CROI 2016 Abstract eBook

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Poster Abstracts

Methods: HIV+ participants aged ≥40 years who received an initial ART regimen as participants in an ACTG randomized clinical trial completed a frailty assessment (4 meter walk, grip strength, and self-reported weight loss, exhaustion, and low physical activity) at A5322 enrollment, a longitudinal study. Participants meeting previously-defined thresholds in 3-5 categories were considered frail, 1-2 pre-frail, and 0 non-frail. Characteristics were compared between frailty groups. Ordinal logistic regression models examined associations with an increase in frailty (from non-frail to pre-frail/frail or non-frail/pre-frail to frail). Covariates with category-specific p-value <0.10 in univariate models were retained in the final multivariable model. Results: There were 1016 HIV+ participants with frailty exams; median age was 51 (IQR 46, 56) years; 19%were female, 30% Black and 20% Hispanic; 51%with CD4 nadir <200 cells/µL. At A5322 entry, median CD4 was 616 (449, 821) cells/µL, 95% had HIV-1 RNA <200 copies/mL, with a median of 7.8 (IQR 4.4, 12.0) years since ART initiation. Frailty criteria were met in 6%; 38%were pre-frail; 56% non-frail. Among frail participants, 90% had exhaustion, 89% low physical activity, 66%weak grip strength, 60% slow walk time, and 27%weight loss. In univariate models, no significant associations were seen between greater frailty and nadir CD4; prior exposure to zidovudine, didanosine or stavudine; time since ART initiation; substance use; or liver disease. Female sex, CD4<350 cells/µL, CD4/8, pre-ART HIV RNA, Hepatitis C, cardiovascular and renal disease, hypertension, diabetes, and cancer were significantly associated with advancing frailty in univariate but not multivariable analyses; significant covariates in the multivariable model are shown in the table. Conclusions: Among older HIV+ adults, modifiable factors (smoking, low physical activity, obesity) were strongly associated with increased frailty, and provide ideal targets for future interventions. The apparent association between frailty and NNRTI-based initial ART requires further investigation. The lack of association between frailty and current/ historical immunosuppression may reflect a highly compliant study population or a survivor effect.

720 Prevalence of Falls Among Older Women in theWomen’s Interagency HIV Study

Anjali Sharma 1 ; Donald R. Hoover 2 ; Qiuhu Shi 3 ; Susan Holman 4 ; MichaelW. Plankey 5 ; Amber L.Wheeler 6 ; KathleenWeber 7 ; Elizabeth Golub 8 ; Marcia K. Holstad 9 ; MichaelT.Yin 10 1 Albert Einstein Coll of Med, Bronx, NY, USA; 2 Rutgers Univ, Piscataway, NJ, USA; 3 New York Med Coll, Valhalla, NY, USA; 4 State Univ of New York Downstate Med Cntr, Brooklyn, NY, USA; 5 Georgetown Univ Med Cntr, Washington, DC, USA; 6 Univ of California San Francisco, San Fransisco, CA, USA; 7 CORE Cntr/Cook County Hlth and Hosp System and Hektoen Inst of Med, Chicago, IL, USA; 8 Johns Hopkins Bloomberg Sch of PH, Baltimore, MD, USA; 9 Emory Univ, Atlanta, GA, USA; 10 Columbia Univ Med Cntr, New York, NY, USA Background: HIV+ women may be at greater risk for reduced bone density and falls, leading to fractures as they age. Methods: We quantified self-report of any fall, ≥2 falls, and fear of falling (FOF) in the prior 6 months in 1,412 HIV+ and 660 HIV- women enrolled in the Women’s Interagency HIV Study ( WIHS). Associations of demographics, behavioral factors, comorbid conditions, and CNS active agents (i.e. antidepressants, antipsychotics, anticonvulsants, sedatives, or muscle relaxants) with odds of any fall and ≥2 falls (vs. none) were evaluated using logistic regression. Results: HIV+ women were older than HIV- women (median 49 vs 47yr, p<0.0001), and more likely to report neuropathy (21% vs 14%, p=0.0003), but less likely to be obese (47% vs 59%) or use marijuana currently (17% vs 25%). HIV+ women had greater exposure to CNS active agents than did HIV- women: 41% vs 33% used at least 1 agent. At least one fall was reported in 243 HIV+ (18%) and 119 HIV- (18%) women (p=0.87), with ≥2 falls reported in 113 HIV+ (9%) and 65 HIV- (10%) women (p=0.73). FOF did not differ by HIV status: 21% of women rated their FOF as “a little”, 7% “quite a bit” and 10% “very much”. Among women with no FOF, only 9% reported any fall; however, among women with “a little”, quite a bit” and “very much” FOF, 28%, 47% and 37% (p<0.0001) reported falls, respectively. Factors associated with any fall in multivariate analysis included age ≥60 (aOR=1.93, 95% CI:1.09-3.44 vs age <39), current marijuana use (aOR=1.98, 95% CI:1.32-2.98) depressive symptoms (aOR=1.55, 95% CI:1.18-2.03 for CES-D ≥16 vs <16), impaired memory (aOR=2.18, 95% CI:1.54-3.07), neuropathy (aOR=1.55, 95% CI:1.86-4.69), obesity (aOR=1.39, 95% CI:1.06=1.82), and number of CNS active agents (aOR= 2.95, 95% CI: 1.86-4.68 for ≥3 agents vs 0). Risk factors for multiple falls were similar, including current marijuana use, depressive symptoms, impaired memory, neuropathy, and number of CNS active agents (all p<0.02). HIV infection was associated with neither any fall nor multiple falls in multivariate analyses. Conclusions: In this cross-sectional study of older women, falls were associated with factors affecting cognition and obesity, and were not associated with HIV status. Longitudinal studies are needed to determine the rate of progression of fall risk by HIV status and whether the clinical consequences of falls differ by HIV status as these women age. 721 Factors AssociatedWith Limitations in Daily Activity Among Older HIV+ Adults Kristine M. Erlandson 1 ; KunlingWu 2 ; Robert Kalayjian 3 ; Susan L. Koletar 4 ; BabafemiTaiwo 5 ; Frank J. Palella 6 ; KatherinTassiopoulos 2 1 Univ of Colorado, Denver, CO, USA; 2 Harvard Sch of PH, Boston, MA, USA; 3 MetroHlth Med Cntr, Cleveland, OH, USA; 4 Ohio State Univ, Columbus, OH, USA; 5 Feinberg Sch of Med, Northwestern Univ, Chicago, IL, USA; 6 Northwestern Univ, Chicago, IL, USA Background: Aging HIV+ adults may have a greater burden of geriatric syndromes, including diminished ability with independent activities of daily living (IADLs). Improved understanding of limitations can assist providers in incorporating interventions to prevent or delay future decline. Methods: A5322 follows HIV+ adults ≥40yrs who previously initiated ART within an ACTG clinical trial. IADL function was assessed at entry in 8 categories (housekeeping, money management, cooking, transportation, telephone use, shopping, laundry, medication management); those who needed assistance in ≥1 category were considered IADL impaired. Associations were examined in logistic regression models; covariates with category-specific p-value <0.10 were retained in the final multivariable model. Additionally, frequency of IADL impairment by frailty status was examined. Frailty included a 4-mwalk, grip strength, and self-reported weight loss, exhaustion and low physical activity; participants meeting criteria in 3-5 categories were considered frail; in 1-2, pre-frail; and in 0, non-frail. Results: Of 1015 HIV+ participants with IADL assessed (19% female, 30% Black, 20% Hispanic), median age was 51 (IQR 46, 56) years; 51% had CD4 nadir <200 cells/µL. At A5322 entry, median CD4 was 616 (449, 822) cells/µL, 95% had HIV-1 RNA <200 copies/mL, with a median 7.8 (IQR 4.4, 12.0) years since ART initiation. There were 11%with 1 IADL

Poster Abstracts

299

CROI 2016