CROI 2015 Program and Abstracts

Abstract Listing

Poster Abstracts

807 HIV and Liver Fibrosis Among Prison Inmates: The IeDEAWest Africa Collaboration Antoine Jaquet 1 ; GillesWandeler 2 ; JudicaelTine 3 ; Claver Dagnra 4 ; Alain Attia 5 ; Akouda Patassi 6 ; Abdoulaye Ndiaye 7 ; Koumavi K. Ekouevi 8 ; Moussa Seydi 3 ; François Dabis 1

1 Inserm U897, ISPED, Université de Bordeaux, Bordeaux, France; 2 Department of Infectious Diseases, Bern University Hospital, Bern, Switzerland; 3 Service de Maladies Infectieuses et Tropicales, CRCF, CHU de Fann, Dakar, Senegal; 4 Service de Virologie, BIOLIM, Université de Lomé, Lomé, Togo; 5 Service de Hépato-Gastroentérologie, CHU de Yopougon, Abidjan, Côte d’Ivoire; 6 Service de Maladies Infectieuses et Tropicales, CHU Sylvanus Olympio, Lomé, Togo; 7 Service de Médecine Interne, CHU Aristide Le Dantec, Dakar, Senegal; 8 Département de Santé Publique, Faculté des Sciences de la Santé, Université de Lomé, Lomé, Togo Background: Prisons are known to be a high-risk environment for addictive behaviors as well as blood-born and sexually transmitted infections leading to liver damage. Little is known about the prevalence of liver fibrosis and associated risk factors among inmates in sub-Saharan Africa. Methods: A liver fibrosis screening was undertaken in two state prisons in West Africa. Inmates incarcerated between September-October 2013 in Lome, Togo and between April-May 2014 in Dakar, Senegal were randomly selected to participate. Those who accepted underwent a non-invasive assessment of liver fibrosis using a portable transient elastography device. Significant liver fibrosis was defined as a liver stiffness measurement ≥ 9.3 kPa. Serological tests for HIV, HBV and HCV infection were subsequently performed. Demographic information, addictive behaviors (alcohol, tobacco, cannabis and intravenous drugs) as well as the use of traditional medicine were assessed through a face-to-face interview. Hazardous drinking was estimated using the alcohol use disorder identification test. An unconditional logistic model was used to estimate Odds Ratio (OR) with 95% Confidence Interval (CI). Results: A total of 703 inmates were included in Lome (n=371) and Dakar (n=332). Their median age was 30 years [interquartile range: 24-35]. The overall prevalence of significant fibrosis was 3.3% (5.1% in Lome and 1.2% in Dakar, p<10 -2 ). Infections with HIV, HBV and HCV were identified in 2.9%, 12.1% and 0.6% of inmates, respectively. Hazardous drinking, current tobacco and cannabis use were reported in 58 (8.2%), 315 (44.8%) and 230 (33.0%) inmates, respectively. In a multivariate analysis, factors associated with a significant liver fibrosis were HIV infection (OR=5.4; CI 1.3-22.6), HBV infection (OR=4.1; CI 1.5-11.0), HCV infection (OR=24.9; CI 2.0-305.0), the use of traditional medicine (OR=3.2; CI 1.2-8.8) and being incarcerated in Lome (OR=4.6; CI 1.4 – 15.2) (ref. Dakar). Conclusions: Although mainly driven by viral hepatitis, HIV infection was identified as an independent determinant of liver fibrosis. In a time of increasing availability of efficient therapy for HIV and now hepatitis infections, appropriate monitoring strategies for liver disease need to be explored in vulnerable populations, including inmates. The association between traditional medicine use and liver fibrosis highlights the need to provide better documentation of etiologic factors leading to liver damages in sub-Saharan Africa. 2:30 pm– 4:00 pm Depression and Alcohol Use Disorders 808 Clinical Correlates of Alcohol Use Disorders Among HIV-Infected Adults in Zambia Michael J. Vinikoor 1 ; Masumba Masaninga 2 ; Carolyn Bolton Moore 3 ;Virginia Munamunungu 4 ; Alice Siyunda 4 ; Lloyd Mulenga 5 ; Matthias Egger 6 ; Benjamin H. Chi 3 ; GillesWandeler 6 IeDEA Southern Africa 1 University of North Carolina, Lusaka, Zambia; 2 Lusaka District Health Management Team, Lusaka, Zambia; 3 University of North Carolina, Chapel Hill, NC, US; 4 Centre for Infectious Disease Research in Zambia, Lusaka, Zambia; 5 University of Zambia, Lusaka, Zambia; 6 Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland Background: Alcohol use among HIV-infected individuals influences antiretroviral therapy (ART) outcomes and mortality. However, data on patterns of alcohol consumption in African settings are scarce. We described the prevalence and correlates of alcohol use, including markers of liver disease, in a cohort of urban Zambian adults on HIV treatment. Methods: At the time of ART initiation, HIV-infected adults (18+ years old) at two public sector facilities in Zambia’s capital Lusaka were screened for alcohol consumption using the World Health Organization’s 3-question Alcohol Use Disorders Identification Test (AUDIT-C). We categorized drinking patterns as minimal to no consumption (NC) if AUDIT-C was negative, alcohol use disorder (AUD) if AUDIT-C was positive but fewer than 3 standardized drinks (10 grams of alcohol/drink) per day were reported, and alcohol use disorder with heavy drinking (HD) if AUDIT-C was positive and patients reported 3+ drinks per day. Using Chi square tests, we compared age, sex, WHO stage, CD4+ count, hepatitis B surface antigen (HBsAg) positivity, ALT, AST, and FIB-4 between alcohol use categories. With multivariable logistic regression we investigated the association of alcohol use category with FIB-4 >3.25, a marker of liver fibrosis. Results: Among 595 participants (median age 34 years, 54%women, and 15%with tuberculosis), 347 (58%) reported NC, 155 (26%) reported AUD, and 94 (16%) reported HD. The HD group had a larger proportion of men (P<0.01) and were more likely to have elevated ALT (P=0.01) or AST (P=0.02) compared to the two other groups (Table 1). Adjusted for age, sex, WHO stage, and HBsAg, HDs were not significantly more likely than those reporting NC to have FIB-4 >3.25 (adjusted odds ratio 0.88, 95% CI 0.34-2.27). THURSDAY, FEBRUARY 26, 2015 Session P-Q13 Poster Session Poster Hall

Poster Abstracts

492

CROI 2015