIV negative partner consult with very advanced disease versus 24.3% of non-Mapuche women (p = 0.03). Conclusions: Chilean women behave similar to other Latin American ones: they access to treatment with very advanced disease, the reasons for testing are an HIV positive partner, due to illness detected in health centres, or during pregnancy. We could observe that Mapuche women are diagnosed later, and they access to care with very advanced disease compared to non-Mapuche. The level of education is independent of admission with very advanced disease. Mapuche housewives, with HIV negative partners, access to care with more advanced disease than those not Mapuche. Finally, we point out that Mapuche women are more vulnerable, which requires a culturally relevant health approach.

P033
High HIV prevalence in non-high risk groups in urban Honduras Introduction: Honduras' HIV prevalence for adults aged 15-49 is reported as 0.4% with rates of 4% and higher reported for high risk groups, that is gay men, transgendered women, commercial sex workers and minority Garifuna members [1]. Siempre Unidos, the only non-governmental organisation authorized by Honduras' government to provide antiretroviral medications, operates two clinics providing HIV education, testing and treatment. Here, we report a study of HIV prevalence at urban sites frequented by the general population, that is people who are not considered to be in the high-risk groups, in two Honduran cities. Methods: Using a cross-sectional design we sampled women and men aged 16 and older at 37-day long health fairs in high poverty neighbourhoods (over half were unincorporated slums where residents lacked access to government services) and central/market sites, for example downtown parks and outdoor markets, in the cities of San Pedro Sula (pop. 1 million) and Siguatepeque (pop. 80,000) between October 2014 and September 2016. A physician, nurse, two health educators and one certified HIV testing counsellor staffed the free health fairs offering primary care and HIV health education. The HIV counsellor obtained written consent and then administered the Determine HIV-1/2 rapid test (Alere Medical Co. Ltd., Chiba, Japan). Positive results resulted in administration of the OraQuick HIV-/12 rapid antibody test (OraSure Technologies, Inc., Bethlehem, PA) for further confirmation. Results: Of the 3471 people who attended the 37 health fairs, 846 requested screening. Of these, 5% (42 people) received positive HIV results. For those testing positive (Table 1), the median age was 32 years with two-thirds male. Thirty-one per cent identified as gay, bisexual or transsexual. 4.8% and 5.3% of people tested at health fairs in high poverty neighbourhoods and commercial sites, respectively, were positive. Conclusions: Service providers and policy-makers focus HIV screening in Honduras on high-risk groups. Our data demonstrate HIV infection in a significant percentage of people not included in those targeted interventions. They include men and women living in impoverished neighbourhoods with little access to health services. HIV screening within the context of community-based general medical care may facilitate better early detection of HIV infection

Introduction and objectives:
LGBT and Men who have sex with men (MSM) have reported high discrimination in the healthcare setting. This discrimination places them at high risk for HIV. Pre-exposure prophylaxis (PrEP), an approach used in high HIV risk populations, is currently not available in the Dominican Republic. This study aimed to evaluate how HIV high-risk patients perceive PrEP and the likelihood of healthcare providers to prescribe PrEP. To our knowledge, this is the first study to assess the acceptability of PrEP between HIV high risk patients and healthcare providers in the Dominican Republic. Methods: Convenience sampling and the snowball effect was used to recruit participants who were 18 yo or older, HIV-positive and self-identified as gay, bisexual, transgender, transsexual or MSM. Heterosexual, HIV-positive and individuals under 18 yo were excluded. PrEP perception, the level of embarrassment and the likelihood of prescribing PrEP were measured using a Likert scale survey ranging from, 1 being "Most likely/embarrassed" to 5 being "Least likely/embarrassed." A Chi-square test compared PrEP interest between sexual orientations Abstract P034- Figure 1. Represents the degree of embarrassment to use PrEP per sexual orientation. MSM and bisexual men were combined as MSM. Carpenter/mechanic 4 (9.5) Labourer/construction/gardener 4 (9.5) University student 4 (9.5) Clerical worker/sales/beautician 4 (9.5) Factory machine operator 3 (7) Nurse/engineer 2 (5) Peddler 2 (5) Commercial sex worker 1 (2) Results: A total of 64 participants and 25 healthcare providers were interviewed. The sample of participants consisted of 17 gay men, 6 bisexual, 4 transvestites, 4 transsexuals, 21 transgenders and 12 MSM. No statistical difference was found between the groups and their PrEP interest, χ 2 (4, N = 64) = 2.81, p = 0.59 (Table 1). As shown in Figure 1, more than 20% of gay, MSM, transgender and transsexual participants reported to not feel embarrassed to take PrEP. While less than 5% of all the participants reported to feel really embarrassed to take PrEP. As shown in Figure 2 Introduction: It is estimated that 200,000 people live with HIV in México, but only 63% know their diagnosis [1]. The lack of universal detection is one of the main barriers to access to care. This article describes a strategy which objective was to strengthen specialized HIV units to contribute to reduce the diagnostic gap, ensure the linkage of people with HIV to health services as their incorporation into ART. Methods: Between January and July 2016, "VIHSITAR strategy" was implemented in four clinics of HIV care, in four states of Mexico (Tlaxcala, Morelos, Sinaloa, Sonora). This strategy was based on the application of rapid tests for detection of HIV antibodies, syphilis, CD4+ cell counts through point of care kits, viral load as well as the active tuberculosis diagnosis, using a molecular biology test. Each participant was provided of pretest general information and post-counselling, essential elements to ensure linkage to care services. Sociodemographic and epidemiological variables were collected. We estimated prevalence of HIV, syphilis antibodies and tuberculosis. The time between diagnosis and incorporation of patients to care services were assessed, as well as the time of ART initiation.
Results: 1688 people were screened. HIV prevalence was 12.5% (n = 211) (20.6% in men vs 3.5% in women, p = 0.00). Syphilis antibodies prevalence in people with HIV was 14.7% (n = 31) (16.5% in males, 3.4% in females p = 0.009), while active tuberculosis prevalence was 1.4% (n = 3). 85.4% of the people were linked to care in an average of 11 days (0-36); 68% occurred in the first 30 days after diagnosis, which showed a significant improvement compared with 2015 [2] (49%). 95% of the people linked to care, started ART ( Figure 1). The mean of CD4 cells at diagnosis was 344 (156-487), the proportion of late diagnosis (CD4+ <200) was 30%, lower than the national average. No statistically significant differences were found between men and women group.
Conclusions: "VIHSITAR strategy" positioned detection as one of the main activities of the specialized units and succeeded in integrating the unit team into a systematized process. The promotion of the strategy contributed to increase the demand for detection. Knowing the immunological status immediately favoured the linkage to care services and to start ART. Definitely, the strategy contributed to improved detection and continuum of care.
approaches. We previously reported that 1/3 of first therapies in Latin America contained Zidovudine and more than 60% were Efavirenz based with large differences between countries. A very low rate of Raltegravir use was highlighted. The aim of this study is to determine the trend in patterns of ARV use in naïve patients of Latin American countries over the last three years. Introduction: HIV epidemic in the Dominican Republic (DR) is concentrated amongst key populations (KP), including MSM, transgender and migrants. Despite progress in development of HIV prevention interventions, still we register newly infections amongst these populations. There is a growing interest to evaluate the cascade of care per each KP, separately from general population (GP) and to monitor effectiveness of each intervention that might modify the continuum in care [1,2]. The aim of this study was to evaluate a model of retention focused in key populations in the DR. Methods: We selected three outpatients HIV clinics in the country with more than 5000 patients to evaluate three interventions: early testing, opportune ART medication and viral suppression. We initiate KP despite CD4 count or viral load after psychological assessment, and developed a case navigator model for retention in care [3]. The model of retention included: case tracking and linkage to services, community-focused services and opportune provision of services on site (HIV/STIs screening, chemistry and screening for HPV infections). We collected data of testing, ART treatment and viral suppression. Results: HIV testing coverage was similar between GP and KP, but the number of positive results was greater in MSM, trans, TRSX and migrant populations (Figure 1). Linkage to care was achieved in 100% of positive cases. At the moment of evaluation 1766 patients were retained in care, and a total of 691 new patients were started in ART. Viral suppression was achieved in 80.2% of the patients ( Figure 2).
Conclusions: Implementation of community focused interventions for KP will increased the number of positive unknown results amongst most-at-risk populations by 18% (normal average in concentrated populations 2-5%), and an increased number of early provision of ART, and a sustained viral suppression will substantially reduce HIV transmission.

P038
Coverage of influenza vaccine (2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)  confirmation may be inaccurate [1]. Timely and optimal identification and treatment of patients during the acute phase of HIV infection impact the long-term outcome of the individual and transmission [2]. Even though universal access to antiretroviral treatment (ART) exists in Mexico [3], entering to care and initiating treatment in public institutions faces important bureaucratic, regulatory and administrative hurdles. These constitute barriers for rapid treatment initiation in patients presenting with acute HIV-infection. Acknowledging these limitations and identifying the bottlenecks in the process of linking patients to care and initiating ARV, a novel enrolment strategy was implemented in 2015 for patients with acute HIV-infection. Methods: Personnel from the key areas involved in the care of HIV patients in our hospital (infectious disease residents, attending physicians, social workers, nurses, laboratory and administrative personnel) were sensitized in the importance of prompt ART for acute HIV. An encrypted instant-messaging group was created with all the involved staff, with the purpose of eliciting an alert whenever any member participating in the chain of care became aware of a patient with probable acute HIV-infection. Once a probable case is identified in any area of the hospital covered by members of the group, a conversation is initiated to discuss the appropriate immediate steps with the purpose of confirming diagnosis, initiating ART as soon as possible and clearing the paperwork and administrative procedures with a high level of priority in all the steps.
Results: Since 2015, 20 patients with acute HIV-infection have been incorporated to care and initiated ART using this approach.
Patients have been followed for 10.21 ± 6.15 months. The median time to ART initiation was less than 24 h, when the median time for chronic patients is 40 days in our centre. At six months of follow-up, there was an 89% retention rate.
Conclusions: By emphasizing instant communication and interdisciplinary approach in all involved personnel, ARV initiation for patients with acute HIV infection is immediate with a high level of retention in care. Longer follow-up is needed to determine the long-term impact of this new approach in these patients.
Introduction: HIV in older adults represents a relatively new topic, with a marked increase in incidence and prevalence worldwide [1,2]; this has occurred because HIV diagnosis has increased in older people and on the other hand, HAART [3,4] has helped HIV patients to get older [5]. The aim of this study was to determine the prevalence of older adults amongst the HIV patients in our cohort and to evaluate the clinical characteristics and evolution in comparison with younger patients. ). Presentation to care with advanced disease was strongly related to age at presentation ranging from less than 25% in younger than 25 yo to close to 50% in older than 60 yo. On the contrary timely presentation to care decreased with age at diagnosis (Figure 1). Along the 3 observed years presentation to care with more than 500 CD4 does not exceed 20%.
Conclusions: Late presentation to care and presentation with advanced HIV disease remain a big problem in Latin America as a direct consequence of insufficient testing in the region. This is especially the case for elderly people who are at increased risk to present to care very late. Strategies to increase testing are usually Abstract P042- Figure 1. CD4 count at presentation to care by age. A decision to shorten therapy to 8 weeks is based on treatment history, cirrhosis status and baseline VL. In a post-hoc analysis of the ION-3 (TN, NC patients) 8 week data, a VL <6M was the best predictor of SVR. RWE is often different from Phase III trials and there is a need to understand real-world 8 week regimens in a broader spectrum of patients. Methods: RWE 8 week LDV/SOF data is emerging from multiple single-centre and multicentre retrospective and prospective cohorts. In this analysis, the phase-3 ION-3 data is compared with data from several diverse real world populations and one postmarketing investigator sponsored HIV/HCV trial. Patient demographics, characteristics, SVR12 and discontinuation data has been collated and compared.
Abstract P050- Two per cent had no data, n/a = not available. a Mean age used. recombination during transfection. PCR amplified plasmids and Nhe I linearized vector pNL4-3ΔV3 were cotransfected in 293-T cells to get the recombinant viral particles and then allowed to infect Ghost CD4 cell lines expressing either CCR5 or CXCR4 to determine tropism. Infection was confirmed by an approximately. Twenty fold more GFP expression of infected cells over noninfected using a fluorescence microscope. Previously described TRT phenotypic assay with pNL4.3ΔV was also performed [1]. Results: Recombinant viruses containing V3 region from pNL4.3 and pNLAD8 showed GFP expression only in Ghost (3) CXCR4 cells and Ghost (3) Hi5 cells, respectively, consistent with the known coreceptor specificity for these strains. There was no GFP expression in mock cells. TRT assay was also performed with reference strains; pNL4.3, and results were in concordance with our assay. Conclusions: We have successfully developed a phenotypic assay based on V3 region of gp120 only, further strengthening the tropism prediction capacity of V3 alone. Small fragment size used here, in comparison to standard assays, makes the laboratory amplification more efficient. The assay eliminates the selective bias associated with selection of X4 viruses in cultures and could be validated to use with proviral DNA, providing advantage for tropism testing of patients with undetectable viremia. Validation of this assay with clinical samples compared to gold standard methods is warranted.

P056
The pace of co-receptor tropism switch in HIV-1 infected individuals after recent infection Introduction: Prediction on switching HIV-1 co-receptor usage over time is uncertain. Here we analyzed timing and predictors for coreceptor evolution amongst HIV-1 recently infected individuals. Methods: Proviral DNA was longitudinally evaluated in 66 individuals using Geno2Pheno false positive rate (FPR). Demographics, viral load, CD4+ and CD8+ T cell counts, CCR5 Δ32 polymorphisms, GBV-C and HLA profile were evaluated. Samples were analysed at baseline and end of follow up. For individuals with a discordant tropism result at the two time points, intermediate samples were also investigated to confirm tropism switch. Ultradeep sequencing (UDS) was performed at initial samples of 11 selected individuals to identify minor HIV strains, which could relate to tropism switch. Logistic regression analysis was performed to determine the FPR cutoff with tropism prediction potential. Results: The mean follow up was 59.5 months (range: 3.7-117.4); >71% were followed for more than 48 months. Tropism switches from R5 to CXCR4 using strains were identified in 9/49 (18.4%).
Only FPR was retained as the significant predictor of tropism switch. Strains with intermediate FPR were identified during evolution towards CXCR4-use and a consistent trend of FPR decay over time was observed with a mean evolution time of 27.29 (range: 8.90-64.62) months amongst ART naïve subjects. UDS of 4/5 R5/ Non-R5 switchers identified no minority CXCR4 using variants in the initial samples. Logistic regression analysis showed that patients with FPR>40.6% presented a stable FPR over time, whereas lower FPRs tend to progressively decay towards to emergence of CXCR4 using strains.
Conclusions: FPR threshold above 40.6% may preclude further tropism determination for prediction of disease progression related to emergence of X4 strains or use of CCR5 antagonists. The detection of variants with intermediate FPRs and the progressive decay of FPRs over time, not only strengths the power of Geno2Pheno in predicting HIV tropism, but also indirectly confirms that a continuous evolution from earlier R5 variants towards CXCR4 using strains is occurring amongst some HIV quasi-species. Larger studies are warranted to confirm the FPR threshold in which tropism will not switch.

P057
Analysis of HIV-1 tropism prediction through deep sequencing genotyping data in patients with treatment failure Introduction: The cell fusion inhibitor, C-C chemokine receptor type 5 (CCR5) antagonist Maraviroc, is ineffective against HIV-1 that does not utilize the CCR5 cell co-receptor for viral entry. A viral genotyping test is suggested to indicate the viral tropism, its co-receptor preference for CCR5 or other co-receptors, such as CXCR4, however, standard genotyping is unable to precisely detect minority variants (<20%), capable of impairing clinical treatment. Viral tropism prediction using deep sequencing genotyping data and standard genotyping data were compared to access the tests sensitivity. Methods: Standard Sanger sequencing and deep sequencing were used to sequence 44 samples of patients experiencing therapeutic failure of the Brazilian National Genotyping Network (RENAGENO), which covered representatives of the most prevalent viral subtypes in the country, subtypes B, C and F. Sequences were submitted to Geno2pheno algorithm to predict viral tropism.
Results: Viral tropism prediction using deep sequencing data detected non-R5 tropism in 19 samples versus 8 with Sanger based sequencing. Tropism predictions were compared demonstrating a concordance of 61.4% between the two sequencing techniques. The majority of discordant predictions (82.3%) occurred in samples with low (2-20%) non-R5 populations, according to deep sequencing data. When compared, subtype B had a lower viral tropism concordance (47.4%) between the different sequencing data used for tropism prediction, than subtypes C (83.3%) and F (66.7%). In addition, a positive correlation was observed between the total number of resistance mutations in the reverse transcriptase, and the presence of non-R5 variants in the samples, especially in subtype B.

Conclusions:
The results suggest a higher HIV-1 tropism prediction sensitivity when based on deep sequencing data other than standard Sanger sequencing data. This higher sensitivity is more apparent in subtype B than in subtypes C and F. The use of deep sequencing data to predict viral tropism in spite of standard Sanger sequencing data could be relevant in the choosing of antiretroviral regimens and its success.

P058
Genetic variability of HIV-1 in treated and untreated Cuban patients during 2016 Introduction: Knowledge of the genetic diversity of HIV-1 is a fundamental premise in epidemiological surveillance due to the presence and transmission of multiple subtypes and recombinant forms and their possible implications for highly active antiretroviral therapy (HAART). The objective of the present study was to determine the genetic variability of HIV-1 in a group of treated and untreated Cuban patients during the 2016. Methods: 86 HIV-1 infected patients who attended outpatient department during 2016 were included in this study. Of the total, 34 patients were receiving HAART and 52 patients were diagnosed during 2016 and did not receive HAART. Viral RNA was isolated from plasma and used to amplify the protease and reverse transcriptase regions of the HIV-1 pol gene by RTnested PCR. PCR products were sequenced and generated data used to determine the subtype by phylogenetic analysis. The resistance to antiretroviral drugs was evaluated according to HIVdb v6.1.1.
Results: The 79.1% of the patients were male and 73.2% of the infections were acquired by homosexual transmission. In the group of treated patients, the predominant viral variants were subtype B (38.2%) and CRF20_BG (29.4%) and 20.6% of the samples presented multiresistant viruses and resistant virus to the combinations of nucleoside reverse transcriptase (NRTI) and non-nucleoside reverse transcriptase (NNRTI) families. In the group of untreated patients, CRF19_cpx (23.1%) and URF (23.1%) were the predominant viral variants and at least one mutation associated with transmitted resistance was detected in 13.5% of samples, which were associated with the antiretrovirals used in the first therapeutic line in Cuba.

Conclusions:
The study showed high genetic variability of HIV-1 in treated and untreated Cuban patients. Continuous monitoring of HIV-1 resistance to antiretroviral drugs makes it possible to implement appropriate therapies for seropositive patients.