Background: Compared to the general population of people living with HIV (PWH), vulnerable PWH, such as those who use drugs, are disproportionately affected by HIV, and are predisposed to lower adherence to antiretroviral therapies (ARTs), which may result in poorer virologic suppression, worse health outcomes, and higher HIV transmission rates. Some may benefit from simpler single-tablet regimens that are effective, well-tolerated, and limit exposure to unnecessary medications. We evaluated clinical outcomes of vulnerable PWH who switched to the single-tablet, 2-drug dolutegravir/lamivudine (DTG/3TC).

Methods: This ongoing chart review study included PWH (≥18 years) in Canada who switched to DTG/3TC between 09/09/19-31/05/23, and had ≥1 of the following vulnerability criteria: recent drug use, opioid agonist use, recent or well-documented history of homelessness or receiving social assistance, Indigenous identity, or ≥65 years of age with diminished autonomy (‘vulnerable senior’). Descriptive summary statistics were generated for demographic and clinical characteristics at baseline (≤12-months pre-switch), and viral load and CD4+ cell counts at 6 (±2) and 12 (±2) months post-switch. Interim results are reported for the ongoing study.

Results: Across 5 sites, 20 eligible people were included (mean age: 49.9±13.0 years; male: 80%; drug use: 80%; vulnerable senior: 20%). Simplification of ART was the predominant reason for switch to DTG/3TC (n=11, 55%). At the time of analysis, 80% (n=16) had at least 6 months of follow-up, and one discontinued DTG/3TC due to intolerance. At 6 months, of those with test results, 8/8 were virally suppressed (<50 cps/mL), and median (IQR) CD4+ cell count was 815 (122.5) cells/mm³. At 12 months, 11/12 were virally suppressed (<50 cps/mL), and median CD4+ cell count was 920 (180) cells/mm³ (n=10).

Conclusions: Preliminary results suggest promising effectiveness outcomes among vulnerable PWH who switch to DTG/3TC. These results support the continued expansion of this study to include more PWH.

Background:
Cabotegravir and rilpivirine long-acting (CAB+RPV LA) is the only complete long-acting regimen for virologically suppressed people with HIV. The reduced dosing schedule of CAB+RPV LA (monthly or every 2 months) may alleviate adherence challenges with daily oral therapy and ease HIV status disclosure concerns. This study describes the real-world experience of Canadian physicians prescribing CAB+RPV LA, focusing on acceptability, convenience, and perceived barriers to CAB+RPV LA treatment.

Methods:
Physicians across Canada who treat ≥50 people with HIV and routinely prescribe CAB+RPV LA completed an online survey regarding perceptions of, and experiences with, CAB+RPV LA (window of recruitment: September 2023-February 2024).

Results:
Nineteen physicians (73.7% cisgender men, 94.8% managing >100 people with HIV) responded as of October 2023. The majority (84.2%) reported extremely/very positive views on implementing CAB+RPV LA in their clinic/practice. Notably, 94.7% of physicians rated reduced pill burden, patient convenience, and patient preference as important factors in CAB+RPV LA prescribing decisions. Seventy-four percent of physicians found CAB+RPV LA easy to integrate into their workflow, 84% reported CAB+RPV LA optimal implementation took ≤6 months in practice, and 80.0% of those with existing patient reminder/follow-up systems did not require any change to it. Ninety percent of physicians deemed the CAB+RPV LA support program clinics and primary care clinic/practice appropriate as alternate administration sites. While 31.6% of physicians expressed moderate concern about oral bridging, none were extremely concerned. Twenty-one percent of physicians expressed moderate concern about CAB+RPV LA injection site reactions, while none were extremely concerned.

Conclusion:
Understanding the current physician experience of prescribing CAB+RPV LA is important for optimal implementation of long-acting HIV treatments in practice and improving the experience of people with HIV. This real-world data (to date) from a small sample of Canadian physicians indicates a positive overall opinion, successful integration, and benefits of CAB+RPV LA.

Introduction: Despite global reductions in HIV, incidence in adolescents continues to increase. While risk-taking behaviour may contribute to heightened incidence, the effect of physical maturation and sexual debut remain uncharacterized among males, both of which may alter the genital microenvironment and lead to inflammation and susceptibility to HIV. Thus, we assessed both physical maturation and sexual debut as HIV risk factors in the male adolescent population.

Methods: We enrolled n=200 uncircumcised adolescent males aged 15-17 with no history of sexual experience, in the Rakai district of Uganda. Over three years of follow-up, we collected penile swabs, urine testosterone, and questionnaire data every 3 months. During this time, 84 adolescents sexually debuted (i.e., engaged in vaginal sex) and 77 adolescents elected to undergo Voluntary Medical Male Circumcision (VMMC). Tissues were collected during VMMC and HIV target cells were quantified by flow cytometry.

Results: 77% of participants completed 7/10 follow-up visits. 41% of adolescents reported initiating sex during the study. Urine testosterone positively correlated with age and Tanner staged. Of the participants who elected to be circumcised, 9 had sexually debuted before circumcision (12%), the median participant age was 16 years, the median Tanner stage was 4, and the median urine testosterone was 484 ng/dL. We observed no significant associations between the proportion of T cell subsets (Th1, Th2, Th17, Th22), HIV co-receptor expression, or T cell activation (HLA-DR+/CD34+) and participant serum testosterone, Tanner stage, or sexual experience.

Significance: Sexual maturation and debut are not associated with changes in the proportional abundance of different T cell subsets. Future research will use immunofluorescent microscopy to examine changes in tissue microstructure and density of other cell types (dendritic cells, macrophages). Addressing the gap in our understanding of sexual maturation changes throughout adolescence will help us better understand HIV transmission in this high-risk population.

People living with HIV or AIDS (PLWHA) experience higher rates of chronic illness than those people who do not have HIV. This may be related to issues such as the effect of: HIV, HIV medications, emotional distress, social exclusion, limited financial resources, individual participation in unhealthy practices and lower participation in health promoting activities.
The team focused on understanding the experience of PLWHA regarding their health and participation in health promoting activities. The intention being to design health promotion interventions that could improve the health of PLWHA.
The project was completed by a core peer team who gathered community information and designed solutions. PLWHA participated in focus groups regarding their health and their participation in health promoting activities.
A number of ideas were endorsed by community members and have been helpful in the development of health promotion interventions:
• The need to place PLWHA at the center of the intervention and including community members and peer supporters at the core of the health team.
• Building an integrated health promotion and primary care system that includes the individual along with peer supporters, family/friends, primary care doctors, specialist doctors, allied health services and social supports (including food, housing and financial supports).
• The integration of health and social care services with a focus on community assets that are meaningful to each individual community member.
The solution is an integrated community based primary care initiative that is intentionally individualized and includes peer led activity. The design is intended to make sure that the individual has the support to identify and access healthcare services and activities that best meets their needs. Processes of peer support are included and intended to help overcome the stigma that may be a barrier to accessing the health promoting activities and services that individual choose to participate in.

This paper summarizes the evaluation of a health design process for an HIV Health Neighborhood (HHN) that was designed to address health risk factors related to chronic health conditions. The HHN will engage people who are recently diagnosed with HIV along with people who have lived with HIV for a while. The goal of the design is to support newly diagnosed individuals to prevent chronic health conditions and to support those currently living with HIV and other chronic health conditions to manage their health more effectively. Currently health and social care are delivered in a very fragmented manner. In the HHN services will be supported by peer workers and delivered in an integrated way. The individual will have the opportunity to make the health promotion plan fit their life experience and values. The added value of the HHN lies, in the opportunities for peer led fellowship and support of group health promotion activities, and, the structured process of peer facilitated self-management. The peer support will be delivered in ways that have been demonstrated through research to be helpful for people living with chronic health conditions in being successful in their self-management, or, to prevent individuals from developing additional chronic health conditions.
The results of a community focus group are reported. The following design elements were considered by the focus group participants as having potential to address the needs that had been identified by community members:
• Health Neighborhood
• Individualized Peer Support, Peer Health Navigation and Peer Health Coaching
• Better Choices Better Health HIV
• Community-based development capacity.
The results of the community focus group endorsed the development of an integrated HHN with these elements.

Management of HIV-1 virologic failure without resistance includes reinitiation of antiretroviral therapy to regain virologic suppression. We examined outcomes following virologic rebound in people with HIV-1 receiving B/F/TAF.

Participants who received B/F/TAF in switch studies 1844, 1878, 1961, 4030, 4449 and 4580, and first-line studies 1489, 1490 and 4458, were included. Viral load was analyzed at baseline/Day 1, at Weeks 4, 8 and 12, then every 12 weeks through end of study plus unscheduled visits. Virologic rebound events (≥1 viral load ≥1,000 copies/mL after virologic suppression [<50 copies/mL]) were counted and categorized by subsequent virologic suppression or viremia (≥50 copies/mL). Time to virologic suppression (first value <50 copies/mL) after virologic rebound and duration of viremia (time between virologic rebound event and last ≥50 copies/mL value) were calculated.

In total, 110 virologic rebound events were identified in 96 of the 3,768 participants (2.5%; Table). Ninety-one virologic rebound events (82.7%) were followed by subsequent resuppression [median time: 23 days (interquartile range [IQR]: 19–38)]. Seven virologic rebound events (6.4%) were followed by continued viremia that persisted without resuppression for a median of 30 days (IQR: 14–87) before discontinuation of B/F/TAF, without emergence of resistance; 12 virologic rebound events (10.9%) were not evaluable (virologic rebound at last assessment). Excluding non-evaluable virologic rebound events, resuppression was noted in 91/98 (92.9%) virologic rebound events.

Among people who experienced virologic rebound after virologic control, the majority achieved rapid viral resuppression with B/F/TAF. No treatment-emergent resistance was observed, supporting the high barrier to resistance of B/F/TAF.

Background:
Cabotegravir + rilpivirine (CAB+RPV) administered monthly or every 2 months (Q2M) is the only complete long-acting (LA) regimen for maintaining HIV-1 suppression. In the Phase 3b SOLAR study, switching to CAB+RPV LA Q2M was noninferior to continuing daily oral bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF). We present results for North American (NA; United States and Canada) participants.

Methods:
SOLAR (NCT04542070) is the first randomized (2:1), open-label, multicenter, noninferiority study assessing switching virologically suppressed adults to CAB+RPV LA Q2M (with oral lead-in or starting with injections) vs. continuing BIC/FTC/TAF. The primary analysis was based on the prespecified modified intention-to-treat exposed (mITT-E) population (n=11 from 1 study site excluded from the ITT-E population for protocol deviation) at Month (M) 12. The primary endpoint was the proportion with HIV-1 RNA ≥50 c/mL. Other endpoints were the proportion with HIV-1 RNA <50 c/mL, incidence of confirmed virologic failure (CVF; 2 consecutive HIV-1 RNA ≥200 c/mL), safety and tolerability (ITT-E), and treatment satisfaction (HIV Treatment Satisfaction Questionnaire status version [HIVTSQs]).

Results:
Of 670 participants (mITT-E), 325 were from North America (LA, 66% [n=216/325]; BIC/FTC/TAF, 34% [n=109/325]). Baseline (BL) characteristics were similar between arms. At M12, 1 participant in each arm had HIV-1 RNA ≥50 c/mL. No NA participant had CVF in the mITT-E population; 1 (0.3%) NA participant excluded from the mITT-E population had CVF (LA arm). Adverse events (AEs), excluding injection site reactions, were similar between the LA (74% [n=164/223]) and BIC/FTC/TAF arms (73% [n=83/113]). More participants in the LA vs. BIC/FTC/TAF arm withdrew due to AEs (8% [n=17/223] vs. <1% [n=1/113]). Mean adjusted HIVTSQs scores improved significantly (p<0.001) from BL to M12 for LA (+3.40) vs. BIC/FTC/TAF (–1.07) participants.

Conclusion:
Consistent with the overall SOLAR population, switching to CAB+RPV LA from BIC/FTC/TAF was efficacious and well tolerated, with improved treatment satisfaction, in NA participants.

Background
Approaches to antiretroviral therapy (ART) adherence abound as to its definition, thresholds, assessment, addressed barriers, and proposed interventions. To gain clarity, this review synthesized these features across HIV clinical guidelines.

Methods
A scoping review was conducted. Eligible HIV guidelines and their updates concerned adults with HIV and ART from Organization for Economic Co-operation and Development (OECD) countries and international health organizations. English or French publications since 2017 were included. Three databases were searched in March 2023, along with grey literature in five guideline-specific databases. A targeted Google search for omitted OECD countries was conducted. Two reviewers participated in document selection and data charting. Content analysis was performed with NVivo software.

Results
There were 24 guidelines identified from 7 countries and 2 international health organizations. Only one (8%) provided a definition of ART adherence and none offered a threshold for adequate adherence (one (4%) addressed this topic, noting the lack of a minimum threshold). However, most guidelines (20;83%) reported interventions for adherence, including reducing pill burden (15;63%), education (13;54%), and peer or social support (13;54%). Nineteen guidelines (79%) highlighted methods to assess adherence, such as clinical assessment with patients (8;33%), viral load monitoring (6;25%), and examining pharmacy records or pill count (5;21%). Eighteen guidelines (75%) proposed a frequency for assessing adherence, including at each visit (11;46%) and suspected or observed drug resistance or virologic failure (8;33%). Fourteen (58%) guidelines identified adherence barriers, including lifestyle or activities (11;46%), social challenges (10;42%), and health system barriers (9;38%).

Conclusions
Despite its centrality to ART’s success, this review underscores a conspicuous lack of definition and consensus around adherence and its management. Very few guidelines define adherence, none offer an optimal threshold, and there is no agreement on how to gauge it. More systematic and preventative approaches to monitoring adherence may be needed.

Background: Pharmacists, often with limited interactions with people with HIV (PWH), need support in decision-making, providing antiretroviral treatments (ART), and updating HIV knowledge. MARVIN-Pharma, an artificial intelligence-based chatbot adapted from MARVIN for PWH, is under development to assist pharmacists. Its configuration and implementation should however be evidence-based.

Objectives: This study aims to ensure MARVIN-Pharma fulfills Québec pharmacists’ needs by assessing their knowledge, attitudes, involvement, and barriers in HIV care, alongside perceptions of MARVIN-Pharma's usability.

Methods: From December 2022 to December 2023, we administered an online bilingual (French and English) cross-sectional questionnaire, inspired by existing surveys, on perceived and objective knowledge, attitudes, involvement and barriers in HIV care, and perceptions of MARVIN-Pharma. Participants included Québec pharmacists, recruited through convenience and snowball sampling, beginning with affiliates of the National HIV and Hepatitis Mentoring Program. Descriptive statistics were generated, with an ethics exemption from the McGill University Health Centre.

Results: Forty-one pharmacists (28 community-based, 13 hospital-based) providing care in 15 Québec municipalities participated. Their perceived HIV knowledge as moderate corresponded to the objective assessment (50% correct answers), revealing gaps in ART, HIV symptoms, and pregnancy-related knowledge. Attitudes towards HIV care were mostly positive (76% favorable), with moderate involvement, peaking in ART adherence counseling (78% engaged) and lowest in post-exposure prophylaxis testing (24% engaged). Major barriers included time constraints (93%), limited staff resources (89%), inadequate clinical tools (82%), and insufficient HIV training (75%). Regarding MARVIN-Pharma's perceived usability, 47% welcomed it, 32% found it work-compatible, but 50% were undecided; 97% were confident using online resources.

Recommendations: For effective MARVIN-Pharma development, addressing pharmacists' knowledge gaps about ART, HIV symptoms, and pregnancy-related issues is crucial. It should include guidelines on adherence counseling and prophylaxis, considering time and training barriers. Continuous updates with ART regimens and active engagement with pharmacists are essential to ensure its adaptability and usability.

Issue: Malnutrition and food insecurity continue to persist among PLWH who use drugs with complex health and social needs. Existing services for people who use drugs (PWUD), such as supervised consumption sites often lack food programs, designated meal spaces, and integration of dietitian expertise. Previous studies indicate drug use influences dietary habits and nutrition status, and PLWH who use drugs are documented to experience significant barriers to HIV care. Integrated care facilities like the Dr. Peter Centre (DPC) utilize nutrition care as a means of engagement with overall health care. This presentation explores the role dietitians play in DPC’s short-term residential stabilization program.

Description: The DPC provides 12 stabilization beds to clients with complex conditions, including HIV, HCV, and mental health and substance use disorders. Dietitians collaborate with an interdisciplinary group of care providers to address complex aspects of client care, creating individualized nutrition care plans that support wellbeing beyond the stabilization program. A recent study found that following enrollment in the program, residents experienced reduced hospitalization (76% pre-admission to 23% post-admission one year after discharge); reduced ER visits: (79%-34%); and improved HIV medication adherence (55%-65%).

Lessons Learned: Dietitians contribute to engagement, stability, and belonging for DPC clients. Integrated care sites show that incorporating holistic and comprehensive nutrition care acts as an anchor to other services. Service users continuously report that meal programs are a crucial anchor to other services. With provision of dignified meal services, providers can take time to form therapeutic relationships, identify additional needs, and support continuum of care.

Recommendations: Integrate dietitians into short-term stabilization residence care programs as they participate in relational care to enhance holistic care for PLWH who use drugs. Addressing malnutrition and long-term food insecurity requires efforts beyond integrated health care programming, acknowledging poverty and substance use healthcare gaps as significant underlying factors.

BICSTaR is an ongoing, multinational, observational cohort study evaluating the real-world effectiveness and safety of B/F/TAF in treatment-naïve and treatment-experienced (TE) people with HIV (PWH).

This analysis included TE virologically suppressed PWH who started B/F/TAF with/without present/past evidence of HIV drug primary resistance mutations (PRMs). We report virologic and other outcomes at 12 months (M).

BL genotypic drug resistance testing data were available for 441/996 (44%) participants (ppts); most tests were historic (Table 1).

Of 441 ppts with BL resistance data, 105/441 (24%) had present/past evidence of PRMs: 13% to NRTI, 11% to NNRTI, 6% to PI, 0.2% to INSTI. The most common PRMs were M184V/I (39 [37%]), ≥ 1 thymidine analog mutation (TAM; 40 [38%]), K103N/S in reverse transcriptase (23 [22%]) and M46I/L in protease (13 [12%]). Primary resistance to > 1 ART drug class was observed in 40 (38%) ppts with PRMs. Ppts with preexisting PRMs were older (≥ 50 years), had more prior ARTs and more prior virologic failure, and had a longer time between HIV diagnosis and starting B/F/TAF.

At 12M, effectiveness (HIV-1 RNA < 50 copies/mL; missing VL data = excluded) was maintained in 78 (99%) and 739 (98%) ppts with, versus without, any BL PRMs, respectively. No treatment emergent PRMs to B/F/TAF were reported. Drug-related adverse events (DRAEs) occurred in 17 (16%) ppts with PRMs versus 113 (13%) without. . Additional outcomes are shown in Table 2.

After 12 months, virologically suppressed PWH initiating B/F/TAF maintained high rates of effectiveness despite the presence of PRMs.

Background: Single tablet regimens are associated with higher rates of sustained virological suppression and patient satisfaction. This is true of STRs including unboosted integrase strand transfer inhibitors with an increased barrier to resistance, tolerability, and fewer drug interactions. This is beneficial for marginalized populations, with challenges of adherence and lower tolerance for side effects. We have previously demonstrated sustained virologic suppression over 18 months among 41/43 HIV-infected active injection drug users following a switch of prior ARV therapy to the STR B/F/TAF. We sought to evaluate whether this benefit would be maintained over an additional 24 months of follow-up.
Methods: The inception cohort consisted of 43 individuals who were followed up after having received B/F/TAF for 18 months. They remained enrolled in a multi-disciplinary program, with B/F/TAF provided with enhanced adherence support, allowing daily observed therapy. The end point of analysis was the rate of virologic suppression after an additional 24 months of follow up, for a total of 42 months after initiating B/F/TAF therapy.
Results: 43 subjects were included in this analysis: median age 54 (34-66) years, 11.1% female, 20% indigenous, 37.8% men who have sex with men, and all were active drug users, with 91.1% being fentanyl users. At 18 months of follow up, we noted median CD4 count 612 cells/mm3. All 43 remained on B/F/TAF for the 24 months of follow up, with no long-term disengagement. 41/43 had maximal virologic suppression, including both participants with detectable HIV RNA at month 18. Two cases of detectable HIV RNA (1520 & 3000 copies/ml) were documented at month 42. In both cases, virologic suppression was achieved after resumption of B/F/TAF.
Conclusion: Among a group HIV-infected drug users experiencing transient viremia, switching to B/F/TAF remains effective in the long-term. Its efficacy and tolerability make it a useful therapeutic option in this vulnerable population.

Background: Single tablet regimens (STRs) have become the standard of care in the treatment of HIV infection, with high efficacy, good tolerability with enhanced adherence compared to multi-tablet regimens. Most STRs include an integrase inhibitor (II), which may be associated with side effects, including metabolic abnormalities and weight gain. The combination of tenofovir dipivoxil, lamivudine and the non-nucleoside reverse transcriptase inhibitor doravirine (TLD) is an STR that could be used among individuals who want or need to switch away for IIs, avoiding II-specific toxicities while preserving the benefits of the STR.
Methods: Among patients on II-based STRs who wished to change therapy were offered TLD as switch therapy. Subjects were monitored according to the standard of care, with HIV RNA and other relevant evaluations completed every 3 months or as clinically indicated. The end point of this analysis at 12 months post-switch was maintenance of TLD therapy, reversal of side effects experienced on II-based STR, safety and tolerability, virologic suppression and the development of drug resistance.
Results: We enrolled 28 subjects, median age 58.5 (36-80) years, 92.8% male, 14.3% indigenous, 19% active drug users. Median baseline CD4 count was 695 (180-1510) cells/uL, with 85.7% showing full virologic suppression. At 12 months, 25 remained on TLD (reasons for switch: 2 TLD-related side effects, and 1 other). Resistance to lamivudine and doravirine was documented among 2 subjects during the course of observation. Therefore, of those still on TLD 23/25 (92%) had maximal virologic suppression at 12 months.
Conclusion: Among a population of PWH enriched for vulnerabilities, TLD was generally effective, with few significant side effects. Little reversal of prior side effects attributed to IIs was observed, and virologic failure was observed in 2 cases, both associated with development of two class drug resistance.

TAF-containing regimens, e.g. B/F/TAF, are approved in Canada in people with an estimated CrCl ≥30 mL/min and have demonstrated comparable long-term renal safety vs non–tenofovir-based regimens. No proximal renal tubulopathies have been reported in 26 TAF trials or in a trial rechallenging those with history of tubulopathy on tenofovir disoproxil fumarate.

We investigated the renal safety profile and efficacy of B/F/TAF in the BICSTaR study, in which 963 TE participants with HIV switched from current antiretroviral therapy (ART) to B/F/TAF.

Of 843 participants with baseline (BL) eGFR data available, 90 had CKD (MDRD eGFR <60 mL/min/1.73 m2), 83% were male and 85% were non-Black. More participants with vs without BL CKD were >50 yrs old (79% vs 43%; P<0.001), had ≥1 cardiovascular condition (54% vs 20%; P<0.001), diabetes mellitus (12% vs 6%; P=0.029) and hypertension (44% vs 16%; P<0.001). Those with vs without BL CKD had longer prior exposure to ART and time from diagnosis to B/F/TAF initiation (Table).

Drug-related (DR) AEs were reported in 16% of people with BL CKD vs 15% in those without. A single DR renal AE (RAE) was reported in 1 person with BL CKD (proteinuria, drug continued); there were no DR RAE discontinuations or serious DR RAEs. Median eGFR was stable through 24 months for people with BL CKD (Fig.).

B/F/TAF was effective and safe with respect to renal outcomes in this real-world study, supporting use of TAF-based regimens in people with eGFR <60 mL/min/1.73 m2.

Background: Cognitive concerns are common among people aging with HIV (e.g., memory loss, difficulty concentrating). Aging with HIV and comorbidities—such as cognitive impairment—results in feelings of uncertainty. Uncertainty involves incomplete or inadequate information about one’s prognosis, treatment options, and outcomes and results in deleterious impacts, particularly when unaddressed. For people aging with HIV, uncertainties are heightened by intersecting experiences of HIV stigma, ageism, increased isolation and reliance on formal healthcare services, and amplified concerns about discrimination in care settings.

Methods: Peer-led focus groups discussed participants’ cognitive concerns and experiences of uncertainty. Purposive sampling was employed to recruit people aging with HIV (40+) in Ontario and Saskatchewan who all self-identified with 5+ cognitive concerns (e.g., memory loss). Three independent coders utilized thematic content analysis to identify themes across transcripts. Participants (n=45) ranged in age (M=53.22, SD=7.62) gender (20 women, 19 men, 6 trans/non-binary/2-spirit), ethnicity (20 White, 15 Black, 6 Indigenous, 4 Mixed-race), sexuality (19 gay, 18 heterosexual, 8 bisexual/queer/lesbian/2-spirit) and employment (15 employed, 30 retired/disability).

Results: Ten, two-hour focus groups were conducted online (August–November 2022). People aging with HIV described concerns with memory, concentration, and attention. Participants felt uncertain about what was causing these cognitive concerns, and how to manage these symptoms. They described hesitancy to seek cognitive screening due to uncertainties about the impact of test results on their lives. Participants reported a paucity of resources and education from providers about cognitive health, aging, and HIV. Some participants identified community resources to partially remediate their cognitive concerns.

Conclusion: Further research is needed to understand these uncertainties, their impacts, and remediation strategies. It is particularly important to explore the multi-faceted impact of uncertainties on individuals’ wellbeing, quality of life, and health-related decision-making.

Background. Hepatitis C virus (HCV) is a major cause of chronic liver disease worldwide. Development of significant liver fibrosis is associated with increased risk of hepatic outcomes. 45-55% of HCV patients develop hepatic steatosis (HS). The term “steatotic liver disease (SLD)” has replaced “nonalcoholic fatty liver disease (NAFLD).” SLD with cardiometabolic risk factors defined as “metabolic dysfunction-associated steatotic liver disease (MASLD).” The new nomenclature emphasizes the metabolic nature of HS and allow its coexistence with other conditions such as HCV. Therefore, we aim to investigate the effect of MASLD and HCV coexistence on liver fibrosis.

Methods. This was a retrospective, cross-sectional study including people with HCV monoinfection. Participants aged ≥18 years without HIV co-infection or other chronic liver diseases were included from 2 centers: McGill University Health Center (MUHC) and The Ottawa Hospital between the year 2014 and 2023. MASLD was defined as the presence of hepatic steatosis by controlled attenuation parameter (CAP) ≥275 dB/m plus one of the following cardiometabolic conditions: increased body mass index (BMI) and waist circumference; prediabetes or diabetes; hypertension; hypertriglyceridemia; low high-density lipoprotein. Liver fibrosis was defined as a liver stiffness measurement (LSM) of ≥7.1 kPa. The prevalence and cofactors of liver fibrosis were investigated.

Results. We included 590 people with HCV monoinfection. The prevalence of liver fibrosis was 57%, 48% 38% in MASLD, SLD without cardiometabolic conditions, and no steatosis group, respectively. After adjusting for age, sex, HCV RNA positivity, HCV genotype, and duration of diagnosis of HCV infection, cofactors of liver fibrosis were MASLD with prediabetes or diabetes (adjusted odds ratio [aOR] 4.92, 95% confidence interval [CI] 1.89-12.77; p=0.001) and MASLD with hypertension (aOR 2.25, 95% CI 1.18-4.29; p=0.01).

Conclusion. MASLD is associated with higher prevalence of fibrosis in people with HCV. Beyond pursuing virological cure, healthcare practitioners should target metabolic conditions.

Background:
CAB+RPV LA, the only complete long-acting regimen for virologically suppressed PWH administered monthly or every 2 months (Q2M), may alleviate daily oral ART adherence challenges. ABOVE evaluated real-world adherence and persistence to CAB+RPV LA versus continuing oral ART.

Methods:
ABOVE was a retrospective US cohort study using Symphony Health Solutions Integrated Dataverse administrative claims database (01/01/2020 to 12/31/2022) of PWH ≥12 years old continuing stable oral ART or initiating CAB+RPV LA. Index date was defined as first injection between 01/01/2021 and 6/30/2022 (LA cohort) or imputed for the oral ART cohort. PWH had to have ≥6 months of follow-up after index. Adherence (proportion of days covered ≥0.9 over 6 months following index) and persistence (days from index to earliest of discontinuation or end of follow-up) were compared.

Results:
393,484 PWH were identified (eligible: oral ART, n=130,362 [N=950 after weighting]; CAB+RPV LA, n=947). Key baseline characteristics were balanced post standardized mortality ratio weighting (Table 1). CAB+RPV LA dosing was mostly Q2M only (50%) or switched from monthly to Q2M (33%). A higher proportion of PWH in the LA versus oral ART cohort were adherent (72% vs 43%, p<0.001) and had higher persistence (274 vs 256 days, p<0.001). The LA cohort had significantly higher odds of being adherent compared with the oral ART cohort (OR: 4.43, 95% CI: 2.38, 8.24, p<0.001).

Conclusion:
Among US PWH on stable oral ART, switching to CAB+RPV LA resulted in significantly higher adherence and persistence, important for long-term treatment success, compared with continuing oral ART.

Background: Efficient HIV clinic triage, particularly in resource-limited settings post-COVID, is critical. Prior patient waitlist management was primarily time-based, and personalized patient-centred triage was hindered by a lack of clinical data linkage (antiretroviral prescription, relevant lab data, time since last appointment, etc.). Challenges with the current system were exacerbated during the COVID pandemic. This project develops and evaluates a personalized care plan triage tool with integrated patient data for improved workload quantification and individual patient and practitioner needs.

Methods: The Excel-based tool was developed with data validation and incorporates patient demographics, visit history, antiretroviral regimens, and lab results enabling automated priority-based scheduling through embedded formulas and conditional formatting. A logic model framework was used to guide the implementation and evaluation of the tool, including the delineation of inputs, activities, outputs, outcomes, and impacts.

Results: Collaborative input from the HIV medical director, administrative staff, nurse, and pharmacist informed design of the medical aspect of the appointment waitlist management tool. Their expertise identified key medical data variables, primary sources and workflow strategies. Data validation features reduced entry errors, ensuring accuracy and reliability of the data. Outputs generated patient profiles with effective, consistently assigned priority. Embedded analytics offered visualizations of patient volumes. Outcomes included improved prioritized patient management, optimized resource allocation, and enhanced care delivery.

Conclusions: Development and implementation efforts yielded a customized, functional and operational personalized care plan waitlist and triage tool within existing software, requiring no additional financial investment. It improves patient care, streamlines resource allocation, and optimizes clinic operations in a resource-constrained setting post-COVID. Future evaluation and refinement work aims to expand this tool's potential by inviting other interested HIV physicians and people living with HIV to extend the function and use of the tool.

Background: Access to fertility care, particularly medically assisted conception (MAC), presents an ongoing reproductive justice concern for individuals with HIV. Canadian research (2007/2014) revealed geographic disparities in access to fertility care for people with HIV. While the U=U principle has negated the recommendation for MAC to reduce horizontal transmission, it may still be pursued for clinical or personal reasons. Accordingly, this longitudinal study investigates current fertility care access for people with HIV in Canada, with a focus on MAC.

Methods: Ethical approval was obtained from Women’s College Hospital. Surveys were distributed to medical and laboratory directors from 58 fertility clinics across nine provinces, adapting a 2014 survey and disseminating it through REDcap. Proportions were used to evaluate clinic policies, MAC access, and awareness/implementation of Canadian guidelines. Responses were initiated by 24/89(27.0%) participants, representing 19/58(32.8%) clinics in 7 provinces. Complete responses were received from 16/24(66.7%) participants.

Results: Of the 19 respondents, 13(68.42%) reported that their clinic will see individuals with HIV in consultation, with an additional 2(10.53%) limiting this to people with an undetectable viral load. The 16 respondents who completed the survey answered questions about access to MAC. 12/16(75%) offer intrauterine insemination (IUI) if the viral load is undetectable, while 10/16(62.5%) offer in vitro fertilization (IVF) under the same condition. 12.5%(2/16) offer IVF regardless of viral load, 18.75%(3/16) do not offer IVF in the context of HIV, while 1 respondent was unsure of the clinic policy. Three-quarters of the respondents were aware of Canadian guidelines related to HIV. Among those adopting guideline recommendations, 75% found them helpful.

Conclusions: Access to fertility care and MAC for people with HIV has not substantially improved since 2014. While the study's low response limits the generalizability, findings suggest that advocacy efforts are warranted to address reproductive rights for people with HIV, emphasizing U=U.

Background: 

Adults aging with HIV are at higher risk for neurocognitive complications and geriatric syndromes including falls and frailty. Polypharmacy and potentially inappropriate medications (PIMs) can further increase these risks. Both anticholinergic (≥3) and sedative (moderate-high) burden scores are associated with increased falls risk. We examined polypharmacy, PIMs, and anticholinergic and sedative burden (ASB) among a cohort of older adults living with HIV in Canada. 

Methods: 

CHANGE-Rx is a substudy of CHANGE-HIV, a longitudinal Canadian cohort of people with HIV aged 65 years and older, established in 2019. Information on medication use, comorbidities, HIV-specific factors and frailty were assessed. Proportion of people with polypharmacy (≥5 non-antiretroviral therapy (ART) drugs), severe polypharmacy (≥10 non-ART drugs), and PIMs (Beers and Screening Tool of Older People's Prescriptions (STOPP) criteria) were determined. Anticholinergic burden was calculated using a combination of the Anticholinergic Cognitive Burden (ACB) scale and German Anticholinergic Burden Scale (GABS). Sedative burden was calculated using the Anticholinergic and Sedative Burden Catalog (ACSBC). 

Results: 

440 CHANGE-HIV participants were included. The median age was 69 (range 65-89), 91% men, 76% Caucasian, 77% MSM, 99.5% were virally suppressed, median CD4 nadir of 200 cells/mm3, median 26 years living with HIV, 15.5% were frail, 19.3% had a fall within the last six months. Excluding ART, 93.6% were on a median five (range 1-26) prescribed comedications, 56% had polypharmacy, 38% had severe polypharmacy, 48.9% had ≥1 PIM. Anticholinergic (≥3) and moderate-high sedative burden were in 17.4% and 41.3% of patients, respectively. Frail patients, compared to non-frail, had more severe polypharmacy, ASB and falls (p<0.05).

Conclusion:

Polypharmacy is common among older adults living with HIV in Canada, with many experiencing PIMs and high ASB. Interventions to address medication-related issues in the aging population are imperative. It remains to be determined if addressing polypharmacy/PIMs would impact falls and frailty.

Background
Non-AIDS comorbidities such as liver steatosis are linked with gut microbiota dysbiosis, gut permeability and inflammation in people living with HIV (PLWH) on ART. Camu Camu (CC), an Amazonian superfruit, modified the gut microbiota and decreased inflammation in obese mice and in smokers. In a single-arm pilot clinical trial, we assessed the influence of daily intake of CC on gut permeability and inflammation in ART-treated PLWH.

Methods
We recruited 22 ART-treated PLWH with a CD4/CD8<1 to select those with higher levels of inflammation. Participants took 1g of CC in capsules daily for 12 weeks while remaining on ART. Blood and stools were collected at 2 baseline visits, after 4 and 12 weeks of CC and 8 weeks after stopping CC. Plasma biomarkers were quantified by ELISA. Stool microbiota was characterized by 16S rDNA sequencing. HIV DNA and RNA in CD4 T-cells were quantified by nested qPCR.

Results
Median age was 53, and 21/22 were male. CD4, CD8 counts, and viral load remained stable. Participants lost a median of 1.2 kg after 12 weeks of CC. Serum levels of liver enzymes AST and ALT decreased from baseline to week 4 (p<0.01) and tended to decrease at week 12. Levels of gut damage markers I-FABP and REG3α tended to decrease at week 4.
Gut microbiota composition remained stable at the genus level during the study.
Plasma levels of CC-chemokine ligand 20 (CCL20), an attractant of protective Th17 T-cells in the gut, decreased at week 4 (p=0.002). Plasma TNFα levels tended to decrease at week 4.
A 1.3-fold increase in HIV RNA levels in CD4 T-cells was observed at week 20 only (p=0.03).

Conclusions
CC intake slightly reduced weight, liver transaminases and tended to decrease inflammation in ART-treated PLWH. This effect should be validated using higher dose of CC in larger studies.

Background: Recent studies indicate that while the dissemination of Clinical Practice Guidelines (CPGs) has improved clinical outcomes, there remains a gap in adapting guidelines for patient and community use. While the Canadian HIV Pregnancy Planning Guidelines (CHPPG) provide a framework for clinicians to support the reproductive and parenting planning needs of people with HIV, to fully integrate evidence and CPGs into practice, the creation of resources tailored for patients and community members is paramount.

Methods: In 2019, the CHPPG Implementation team engaged three community consultants with diverse expertise to enhance community dissemination. Collaborations between these consultants, clinicians, and our research team led to a partnership with The Public, an activist design studio. Together, we facilitated a co-creation process to produce CHPPG-informed resources tailored for the community.

Results: Through a co-design process involving 11 individuals with HIV from across Canada, the team developed a multimedia digital toolkit. This toolkit, informed by both academic research and lived experience, provides a unique intersectional perspective aimed at empowering individuals with HIV to advocate for their parenting planning options and rights. Notably, the toolkit features vignettes and audio recordings of five personal parenting planning journeys, offering a deeply personal and relatable touch. The toolkit has been well-received in initial community feedback sessions, indicating its potential as a valuable resource.

Conclusions/Implications: The development and dissemination of CPGs tailored for community audiences are seldom documented, yet our project demonstrates the feasibility and impact of such an approach. The digital toolkit, led and informed by community consultants, design team members, and research team mentors, exemplifies a successful co-design framework. This model not only fosters effective community engagement but also sets a precedent for future initiatives aiming to translate complex guidelines into accessible, community-driven resources. Further research will explore the toolkit's long-term impact on community empowerment and health outcomes.

Poster only

Only poster

Background Injectable anti-retroviral treatment is a new option for people living with HIV. Selected individuals can receive one intramuscular injection per month or bimonthly instead of a daily pill. We examined access to and interest in injectable ART within a cohort of people living with HIV (PLHIV).
Methods The OHTN Cohort Study (OCS) is a longitudinal cohort following people living with HIV at 15 clinics in Ontario. Questions regarding injectables were added to the annual interviewer administered questionnaire in 2022. Participants were asked about preferences for injections, if they took injectables and how they covered the cost, and interest in injectables. Results were compared to the demographics and HIV risk factors.
Results The sample includes 1,997 respondents. 37 (1.9%) were already taking injectable ART, but another 63.7% said they probably or definitely would, if offered. Of those currently taking injectables, 11 (29.7%) were receiving it through a clinical trial, 16 (43.3%) through public insurance and 5 (13.5%) through private insurance. The greatest percentage of those already on injectables was in Ottawa/Eastern Ontario (3.3%) followed by Toronto (2.0%). 22.6% of participants said that they would do an injection as frequently as once a month and 30.9% would do once every six months. 40.7% prefer to get an injection in their HIV clinic, with 25.2% in pharmacy and 11.8% at home. People living with HIV for 1-10 years were more interested in injectables (71.2%) compared to those living with HIV for more than 20 years (59.0%) (p=0.006). Interest appeared to differ slightly by key population (PWID 58.9%, Women 65.5%, GBMSM, 65.4%, ACB 69.6%).
Conclusions While uptake of injectable ART was low in the cohort, participants showed strong interest in the option of an injectable. As this new option is available, it is important for physicians to discuss injectables with their patients.

B/F/TAF Studies 1489, 1490, 4458, 1844 and 4030 demonstrated the noninferior efficacy of B/F/TAF versus DTG + 2 nucleoside reverse transcriptase inhibitors (NRTIs). We retrospectively assessed drug adherence and effect on virologic outcomes.

All studies were double-blind, placebo-controlled, and enrolled treatment-naïve (1489, 1490, 4458) or virologically suppressed (1844, 4030) adults. Participants were randomized 1:1 to receive B/F/TAF or DTG + 2 NRTIs (Table) plus placebo; thus, all received multiple tablets. Adherence was calculated by pill count.

2,622 participants were included (B/F/TAF: 1,306; DTG + 2 NRTIs: 1,316). The proportions of participants with high (≥ 95%), intermediate (≥ 85%‒< 95%) or low (< 85%) adherence were similar; few had low adherence (B/F/TAF: 46 [3.5%]; DTG + 2 NRTIs: 69 [5.2%]). In the B/F/TAF group, virologic suppression (HIV-1 RNA < 50 copies/mL) was similar in high and intermediate adherence versus low adherence. In the DTG + 2 NRTI group, virologic suppression was significantly higher in high and intermediate adherence compared with low adherence (P ≤ 0.002, Figure). Similar results were observed at W144 . Nine participants with low adherence had HIV-1 RNA ≥ 50 copies/mL at their last visit through W48: 3 subsequently resuppressed (B/F/TAF: 1; DTG + 2 NRTIs: 2), 5 discontinued (all DTG + 2 NRTIs) and 1 lost to follow-up (B/F/TAF).

Most participants receiving either B/F/TAF or DTG + 2 NRTIs demonstrated ≥ 85% adherence. In those with suboptimal adherence, B/F/TAF maintained high levels of virologic suppression, while those with suboptimal DTG + 2 NRTI adherence had reduced virologic suppression.

Background:
Treatment of acute bacterial skin and skin structure infections (ABSSSIs) with parenteral antibiotics is difficult in marginalized populations including PWID due to challenges with homelessness necessitating prolonged hospitalization for IV therapy, and frequent accessing of IV lines for drug use. Dalbavancin which is a novel lipoglycopeptide antibiotic with activity against gram-positive organisms with a duration of action of 7-14 days may be an ideal antibiotic in patients in whom administering parenteral antibiotics may be difficult.

Methods:
Prospective cohort study consisting of 19 patients who were referred to the Cellulitis Clinic at London, Ontario, Canada who were referred for ABSSSI between February 1st and July 30th, 2023. Patients were treated as outpatients with one dose of IV dalbavancin. Patients had social factors which precluded administration of outpatient parenteral antibiotics in a traditional setting, such as injection drug use, severe psychiatric comorbidities, or unstable housing.

Results:
The median age of patients enrolled was 43 (range 36 to 56), were predominantly male (74%), unemployed (90%), and with unstable housing (58%). Treatment with dalbavancin was successful in 13/19 (68%); indeterminate (presumed success as could not be reached for follow-up but were not admitted to any institution within our catchment area) 3/19 (16%); Failure (needed further antibiotics following dalbavancin) 3/19 (16%).

Conclusions:
Administering dalbavancin through a single IV infusion eliminates the need for indwelling IV access and may enhance treatment of ABSSSI without the need for hospital admission, in those with challenging socioeconomic factors who may have difficulty with adherence to outpatient antibiotic therapy.

Background: Routine viral load (VL) testing is recommended for pregnant women living with HIV (WLWH) antenatally to confirm viral suppression and inform the appropriate mode of delivery, although the exact timing of this bloodwork varies. Our hospital implemented a policy for physicians to order and for nurses to draw VLs for all pregnant WLWH on admission to Labour and Delivery, to obtain an up-to-date virological status immediately prior to delivery. This study characterized VL testing practices over the past ten years since the implementation of this policy.

Methods: Retrospective chart review of all pregnant WLWH admitted to Labour & Delivery at St. Michael’s Hospital in Toronto, Ontario from January 2013 – December 2022. Outcomes of interest included VL order status and drawing status. Statistical analyses stratified these outcomes by antenatal data, admission date and diagnosis, group B Streptococcus (GBS) status, and labour epidural usage.

Results: This study identified 135 admissions among pregnant WLWH. The majority had VLs ordered (61.5%) and drawn (85.9%) on admission. VL ordering improved over the latter half of the study period (44.6% vs 82.0%, p<0.001). More VLs were ordered among GBS-negative patients (71.3%) compared to positive (41.4%) (p=0.031) and among those who received an epidural (74.2% vs 50.7%, p=0.020). More VLs were drawn by nurses among patients who delivered during the admission (90.9% vs 42.9%, p<0.001) and patients who received an epidural (93.5% vs 79.5%, p=0.019).

Conclusions: While the rate of ordering VLs gradually rose over the course of the study, the rate of drawing VLs remained high throughout the decade, indicating that nurses consistently drew the bloodwork irrespective of a written order. VL testing varied by GBS status, epidural usage, and delivery status. These findings offer opportunities to improve VL testing and to guide future clinical practices on virological testing prior to delivery.

Background: Maintenance of a suppressed viral load (VL) allows people living with HIV (PLWH) to experience health and longevity, while also eliminating transmission of HIV to sexual partners. We examined the frequency of virologic failures among those in care using a longitudinal cohort study.
Methods: OCS is a longitudinal cohort of PLWH receiving care in 15 clinics across Ontario. VL data are obtained through chart review and linkage with the Public Health Ontario Laboratory, which provides all VL testing for the province. Virologic failure is defined as a person who had achieved viral suppression (VL<200 copies/ml) who later experience a VL higher than 200 copies/ml. Analysis was limited to participants receiving VL tests any time from 2007-2021, and whose first viral load was not suppressed (n=5,858).
Results: Among those virally suppressed in 2007 (n=4,444), 438 experienced VL failure that year (9.9%). This has improved steadily over time; in 2021 (n=4,728) 185 individuals experienced VL failure (3.9%). The frequency of VL failure per person has also declined. For those with a first VL in 2007 (n=207), the median (IQR) number of VL failures was 2(1-3), while those with a first VL in 2017 (n=126) the median (IQR) was 1(1-2). Among those who experienced VL failure and were re-suppressed in 2007 (n=416) it took a median (IQR) of 197(89-630) days to achieve VL suppression again, as compared to those experiencing VL re-suppression in 2017 (n=232), where it took a median of 116(56-294) days.
Conclusions: While a very high percentage of people on treatment are able to achieve viral suppression, virologic failure is not uncommon. Most are able to re-achieve VL suppression, though it can take some time. Outcomes have improved over time, and the drivers of continued virologic failure must be better understood.

Background
Metabolic dysfunction-associated steatotic liver disease (MASLD), a positive, non-stigmatizing definition emphasizing the association with metabolic disease, has recently replaced non-alcoholic fatty liver disease (NAFLD). The impact of MASLD definition in comparison to NAFLD in people with HIV (PWH), who are at high risk for this liver disease, remains unexplored.

Methods
We conducted a cross-sectional study of two prospective cohorts comprising PWH on stable antiviral therapy screened for hepatic steatosis, defined as controlled attenuation parameter ≥248 dB/m, and significant liver fibrosis, defined as liver stiffness ≥7.1 kPa, by fibroscan. PWH with alcohol abuse were excluded. NAFLD was defined as hepatic steatosis without Hepatitis B virus (HBV) or Hepatitis C virus (HCV) co-infection. MASLD, which does not require exclusion of HBV or HCV coinfection, was defined as hepatic steatosis plus any among overweight, diabetes, hypertension, or dyslipidemia. Factors associated with both conditions were explored by logistic regression.

Results
We included 1947 PWH (mean age 54 years, 74% males, median HIV duration 21 years, median current CD4 703, 98% with undetectable HIV viral load). NAFLD was diagnosed in 618/1714 (36.1%) PWH, after excluding those with HBV (1.2%) and HCV (9.2%), while 648/1947 (33.3%) PWH fulfilled MASLD criteria. Figure 1A depicts proportions of PWH with NAFLD, MASLD and NAFLD/MASLD overlap. Out of 618 PWH with NAFLD, 483 were reclassified as MASLD (78.1% overlap). Prevalence of significant liver fibrosis was 9.9% in no NAFLD-no MASLD, 9.3% in NAFLD-no MASLD, 26.5% in NAFLD/MASLD overlap, respectively. Male sex, CD4, triglycerides and BMI were associated with NAFLD/MASLD, while significant liver fibrosis was associated with MASLD (Figure 1B).

Discussion
There is substantial overlap between NAFLD and MASLD definitions in PWH. Interestingly, given the association between significant liver fibrosis and MASLD, this new definition may better characterize PWH with hepatic steatosis requiring surveillance and interventions to manage liver fibrosis.

OBJECTIVE:To examine changes in physical activity, body composition, and strength among adults with HIV engaged in an online community-based exercise (CBE) intervention.

METHODS:We conducted a 12-month intervention study with adults with HIV. We measured engagement in physical activity weekly, and body composition, and strength outcomes bimonthly across two phases: 1)Intervention: participants were asked to exercise 3 times/week, supervised biweekly with online personal coaching, and monthly online educational sessions (6-months), and 2)Follow-Up: participants were asked to continue exercising thrice weekly, independently (6-months). We used segmented regression to assess the change in trend (slope) between phases.

RESULTS:Of the 32 participants who initiated, 22(69%) completed the intervention; and 18(56%) completed the study. The majority were males (69%), median age was 53 years (25th,75th percentiles:43,60), with a median of 3(1,7) concurrent health conditions. Median number of coaching sessions attended across participants was 10/13(77%). Participant engagement in ≥30min of moderate-vigorous physical activity in the past week increased a median of 0.02 days/week (95%Confidence Interval(CI):0.01,0.04), from 3.24 days at baseline (95%CI:2.69,-379) to 3.77 days (95%CI:3.22,4.33) at the end of intervention. At end of the intervention there were mean decreases for weight (-1.2kg), body mass index(BMI) (-0.6kg/m2), and waist circumference (-3cm); and mean increases for push-ups (7 in a minute), plank time (39sec), sit-to-stand (3 in 30sec), and sit-and-reach (3.6cm). During the 6-month intervention, the monthly rate of change (slope) was significant for weight (-0.2kg/month;95%CI:-0.39,-0.04), BMI (0.1kg/m2;95%CI:-0.13,-0.01), waist circumference (-0.5cm;95%CI:-0.69,-0.28), push-ups (1.2 pushups/month;95%CI:0.88,1.52), plank time (6.5sec/month;95%CI:4.72,8.33), sit-to-stand (0.5 times/month;95%CI:0.28,0.75), and sit-and-reach (0.6cm/month;95%CI:0.36,0.88). During follow-up, there was a reduction in benefits compared with those observed during the intervention for push-ups, and plank time.

CONCLUSION:Participants who remained in the study demonstrated increases in physical activity and improvements in strength, and body composition during the CBE intervention. Future research should consider strategies that support retention and engagement in physical activity.

Antiretroviral therapies (ART) have reduced HIV infection-associated morbidity and mortality improving the quality of life of people living with HIV (PLWH). However, the risk for co-morbidities such as cancer, neurocognitive disorders, liver dysfunction and cardiovascular diseases (CVDs) remains elevated owing to chronic inflammation and immune activation fueled by residual HIV production, microbial translocation and immune-dysfunction. Emerging evidence has shown chronic inflammation and immune activation amplifying the risk for CVDs, which is further aggravated by life-style factors and dyslipidemia among ART-treated PLWH. Lipid-lowering statins are emerging as immune-modulators in a variety of conditions including HIV. Herein, we reviewed recent studies showing pleiotropic effects of statins among ART-treated PLWH. We used multiple combinations of terms on pubmed database including “HIV, co-morbidities, statin(s), pleiotropic functions, inflammation and immune-modulation” to search relevant studies besides citing our published primary research.

The international RCT REPRIEVE recently shed light on reduction of CVDs with statin therapy among PLWH indicating more than expected benefit of statins beyond lowering lipids. However, muscle-related symptoms and incident diabetes mellitus limit statin use besides interactions with certain earlier ART regimens still in use. Despite such adverse effects, statins constitute 1st-line therapy for decreasing CVDs owing to their overall safety and efficacy. The anti-inflammatory and immune-modulatory functions of statins are associated with decreases in plasma levels of C-reactive protein, soluble CD14 and ox-LDL, inhibition of NF-KB, nitric oxide production and decrease in T-cell activation (Figure-1). Overall, the broader implication of statins can guide policy to lessen co-morbidities among aging PLWH taking long-term ART.

Background: Prior research shows women with HIV experience mental health concerns, including depression, anxiety and post-traumatic stress disorder (PTSD) more often than women without HIV. Immigrants to Canada face multiple barriers such as access to healthcare, language challenges, and lack of social support. Yet, there remains a paucity in the research of mental health of immigrant women with HIV. Our objective is to describe and compare the mental health of immigrant women with and without HIV.

Methods: Demographics and psycho-social variables were assessed via the BCC3 questionnaire. Groups were compared by Wilcoxon, Chi-squared or Fisher’s Exact tests. Immigration was defined as those who were not born in Canada. Multivariable logistic regressions assessed associations between psycho-social variables and HIV status (Table 1).

Results: Participants (n=155) are described in Table 1, with 57% (n=80) of them having >= 1 mental health concern. In the multivariable logistic regression models, mental health concerns (PTSD, General Anxiety and Depression) were similar by HIV status (all p>0.05). Higher resilience and social support were independently associated with lower odds of having >=1 mental health concern (adjusted odds ratio (AOR) = 0.94 [95%CI: 0.89-0.99], p<0.001 and AOR=0.73 [95%CI: 0.63-0.83], p<0.001 respectively).

Conclusion: Mental health did not differ by HIV status. However, our data revealed a high prevalence of mental health concerns among immigrant women, and significantly less social support for immigrant women with HIV than controls. Our data reflects a considerable need for immigrant-specific initiatives to build community and reduce stigmas, a likely stress for newcomers to Canada.

Our study examined the impact of Dolutegravir (DTG)-based antiretroviral treatment on the maternal metabolome during pregnancy and its potential effects on fetal development, focusing on metabolite changes in maternal plasma and liver in a mouse pregnancy model.

Pregnant C57BL/6J mice were divided into control (water, N=10), 1x-DTG (2.5 mg/kg, N=10), and 5x-DTG (12.5 mg/kg, N=11), with DTG administered alongside 50mg/kg tenofovir disoproxil fumarate and 33.3mg/kg emtricitabine (TDF/FTC). Metabolites in maternal plasma and liver (N=31 each) were analyzed using liquid chromatography-mass spectrometry. Welch’s t-test was used to test for significant differences between groups.

Significant metabolite differences were observed in maternal plasma and liver from mice treated with DTG-based ART compared to control. Compared to control plasma from the 1xDTG+TDF/FTC group had 73 (24 upregulated, 49 downregulated) and from the 5xDTG+TDF/FTC group 385 (264 upregulated, 121 downregulated) metabolite differences. Liver from the 1xDTG+TDF/FTC group had 80 (22 upregulated, 58 downregulated) and from the 5xDTG+TDF/FTC group 315 (74 upregulated, 241 downregulated) metabolite differences. In the one carbon metabolic pathway we observed higher plasma choline phosphate, betaine, adenosylhomocysteine, and cysteine levels, while liver choline phosphate, betaine, and cystathionine levels were lower in the 5xDTG+TDF/FTC group versus control. In carbohydrate and energy metabolic pathways, plasma glucose and pyruvate levels were significantly higher in the 5xDTG+TDF/FTC group versus control, while fructose 6-phosphate, dihydroxyacetone phosphate, and pyruvate were higher in liver of the 1xDTG+TDF/FTC group versus control. In lipid metabolic pathway, phosphatidylethanolamine levels were higher while free fatty acids were lower in the 5xDTG+TDF/FTC plasma and liver versus control. Dicarboxylate fatty acids were lower in the liver of both DTG groups, but higher in the plasma of the 5xDTG+TDF/FTC group versus control.

Plasma and liver from pregnant mice receiving DTG demonstrated dose-response alterations to metabolites associated with one carbon, carbohydrate and energy, and lipid metabolism pathways.

Background: Women 45 + newcomer HIV+TB older Adult are facing mental health issues because misundertood the stystem after been accepted .Because of canadian law all the people who claim refugee need immigration test in three different categories, HIV,TB and Syphilis.The problematic cause mental health of women newcomer 45+ HIV+ TB Stigma is because they receive the news of disease without counselling. women with serious mental illness have higher morbidity and mortality .

Method: We create social group in safe places for women living with HIV and have experience of living with TB to come together to learn .The support session provided a safe place where women can speak about mental health issues ,medication, and accessing services and program.It is a place to empower and interact with each other and build each other capacity and knowlegde of HIV, TB stigma its related issues.They gain a sence of family and connection through cookig ,designer, knitting and other subject that women can bond, and learn.Peer support who run these groups received training in supporting and mentoring as home base care provider and facilitator.

Result: This project engaged 60 HIV+ 45 + TB stigma group exercises and skills capacity building activities at workshops. The workshop were hosted in Toronto (n=30),London Ontario (n=20) and Quebec (n=10) all workshop took place between March and june 2023 ,each lasting 6.5 hours The workshop participants identify themselves as follows 72% as female ,28% as transwomen and they age range was 45-65 87% identify as female, 13% identify as transwomen attend the group session.

Conclusion: We are confident that social group for womens living with HIV,TB help to seek services ,reduce isolation and promote adhrence .Meaningful Involvement is more that inviting women at decision making tables but also addressing stigma and other personnal barriers that women might have.

Background: New HIV infections occur every year in Canada, emphasizing the need for integrated prevention programs. Pre-exposure prophylaxis (PrEP) and Post-exposure prophylaxis (PEP) are standard-of-care HIV prevention strategies for which the Canadian guidelines will be updated in 2024.
Methods: We assembled a multidisciplinary panel of experts and identified clinical questions that were priorities for the guidelines to address. We conducted updated systematic reviews of PrEP and PEP literature and constituted sixteen writing groups among panel members to update the guideline text. Community engagement has been critical to the process and has involved the inclusion of community member panelists, literature review, and consultation meetings with national community and professional stakeholder groups on priorities and expectations for the updated guidelines.
Results: The 19 panelists represent five regions of Canada and diverse disciplines (infectious diseases, internal medicine, primary care, adolescent medicine, emergency medicine, pharmacy, nursing, public health, community, and knowledge translation). Key questions for the guidelines to address were clinical indications, regimens, testing strategies, and transitions between PEP/PrEP. Systematic reviews included data from 101 full-text articles (79 PrEP, 22 PEP). During consultations with 9 community stakeholders and professional groups, priorities were: 1. Broadening PrEP eligibility criteria, 2. Equitable access to PEP and PrEP, 3. Modifying messaging/language to be more inclusive of diverse groups; 4. Practical/clinical considerations (e.g., choosing between prevention modalities, PEP/PrEP transitions, safety monitoring); 5. Engaging a wider range of PEP and PrEP prescribers; 6. Integration of PEP/PrEP into other healthcare services; 7. Effective knowledge translation of the final guideline. Participants comprised groups that promote the health of sexually diverse people and genders, women, racialized communities, indigenous people, injection drug users, nurses, and pharmacists in HIV/AIDS care.
Conclusions: The panel will next formulate recommendations using the GRADE framework and gather stakeholder feedback before final dissemination planned for mid-2024.

Introduction: There is significant heterogeneity among CM users in frequency of use and related symptoms. This heterogeneity may be correlated with differences in sexual health factors such as bacterial STI and HIV diagnoses.

Methods: We used Latent Class Analysis (LCA) to identify distinct patterns of CM use using the WHO-ASSIST scale and related symptoms using baseline survey and nurse-administered testing data from the Engage Cohort Study (2017-2019). Based upon bivariate analyses with CM use class, we selected demographic, sexual health, and STI and HIV diagnoses in a multinomial logistic model to examine associations with class membership.

Results: Among 228 CM-using GBM in Engage, four classes best fit the data: Class 1, Occasional users without reported concerns and problems (36.0%); Class 2, Occasional users with reported concerns and attempts to stop/control use (25.9%); Class 3, Monthly users with consequences (10.5%); and Class 4, Weekly users with frequent consequences (27.6%). In the multinomial regression (see Table), we found multiple Class differences. Class 1 had lower sexual compulsivity and escape motives than Classes 3 and 4. Class 4 was most likely to have GBM living with HIV. Injection drug use differed between classes, with the highest in Class 3 > Class 4 > Class 2 > Class 1 being the lowest.

Discussion: CM use classes differed in frequency and patterns of use and multiple STI and HIV-related variables. Our analysis underscored the importance of better integrating CM-specific health promotion and harm reduction services into GBM-serving STI/sexual health agencies and clinics.

Introduction: The intersection of the HIV care continuum with the challenges posed by the COVID-19 pandemic has significantly altered the healthcare landscape in middle-income countries, amplifying existing vulnerabilities. Limited financial resources and pandemic-induced restrictions have exacerbated healthcare inequities. This systematic review aims to elucidate the structural dimensions of the impact of COVID-19 on HIV care, with a specific focus on identifying barriers and facilitators.
Methods: Employing The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, our methodology encompassed a systematic search of electronic databases and a meticulous manual assessment of references. The review, spanning 2020 to 2022, included quantitative, qualitative, and mixed-method studies conducted in middle-income countries, with no age or gender restrictions.
Results: A comprehensive analysis of 51 studies revealed that the adverse impact on the HIV care continuum was intricately linked to pandemic-induced restrictions, compounded by the dual fears of COVID-19 contraction and HIV status disclosure. Telemedicine emerged as a pivotal facilitator for sustaining HIV treatment continuity amid the challenges. However, the pandemic-induced disruptions negatively affected income, increased vulnerability to HIV, compromised preventive measures such as PrEP, and escalated risky behaviors and mental health challenges among individuals living with HIV. HIV testing and diagnoses faced reduced access and frequency, particularly among key populations. Disruptions in linkage and retention in care, especially in urban areas, exacerbated barriers to essential HIV treatment.
Conclusions: The coexistence of COVID-19 and HIV has structural implications, manifesting as service restrictions, widened care gaps, and a break in the transmission chain. This abstract provides insights into the impact on medical appointments, adherence, and treatment engagement. Understanding these dimensions is crucial for targeted interventions to mitigate collateral consequences on the structural integrity of the HIV care continuum in middle-income countries.
Key words: HIV care continuum, Middle-income countries, barriers, facilitators, COVID-19

Background: Pediatric HIV has become a manageable, chronic disease. Increasing numbers of youth are entering adulthood and transitioning from pediatric to adult HIV care. We describe the epidemiology of the transitioned and current Canadian cohorts of children with HIV.

Methods: We reviewed Canadian Perinatal HIV Surveillance Program data from 01/1990–12/2022. Demographic comparisons between transitioned and current cohorts were by Chi-square or Fisher’s exact tests.

Results: 797 children born since 1980 were reviewed. 113 died while in pediatric care, 102 (90%) due to AIDS-defining illness, with marked decreases in AIDS deaths after 1997 and the last reported in 2007. As of 2022, 483 had reached 19y and were presumed to have entered adult care; half (50%) of the 201 children in pediatric care are at least 14y. Numbers in pediatric care each year have decreased over time (maximum 325 in 2009; minimum 200 in 2021). Almost all (678/684, 99%) survivor children were infected perinatally. Significant proportion differences were noted in demographics of the current versus transitioned cohort; fewer were born to mothers with reported heterosexual acquisition and slightly more with IDU. More of the current cohort were born to Indigenous mothers, were born abroad, and resided in Saskatchewan, Alberta and BC.

Conclusions: Since 1990, 70% of youth with HIV have transitioned from pediatric to adult care in Canada, and half the current pediatric cohort will transition in the next 5y. Demographic changes have occurred over time, with a higher proportion now being born abroad and/or residing in Western Canada.

Background

People with HIV in British Columbia (BC) receive centrally-distributed antiretroviral therapy (ART) through the BC Centre for Excellence in HIV/AIDS (BCCfE) Drug Treatment Program (DTP). Pharmacy services vary across BC; remote services were enhanced one decade ago. We compared clinical outcomes across HIV pharmacy service levels.

Methods

DTP participants aged ≥19 years, with ≥2 ART dispensings between 01-Jan-2019 to 31-Dec-2019 were included and categorized by pharmacy service level:

-Comprehensive: In-person counselling, adherence monitoring, labwork review (efficacy and safety) with HIV-trained pharmacist at multidisciplinary clinic.

-Intermediate: In-person counselling, adherence monitoring at BCCfE-affiliated pharmacy.

-Basic: Telephone consultation, adherence monitoring, labwork review (efficacy) with pharmacist.

We describe demographics and clinical outcomes, including HIV plasma viral load suppression (pVL <50 copies/mL), monitoring (pVL ≥twice/year), and adherence (≥1 treatment interruption alert sent). We compared outcomes between groups using Chi-square and Wilcoxon rank-sum tests. Confounder logistic models were used for multivariate analysis to identify relationships between pharmacy service levels and clinical outcomes, adjusting for other variables.

Results

Of 4560 participants included, 63% received Comprehensive pharmacy services, 10% Intermediate and 27% Basic. Demographic and clinical characteristics differed between groups (Table). Odds of viral suppression did not differ between groups; all rates were ≥90%. Compared to Comprehensive, Intermediate and Basic groups had significantly lower odds of recommended pVL monitoring frequency and different odds of receiving ≥1 treatment interruption alert.

Conclusion

High viral suppression rates were achieved in all HIV pharmacy service groups. Intermediate and Basic groups may benefit from additional support to meet recommended monitoring standards.

Background: HIV presents as a persistent, long-term health challenge. Virtual care has been integrated as one of the care modalities in Ontario, yet its effectiveness compared to traditional care for PLHIV remains relatively unexplored.
Objectives: This study aims to find the effect of virtual visits on adherence to antiretroviral therapy (ART), viral load, and quality of life (QOL) in PLHIV in Ontario, Canada
Methods: A cross-sectional study was conducted on PLHIV utilizing data from the Ontario HIV Treatment Network Cohort Study (OCS). The study included participants who completed the OCS questionnaire in 2022. Data was collected from standardized self-reported OCS questionnaires, medical charts and through record linkage with the Public Health Ontario (PHO). Three categories were used for the mode of care: (1) virtual care, (2) in-person care, and (3) both in-person and virtual care. Participants' characteristics were analyzed using descriptive analysis, with counts and percentages for categorical variables and medians and the interquartile range (IQR) for continuous variables. Logistic regression analysis was performed for dichotomous outcomes (adherence to ART and viral load), and multiple linear regression analysis was employed for the continuous outcome (quality of life).
Results: In 2022, a total of 1930 participants accessed HIV care in the Ontario Cohort Study (OCS). Among them, 19% of the participants utilized virtual care mode, 45.6% received in-person care, and 34.3% received care through virtual and in-person modalities. The median age of the participants was 55 years (IQR: 45-62], and 78% of the total sample was comprised of men. In the multivariable model, virtual care was associated with increased likelihood of optimal adherence to antiretroviral therapy (Adjusted Odds Ratio (AOR) 1.31, 95% confidence interval (CI): 1.00-1.71) and an increased likelihood of achieving viral load suppression (AOR 0.608,95% CI: 0.381-0.971). Furthermore, virtual and in-person care was associated with an improved QOL in terms of Mental Component Summary Score (MCS) compared to solely in-person care (Adjusted β1 0.960, 95% CI 0.052,1.869)
Conclusion: This study suggests virtual care positively impacts adherence to antiretroviral therapy (ART) and viral suppression within this context. However, further investigation is necessary to understand the long-term effects of virtual care.

Keywords: retention in care, cross-sectional study, HIV, antiretroviral therapy (ART), virtual visits.

Background: Switching to DTG/3TC from 3- or 4-drug TAF-based regimens showed durable high efficacy in virologically suppressed adults with HIV-1 through Week (W) 196 in the TANGO study. To further investigate DTG/3TC efficacy in TANGO participants who switched to DTG/3TC on Day 1 and those who switched at W148, we present Snapshot virologic response by subgroup based on demographic and baseline disease characteristics and baseline third agent class.

Methods: TANGO is an open-label, multi-center, randomized, phase 3 study assessing efficacy and safety of switching to DTG/3TC vs continuing TAF-based regimens. Adults with HIV-1 RNA <50 c/mL on TAF-based regimens for >6 months without prior virologic failure or documented NRTI or INSTI resistance were eligible. Participants were stratified by baseline third agent class and randomized 1:1 to switch to DTG/3TC on Day 1 (early-switch [ES] group) or continue TAF-based regimens for 144 weeks. Participants who continued TAF-based regimens and maintained virologic suppression at W144 switched to DTG/3TC at W148 (late-switch [LS] group).

Results: At W196, TANGO included 369 ES group and 298 LS group participants treated with DTG/3TC for 196 and 48 weeks, respectively. Few ES participants (3/369 [<1%]; 95% CI, 0.0%-1.7%) and 0/298 (95% CI, 0.0%-0.0%) LS participants had HIV-1 RNA ≥50 c/mL at W196 by Snapshot analysis (ITT-E). Overall ES group and LS group Snapshot virologic response rates were consistent with rates across their respective subgroups related to demographic characteristics, baseline disease characteristics, and baseline third agent class at W196. Safety was consistent across subgroups within ES and LS groups. Confirmed virologic withdrawal criteria were met by 1/369 (<1%) ES and no LS participants through W196, with no resistance observed.

Conclusions: These results support that switching to DTG/3TC from TAF-based regimens effectively maintains virologic suppression across different demographic and baseline characteristic subgroups at 48 and 196 weeks.

In 2018, Canada legalized cannabis for recreational purposes, though the use of cannabis for medical purposes has been legal for over 20 years. People living with HIV use cannabis at 3-4 times the rates of the general population which may reflect widespread medical and/or problematic use. There is a need for health care providers (HCPs) to engage with patients about cannabis. However, HCPs have noted gaps in knowledge and a lack of evidence on health effects as barriers to service delivery. To help understand legalization impacts and document facilitators and barriers to service delivery, we engaged HCPs across Canada in an online survey assessing cannabis-related education, knowledge, and clinical experiences. The survey was completed by 82 HCPs (63% nurses, 22% physicians/residents, 15% pharmacists). Findings show that 23% are authorized prescribers and 52% recommend medical cannabis when clinically appropriate. The top indications for cannabis were pain, nausea, appetite, seizure disorders and multiple sclerosis. The majority of HCPs did not receive formal cannabis education and reported engaging in compensatory self-directed learning to meet patient needs. Overall, HCP perceptions of cannabis knowledge and medical access system knowledge were low. HCPs reported the most knowledge of routes of administration, therapeutic benefits and effects of use, and the least knowledge of dosing and drug interactions. HCPs reported low knowledge of laws, regulations, and referral procedures. Despite low knowledge levels and rates of prescribing, most HCPs viewed medical cannabis as a valid treatment option but felt that more research is needed to guide their clinical practice. Recommendations to improve service delivery include comprehensive and continuing cannabis-related medical education, investments in cannabis research to build the evidence base and improved communication and guidance from medical regulators.

Introduction
People living with HIV (PLWH) are disproportionately affected by mood/anxiety disorders and substance use disorders (SUD). Meanwhile, comprehensive research on the effect of these disorders on the HIV continuum of care is lacking. This study assessed the impact of SUD and mood/anxiety disorders on the HIV continuum of care in British Columbia (BC), Canada and identified the continuum stage with the highest attrition.
Methods
This retrospective population-based cohort study utilized data from the Comparative Outcomes And Service Utilization Trends (COAST) study that contains data on all diagnosed PLWH in BC. Eligible individuals were ≥19 years of age and followed during 2001-2019. Our exposure variable was SUD or mood/anxiety disorder diagnoses. Our outcomes were the achievement of the following stages of the HIV continuum of care: (1) Antiretroviral therapy (ART) initiation, (2) On-ART, (3) ART adherence, (4) Viral suppression, and (5) Maintained suppression. We estimated attrition by estimating the proportion of PLWH who proceed to each stage. Generalized linear mixed-effect models assessed the association between SUD and mood/anxiety disorders and the achievement of each stage while controlling for sociodemographic and HIV-related confounders.
Results
For the 14,398 eligible PLWH, Maintained suppression exhibited the highest attrition. Having SUD or both SUD and mood/anxiety disorder were significantly associated with reduced odds of achieving all stages of the HIV continuum of care except On-ART. SUD had the strongest association with ART adherence (adjusted Odds Ratio (aOR) 0.47, 95% CI: 0.42-0.53) and Maintained suppression (aOR 0.58, 95% CI: 0.53-0.63). Mood/anxiety disorders were also associated with reduced odds of ART adherence (aOR 0.78, 95% CI: 0.71-0.87) and Maintained suppression (aOR 0.82, 95% CI: 0.77-0.88).
Conclusion
Our findings indicate that SUD and mood/anxiety disorders contribute to attritions across the continuum, emphasizing the need for integrated mental health and substance use services to support HIV care.

Background: Dolutegravir is a preferred first-line antiretroviral however neuropsychiatric adverse events (NP-AEs) may lead to an increased risk of treatment discontinuation. The primary objective was to estimate the association between the initiation of a dolutegravir-based antiretroviral therapy (ART) and the development of clinically relevant NP-AEs.
Methods: Substudy of Positive Brain Health Now (+BHN), a Canadian multicentric prospective observational cohort. We included participants from the cohort who had an ART modification after +BHN study entry, without clinically relevant NP-AEs before ART modification and with consecutive pre and post ART modification +BHN assessments. At each visit, participants completed questionnaires evaluating: self-reported cognitive deficit, depression, anxiety, insomnia, fatigue, dizziness and headaches. A composite endpoint defined as the presence of any of these symptoms that were clinically relevant was used. Multivariate Poisson regressions were used to estimate the association between the initiation of dolutegravir and the development of clinically relevant NP-AEs.
Results: Among the 856 participants in the +BHN cohort, 90 participants were included in this analysis: mean (range) age 53.5 (38-69) years, 13.3% female, mean time since HIV diagnosis 16.2 years, 91.9% viral load < 50 copies/mL. Forty-two (46.7%) participants were switched to a dolutegravir-containing regimen. Our findings show a tendency towards an association between dolutegravir and the development of clinically relevant NP-AEs (RR 2.02, 95%CI 0.94-4.36, p=.073). Participants who initiated dolutegravir presented an approximate 7-fold increased risk of developing clinically relevant insomnia (RR 6.85, 95%CI 1.57-28.85, p=.01). No tested variable significantly modified the association between dolutegravir initiation and NP-AEs. The incidence rate of the NP-AE composite was highest for dolutegravir (38.1%), followed by elvitegravir (25.0%) and raltegravir (10.0%).
Conclusion: Dolutegravir was associated with an increased risk of insomnia. A larger sample size may have confirmed an increased risk of other NP-AEs. Similar studies should be conducted with more recent integrase inhibitors.

Background. Recently, causes of hepatic steatosis (HS) were grouped under the term “steatotic liver disease (SLD)”. Under the revised nomenclature, nonalcoholic fatty liver disease replaced “metabolic dysfunction-associated steatotic liver disease (MASLD),”(1) and different HS causes are allowed to coexist (2). In the context of HCV, it is unclear how sustained virologic response (SVR) affects HS in the framework of MASLD. Thus, we aim to estimate the effect of SVR on SLD and liver fibrosis.

Methods. This is a retrospective study of HCV patients evaluated for HS and liver fibrosis using transient elastography (TE) and controlled attenuation parameter (CAP) before receiving direct-acting antivirals (DAA) and 6 months after SVR (end of follow-up EOF). Participants were deemed eligible if they were 18 years old and had achieved SVR following DAA therapy. HS plus 1 cardiometabolic risk factor—high BMI or waist circumference, prediabetes or diabetes, hypertension, hypertriglyceridemia, and low HDL cholesterol—defined MASLD. To identify HS, significant liver fibrosis, and cirrhosis, CAP of 248 dB/m and TE of 8 and 13 kPa, respectively, were utilized. We employed a multivariate logistic regression analysis to determine the effect of SVR on HS and significant liver fibrosis while accounting for potential confounders.

Results. We included 89 HCV mono-infected patients (mean age 65 years, 49% male). At EOF, SLD and post-SVR SLD (not meeting MASLD criteria) rose, while significant liver fibrosis and cirrhosis declined to the extent that 65% of patient’s TE decreased to a level below the threshold of significant liver fibrosis. Meanwhile, MASLD remained unchanged. In the multivariate model, SVR was associated with higher odds of post-SVR SLD (aOR 2.7, 95%CI 1.38 – 5.52) but showed no impact on MASLD (aOR 1.87, 95%CI 0.95 – 3.68).

Conclusions. SLD nearly tripled post-SVR, but not MASLD. The effect of SVR on liver fibrosis was consistent with previous research.

Abstract

Background

Data regarding the prevalence of amphetamine/methamphetamine use in Canada are limited.

Objectives

To estimate the prevalence of methamphetamine/amphetamine use in Ontario based on laboratory drug screening tests, and to describe the socio-demographic characteristics of methamphetamine/amphetamine users.

Methods

A cross-sectional study of persons tested with urine/serum drug screens for methamphetamine/amphetamine from an electronic database of laboratory test results from selected community and hospital-based laboratories across Ontario during 2017-2018. Persons who filled a prescription for stimulants within 120 days prior to testing were excluded. We used descriptive statistics to summarize the characteristics of those who tested positive for methamphetamine/amphetamine use, relative to those who tested negative.

Results

Over the two-year period, 215,529 persons were tested for methamphetamine/amphetamine, with 26,392 individuals testing positive. This suggests that 0.17% of the population covered by the database tested positive for methamphetamine/amphetamine use. Of those who tested positive, most were between the ages of 20-40 years, but 19.5% were over 50 years of age. 41.1% of those testing positive were women, and 40.5% were in the lowest income quintile. Within the past 2 years, those testing positive had a mean of 46.5 (SD = 54.2) primary care visits, 5.0 (SD = 11.0) emergency department (ED) visits, and 0.8 (SD = 2.1) hospitalizations. Of those who tested positive for methamphetamine/amphetamine use, 27.0 % also tested positive for opiates and 29.2% tested positive for cocaine.

Interpretation

Methamphetamine/amphetamine use is associated with poverty and a large burden on the health care system. Use among women and in those over 50 years of age may have been underestimated in previous studies, and concurrent opiate and cocaine use is common. Drug testing results can inform the assessment of the population demographics of drug use.

Background: Hepatitis C is burdensome infection, significantly affecting people living with HIV, and the WHO seeks to eliminate it by 2030. However, many people living with HCV remain untreated. Because of their accessibility and existing patient relationships, family physicians are uniquely positioned to treat Hepatitis C. We developed and evaluated an initiative to support clinicians in treating HCV within primary care.

Methods: The HCV treatment initiative was implemented within a Family Health Team based in Toronto’s inner city. The initiative included supports and education for clinicians, enhanced interprofessional team supports and mentorship, as well as patient outreach. To evaluate the initiative, we conducted focus groups with physicians and pharmacists to understand their perspectives on the implementation and impact of the intervention, and individual interviews with patients to explore perceived barriers and facilitators to seeking HCV treatment.
Results: Physicians and pharmacists reported that the intervention helped raise awareness and confidence for treating HCV in primary care. A collaborative team environment, and decision-support tool integrated into the electronic record were enablers of success. Patient psychosocial complexity remained a barrier to engagement in treatment. Many patients were reluctant to initiate treatment stating concern about side effects, competing health interests and complex social situations. People who did initiate treatment cited readiness and personal motivation as strong factors in their ability to receive treatment. Others reflected on increased awareness of new treatments, ease of access to these treatments through the family health team, and government coverage of costs.
Conclusion: A primary care initiative raised awareness and increased clinician confidence for treating HCV. Some physicians and patients were reluctant to start treatment due to psychosocial barriers, including some related to mental health and addiction. Those who did start therapy cited personal readiness as a significant factor.

Objectives: Our aim was to explore the nature and extent of goal setting and achievement among adults living with HIV involved in an online community-based exercise (CBE) study.
Methods: We recruited adults living with HIV in Toronto to participate in a two-phased study involving a 6-month online CBE intervention (thrice-weekly unsupervised exercise, bi-weekly supervised personal trainings, monthly educational sessions), and a 6-month follow-up period. We administered the Goal Attainment Scale (GAS) to measure participants’ desired goals at Months 0 (baseline) and 6 (end of intervention), and whether goals were achieved at Months 6 and 12 (follow-up). Text analysis was performed to categorize types of goals articulated. We reported the number and nature of goals set at Months 0 and 6, and of these, the number (%) achieved at Months 6 and 12.
Results: Thirty-two participants initiated the intervention and completed the GAS at baseline. The majority were males (69%) with a median age of 53 (interquartile range [IQR]=15.8). Participants set a median of 4 goals (IQR=1.25) at baseline. The most frequently stated goals included weight reduction (n=17 participants), muscle gain (n=12), and increased water intake (n=10). At Month 6, the median number of goals achieved was 2 (IQR=2; average achievement rate=46%). Among participants who completed the intervention (22/32; 69%), a median of 4 goals were set for the follow-up phase (IQR=2), with the most frequently stated goals shifted to increasing exercise (n=9), improving strength (n=9), and reducing weight (n=9). At Month 12, participants achieved a median of 2 goals set at Month 6 (IQR=2.3; average achievement rate=47%).
Conclusion: In this online CBE intervention study, participants set goals in areas of weight, strength, and exercise engagement. Approximately 50% of their set goals were achieved. Findings may help to inform goal setting and personalized exercise interventions for adults living with HIV.

Objectives: To characterize trajectories of disability and assess the influence of contextual factors on these trajectories among adults living with HIV.
Methods: We analyzed longitudinal, observational data from a community-based study in which adults living with HIV in Toronto completed bimonthly questionnaires over 8 months (5 time points). Disability was measured across six different dimensions (physical, cognitive, mental-emotional, uncertainty, day-to-day activities, social inclusion) using the Short-Form HIV Disability Questionnaire (SF-HDQ). Higher SF-HDQ scores (range 0-100) indicate greater severity of disability. We assessed intrinsic contextual factors (age, gender, comorbidities) through a baseline demographic questionnaire and extrinsic contextual factors (stigma, social support) using the HIV Stigma Scale and MOS Social Support Scale, respectively. We performed latent class growth curve analyses to identify disability trajectories across six dimensions over 8 months. Poisson regression models were used to assess the influence of contextual factors on the disability trajectories.
Results: Of the 108 participants, 89% were men with a median age of 51 years (Interquartile range [IQR]=14). Each participant had an average of 4/5 assessments. Longitudinal analyses showed three common trajectories– low, middle, and high– in the physical, mental-emotional, and activity difficulties dimensions. Four common trajectories– low, middle-low, middle-high, and high– were identified in the cognitive, uncertainty, and social inclusion dimensions. Greater numbers of comorbidities (Incidence Rate Ratio [IRR]=1.14; 95%CI:1.08, 1.21) and higher HIV stigma scores (IRR=1.02; 95%CI:1.01, 1.03) were associated with greater numbers of high-shaped trajectories (greater disability), whereas older age (IRR=0.96; 95%CI:0.93, 0.99) and greater social support (IRR=0.98; 95%CI:0.97, 0.99) were associated with fewer high-shaped trajectories.
Conclusion: Experiences of disability among adults living with HIV followed three or four distinct trajectories over an 8-month period. Results contribute to a better understanding of the influence of contextual factors and may inform interventions or programs to mitigate disability among adults living with HIV.

Background

Resistance-associated HIV mutations may impact response to antiretroviral therapy (ART). Most literature focuses on HIV treatment-emergent resistance, and there is little literature on the impact of transmitted resistance-associated mutations on initial viral suppression. We report virologic response to initial treatment in a cluster of people newly diagnosed with pre-treatment thymidine analogue mutation (TAMS) containing HIV.

Methods

All Nova Scotians with a first-time HIV diagnosis and pre-treatment TAMS between January 1, 2022 to December 31, 2023 were identified.  HIV virtual phenotype and mutations, initial and on-therapy HIV viral load (VL; copies/ml), and ART regimens are reported.

Results

Sixteen people with new HIV infection were identified. TAMs and protease inhibitor (PI) resistance mutations were identified in all (Table). Fifteen had tenofovir resistance-associated mutations. 11 people started on standard tenofovir containing NRTI-based triple therapy, 9 have had follow-ups. 6/9 had HIV VL <200 copies/mL and 3/9 suppressed after addition of a protease inhibitor or an NNRTI. 1/1 person started on a tenofovir-sparing NRTI-based triple therapy suppressed, and 4/4 people started on initial quadruple regimens suppressed.  

Conclusion

In this case series, all HIV-positive treatment naïve people with pre-treatment TAMS achieved viral suppression. For those without initial suppression, delayed addition of an additional agent did not compromise short-term viral suppression. With increased use of prophylactic antiretrovirals and potential for increased transmission of thymidine analogue mutation containing HIV, reports such as this and larger databases will be needed to determine best approaches to initial antiretroviral therapy.

Objectives/Aim: Weight gain associated with integrase inhibitors (INSTI) and/or tenofovir alafenamide (TAF) may be progressive beyond normal aging/return-to-health, but its nature after switching antiretroviral therapy (ART) is not fully elucidated. We aimed to characterize weight trajectory in a diverse population of persons with HIV after switching from their first ART.

Methods: Single-centre, retrospective cohort study using data from a research registry database of a Canadian tertiary care HIV clinic. Inclusion: adults starting first ART for ≥1 year from 01/01/2010-30/09/2022, then switched to a second ART for ≥1 year with ≥2 weights recorded. The primary outcome was change in weight (kg/year) during the switch period. Participant-level regression was used to represent change; the models used piecewise linear slopes with a knot at the time of switch. Participants were categorized into stable weight (slope within ±1 kg/year), increased weight (>1 kg/year), and decreased weight (<-1 kg/year).

Results: 144 participants (83% male, 47% white, 55% born outside Canada, median age 42 years, CD4 326/mm3, weight 75.0 kg, BMI 24.8 kg/m2) started first ART (47% NNRTI/34% INSTI/19% PI with 90% TDF/2% TAF) for a median follow-up of 3.8 years. Participants switched to 12% NNRTI/84% INSTI/1% PI with 22% TDF/48% TAF for a median 4.5 years. During this period, weight remained stable (41%), increased (39%) or decreased (20%). Among those who switched to TAF, 55% increased, 28% stable and 17% decreased (p=0.006 compared to switches without TAF). The proportion who switched to bictegravir/dolutegravir+TAF who increased weight was higher than those who switched to bictegravir/dolutegravir without TAF or to other regimens [9/11 (82%) vs. 12/45 (27%) and 35/88 (40%), respectively; p=0.02].

Conclusions: In a contemporary cohort of people, those who switched to TAF were more likely to experience weight gain. Significant weight gain was less frequent in those switching to other regimens including bictegravir/dolutegravir without TAF.

Background: In randomized trials, doravirine (DOR) appears relatively weight-neutral, while tenofovir DF (TDF) may be weight-suppressive. We designed a prospective, observational pilot study to assess whether a switch to DOR/3TC/TDF would stabilize or reverse weight trajectory in patients experiencing significant INSTI-associated weight gain.

Methods: Virally suppressed adults with ≥10% increase in body weight while on an INSTI-regimen for 1-5 years were switched to DOR/3TC/TDF for 12 months. Weight, waist circumference, adherence, diet/exercise habits, and routine bloodwork including fasting lipids/glucose were measured at baseline and every 12 weeks. DXA scan and body image questionnaires were administered at baseline and week 48. The target enrollment was 25 participants. Patients receiving specific weight-loss interventions (including GLP-1 agonists/bariatric surgery) other than diet/exercise were excluded.

Results: The study protocol was developed in 12/2019, but enrollment began in 09/2021 due to delays in securing funding, institutional contract approval, and research holds during the COVID pandemic. Between 09/2021-09/2023, 4 participants were enrolled with results available for 3 women (Black, age 51/56/70 years, CD4 139/801/664/mm3, weight 146.8/100.2/75 kg, BMI 45.3/33.9/30.8, 56/45.7/50% total body fat, on dolutegravir/abacavir/3TC, dolutegravir/FTC/TAF or elvitegravir/cobicistat/FTC/TAF for 5.5/4.25/4.5 years). At 12 months, reductions in weight (0/-7.5/-5 kg), BMI (0/-2.6/-2), waist circumference (-0.8/-1.1/+1 cm), total body fat (-1.5/-2.9/-3.5%), systolic and diastolic BP (+2/-9/-10 and -1/-3/-6 mmHg), fasting glucose (-1.8/-1.6/-0.2 mmol/L) and lipids were observed. Body image/self-esteem improved; all remained virally suppressed with no proteinuria or significant eGFR change. Due to low enrollment, the study was closed to futility.

Conclusions: In a small sample of people with ≥10% INSTI-associated increase in body weight, small improvements in weight, metabolic, and body image/self-esteem were observed after switching to DOR/3TC/TDF. Institutional and pandemic challenges significantly impacted the ability to enroll participants in this trial. A larger trial of similar design conducted by the ACTG (NCT04636437) is underway.

PrEP, PEP, and PEP-in-pocket (PIP) are effective HIV prevention strategies, yet HIV rates are increasing among Canadian women, and studies elsewhere have shown significantly lower PrEP-to-need ratio among women as compared to men. The objective of this study was to assess women’s HIV risk and prophylaxis awareness and access.
This cross-sectional questionnaire study included prophylaxis-naïve self-identified cis and trans women who are sexually active and/or using drugs. Recruitment occurred in community-based organizations across Ontario. The questionnaire included demographics, HIV risk factors, and interest and knowledge on prophylaxis. Responses were grouped into high or low risk for HIV. Awareness, interest, and prior offers of prophylaxis were compared between risk groups using chi-square testing.
Responses from 175 women were analyzed. Of these, 17% were <26 years old, and 74% reported having a primary care provider. Homelessness occurred in 40%, and 59% had public funding for medications, while 11% reported no coverage. In total, 50% were grouped as “high risk”; sexual (46% of sample) and drug risk factors (29%) were correlated (p<0.0001). Despite these responses, 71% reported “low/very low” subjective HIV risk. In the sample, 49%, 50%, and 68% reported no awareness of PrEP, PEP, and PIP respectively. Neither subjective nor objective risk was associated with awareness. Only 7% of respondents had been previously offered prophylaxis, with no significant difference related to risk. Of those reporting previous sexual violence, only 10% had been offered PEP, and there was no association between recent sex work and prophylaxis offer. There was strong interest in prophylaxis (69%), but cited barriers included access (54%), side effects (49%), and low subjective risk (31%).
Women at risk of HIV acquisition may not perceive their risk, and women have low knowledge and access to prevention options. This understanding is essential to addressing barriers to HIV prophylaxis uptake among women.

BACKGROUND: While substance use is prevalent in women living with HIV (WLWH), knowledge on the synergistic impact of substance use and HIV infection on pregnancy remains limited. Our study aimed to investigate substance use in pregnancy on preterm birth rates in WLWH.

METHODS: We analyzed the British Columbia perinatal HIV surveillance database for births from January 1997 to December 2022. The primary outcome is preterm births, defined as deliveries < 37 weeks gestational age. Substance use history is obtained through antenatal records and clinical notes. Risk factors were identified through univariate and multivariate logistic regression analyses.

RESULTS: Out of 578 singleton pregnancies in PLWH, 111 (19.2%) delivered preterm. In our cohort, 20% endorsed using substances in pregnancy. For individuals who endorsed using any substances, their preterm birth rate was 31% versus 16% for those who did not (OR: 1.95; p = 0.0004). Specifically, individuals who used tobacco (OR: 2.17; p < 0.0001), methadone (OR 2.45; p < 0.0001), non-prescription opioids (OR: 3.24; p < 0.0001), cocaine (OR: 2.64; p < 0.0001) and crystal methamphetamines (OR. 3.35; p < 0.0001) had a significantly higher preterm birth rate. After adjusting for lower genital tract infections, ethnicity, history of preterm births, and viral load suppression, substance use in pregnancy remains a significant risk factor for preterm birth (OR: 2.08; p = 0.013).

CONCLUSION: Substance use in pregnancy is a significant independent risk factor for preterm birth in PLWH. Counselling about preterm births is crucial for pregnant people using substances and living with HIV.

Background
HCV elimination efforts mean that an increasing percentage of new infections are reinfections. We consider the implications of spontaneous clearance after reinfection for the optimal frequency of clinical monitoring.

Methods
We simulate plausible reinfection and spontaneous clearance data for CCC participants; derive data that would be observed under different monitoring frequencies; then estimate the time to clearance from the observed data. We assume time from successful treatment to reinfection is distributed Weibull with a decreasing rate of reinfection; 90% of reinfections clear; and time from reinfection to clearance is distributed exponential (mean 0.22 years). We assume monitoring for five years, with frequencies varying from daily to yearly. We estimate the time to clearance using a Markov chain Monte Carlo model for double interval censored data and Poisson regression.

Results
With monitoring every three months, 53% of reinfections are missed. This amounts to only 7% of the total time infected over five years because the missed reinfections clear quickly (Table). However with yearly monitoring, 25% of the total time infected is never observed. Monitoring every three months in the first year and then yearly thereafter reduces the unobserved time infected to 8%.
With infrequent monitoring, estimates of the mean time to clearance are too high. Rapid clearances are often missed.

Conclusion
Yearly monitoring (recommended in guidelines for those at risk of reinfection) will miss roughly 25% of the total time reinfected, with the potential for continued HCV transmission. More frequent monitoring is needed in the first year after successful treatment.