CROI 2015 Program and Abstracts

Abstract Listing

Oral Abstracts

Conclusions: Older patients, those on stavudine, those overweight or with low CD4 counts should be targeted for frequent TC monitoring and identification of other risk factors of CVD in order to implement lifestyle modifications and pharmaceutical therapy. 782 Metabolic Changes and Second-Line ART in Africa (2LADY/ANRS 12169 Trial) Amandine Cournil 1 ; Assane Diouf 3 ; Sabrina Eymard-Duvernay 1 ; Adrien Sawadogo 2 ; Liliane Ayangma 4 ; Louise Fortes-Deguenonvo 3 ; Jean-Marc Mben 6 ; Eric Delaporte 1 ; Laura Ciaffi 1 ; Sinata Koulla-Shiro 5 1 IRD/UM 1, Montpellier, France; 2 CHU Souro Sanou, Bobo Dioulasso, Burkina Faso; 3 CRCF, Dakar, Senegal; 4 Yaounde Military Hospital, Yaounde, Cameroon; 5 FMSB/University Yaounde 1, Yaounde, Cameroon; 6 ANRS Research Center, Yaounde, Cameroon Background: Beyond efficacy, information about the impact on metabolism of 2 nd line antiretroviral combinations can be of value in the evaluation of long term benefit of treatment in the African context. The aimwas to compare changes over 48 weeks in metabolic profile of three second line regimens within the randomized 2LADY/ANRS 12169 trial (Yaounde, Cameroon; Bobo Dioulasso, Burkina Faso; Dakar, Senegal). Methods: 451 HIV-1 positive adults, failing standard first line ART were randomized to tenofovir disoproxil fumarate (TDF) + emtricitabine (FTC) + lopinavir/ritonavir (LPV/r) [reference]; abacavir (ABC) + didanosine (ddI) + LPV/r [ABC/ddI] or TDF + FTC + darunavir (DRV) /r [DRV]. Cardiovascular disease (CVD) risk factors considered were obesity or overweight (Body Mass Index (BMI) ≥ 25kg/m 2 ); hypercholesterolemia ( ≥ 200mg/dL); hypertriglyceridemia ( ≥ 150mg/dL); hypertension ( ≥ 130/85mmHg) and metabolic syndrome according to IDF/AHA/NHLBI criteria. Results: 432 (71%women) patients with a median age of 38 years were analyzed. At entry, the median CD4 count was 183 cells/ m l; (IQR: 90-290), 32%were obese or overweight; and 11% had metabolic syndrome with no difference between arms. The mean weight gain (kg) over 48 weeks was significantly greater in DRV group (+3.0 ± 4.9) than in reference (+0.7 ± 5.2) and in ABC/ddI groups (+0.8 ± 4.7). In DRV group, over 48 weeks 26% of patients increased BMI from normal to overweight or obese. In contrast, the ABC/ddI compared with DRV group had greater mean increases (mg/dL) in triglycerides (+33 ± 68 vs -6 ± 60; P<0.01) and in cholesterol (+30 ± 53 vs -1 ± 43 ; P<0.001) with significant increases in both HDL- and LDL-cholesterol. Over 48 weeks a significantly higher proportion of patients developed hypercholesterolemia, hypertriglyceridemia and metabolic syndrome in the ABC/ddI compared with DRV group. CVD risk factors did not differ between DRV and reference group. Lipids levels changes and incidence of metabolic syndrome remained independently associated with treatment regimen in multivariable analyses including baseline clinical and metabolic variables.

Oral Abstracts

Both efficacy (CROI2014) and metabolic tolerance results at 48 weeks indicate that the recommended WHO regimen remains a valid option. Conclusions: Despite a marked weight gain with high incidence of overweight and obesity in the DRV group, the most worrying changes in metabolic profile were observed in the ABC/ddI group with important increase in CVD risk factor which could compromise the long term benefit of this combination.

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CROI 2015