CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

HBV infection and alcohol, HBV-infected hazardous drinkers had an OR of 149.8 (CI 13.5-1 667.0) and HBV mono-infected an OR of 57.4 (CI 18.8-175.3) (ref: HBV-negative with no hazardous drinking). Conclusion: No independent association was reported between HCC and HIV itself. However, HBV/HIV co-infected patients seemed to have a higher risk of HCC compared to HBV- infected patients supporting the deleterious effect of HIV on HBV infection that might facilitate the occurrence of HCC. Aside the independent association of alcohol use, HBV and HCV infections with HCC, a synergistic effect between alcohol use and HBV infection was identified. Timely preventive measures against HBV infection and hazardous drinking in West Africa might prevent a significant number of HCC, especially in those diagnosed with HIV.

Poster and Themed Discussion Abstracts 608 THE EFFECT OF ART ON INFLAMMATION, COAGULATION, AND VASCULAR INJURY IN START Jason Baker , Shweta Sharma, Birgit Grund, for the INSIGHT START (StrategicTiming of AntiRetroviralTreatment) Study Group Univ of Minnesota, Minneapolis, MN, USA

Background: The INSIGHT START trial demonstrated that immediate (at CD4 >500cells/µL) versus deferred (to CD4 <350cells/µL or AIDS) antiretroviral therapy (ART) initiation led to reductions in AIDS and serious non-AIDS (SNA) events. ART decreases inflammation and coagulation, and we have previously demonstrated that IL-6 and D-dimer strongly predict risk for SNA events. We studied the effect of ART initiation on 7 biomarkers of inflammation, coagulation and vascular injury in START. Methods: Biomarker levels (Table) were measured from stored plasma at baseline and month 8. Mean changes in biomarker levels from baseline to month 8 were compared between the immediate and deferred ART arms by intent-to-treat using ANCOVA models, adjusted for baseline levels. Predictors of biomarker changes in the immediate ART group (age, gender, race, CD4 cell counts, CD4:CD8 ratio, log10 HIV RNA, BMI, smoking) were evaluated in multiple regression models, and biomarker changes within the 1st and 4th quartiles were presented for 2 factors that were consistently associated with biomarker changes. In all models, biomarkers were analyzed on the log2 scale; mean changes were back-transformed and presented as percent change on the original scale. Results: Of the 4,685 participants in START, 4487 (96%) consented to store plasma and 3890 participants (85%) had baseline and month 8 biomarkers. At month 8, 96% in the immediate and 9% in the deferred groups were using ART. Levels of IL-6, D-dimer, amyloid A, sICAM and sVCAM declined in the immediate group; differences between immediate and deferred ART at month 8 ranged from 12%-21% (each p<0.001; Table). Higher baseline viral load and lower CD4:CD8 ratios were significantly associated with steeper biomarker reductions following ART initiation for 6 and 5 of the 7 biomarkers, respectively (Table). To illustrate, the reduction in IL-6 for those in the lowest (<0.48) versus highest (>0.89) quartile of the CD4:CD8 ratio was 12.7% versus 2.7%, respectively (p<0.001 for association of CD4:CD8 with IL-6). No other clinical factors were consistent predictors of biomarker change in multivariate models. Conclusion: In START, early ART initiation reduced biomarker levels of inflammation, coagulation and vascular injury. Those with higher HIV viral load and lower CD4:CD8 ratio tend to experience greater reductions in systemic inflammation and coagulation following ART initiation.

CROI 2017 258