CROI 2016 Abstract eBook

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Poster Abstracts

677 Population-Level Decline in BMI and Blood Pressure Following Mass HIV Treatment

Pascal Geldsetzer 1 ; Andrea B. Feigl 1 ; FrankTanser 2 ; Dickman Gareta 2 ; Deenan Pillay 2 ;Till Bärnighausen 1 1 Harvard Sch of PH, Boston, MA, USA; 2 Africa Cntr for Hlth and Pop Studies, Mtubatuba, South Africa

Background: Clinic-based cohort studies have found that antiretroviral therapy (ART) leads to an increase in BMI. The aim of this study is to determine whether the scale-up of ART is also associated with a population-level increase in BMI, blood pressure (BP), and prevalence of obesity and hypertension in a high HIV-prevalence (29% of adults HIV- infected) population in rural South Africa. Methods: We conducted a cross-sectional anthropometric survey of height, weight, and BP in adults in rural KwaZulu-Natal, South Africa, before ART scale up (in 2004) and when ART coverage in the community was 25% (in 2010). 3,000 individuals were contacted for each survey. Anthropometric data was linked with data on HIV status collected as part of intensive HIV surveillance in the area. Results: 2,252 and 2,088 individuals in 2004 and 2010, respectively, agreed to a height and weight measurement. BMI, and overweight and obesity prevalence declined between 2004 and 2010 in both females and males. Among females, BMI decreased from 29.9kg/m 2 to 29.1kg/m 2 (p=0.002), overweight prevalence from 30.1% to 28.8% (p=0.050), and obesity prevalence from 42.8% to 40.0% (p=0.020). Among males, the declines were even more marked with BMI decreasing from a mean of 24.2kg/m 2 to 23.0kg/m 2 (p<0.001), and overweight and obesity prevalence decreasing from 20.2% to 15.2% (p=0.005), and from 11.7% to 7.0% (p=0.001), respectively. Mean systolic BP also decreased significantly from 122.9mmHg to 118.2mmHg (p<0.0001) among females, and 128.4mmHg to 123.2mmHg (p<0.001) among males. Mean diastolic BP increased slightly from 79.6mmHg to 81.4mmHg (p<0.001) and 79.0mmHg to 80.7mmHg (p=0.005) among females and males, respectively. There were no significant changes in hypertension prevalence. Among HIV-infected individuals, BMI and systolic BP declined in females and did not change in males. Conclusions: Population-level BMI and systolic BP declined significantly during the first seven years of ART scale-up in a high HIV prevalence community. This finding is likely due to ART substantially increasing survival of HIV-infected individuals in advanced disease stages and with substantial HIV-induced weight loss. For the large proportion of individuals who were overweight or obese prior to advanced HIV infection, the HIV-related decrease in BMI coupled with enrolment in chronic ART services may offer a unique opportunity to maintain healthy BMI levels through nutritional and lifestyle counselling at ART clinics. 678 HIV Infection, ART Use, and Access to Care for NCDs in Agincourt, South Africa Jennifer Manne-Goehler 1 ; Livia Montana 2 ; Xavier Gomez-Olive 3 ; AlishaWade 4 ; StephenTollman 4 ;Thomas A. Gaziano 5 ;Till Bärnighausen 2 1 Beth Israel Deaconess Med Cntr, Boston, MA, USA; 2 Harvard Sch of PH, Boston, MA, USA; 3 Med Rsr Council/Wits Rural PH and Health Transition Unit, Johannesburg, South Africa; 4 Univ of the Witwatersrand, Johannesburg, South Africa; 5 Brigham and Women’s Hosp, Harvard Med Sch, Boston, MA, USA Background: There is limited population-based data on the role of ART programs in the delivery of care for non-communicable diseases (NCDs) in Sub-Saharan Africa. The aims of this study were to assess differences in access to care for diabetes, hypertension and hyperlipidemia among those who are HIV-infected but have never used ART (HIV/Never ART) as compared to those who are HIV-infected but have ever accessed ART (HIV/Ever ART) and to assess the relationship between ART program participation and access to care for NCDs in the Agincourt sub-district of South Africa. Methods: The Health and Aging in Africa: Longitudinal Studies of INDEPTH communities (HAALSI) Study is a cohort of adults aged 40 and over based in Agincourt, South Africa. The study began in November 2014 and will end in November 2015. The study consists of a survey of self-reported demographic, health and economic data as well as clinical biomarker testing including glycosylated hemoglobin, cholesterol, HIV antibody and blood pressure measurement. The survey also includes self-reported data on healthcare utilization. Multivariate logistic regression was used to assess the relationship between self-reported ART use and measurement of blood pressure, blood sugar and receipt of lifestyle modification advice from a healthcare provider. Results: Among 4,767 participants, 979 (20.5%) were HIV-infected and 511 (10.7%) reported ever receiving ART. The HIV/Ever ART group reported higher rates of ever measured blood sugar (52.8% v. 38.8% in HIV/Never ART), ever measured blood pressure (74.4% v. 68.5%) and receipt of advice from a healthcare provider to change diet (13.3% v. 5.0%) and exercise (9.0% v. 2.6%). In multivariate logistic regression models, there was a significant association between ever receiving ART and having had a blood pressure (OR = 1.61, CI: 1.14 – 2.27) or blood sugar (OR = 1.94, CI: 1.43 – 2.63) measurement. Ever receiving ART was also associated with a greater odds of receiving recommendations from a healthcare provider to change diet (OR = 2.88, CI: 1.70 – 4.88) or exercise (OR = 2.39, CI: 1.18 – 4.81). All models were adjusted for age, sex, BMI, and educational attainment. Conclusions: The HIV-infected population in Agincourt that had ever received ART reported greater access to preventive care for NCDs. The positive spillover effects from ART utilization to preventive care for other chronic conditions could provide a powerful vehicle for broader population health improvements via increased programmatic integration.

Poster Abstracts

679 The Burden of NCDs Among the HIV-Infected Population in Agincourt, South Africa Jennifer Manne-Goehler 1 ; Livia Montana 2 ; Xavier Gomez-Olive 3 ; AlishaWade 4 ; StephenTollman 4 ;Till Bärnighausen 2 ;Thomas A. Gaziano 5 1 Beth Israel Deaconess Med Cntr, Boston, MA, USA; 2 Harvard Sch of PH, Boston, MA, USA; 3 Med Rsr Council/Wits Rural PH and Health Transition Unit, Johannesburg, South Africa; 4 Univ of the Witwatersrand, Johannesburg, South Africa; 5 Brigham and Women’s Hosp, Harvard Med Sch, Boston, MA, USA Background: With increasing survival of HIV-infected populations due to ART, a greater burden of cardiometabolic disease may be unmasked. However, the population level impact of HIV and ART on cardiometabolic risk in communities that are severely affected by the HIV epidemic is poorly understood. The aim of this analysis was to assess differences in the burden of diabetes, hypertension, hyperlipidemia and chronic kidney disease (CKD) among those who were HIV-infected and had ever used ART (HIV/Ever ART) compared to the HIV-negative and HIV-infected population that had never used ART (HIV/Never ART) in the Agincourt sub-district of South Africa. Methods: The Health and Aging in Africa: Longitudinal Studies of INDEPTH communities (HAALSI) Study is a population-based cohort study of about 5,000 adults aged 40 and older in Agincourt. Enrollment began in November 2014 and will close in November 2015. The study consists of a survey of demographic, health and economic data in addition to

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