CROI 2015 Program and Abstracts

Abstract Listing

Poster Abstracts

THURSDAY, FEBRUARY 26, 2015 Session P-Q10 Poster Session

Poster Hall

2:30 pm– 4:00 pm Pulmonary Disease 800 Risk Factors for Airflow Obstruction Among HIV+ Individuals in Nairobi, Kenya Engi F. Attia 1 ; Elizabeth Maleche-Obimbo 2 ; NellyYatich 1 ; Lillian Ndukwe 3 ; Julia Njoroge 3 ; Sameh Sakr 3 ; Neveen El Antouny 3 ; Fr. Mena Attwa 3 ; Kristina Crothers 1 ; Michael Chung 1 1 University of Washington, Seattle, WA, US; 2 University of Nairobi, Nairobi, Kenya; 3 Coptic Hope Center for Infectious Diseases, Nairobi, Kenya Background: Antiretroviral therapy (ART) and prolonged survival are shifting the spectrum of HIV-related pulmonary complications toward a greater burden of chronic lung disease (CLD). In developing countries, this impacts HIV+ individuals at all ages, including adolescent survivors of vertically-acquired HIV, yet risk factors for CLD are incompletely understood. We hypothesized that vertically-acquired HIV, indoor biofuel burning and cigarette smoking are associated with airflow obstruction, a CLD manifestation, among HIV+ individuals in Nairobi. Methods: We performed a cross-sectional analysis of 451 HIV+ adults and adolescents ≥ 10 years old enrolled in the Coptic Hope Center for Infectious Diseases in Nairobi; HIV acquisition route was assessed at enrolment. Included adolescents met criteria for vertically-acquired HIV. Subjects underwent pre- and post-bronchodilator (BD) spirometry per American Thoracic Society standards. Oxygen saturation was measured before and after ambulation. Respiratory symptoms, biofuel burning, smoking and other exposures were gathered via questionnaires. Recent CD4 was abstracted from Hope Center databases. We generated multivariable logistic regression models to determine the independent risk of vertically-acquired HIV, indoor biofuel burning and cigarette smoking with airflow obstruction, defined as the post-BD ratio of forced expiratory volume in 1 second to forced vital capacity (FEV1/FVC) <0.7. Results: Recent CD4 was significantly higher among adolescents though most subjects were on ART (Table). No adolescents reported cigarette smoking. Biofuel burning did not differ by age. Adolescents had twice the prevalence of cough, phlegm and desaturation and were more likely to have airflow obstruction. In multivariable analyses, vertically- acquired HIV (OR 2.84, 95% CI 1.12-7.20) and cigarette smoking (OR 3.11, 95% CI 1.23-7.86) were significantly associated with post-BD airflow obstruction. There was no significant association between biofuel burning, CD4 and ART use with airflow obstruction.

Poster Abstracts

Conclusions: Vertically-acquired HIV and cigarette smoking are independent risk factors for airflow obstruction among HIV+ individuals. Children who acquired HIV vertically and have survived to adolescence have a substantial burden of chronic respiratory signs and symptoms despite ART use and high CD4. These data suggest that acquisition of HIV infection during early ages that are critical in lung development may impact the mechanisms and manifestations of CLD in developing countries. 801 Pulmonary Complications of HIV-1 in Youth: The PHACS AMP Study William T. Shearer 1 ; Erin Leister 2 ; George Siberry 3 ; Denise L. Jacobson 2 ; Russell B.Van Dyke 4 ; Hannah H. Peavy 5 ; Suzanne Siminski 6 ; Meyer Kattan 7 ; Laurie Butler 6 ; Andrew Colin 8 1 Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, US; 2 Harvard School of Public Health, Boston, MA, US; 3 National Institutes of Health (NIH), Bethesda, MD, US; 4 Tulane University Health Sciences Center, New Orleans, LA, US; 5 National Heart, Lung, and Blood Institute, Bethesda, MD, US; 6 Frontier Science and Technology Research Foundation, Amherst, NY, US; 7 Columbia University Medical Center, New York, NY, US; 8 University of Miami Health System Batchelor Research Institute, Miami, FL, US Background: Perinatally HIV-infected (PHIV) youth may have an increased risk of asthma compared to perinatally HIV-exposed uninfected (PHEU) youth, particularly after antiretroviral therapy. Prior studies have diagnosed asthma by history, asthma medications, and physician examination. The present multi-center study used pulmonary function tests (PFTs) to compare the prevalence of obstructive (OBS) and restrictive (RES) pulmonary patterns in PHIV and PHEU youth. Methods: PHIV and PHEU youth enrolled in the Pediatric HIV/AIDS Cohort Study/Adolescent Master Protocol (PHACS/AMP Study) were evaluated for evidence of OBS, RES, and reversible (REV) airway patterns by PFTs without and with bronchodilators. Flow volume loops from 11 PHACS/AMP PFT laboratories were evaluated centrally by two blinded pediatric pulmonologists for acceptability. Predicted values were centrally calculated as the percent of normal values based on age-sex-race adjusted reference values in healthy children. Pulmonary disease status from pre-bronchodilator results was defined as OBS only (FEV1 < 80% or FEV1/FVC < 80% or FEF < 65%), OBS+RES (FEV1 < 80% and FEV1/ FVC < 80%), RES only (FVC < 80% and FEV1/FVC > 80%), or normal (not RES or OBS). Reversible airway function was defined as a >10% increase in FEV1 after bronchodilator. PFT results were compared by HIV status using a Chi-square test. Results: Of the 216 PHIV and 151 PHEU youth who had a PFT test, 188 (87%) and 132 (87%) produced reproducible and acceptable PFT test results, respectively. A post- bronchodilator PFT was available on 183/188 PHIV and 126/132 PHEU. Of those with evaluable PFTs, the median age was 15.9 (range 10-21) years of age with 45%male and 68% African-American.. The prevalence of pulmonary function abnormalities was similar for PHIV and PHEU youth (P=0.37), but PHIV had a lower prevalence of reversibility than PHEU youth (9% versus 17%, P=0.052). Abnormal PFT results for PHIV vs PHEU youth were: 31 (16%) vs 24 (18%) had OBS, 13 (7%) vs 4 (3%) had OBS+RES, and 18 (10%) vs 17 (13%) had RES PFT abnormalities; 126 (67%) and 87 (66%) had normal results, respectively.

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CROI 2015