CROI 2015 Program and Abstracts

Abstract Listing

Oral Abstracts

Conclusions: Although N(t)RTI-sparing in SECOND-LINE was associated with improved peripheral limb fat gain over 96 weeks, it was not significant after adjustment for other predictors on multivariate analysis. Significant predictors of peripheral fat gain were female sex, higher baseline BMI and a greater increase in BMI. Africans were more likely to lose limb fat than Asians. Those with more limb fat at baseline were more likely to lose limb fat over 96 weeks. Thymidine-analogue duration prior to study had a borderline association with less peripheral fat gain. 780 Bone Quality by Quantitative Ultrasound at the Radius Does Not Differ in ART-Naïve HIV+ and HIV- RwandanWomen Eugene Mutimura 1 ; Qiuhu Shi 2 ; Donald R. Hoover 3 ; Kathryn Anastos 4 ; Emmanuel Rudakemwa 5 ; Jean Claude Dusingize 1 ; Jean D’Amour Sinayobye 1 ; MichaelTYin 6 1 Regional Alliance for Sustainable Development, Kigali, Rwanda; 2 School of Health Sciences and Practice, New York Medical College, New York, NY, US; 3 State University of New Jersey, New Brunswick, NJ, US; 4 Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, US; 5 King Faisal Hospital, Kigali, Rwanda; 6 Columbia University Medical Center, New York, NY, US Background: Fracture incidence appears to be increased in HIV+ individuals, especially after ART. Dual-energy x-ray absorptiometry (DXA) characterizes bone mineral density (BMD) and is predictive of fracture, but is not widely available in resource-constrained settings (RCS). Quantitative ultrasound (QUS) assesses bone quality by measuring speed of an ultrasound wave (SOS) through bone; lower SOS is predictive of increased fracture risk in older women. We compared bone quality by QUS at the radius in HIV+ and HIV- women in Rwanda. Methods: Cross sectional study of 646 ART-naïve HIV+ and 211 HIV- women. Demographic, anthropomorphic, laboratory, co-morbidity, and socioeconomic data were collected. A Sunlight Omnisense 7000 QUS (BeamMed Ltd, Israel) was utilized to measure SOS at the radius using 2 trained technicians. Inter-observer agreement assessed on a subset (N=56) was high (kappa>0.90). Mean SOS ± SD, T-scores (compared to SOS from young women), Z- scores (compared to SOS fromwomen of same age) using the manufacturer’s reference based upon American norms were calculated. Results: HIV+ women were younger than HIV- women (35 ± 7 vs 42+10 years, p<0.001), had more chronic diarrhea (23% vs 8%, p<0.001), and lower albumin (3.4 ± 0.7 vs. 3.9 ± 0.5 g/dL, p<0.001), but similar body mass index (BMI, 21.5 ± 3.7 vs 21.3 ± 3.8 kg/m 2 , p=0.51). Among HIV+ women, mean CD4+ T cell count was 285 (SD=166) cells/mm 3 and 30% had an AIDS defining illness. Average SOS was slightly higher in HIV+ than HIV- women (4024.4 ± 110.5 vs. 4003.9 ± 113.1 m/s, p= 0.02); this group difference was attenuated by adjustment for age (p=0.04) but not BMI (Table). SOS T- and Z-scores did not differ pre or post adjustment for BMI between HIV infection groups. Among HIV+ women, SOS did not differ by CD4+ count <200 vs. ≥ 200cells/mm 3 : 4016 ± 117 vs 4028 ± 107m/s, respectively (p=0.19). Conclusions: Despite having relatively advanced HIV disease, ART-naïve, predominantly premenopausal Rwandan women did not have worse bone quality by radius QUS than uninfected controls. Our results are consistent with data from a South African study that found that BMD by DXA were similar in ART-naïve HIV+ women and uninfected controls. Unlike DXA, radius QUS is uninfluenced by weight or body fat, is portable, inexpensive, and does not emit radiation or require high-level training. QUS may be an ideal modality to track bone quality and fracture risk after ART-initiation in HIV+ individuals in RCS. Bone Quality by Quantitative Ultrasound among ART-naïve HIV+ and HIV- Rwandan women Data are presented as Mean ± SD; *The p-value is from ANOVA; ART, antiretroviral therapy; HIV+, HIV-infected; HIV, HIV-uninfected; BMI, Body mass index; SOS, ultrasound wave. Conclusions: Despite having relatively advanced HIV disease, ART-naïve, predominantly premenopausal Rwandan women did not have worse bone quality by radius QUS than uninfected controls. Our results are consistent with data from a South African study that found that BMD by DXA were similar in ART-naïve HIV+ women and uninfected controls. Unlike DXA, radius QUS is uninfluenced by weight or body fat, is portable, inexpensive, and does not emit radiation or require high-level training. QUS may be an ideal modality to track bone quality and fracture risk after ART-initiation in HIV+ individuals in RCS. 781 Predictors and Outcomes of Incident High Cholesterol in Adults on ART in South Africa Background: As the HIV-infected population ages in sub-Saharan Africa, non-communicable chronic disease incidence among patients on ART is likely to rise. Specific antiretroviral drugs are considered independent risk factors for cardiovascular disease (CVD), and high total cholesterol (TC) is a risk factor for CVD, stroke and renal disease. We examined predictors of high TC in ART patients in South Africa. Methods: Prospective study of HIV-positive, ART-naïve adults initiating ART at a large urban clinic in Johannesburg from 04/04 to 07/12. Patients with TC ≥ 6mg/dl at ART initiation were excluded. We defined incident high cholesterol as a TC ≥ 6mg/dl and categorized it as (i) one elevated TC, (ii) elevated TC with repeat TC <6mg/dl or (ii) elevated TC with repeat ≥ 6mg/dl. Cox regression was used to identify variables at ART initiation associated with incident high TC. Person-time started at ART initiation and ended at the earliest of high TC, death, loss to follow up (LTF; >3 months late for next scheduled visit), transfer, completion of 24 months of follow-up, or dataset closure (07/2014). Results: Among 18,998 eligible patients, 2990 (16%) had a high TC by 24 months on ART. Of these, 488 (16%) had no repeat TC, 1323 (44%) had a repeat TC <6mg/dl, and 1179 (40%) had a persistently high TC ≥ 6mg/dl. Regression models showed patients ≥ 40 vs. <40 years, those with a CD4 count <100 vs. ≥ 100cells/mm 3 or BMI ≥ 25 vs. <25kg/m 2 at ART initiation had an increased hazard of high TC over the first 24 months on ART (Table). Of the 2990 patients with a high TC, 5% died, 7%were LTF and 11% developed moderate or severe renal insufficiency (creatinine clearance <60ml/min). Among those with a repeat TC, rates of mortality (0.82 vs. 0.83/100pys) and LTF (6.1 vs. 7.3/100pys) after high TC were similar for those with incident high TC and a repeat TC <6mg/dl compared to those with a persistently high TC ≥ 6mg/dl. However, those with persistently high TC ≥ 6mg/dl had a higher rate of renal insufficiency (CrCl <90ml/min) (19.0/100pys) after high TC compared to those who reduced their TC <6mg/dl (16.0/100pys). 31% of patients with a high TC changed a single drug, mainly from d4T to TDF or ABC, while 29%were prescribed cholesterol lowering drugs and 13% had both. Denise Evans 1 ; AlanaT. Brennan 2 ; Faith Moyo 1 ; David Spencer 3 ; Kay Mahomed 3 ; Mhairi Maskew 1 ; Lawrence Long 1 ; Sydney Rosen 2 ; Matt P. Fox 2 1 University of the Witwatersrand, Johannesburg, South Africa; 2 Boston University, Boston, MA, US; 3 Right to Care, Johannesburg, South Africa

Oral Abstracts

112

CROI 2015