CROI 2015 Program and Abstracts

Abstract Listing

Poster Abstracts

Conclusions: In a South African cohort of HIV + children and population-appropriate HIV - controls, HIV + children were of smaller size than controls. Unfavorable alterations in lipid profiles were detected in HIV + children on LPV/r as well as those on NNRTIs compared to controls. In light of childhood origins of CVD and the need for HIV + children to remain on lifelong ART, strategies for early life management of lipid alterations may be warranted.

THURSDAY, FEBRUARY 26, 2015 Session P-U7 Poster Session

Poster Hall

2:30 pm– 4:00 pm Complications of HIV and ART: Bones, Brains, and Kidneys 931 Vitamin D Status and Bone Outcomes in Perinatally HIV-Infected Children Denise L. Jacobson 1 ; Mitchell Geffner 2 ; Charles B. Stephensen 3 ; Rohan Hazra 4 ; Kunjal Patel 8 ;Tracie L. Miller 5 ; Russell B.Van Dyke 6 ; Angela Ellis 9 ; Linda A. DiMeglio 7 For the Pediatric HIV/AIDS Cohort Study

1 Harvard School of Public Health, Center for Biostatistics in AIDS Research, Boston, MA, US; 2 Children’s Hospital Los Angeles, Keck School of Medicine, Los Angeles, CA, US; 3 USDA, Davis, CA, US; 4 Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, US; 5 University of Miami, Miami, FL, US; 6 Tulane University School of Medicine, New Orleans, LA, US; 7 Indiana University, School of Medicine, Indianapolis, IN, US; 8 Harvard School of Public Health, Boston, MA, US; 9 Frontier Science and Research Foundation, Amherst, NY, US Background: HIV-infected children (HIV+) are at risk for poor bone mineral accrual, but the predisposing etiological factors are ill-defined. We previously reported lower than recommended intakes of vitamin D in over half of HIV+ children enrolled in the US-based Pediatric HIV/AIDS Cohort Study Adolescent Master Protocol (AMP) (DiMeglio 2013). In this study, we hypothesized that serum 25-hydroxy vitamin D (25D) levels would be lower in HIV+ children than HIV-exposed uninfected (HEU) children and would be associated with lower bone mineral density (BMD) in HIV+ children. Methods: We measured serum levels of 25D, parathyroid hormone (PTH), calcium, and phosphate in perinatally HIV+ (N=426) and HEU (N=219) children. Dual-energy X ray absorptiometry (DXA) was performed in HIV+ to assess total body and spine BMD and percent body fat. Z-scores were calculated for bone measures based on reference data. Among HIV+ children, 396 had a DXA scan within 365 days of the 25D assay. Low serum 25D was defined as < 20 ng/mL. The prevalence ratio (PR) and 95% confidence interval (95%CI) of low 25D in HIV+ relative to HEU children was determined as were associations of 25D levels with BMD outcomes in HIV+ children, unadjusted and adjusted for confounding. Results: The median age of the HIV+ and HEU children was 13.0 and 10.7 years, respectively. The majority of children were Non-Hispanic Black (62%) or Hispanic (28%). Prevalence of low 25D was 43% in HIV+ versus 34% in HEU children (P=0.027), with a prevalence ratio of 1.27 (95%CI 1.02, 1.58) and 1.14 (95%CI 0.93, 1.41) unadjusted and adjusted, respectively. On univariable analysis, low 25D was associated with older age, Non-Hispanic Black race/ethnicity, female sex, born on mainland US versus Puerto Rico, winter or spring season, and higher total body fat % by DXA. In children with low 25D, mean level of PTH was higher and calcium and phosphate levels were lower. Among HIV+ children, for each 1 ng/mL decrease in 25D level there was a 0.013 SD decrease in total body BMD z-score (P=0.079), adjusted for confounders (age, race/ethnicity and height). No association was observed between 25D and spine BMD z-score (adjusted estimate 0.0042, P=0.56). Conclusions: Low 25D is common in both HIV+ and HEU children. There was a trend for an association between vitamin D deficiency and lower total body BMD in HIV+ children. HIV+ children should be monitored routinely for 25D deficiency due to possible adverse effects on BMD. 932 Bone Quality by Ultrasonometry in South African HIV+ Children and HIV- Controls Stephen M. Arpadi 1 ; Stephanie Shiau 1 ; Renate Strehlau 2 ; Francoise Pinillos 2 ; Faeezah Patel 2 ; Louise Kuhn 1 ; Ashraf Coovadia 2 ; Sarah Ramteke 1 ; Jonathan Kaufman 3 ; MichaelT.Yin 1 1 Columbia University, New York, NY, US; 2 University of the Witwatersrand, Johannesburg, South Africa; 3 Mount Sinai School of Medicine, New York, NY, US Background: Due to limited access to dual x-ray absorptiometry (DXA), few studies have described bone quality among HIV+ children in resource-limited settings (RLS), where the majority of HIV-infected children reside. Quantitative ultrasonography (QUS) is portable, relatively inexpensive, quick, simple to use and does not involve radiation exposure, making it well-suited for monitoring and evaluating bone acquisition in RLS. Although data are limited, QUS appears to have good agreement with DXA. We compare bone quality by QUS of South African HIV+ children receiving antiretroviral therapy (ART) to healthy HIV- children recruited as a control group. Methods: Data were obtained from the bone sub-study (79% of target sample accrued) of CHANGES (Childhood HAART Alterations in Normal Growth, Genes, and aGing Evaluation Study), a longitudinal study of perinatally HIV+ children and HIV- controls in Johannesburg, South Africa. Weight- (WAZ), height- (HAZ), and BMI-for-age (BAZ) z-scores were calculated using WHO standards; CD4 and HIV-1 RNA levels were measured. Speed of sound (SOS) and broadband ultrasound attenuation (BUA) at the heel/calcaneus were measured by QUS (Lunar Achilles Insight). Calcaneus stiffness index (SI) was calculated as per manufacturer: SI = (0.67 x BUA + 0.28 x SOS) – 420.

Poster Abstracts

559

CROI 2015