CROI 2016 Abstract eBook

Abstract Listing

Poster Abstracts

708 Hospitalizations With AIDS and Chronic End-Organ Conditions in HIV Outpatient Study

Kate Buchacz 1 ; Linda A. Battalora 2 ; Carl Armon 3 ; Rachel Hart 3 ; JohnT. Brooks 1 ; for the HIV Outpatient Study 1 CDC, Atlanta, GA, USA; 2 Colorado Sch of Mines, Golden, CO, USA; 3 Cerner Corporation, Kansas City, MO, USA Background: Combination antiretroviral therapy (ART) has extended survival of HIV-infected patients in the United States (U.S.) resulting in more patients aging to experience chronic conditions. We assessed the frequency of select conditions at hospitalization among HIV-infected patients before and during the era of ART. Methods: We analyzed data from HIV Outpatient Study (HOPS) participants seen at 9 U.S. HIV-specialty clinics during 1994-2014. We evaluated the percentage of hospitalizations of at least 1 night stay among HOPS participants with the following associated diagnoses (classified hierarchically): AIDS-defining opportunistic illnesses (OIs), non-AIDS defining cancers, chronic-end organ conditions (including cardiovascular, hepatic, renal, and pulmonary events), and other conditions, in seven three-year calendar periods during 1994- 2014. We used Cochran-Armitage test of trend to analyze changes in frequency of associated conditions and characteristics of hospitalized patients over time, and Wilcoxon rank sum test to analyze changes in length of stay in hospital (LOS). Results: Among 8,358 HOPS participants, 2,100 had been hospitalized with a total of 5,001 hospitalizations during 1994-2014 (29% for women, 47% for blacks, and 14% for Latino/Hispanic or other race/ethnicity patients). In analyses restricted to first hospitalization per patient per calendar period (n=2,871 hospitalizations), and comparing hospitalizations from 1994-1996 through 2012-2014, those with AIDS OIs fell from 45% to 6% (p < 0.001), those with chronic end-organ disease rose from 4% to 17% (p < 0.001), and those with non-AIDS defining cancers did not change significantly (Figure). The characteristics of patients at hospitalization also shifted: age > 50 years increased from 8% to 45%, CD4 cell count > 200 cells/mm 3 rose from 24% to 76% and HIV viral load < 1000 copies/mL rose over time to 77% (all p < 0.001). Median LOS was 7 days in the first period and 3 days in the last period (p < 0.001). Conclusions: During this 21-year prospective HIV cohort study, coincident with more widespread use of increasingly effective ART, the percentage of hospitalizations associated with AIDS OIs decreased as the percentage associated with chronic end-organ conditions increased. Hospitalizations occurred increasingly among patients who were older, had higher CD4 cell counts and lower HIV viral loads. These findings highlight the growing need for preventative primary care.

709 AgeingWith HIV: Emerging Importance of Chronic Comorbidities in Patients Over 75

Clotilde Allavena 1 ; Camille Bernaud 1 ; Sylvie Lariven 2 ; Marc-AntoineValantin 3 ;Tristan Ferry 4 ; Lise Cuzin 5 ; Alissa Naqvi 6 ; Matthieu Hanf 1 ; André Cabié 7 ; for the DatAIDS Study Group 1 CHU Nantes Univ Hosp, Nantes, France; 2 Hosp Bichat-Claude Bernard, Paris, France; 3 Pitié Salpétriêre Hosp, Paris, France; 4 Hosp de la Croix-Rousse, Lyon, France; 5 CHU Toulouse, Toulouse, France; 6 CHU Nice, Nice, France; 7 CHU Fort de France, Fort de France, France Background: As HIV-infected adults on successful ART are expected to have close to normal lifespans, they will increasingly develop age-related comorbidities. Only scarce epidemiological and clinical data are available in a geriatric HIV population. Methods: From the prospective multicenter (15 sites) DatAIDS cohort, we selected patients with at least one visit since 2004 and aged over 75 at the latest visit (geriatric group). Demographic, immuno-virological characteristics, as well as current ART regimen and comorbidities were compared with the elderly population, aged 50 to 75 (elderly group). P values < .05 were considered significant. Statistical tests used Wilcoxon test or χ2, as appropriate. Results: Of the 43,522 patients, characteristics of the 654 patients over 75 years (1.5%) were as follow: median age 78 years [IQR 76-82], 72%male, 31% HSH, with a median age at HIV diagnosis of 64 years [58-70] (age >75 at diagnosis in 10%) and a median duration of HIV infection of 15 years [10-20]. Death occurred in 146 patients (22 %). Among the 430 patients alive at the censoring date (01/09/2014), 420 (98 %) were receiving a triple therapy, a mono/dual therapy or at least 4 ARVs in 78%, 14% and 6% of cases, respectively. Main significant differences (p<0.05) between geriatric and elderly groups were: median age 78 vs. 56 years, hepatitis co-infection 9% vs. 24%, CMV serology positive 95% vs. 87%, low BMI 22% vs. 4%, overweight 6% vs. 29%, CDC stage C 34% vs. 29%, current smokers 5% vs. 37 %, median CD4 cell count 494 vs. 560/mm 3 , age at ART initiation 64.5 vs. 44.5 years, number of previous ART regimen 6 vs. 5, and current NRTI-sparing regimen use 30% vs. 26%. Virologic success rate (HIV RNA < 50 c/mL) was 89.2% in both groups. The geriatric group had more frequent age-associated non communicable comorbidities (AANC) than the elderly group: 45.8% vs. 71.1% had no more than 1 AANC, 40.2% vs. 24.7% had 2 or 3 AANC and 14% vs. 4.3% had more than 4 AANC (all p<0.05). ART, immunological characteristics and details of AANC are presented in table. Conclusions: In the HIV ageing population commonly defined as over 50, age-related comorbidities and undernourishment dramatically increased in the geriatric population, after 75, whose prevalence starts to be relevant. Despite an insufficient immunologic reconstitution and more frequent unusual ARV regimens, rate of virological success is high.

Poster Abstracts

294

CROI 2016