CROI 2015 Program and Abstracts

Abstract Listing

Poster Abstracts

Conclusions: Prior investigation in HIV+ adults identified an association between increased carotid lesions and T-cell activation markers. We identify a significant relationship between increased coronary plaque and levels of activated T-cells in AYA with life-long HIV. Further, soluble E-selectin, which has also been linked with carotid artery plaque and atherosclerosis, was positively correlated with coronary plaque in the present study. The presence of increased circulating adhesion molecules and markers of immune activation may be early predictors of atherosclerosis in AYA infected with HIV early in life. 929 High Prevalence of Dyslipidemia and Insulin Resistance in African Children on ART Steve Innes 1 ; Kameelah L. Abdullah 2 ; Richard Haubrich 2 ; Sara Browne 2 ; Mark F. Cotton 1 1 Stellenbosch University, Cape Town, South Africa; 2 University of California San Diego, San Deigo, CA, US Background: Antiretroviral therapy (ART)-induced dyslipidemia and insulin resistance in African children may be a major public health threat to an already vulnerable population. Data describing the true extent of dyslipidemia and insulin resistance in perinatally-infected children on ART in Africa is sparse. Methods: Fasting total cholesterol, LDL, HDL, triglycerides, insulin and glucose were performed on the first 100, of 190 pediatric HIV clinic attendees on ART. Diet assessment was performed by a trained dietician. Lipoatrophy was formally graded by consensus between two expert HIV pediatricians. Durations of previous ART exposures, WHO clinical stage, pre-ART viral load, nadir and current CD4 were recorded. Dual energy X-ray Absorptiometry (DEXA) was performed on a subset of 42 patients selected semi-randomly. Results: Prevalences of insulin resistance, abnormal total cholesterol, LDL, HDL and triglyceride were 10%, 13%, 12%, 13 % and 9% respectively. Overall, 40% had at least one lipid abnormality or insulin resistance. Adjusted mean LDL cholesterol increased by 0.24mmol/L for each additional year of cumulative lopinavir/r exposure (p=0.03) after adjusting for age, gender, body mass index, previous stavudine exposure, dietary fat and refined carbohydrate, while adjusted mean LDL cholesterol was 0.9mmol/L higher in children exposed to efavirenz within the previous six months (p=0.01). We found no significant difference in blood lipids or insulin resistance index in patients with and without visually obvious lipoatrophy (p>0.20), and no correlation with DEXA measures of peripheral fat maldistribution (p>0.15).

Poster Abstracts

Multivariate Regression model of the predictors of fasting LDL cholesterol (mmol/L) Conclusions: Prevalences of insulin resistance and dyslipidemia were high. Cumulative lopinovir is an independent risk factor for dyslipidemia, with efavirenz exposure having only transitory effect. ART-induced dyslipidemia and insulin resistance occur independently of lipoatrophy and should not be coalesced under the label “Lipodystrophy Syndrome”. 930 Growth and Lipid Profiles in a South African Cohort of HIV + Children and HIV - Controls Background: Prior studies from sub-Saharan Africa report elevated lipids and different patterns of regional fat distribution in perinatally HIV + children receiving ritonavir-boosted lopinavir (LPV/r) compared to non-nucleoside reverse transcriptase inhibitors (NNRTIs); however, interpretation of findings is limited by lack of comparison data from HIV - children. Here, we compare lipid profiles and body composition between HIV + children (stratified by LPV/r vs NNRTIs) and HIV - controls. Methods: The Childhood HAART Alterations in Normal Growth, Genes, and aGing Evaluation Study (CHANGES) is a longitudinal cohort study of perinatally HIV + children and HIV - controls aged 4-9 years in Johannesburg, South Africa. At enrollment, anthropometrics, viral load, CD4, total cholesterol (TC), HDL, LDL, and triglycerides (TG) were measured. Weight- (WAZ), height- (HAZ), and BMI-for-age (BAZ) z-scores (per WHO) were calculated. US pediatric thresholds for dyslipidemia were used. Results: 553 HIV + children (46%male, median age 6.9 years) and 300 controls (54%male, median age 7.0 years) were enrolled. Of the HIV + children, 94.8%were on antiretroviral therapy (ART) (69.6% on LPV/r and 30.2% on NNRTIs) and 85.9% had undetectable plasma HIV RNA; median CD4%was 34.4. Compared to controls, mean WAZ was lower in HIV + children (-0.7 vs -0.3, p<0.01), a greater proportion of HIV + children were stunted (HAZ <-2) (18.4 vs 9.3%, p<0.01), and a smaller proportion were overweight (BAZ>1) or obese (BAZ>2) (14.9 vs 21.7%, p=0.01). Whether on LPV/r or NNRTIs, a higher proportion of HIV + children had borderline/elevated TC or abnormal TG than controls, although a higher proportion of those on LPV/r had borderline/elevated TC, borderline/elevated LDL, or abnormal TG than those on NNRTIs. A greater percentage of children on LPV/r had borderline/ elevated LDL than controls ( Table ). Sarah Ramteke 1 ; Stephanie Shiau 1 ; Marc Foca 1 ; Renate Strehlau 2 ; Francoise Pinillos 2 ; Faeezah Patel 2 ; AvyViolari 3 ; Afaaf Liberty 3 ; Stephen M. Arpadi 1 ; Louise Kuhn 1 1 Columbia University, New York, NY, US; 2 University of the Witwatersrand, Johannesburg, South Africa; 3 University of Witwatersrand, Johannesburg, South Africa

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CROI 2015