CROI 2015 Program and Abstracts

Abstract Listing

Poster Abstracts

Conclusions: Hazardous alcohol use was present in nearly half of HIV-infected patients in this urban Zambian cohort. HD was more common among men and was associated with serum transaminase elevation but not with liver fibrosis. Screening for alcohol use with a brief tool such as AUDIT-C should be expanded in settings like ours and longitudinal assessment of ART and liver outcomes is needed among such populations reporting high alcohol use. 809 Depression and Treatment Outcomes Among Tanzanian Adults Initiating HAART Christopher R. Sudfeld 1 ; Sylvia Kaaya 2 ; Nilupa S. Gunaratna 1 ;Wafaie Fawzi 1 ; Ferdinand Mugusi 2 ; Mary C. Smith Fawzi 3 1 Harvard School of Public Health, Roxbury Crossing, MA, US; 2 Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania; 3 Harvard Medical School, Boston, MA, US Background: Depressive symptoms are common among HIV-infected individuals; however, data on the association of depression with mortality, morbidity, and CD4 T-cell reconstitution are lacking for individuals initiating HAART in sub-Saharan Africa. Methods: Depressive symptoms and social support were assessed at ART initiation for 2,134 HIV-infected adult men and women enrolled in a trial of multivitamins in Dar es Salaam, Tanzania conducted during 2006–2010. Symptoms comparable with major depressive disorder were defined based on a modified and validated Hopkins Symptom Checklist (HSCL-25). Participants were prospectively followed at monthly clinic visits for a median of 20.6 months and CD4 T-cell measurements were obtained every 4 months. Proportional hazard models were utilized for prospective analysis of mortality, morbidity, and anthropometric outcomes while generalized estimating equations were used to analyze differences in CD4 T-cell count reconstitution. Results: At HAART initiation 53% of Tanzanian men (343 of 647) and 59% of women (859 of 1,487) reported symptoms consistent with major depressive disorder. Significant independent risk factors for depression at HAART initiation included female sex, being single, WHO stage IV disease, smoking, low levels of social support, and lack of HIV status disclosure (all p<0.05). After multivariate adjustment for sociodemographics, HIV disease severity, and social support, individuals with depression had 1.82 (95% CI: 1.24-2.66; p<0.01) times the hazard of death as compared to individuals not reporting depressive symptoms. Depression was also associated with increased risk of >10%weight loss (HR: 1.29; 95% CI: 1.00-1.66; p=0.049) and oral candidiasis (HR: 1.50; 1.15-1.96; p<0.01) after treatment initiation. There was no significant difference in the trajectory of CD4 T-cell count reconstitution or risk of missing clinic visits by depression status (p>0.05). Conclusions: Depression is present in over half of HIV-infected Tanzanian men and women at HAART initiation. Due to both the high prevalence and high risk of adverse treatment outcomes associated with depression providing effective psychosocial interventions may have a large population-level impact on reducing mortality and improving quality of life for adults initiating HAART in sub-Saharan Africa.

TUESDAY, FEBRUARY 24, 2015 Session P-R1 Poster Session

Poster Hall

2:30 pm– 4:00 pm Immune Reconstitution Inflammatory Syndrome in Opportunistic Infections 810 Discordant Early Immune Responses Distinguish TB IRIS and Death in HIV/TB Coinfection Shruthi Ravimohan 1 ; NeoTamuhla 2 ; Andrew Steenhoff 2 ; Rona Letlhogile 2 ; Kebatshabile Nfanyana 2 ;Tumelo Rantleru 2 ; Robert Gross 1 ; DrewWeissman 1 ; Gregory P. Bisson 1 1 Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, US; 2 Botswana University of Pennsylvania Partnership, Gaborone, Botswana

Background: Advanced HIV/TB patients commenced on antiretroviral therapy (ART) are at high risk for both early mortality and TB immune reconstitution inflammatory syndrome (TB IRIS). Because TB IRIS and early mortality appear to be related to rapid and minimal immune recovery, respectively, we hypothesized that these two outcomes are characterized by distinct immunologic profiles after ART initiation. Methods: We conducted a prospective cohort study in Botswana among ART-naïve HIV-infected adults with active TB and CD4<125 cells/mm 3 . Primary exposures included change from baseline to week 4 post-ART initiation in: (1) levels of 29 soluble plasma biomarkers by Luminex and (2) TB-specific immune responses measured by interferon (IFN)- γ enzyme linked immunosorbent spot (ELISPOT) assay. Patients were classified as paradoxical TB IRIS, death, or survivors without TB IRIS (controls) based on outcomes observed within 6 months of ART initiation. Rank-sum tests and logistic regression were used for analysis. Results: Of the 159 patients with data at baseline and week 4 post-ART initiation, 116 (73%) were controls, 33 (21%) experienced TB IRIS, and 11 (7%) died. HIV RNA decreases from baseline in controls (-2.9 log 10 copies/ml [interquartile range (IQR): -3.4, -2.4]), TB IRIS (-2.9 log 10 copies/ml [IQR: -3.4, -2.4]), and deaths (-3.1 log 10 copies/ml [-3.6, -2.0]) were all similar (p>0.05). Both the TB IRIS and death groups were characterized by robust increases in systemic inflammatory biomarkers, with pro-inflammatory cytokines, chemokine, and growth factors being independently associated with each outcome (Table). In striking contrast, CD4 counts and TB-specific immune reconstitution from baseline to week 4 post-ART initiation were greater among the TB IRIS patients compared to controls, but markedly diminished in those who died compared to controls.

Poster Abstracts

493

CROI 2015