CROI 2016 Abstract eBook

Abstract Listing

Poster Abstracts

675 Coronary Artery Calcification on Chest Computed Tomography in HIV-Infected Smokers Alain Makinson 1 ; Sabrina Eymard-Duvernay 2 ; Iskander Bouassida 1 ; François Raffi 3 ; Sophie Abgrall 4 ; PierreTattevin 5 ;Vincent Le Moing 1 ; Jacques Reynes 1 ; Sébastien Bommart 1 ; for the ANRS EP48 HIV CHEST StudyTeam 1 Univ Hosp Montpellier, Montpellier, France; 2 INSERM, Montpellier, France; 3 Univ Hosp Nantes, Nantes, France; 4 Univ Hosp Antoine-Béclère, Clamart, France; 5 Pontchaillou Univ Hosp, Rennes, France Background: Lung cancer screening in heavy smokers with chest Computed Tomography (CT) is also an opportunity to diagnose other asymptomatic smoking-related complications. The objective of our study was to evaluate the prevalence of coronary artery calcification (CAC) on chest CT in a population of HIV-infected heavy smokers, and to identify risk factors for CAC. Methods: Post-hoc analysis of systematic chest CT scans performed during the ANRS EP48 HIV-CHEST multicentre study, which evaluated the feasibility of early lung cancer diagnosis in HIV-infected heavy smokers. Subjects were aged ≥ 40 years, had a history of smoking of at least 20 pack-years, a CD4 T-lymphocyte nadir cell count < 350 cells/µl, and a current CD4-T cell count > 100 cells/µl. We used a modified, published, semi-quantitative CAC score. Two radiologists reviewed the images, and discordant scores were discussed until consensus. Factors associated with presence of CAC were identified using a logistic regression model. Results: The 396 subjects enrolled had a median age of 50 years, 83%were men, median pack-years of smoking was 30, 90% of subjects had a HIV viral load < 50 copies/mL, and median last CD4 count was 574 cells/μL. CAC were observed in 266 (67%, 95% confidence interval (CI) [63; 72]) subjects, and 57 subjects (14.5%) had a CAC score ≥ 4, which has been shown to be significantly associated with cardiovascular death. In multivariate analysis, older age (per 10 years increase, with an odd ratio (OR) of 2.29, 95% CI [1.72; 4.04]), male sex (OR 2.00, 95% CI [1.17; 3.42]) and duration of antiretroviral treatment (per 5 years increase, OR 1.27, 95% CI [1.05; 1.54]) were associated with CAC. Cannabis inhalation, smoking in pack-years, nadir CD4 levels, last CD4 count, hepatitis C co-infection and a last HIV viral load < 50 copies/ml were not associated with CAC. Conclusions: In a population of HIV-infected heavy smokers, CAC prevalence was high (67%) on chest CT scans, and was associated with age and sex as well as antiretroviral treatment duration, but neither immunological nor virological factors. Chest CT assessment in HIV-infected smokers should include CAC scoring, but whether subjects with a high CAC score should benefit from screening for silent myocardial ischemia remains to be determined. 676 Incidence and Predictors of Hypertension Among HIV Patients in Rural Tanzania Eduardo Rodríguez-Arbolí 1 ; KimMwamelo 2 ; AnethV. Kalinjuma 3 ; Hansjakob Furrer 4 ; Christoph Hatz 5 ; MarcelTanner 5 ; Manuel Battegay 6 ; Emilio Letang 5 ; for the KIULARCO Study Group 1 Virgen del Rocio Univ Hosp, Seville, Spain; 2 Ifakara Hlth Inst, Ifakara, Tanzania; 3 Ifakara Hlth Inst, Morogoro, Tanzania; 4 Bern Univ Hosp and Univ of Bern, Bern, Switzerland; 5 Swiss Trop Inst of PH, Basel, Switzerland; 6 Univ Hosp Basel, Basel, Switzerland Background: Management of non-communicable comorbidities is emerging as an essential part of HIV care in resource-limited settings. Yet, scarce data are available on the burden and epidemiology of cardiovascular risk factors among HIV patients in rural Sub-Saharan Africa. We explored the prevalence, incidence and predictors of hypertension development among ART (antiretroviral therapy)-naïve patients enrolled in a rural HIV clinic in southern Tanzania. Methods: Prospective longitudinal study including patients enrolled in the Kilombero-Ulanga Antiretroviral Cohort (KIULARCO) between January 1, 2013 and March 2, 2015. Hypertensive patients at baseline, pregnant women and those exposed to ART before recruitment were excluded from the longitudinal analysis. Standardized blood pressure measurements were routinely performed at each visit. Incident hypertension was defined as systolic blood pressure (SBP) ≥ 140 mmHg and/or diastolic blood pressure (DBP) ≥ 90 mmHg on two consecutive visits. Cox proportional hazards models were used to assess the association of hypertension with demographic, clinical and treatment characteristics. Results: Among 955 eligible subjects, 111 (11.6%) were hypertensive at baseline. Ten women who became pregnant during follow-up were excluded. The remaining 834 individuals contributed 7967 person-months (pm) to follow-up (median 231 days, IQR 119-421) and 80 (9.6%) of them developed hypertension during a median follow-up of 144 days (incidence rate 0.01 cases/pm). Median age at recruitment was 38 years (IQR 32-46), median CD4 count 188 cells/µL (IQR 66-367) and 62%were female. ART was started in 657/834 (79%) patients, with a median time on ART of 7 months (IQR 4-14). Cox regression models identified age (adjusted hazard ratio (aHR) per 10 years 1.34, 95% confidence interval (CI) 1.07-1.68, p =0.010), body mass index (BMI) (aHR per 5 kg/m2 1.45, 95% CI 1.07-1.99, p =0.018) and estimated glomerular filtration rate (eGFR) (aHR < 60 versus ≥ 60 ml/min/1.73 m2 3.79, 95% CI 1.60-8.99, p =0.003) as independent predictors of incident hypertension (Fig. 1). Conclusions: Prevalence and development of hypertension are common among HIV patients in rural Tanzania. Traditional cardiovascular risk factors such as age, BMI or eGFR were predictive of incident hypertension, but no association was observed with immunological or ART status. These data support the implementation of routine hypertension screening and management strategies into integrated HIV programmes in rural Sub-Saharan Africa.

Poster Abstracts

279

CROI 2016