CROI 2016 Abstract eBook

Abstract Listing

Poster Abstracts

688

The Racial Survival Paradox in HIV+ End-Stage Renal Disease (ESRD) Patients Keri N. Althoff 1 ; Michelle Estrella 2 ; Alison Abraham 1 ; John Gill 3 ; Mari M. Kitahata 4 ; Michael A. Horberg 5 ; MarkW. Hull 6 ; Angel M. Mayor 7 ; Frank J. Palella 8 ; Gregory M. Lucas 9 1 Johns Hopkins Bloomberg Sch of PH, Baltimore, MD, USA; 2 Johns Hopkins Univ Sch of Med, Baltimore, MD, USA; 3 Univ of Calgary, Calgary, AB, Canada; 4 Univ of Washington, Seattle, WA, USA; 5 Mid-Atlantic Permanente Med Group, Rockville, MD, USA; 6 BC Cntr for Excellence in HIV/AIDS, Vancouver, BC, Canada; 7 Univ Central del Caribe, Bayamon, PR, USA; 8 Northwestern Univ, Chicago, IL, USA; 9 Johns Hopkins Univ, Baltimore, MD, USA Background: The survival paradox among ESRD patients in the general population suggests older black patients have better survival compared to whites, but that this association is reversed at younger ages. As survival after ESRD in HIV-infected adults has not been well described, we sought to investigate the existence of the racial survival paradox in HIV- infected adults. Methods: Adults (>=18 years old) participating in one of 12 contributing cohorts to the NA-ACCORD with validated ESRD diagnosis from 1 Jan 2000 to 31 Dec 2009 were included and followed from ESRD diagnosis to death or censoring. Demographic data, smoking, diabetes, treated hypertension, hypercholesterolemia, statin use, past clinical AIDS diagnosis, CD4 count, ART and HIV viral load status, prior tenofovir exposure, and hepatitis B and C co-infection at ESRD diagnosis were examined for their relationship with death using adjusted hazard ratios (aHR) and 95% confidence intervals ([,]) from Cox proportional hazard models. Results: 540 adults with ESRD contributed 1,958 person-years and 255 deaths. Median follow-up time was 2.5 years. Death more likely to be among those who are black, those with heterosexual or injection drug use HIV transmission risks, smokers, those with past AIDS defining illness, low (<200 cells/mm 3 ) CD4 count, and detectable (>400 copies/mL) HIV RNA. At ESRD diagnosis, 52% of participants were not prescribed ART, 29%were prescribed ART but not virologically suppressed, and 19%were prescribed ART and virologically suppressed. The racial survival paradox was apparent among HIV-infected persons, though the number of white ESRD patients was very small (Figure 1). In multivariate models, older age (≥60 years vs. <40 years, aHR=1.77 [1.01, 3.10]), hypercholesterolemia (aHR=1.59 [1.13, 2.24]), an AIDS defining illness (aHR=3.08 [2.21, 4.48]), no ART prescription (aHR=18.16 [7.31, 45.16]), and tenofovir use prior to ESRD (aHR=2.16 [1.38,13.38]) increased the risk of death, and a higher CD4 count was protective (CD4 ≥500 vs. <200 cells/mm 3 , aHR=0.41 [0.27, 0.61]). Conclusions: The suggestion of the racial survival paradox in HIV-infected adults motivates the need for understanding the factors contributing to higher mortality among younger (<60yo), black, HIV-infected adults with ESRD.

689 Activation and Senescence Markers in HIV Patients With Chronic Kidney Disease Alexandra Ozanne 1 ; Frédéric-Antoin Dauchy 2 ; Claire Rigothier 2 ; Cécile Le Scanf-Terrien 2 ; Pierre Duffau 2 ; Estibaliz Lazaro 2 ; Charles Cazanave 3 ; Sylvie Lawson-Ayayi 4 ; LindaWittkop 2 ; Isabelle Pellegrin 2 1 Univ de Bordeaux, Bordeaux, France; 2 CHU de Bordeaux, Bordeaux, France; 3 CHU de Bordeaux, Bordeaux Cedex, France; 4 INSERM, ISPED, INSERM U897, Bordeaux, France Background: ART-treated HIV-infected individuals remain at higher risk for chronic kidney disease (CKD) than the general population and multiple causes are hypothesized. We evaluated the association between T cell immune activation (IA) and -senescence (IS), and CKD in these patients. Methods: Patients with undetectable viral load and an estimated Glomerular Filtration Rate (eGFR) measurement were part of the cross-sectional CIADIS substudy (2011-2013) of the ANRS CO3 Aquitaine cohort. The CIADIS score was determined with CD4 and CD8 activation (DR+), maturation (T naive, memory) and senescence (CD57+CD28-) markers (Duffau et al . AIDS in press): positive values represent a phenotype with high IA and IS, negative values a profile with low IA/IS and with high proportion of naive T cells. The association between the CIADIS score and CKD was evaluated for two separate outcomes: i) eGFR <60 mL/min/1.73m 2 and ii) eGFR<90 mL/min/1.73m 2 . Logistic regression models adjusted for age, sex, tenofovir (TDF) use and non-HIV related comorbidities (diabetes, cardiovascular events, dyslipidemias, hypertension and cancer) were constructed. In a sub- group analysis, urine protein-creatinine ratio (uPCr) >30 mg/mmol was combined with eGFR≥90 to define early kidney dysfunction. Results: We included 849 patients with a median age of 51 years; 74%were men, 23% at CDC stage C; they were on ART for a median of 13 years, 85% of patients had an ongoing or previous TDF-containing regimen. eGFR was ≥90, 60-89 and <60 in 68 %, 28% and 4% of patients, respectively. The median CIADIS score was -0.1 (IQR -1.5;1.5) and increased significantly with decreasing kidney function (Figure). In univariable analysis: an increase of the CIADIS score was significantly associated with an eGFR<60, (OR=1.2; 95% CI 1.0-1.5; P =0.04) and eGFR<90 (OR=1.1; 95% CI 1.0-1.2; P <0.01). After adjustment, the CIADIS score remained significantly associated with an eGFR<60 (OR=1.3; 95% CI 1.0-1.6; P =0.03) only. Among 221 patients with an eGFR ≥90 and available uPCr, 9% had an early kidney dysfunction. No difference in the score was found whether uPCr was ≤30 or >30 ( P =0.46). Conclusions: Higher IA and IS levels were independently associated with advanced CKD. Although other factors may contribute to kidney damage, persisting T-cells activation and senescence could induce inflammation and thus play a direct role even in successfully treated patients. Follow-up continues; longitudinal analysis will allow studying the development of CKD according to IA/IS profiles.

Poster Abstracts

285

CROI 2016