CROI 2016 Abstract eBook

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Poster Abstracts

WITHDRAWN

702

703 Incidence and Risk Factors for Overweight and Obesity After Initiation of ART Alexander Kintu 1 ; Enju Liu 2 ;Till Bärnighausen 1 ; Donna Spiegelman 3 ;WafaieW. Fawzi 1 ; for the Alex Kintu, Enju Liu,Till Baernighausen, Donna Spiegelman,Wafaie Fawzi 1 Harvard Sch of PH, Boston, MA, USA; 2 Harvard T.H. Chan Sch of PH, Boston, MA, USA; 3 Harvard Unviersity, Boston, MA, USA Background: The scaling up of HIV treatment services in sub-Saharan Africa has resulted in a large increase in the number of people currently receiving antiretroviral therapy (ART) in this region. Increased ART coverage in-turn has enabled more patients to survive to ages that have been associated with a higher prevalence of NCDs, including overweight and obesity. To our Knowledge, no study has previously assessed risk factors for these two outcomes in a sub-Saharan population. The objective of this study therefore was to describe the incidence of overweight and obesity after ART intiation and to explore risk factors for these two outcomes in patients receiving care in Dar-es-Salam, Tanzania . Methods: We used cox proportional hazards models to investigate risk factors of incident overweight and obesity after ART initiation. Results: 13,172 (26%) patients became overweight [median follow-up of 0.8 years, interquartile range (IQR): 0.2-2.4 years], and 6996 (11%) patients became obese [median follow-up 1.3 years, IQR: 0.3-3.3-y years]. The incidence rate of obesity was 6.0 per 100 person-years (95% C.I: 5.9-6.1). In multivariate analyses, female sex, being married, later year of ART initiation, higher baseline BMI and high adherence were all associated with increased risk for overweight and obesity. Being on an Efavirenz based regimen was associated with a 16% increased risk for obesity as compared to being on a Nevirapine based regimen (RR: 1.16, 95% C.I: 1.07-1.25). Patients on Stavudine containing regimen had higher risk for obesity as compared to those on Zidovudine containing regimen (RR: 1.09, 95% C.I: 1.01-1.18). Conclusions: Overweight and obesity are increasingly becoming common outcomes after ART initiation in this sub-Saharan population. Long-term follow up of HIV patients will require regular screening and targeted interventions for patients with specific risk factors for these two outcomes. 704 Measurement of Abdominal Fat Changes in HIV-Infected Individuals Initiating Therapy Priya Bhagwat 1 ; Ighovwerha Ofotokun 2 ; Grace A. McComsey 3 ;ToddT. Brown 4 ; Carlee B. Moser 5 ; Heather J. Ribaudo 5 ; Catherine A. Sugar 1 ; Judith S. Currier 6 1 Univ of California Los Angeles Sch of PH, Los Angeles, CA, USA; 2 Emory Univ Sch of Med, Atlanta, GA, USA; 3 Case Western Reserve Univ, Cleveland, OH, USA; 4 Johns Hopkins Univ, Baltimore, MD, USA; 5 Harvard Sch of PH, Boston, MA, USA; 6 David Geffen Sch of Med at Univ of California Los Angeles, Los Angeles, CA, USA Background: Visceral adipose tissue (VAT) accumulation remains common with contemporary HIV treatment and may be an important cardiovascular disease (CVD) risk factor. We examined whether changes in waist circumference and self-reported fat gain are valid methods of estimating change in abdominal fat for those initiating antiretroviral therapy (ART). Methods: Prospectively collected data from A5257, a treatment initiation study, and its metabolic substudy, A5260s, were used for this analysis. ART-naïve HIV-infected participants were randomized to one of three ART regimens. Objective changes in abdominal CT-measured VAT and total adipose tissue (TAT) and DXA-measured trunk fat were tested for association with measured waist circumference changes (by Spearman correlation) and categories of self-reported abdominal fat changes (by regression modeling) between entry and week 96. General linear models compared waist circumference and self-reported fat changes. Results: The study population (N=328) was predominantly male (90%) and white non-Hispanic (44%) with a median age of 36 years and BMI of 25 kg/m 2 . Waist circumference changes between entry and week 96 ranged from -19.2 cm to 38.4 cm (N=287). At week 96, 53% indicated “Lost/No Change”, 39% “Gained Some/Somewhat Larger”, and 8% “Gained A Lot/Much Larger” as their self-reported changes in abdominal fat (N=295). Trunk fat, VAT, and TAT changes differed between the self-reported groups (ANOVA p<0.0001), and the ordering of the groups was as expected. A strong correlation was found between waist circumference changes and CT and DXA changes (trunk fat: ρ =0.70, p<0.0001; VAT: ρ =0.52, p<0.0001; TAT: ρ =0.66, p<0.0001). While waist circumference changes explained a greater proportion of the variation of VAT, TAT, and trunk fat, self- reported fat change still explained a significant proportion of these fat measures after controlling for waist circumference (p<0.05). Conclusions: After initiation of ART, changes in self-reported abdominal fat and measurements of waist circumference each correlated directly with imaging-derived measures of abdominal fat. These simple measures can be used as reliable, affordable tools for central body fat assessment. 705 Metabolic Alterations and Physical Function in Older HIV-Infected Adults Mehri McKellar ; James Bain; Olga Ilkayeva; Michael Muehlbauer;Thomas O’Connell; Robert Stevens; MiriamMorey; Carl Pieper;William Kraus; Kim Huffman Duke Univ, Durham, NC, USA Background: HIV-infected older persons have accelerated rates of physical function decline compared to HIV-uninfected persons of similar age and gender. The biological mechanisms for this are not well-understood but may include disordered metabolism. To identify possible metabolic perturbations, we conducted metabolic profiling in a cohort of older HIV-infected patients on antiretroviral therapy (ART) who had completed physical performance measures. Methods: Physical performance testing (8-foot walk, grip strength, 30-second chair stand, and 6-minute walk) was performed in 117 HIV-infected older persons (>50 years old) on ART with undetectable HIV-1 viral loads in the Duke HIV Clinic, in Durham, NC. Targeted metabolic profiling of acylcarnitines and amino acids was conducted using mass spectrometry on plasma collected at time of physical performance testing. Metabolites were then correlated with physical performance and a comorbidity index (1 low – 5 high) using Spearman’s Rank Correlation Coefficient.

Poster Abstracts

292

CROI 2016