CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

348 WITHDRAWN 349 HIV NEUROLOGICAL DISORDERS CAN OCCUR IN PATIENTS WITH SUPPRESSED HIV-1 VL IN PLASMA Cathia Soulie 1 , Maxime Grudé 2 , Corinne Amiel 3 , Laurence Morand-Joubert 4 , Stephanie Raymond 5 , Coralie Pallier 6 , Pantxika Bellecave 7 , Diane Descamps 8 , Anne-Geneviève Marcelin 1 , for the ANRS Resistance AC11 Group 1 Pitié Salpêtrière Hosp, Paris, France, 2 INSERM, Paris, France, 3 Tenon Hosp, Paris, France, 4 Saint Antoine Hosp, Paris, France, 5 Toulouse Univ Hosp, Toulouse, France, 6 Paul Brousse Hosp, Villejuif, France, 7 Pellegrin Hosp, Bordeaux, France, 8 Bichat Hosp, Paris, France Background: HIV antiretroviral (ARV) therapy is successful in reducing the cerebrospinal fluid (CSF) HIV RNA levels and also in preventing HIV associated dementia or disorders related to HIV encephalitis. However, associated brain disorders could persist despite antiretroviral therapy. Contributing factors remain poorly understood. We studied a large population of antiretroviral treated patients who had a HIV RNA viral load (VL) >1.7 log10 copies/mL in CSF associated with cognitive impairment. Methods: Blood and CSF samples were collected at time of neurological disorders for 227 patients in 22 centers in France and 1 center in Switzerland. Demographic data and ARV treatment were collected. Bulk genotypic HIV resistance tests were realized on CSF. The genotypic susceptibility score (GSS) of current treatment was calculated according to the last ANRS AC-11 genotype interpretation algorithm: 0 (resistant), 0.5 (intermediate) or 1 (susceptible). Comparisons between groups were performed by using non-parametric tests. Results: 227 patients (65%male, median age 45 years) were studied. Current and nadir CD4 cell counts were 230 (110-452) and 67 (24-165) cells/mm3, respectively. Overall, median CSF HIV RNA was 3.8 (3.1-4.6) log10 copies/mL. Among the 227 patients, 195 had a VL also detectable in plasma (median VL = 3.7 (2.7-4.7) log10 copies/mL) and 32 were discordant with a VL undetectable in plasma (VL<1.7 log10 copies/mL). The clinical and virological factors were then compared between these two groups of patients. The CSF VL was lower (2.8 vs 4.0 log10 copies/mL; p=3.34 109) and the CD4 cell count was higher (476 vs 214; p=0.0003) in the group of patients with VL<1.7 log10 copies/mL in plasma compared with patients with plasma VL>1.7 log10 copies/mL. The CD4 nadir tended to be higher (92 vs 63; p=0.0640) in the group of patients with undetectable VL in plasma. No difference was observed between the 2 patient’s groups for GSS (2) and Charter score (8 and 7 for patients with plasma HIV VL<1.7 and >1.7 log10 copies/mL, respectively). Conclusion: 14% of patients with cognitive impairment and HIV RNA > 1.7 log10 copies/mL in CSF were well controlled in plasma. Thus, it is important to explore HIV CSF (VL and resistance genotype) even if the HIV VL is controlled in plasma because HIV resistance could be observed. Indeed, an optimization of antiretroviral treatment could be necessary using fully active drugs with improved central nervous system penetration. 350 COGNITIVE TRAJECTORIES OVER 4 YEARS AMONG HIV+WOMEN WITH OPTIMAL VIRAL SUPPRESSION Leah H. Rubin 1 , Gayle Springer 2 , Pauline M. Maki 1 , Kathryn Anastos 3 , Deborah Gustafson 4 , Maria Villacres 5 , Drenna Waldrop-Valverde 6 , David Vance 7 , Hector Bolivar 8 , Victor Valcour 9 1 Univ of Illinois at Chicago, Chicago, IL, USA, 2 The Johns Hopkins Univ, Baltimore, MD, USA, 3 Albert Einstein Coll of Med, Bronx, NY, USA, 4 SUNY Downstate Med Cntr, Brooklyn, NY, USA, 5 Univ of Southern California, Los Angeles, CA, USA, 6 Emory Univ, Atlanta, GA, USA, 7 Univ of Alabama at Birmingham, Birmingham, AL, USA, 8 Univ of Miami, Miami, FL, USA, 9 Univ of California San Francisco, San Francisco, USA Background: An estimated 50% of HIV-infected individuals will exhibit cognitive impairment during their lifetime despite benefits of combination antiretroviral therapy (cART). Although rates of impairment are lower among virally suppressed HIV-infected (HIV+VS) individuals, impairment still persists even among this subgroup. Little is known about cognitive trajectories among HIV+VS individuals which is needed to provide a framework for understanding mechanisms of detrimental change. Thus, we compared the cognitive trajectories between HIV+VS, HIV-uninfected (HIV-), and HIV+ women without systematic viral control (HIV+NVS). We expected that HIV+VS+ women would performworse than HIV- women but better than HIV+NVS women on global neuropsychological (NP) test performance, learning, memory, and attention. Methods: From 2009-2016, 1757 Women’s Interagency HIV Study participants underwent neurocognitive testing at baseline and biennially for 4 years (max 3 testing sessions/ person). Of 1757 women, there were 661 HIV+VS, 611 demographically-similar HIV-, and 485 HIV+NVS women. VS was defined as consistent HIV RNA in plasma <500ml/cp and cART use across all sessions. Mixed effects regressions were used to examine group differences and group x time interactions on cognition controlling for relevant demographic, behavioral, and clinical factors. Results: The cohort was 61% non-Hispanic Black, middle-aged (mean=46yrs, SD=9), and 54% had high school or less education. HIV+VS women demonstrated lower scores on global NP performance, memory, attention, executive function, and speed versus HIV- women (p’s<0.05; Figure 1). HIV+NVS women showed lower scores versus HIV+VS women on global NP performance, memory, learning, and motor skills (p’s<0.05). HIV- women showed improved motor skills whereas HIV+VS women did not improve (p<0.01). HIV+NVS women did not demonstrate global NP performance gains as those seen among HIV+VS women (p<0.05). HIV+NVS women showed less improvement on motor skills and executive function as compared to the HIV- women (p’s<0.05). Conclusion: Cognitive difficulties remain present even among women with consistent viral suppression. While there are some differences in trajectories between groups, cognitive difficulties persist in HIV+VS women over time. Findings reinforce a need to identify mechanisms bypassing the direct and indirect effects of the virus on the CNS and the importance of developing novel therapies to attenuate cognitive problems.

Poster and Themed Discussion Abstracts

CROI 2017 137