CROI 2015 Program and Abstracts

Abstract Listing

Poster Abstracts

Conclusions: Vit D/Cal supplementation over 48 weeks did not attenuate increases in insulin resistance with initiation of efavirenz/emtricitabine/tenofovir in ART-naïve persons. The prevalence of metabolic syndrome did not increase significantly over the course of follow up. Vitamin D supplementation had minimal impact on metabolic parameters with ART initiation. 788 First-Line NRTIs and Risk of New Onset Diabetes in HIV-Infected Adults in Thailand Prakit Riyaten 1 ; Nicolas Salvadori 2 ; PatrineeTraisathit 1 ; Nicole Ngo-Giang-Huong 2 ; Rapeepan Suaysod 2 ; Guttiga Halue 3 ; NarueponYutthakasemsunt 4 ; Apichat Chutanunta 5 ; Jacqueline Capeau 6 ; Gonzague Jourdain 2 1 Chiang Mai University, Chiang Mai, Thailand; 2 Institut de Recherche Pour le Développement UMI 174-PHPT, Chiang Mai, Thailand; 3 Phayao Provincial Hospital, Phayao, Thailand; 4 Nong Khai Hospital, Nong Khai, Thailand; 5 Samutsakhon Hospital, Samutsakhon, Thailand; 6 Sorbonne University, Paris, France Background: Exposure to some antiretrovirals (ARVs), in particular thymidine analogue nucleosides, has been associated with a higher risk of diabetes. However, this risk may vary according to ARVs and combinations. We estimated the risk of new onset diabetes in a large HIV-infected adult cohort in Thailand and studied the impact of four different nucleos(t)ide reverse transcriptase inhibitors (NRTIs) containing first-line regimens. Methods: We selected all HIV-1 infected, antiretroviral therapy (ART)-naïve adults, enrolled in the multicenter PHPT cohort in Thailand (NCT00433030) between January 1, 2000 and December 31, 2011, with no history of diabetes, who received exclusively and for at least 2 years tenofovir disoproxil fumarate (TDF), zidovudine (ZDV), stavudine (d4T) or didanosine + stavudine (ddI+d4T) as part of their first-line regimen. Diabetes was defined as confirmed either fasting plasma glucose ≥ 126 mg/dL or random glucose ≥ 200 mg/ dL. Incidence of diabetes was estimated as the number of new cases divided by the total number of person-years. Cox proportional hazards models were used to compare the risk of diabetes between regimens. Results: A total of 520 HIV-infected patients, 329 (63%) female, participated in this analysis. At ART initiation, median age was 34.1 years (interquartile range 29.5-40.1), body mass index (BMI) 20.7 kg/m 2 (18.9-22.9), CD4 count 139 cells/mm 3 (74-208) and HIV RNA load 4.8 log 10 copies/mL (4.2-5.2). 329 (63%) patients received TDF, 28% ZDV, 7% d4T and 2% ddI+d4T, usually in addition to lamivudine or emtricitabine. Over 3,318 person-years, 13 patients met the criteria for diabetes. Incidence of new onset diabetes was 3.9 per 1,000 person-years (95% confidence interval [CI] 2.3-6.7). Upon multivariate analysis, adjusting for gender, age, BMI, hepatitis B surface antigen, hepatitis C antibody and CD4 cell count at ART initiation, the adjusted hazard ratios for new onset diabetes were 6.8 (95% CI 1.6-30.0) in patients on ZDV, 14.7 (1.3-167.8) on d4T, and 91.3 (12.4-674.2) on ddI+d4T compared to those on TDF containing regimens (reference) ( p <0.001). Conclusions: Overall, the incidence rate of diabetes in this lean and predominantly young, female population was relatively low. However, first-line use of ZDV, d4T and d4T+ddI resulted in increased diabetes incidence. In most ART programs, d4T as well as ddI have now been phased out but our study shows that ZDV as first-line regimen was associated with a higher risk of diabetes than TDF. 789 Diabetes Mellitus Among HIV-Infected Adults in Care in the United States, 2009–2010 Alfonso C. Hernandez-Romieu Emory University Rollins School of Public Health, Decatur, GA, US Background: Diabetes mellitus (DM) is increasingly prevalent among the U.S. general adult population, but prevalence estimates among HIV-infected persons, who are living longer, are lacking. Methods: We used 2009-2010 data from the Medical Monitoring Project (MMP) to determine DM prevalence among a nationally representative cross-sectional sample of HIV- infected adults receiving medical care in the United States. Data were obtained through medical record abstraction and in-person interviews. Diagnosed DM was defined as a recorded diagnosis of DM or prescription of DM-specific pharmacotherapy; undiagnosed DM was defined as any record of fasting blood glucose ≥ 126 mg/dl or glycated hemoglobin ≥ 6.5% in the absence of diagnosed DM. Standardized prevalence ratios (sPR) were used to compare diagnosed DM prevalence among HIV-infected adults to the general U.S. population in the National Health and Nutrition Examination Survey 2009–2010. Bivariate analyses and multivariate logistic regression were used to examine factors associated with DM prevalence (diagnosed + undiagnosed) among HIV-infected adults. Results: Overall, 14.2% (95% confidence interval [CI] 12.8-15.6) of HIV-infected adults had DM; 10.3% (CI 9.1-11.2) with diagnosed DM and 3.9% (CI 2.9-5.0) with undiagnosed DM. Compared to the U.S. adult population, the race-standardized prevalence of diagnosed DM among HIV-infected adults was substantially higher in those aged 20-44 years (sPR 2.27, CI 2.21-2.34), and lower in those aged 45-59 years (sPR 0.93, CI 0.92-0.94) and ≥ 60 years (sPR 0.78, CI 0.75-0.80). Among HIV-infected adults, factors independently associated with DM included older age, duration of HIV ≥ 10 years, and body mass index ≥ 30 kg/m 2 (Table 1).

Poster Abstracts

481

CROI 2015