CROI 2016 Abstract eBook

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Poster Abstracts

Conclusions: The serological prevalence of H. pylori infection in HIV-infected patients is significant lower than in HIV negative patients. In patients with advanced clinical stages of HIV the serological prevalence of H. pylori is lower than in patients at an early stage leading to the hypothesis that HIV-infection impacts on the diagnostic sensitivity of H. pylori serology. The chronicity of H.pylori infection seems to be driven by effective mucosal immunity disturbed in HIV- infected patients. 636 Design, Implementation, and Findings of Next Generation Stroke Adjudication in HIV Heidi M. Crane 1 ; Felicia Chow 2 ; Kyra J. Becker 1 ; Christina Marra 1 ; Joseph Zunt 1 ; Emily L. Ho 1 ; RIzwan Kilani 1 ; Robin Nance 1 ; Joseph A. Delaney 3 ; DavidTirchwell 1 1 Univ of Washington, Seattle, WA, USA; 2 Univ of California San Francisco, San Francisco, CA, USA; 3 Univ of Washington Sch of PH and Community Med, Seattle, WA, USA Background: To address questions regarding stroke during HIV infection we developed a stroke adjudication protocol for HIV cohort research that enables comparisons with traditional cohort studies, addresses issues specific to HIV, and allowed us to examine factors associated with stroke in HIV. Methods: CNICS is a U.S multisite clinical cohort of HIV-infected patients receiving longitudinal HIV care. The CNICS stroke protocol was based on a modified traditional protocol (Multi-Ethnic Study of Atherosclerosis). Potential events at 5 CNICS clinical sites through 12/2012 were identified. Case identification criteria included a range of diagnoses and procedure codes such as cerebral angiography. For each potential event, the site assembled de-identified packets with provider notes, imaging results, and ECGs. Antiretroviral medication exposure was redacted to allow blinded review. Using standardized criteria in the setting of ongoing quality control, two neurologists reviewed each packet, followed by a 3 rd reviewer when discrepancies occurred, and categorized each stroke as Definite, Probable, or Possible. Stroke types and subtypes and whether the event was related to infection or illicit drug use was determined. Multivariable Cox regression analyses were used to determine traditional and HIV-specific risk factors for stroke comparing patients with and without stroke followed from enrollment at these 5 sites (N=16,924). Results: Among 500 potential adjudicated events, 175 (35%) had a stroke. Ischemic strokes made up 81% of events, 10%were hemorrhagic, and in 9% the type was unidentifiable. Ischemic stroke subtypes included large vessel atheroembolic (19%); cardioembolic (28%); small vessel (29%); and other/unknown subtypes (23%). Strokes occurred in the setting of illicit drug use in 19% and infection in 20%. The case-fatality rate was 9%. In addition to traditional risk factors, HIV-specific factors (lower CD4 count and higher viral load) were associated with stroke (see Table). Conclusions: Strokes were predominantly ischemic and were associated not only with traditional risk factors but with lower CD4 count and higher viral load suggesting potential additional benefits of earlier antiretroviral treatment initiation. Standard adjudication protocols facilitate cross-cohort comparisons but require modification to address issues such as identification of strokes related to infection or illicit drug use that is more common in HIV-infected patients.

637 Differences in Predictors for Ischaemic and Haemorrhagic Strokes in HIV+ Individuals Camilla I. Hatleberg 1 ; David Kamara 2 ; Lene Ryom 1 ; Stephane deWit 3 ; Matthew Law 4 ; Peter Reiss 5 ; Antonella d’Arminio Monforte 6 ; Jens D. Lundgren 1 ; Caroline Sabin 2 ; for the Data Collection on Adverse Events of Anti-HIV Drugs Study Group 1 Rigshospitalet, Univ of Copenhagen, Copenhagen, Denmark; 2 Univ Coll London, London, UK; 3 St Pierre Univ Hosp, Brussels, Belgium; 4 Univ of New South Wales, Sydney, Australia; 5 Amsterdam Inst for Global Hlth and Develop, Amsterdam, Netherlands; 6 Infectious Diseases Clinic, San Paolo Hosp, Univ of Milan, Milan, Italy Background: It is unknown whether there are any differences in risk factors for haemorrhagic and ischaemic stroke in HIV+ individuals, or whether elevated blood pressure (BP) is a major risk factor for haemorrhagic stroke as known from the general population. Methods: D:A:D study participants were followed from the time of the first BP measurement at/after 1/1/1999 or individual study entry and until the first of a validated stroke, 6 months after last follow up or 1/2/2014. Elevated BP during follow-up was defined as current systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg. Poisson regression models were used to determine associations between haemorrhagic/ischaemic stroke and time-updated demographic, cardiovascular disease (CVD) -and HIV-related factors. Results: Of the 43,564 included persons, 74%were men; 69%were aged 30-50 years; 42%were smokers; 26% had elevated BP and 63% had received antiretroviral therapy (ART). Of 590 strokes; 83 (14%) were haemorrhagic (incidence rate (IR)/1000 person years 0.24, 95% confidence interval [0.19, 0.30]); 296 (50%) were ischaemic (0.87 [0.77, 0.97]) and the remaining 211 strokes were of unknown etiology. IRs for both stroke subtypes were higher in those with elevated BP than in those without; haemorrhagic stroke: (0.57 [0.41, 0.73]) vs. 0.13 [0.09, 0.18]); ischaemic stroke (1.74 [1.46, 2.02]) vs. 0.58 [0.49, 0.67]). In univariable models, factors most strongly associated with increased risk for both stroke subtypes were age, elevated BP and a low estimated glomerular filtration rate (eGFR) or CD4 count. The risk factor profile for the two stroke subtypes appeared to differ in multivariable models; Ischaemic strokes were more strongly associated with metabolic CVD risk factors (dyslipidaemia, previous CVD, diabetes) and smoking than haemorrhagic stroke. Conversely, elevated BP was associated with both stroke subtypes, but the association appeared stronger for haemorrhagic strokes. Low eGFR was markedly associated with haemorrhagic stroke only. Of the HIV-related variables, only low CD4 count but not type of ART was associated with risk of both stroke subtypes; previous AIDS and HIV acquisition via injection drug use were associated with ischaemic stroke only (Figure). Conclusions: Elevated BP, age and low CD4 count were the strongest predictors for both stroke subtypes. Our findings suggest that similarly to the general population, elevated BP may be a stronger predictor for haemorrhagic than ischaemic stroke in HIV+ individuals.

Poster Abstracts

259

CROI 2016