CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

ART exposure. We did multivariable logistic regressions to estimate the relationship between ART and measures of healthcare services for diabetes and hypertension, controlling for age, sex, body mass index (BMI), educational attainment and wealth quintile. Results: The prevalence of diabetes and hypertension were as follows: HIV-negative 12.3% & 63.7%, HIV+/No ART 6.3% & 43.5%, HIV+/ART 7.8% & 38.7%. Compared to the HIV-negative population, mean age, BMI and systolic blood pressure were all lower in the HIV-positive population (all p<0.001), as was the percentage of participants with hypertension and diabetes (all p<0.001). Multivariable logistic regression showed that ART was significantly associated with greater odds of blood sugar measurement (aOR 1.27 95% CI 1.07-1.52), blood pressure measurement (aOR 1.26, 95% CI 1.03-1.53), and counseling regarding exercise (aOR 1.74, 95% CI 1.23-2.46). ART was also significantly associated with greater odds of awareness of hypertension diagnosis (aOR 1.49, 95% CI 1.11-2.02) and receipt of hypertension treatment (aOR 1.62, 95% CI 1.21-2.16). Conclusion: The burden of diabetes and hypertension is substantial in Agincourt. HIV-positive patients who use ART are more likely to have received healthcare services for diabetes and hypertension. This apparent ART advantage needs to be confirmed in future studies but points to the potential of ART programs as a vehicle for strengthening health systems. 640 CARDIOVASCULAR RISK ASSESSMENT IN A SUB-SAHARAN AFRICA HIV CLINICAL COHORT Mosepele Mosepele 1 , Linda C. Hemphill 2 , Tommy Palai 1 , Isaac Nkele 3 , Kara Bennett 4 , Shahin Lockman 5 , Virginia Triant 2 1 Univ of Botswana, Gaborone, Botswana, 2 Massachusetts General Hosp, Boston, MA, USA, 3 Botswana–Harvard AIDS Partnership, Gaborone, Botswana, 4 Bennett Statistical Consulting Inc, New York, NY, USA, 5 Harvard Univ, Boston, MA, USA Background: HIV-infected patients are at increased risk for cardiovascular disease (CVD). However, risk prediction for CVD in HIV-infected persons has not been well-established in sub-Saharan Africa, which suffers from both the highest global burden of HIV and a rising rate of CVD. Methods: HIV-infected adults between 30-50 years of age with documented virologic suppression were enrolled into a cross-sectional study in Gaborone, Botswana. All participants were screened for the following CVD risk factors (CVDRF): hypertension (current blood pressure) or use of anti-hypertensive treatment, weight, height, waist circumference, cigarette smoking, lipid profile, glycosylated hemoglobin. Bilateral carotid intima-media thickness (cIMT) was measured and 10-year predicted risk of cardiovascular disease was calculated using the 2013 Pooled Cohorts Equation (ASCVD). ASCVD ≥7.5%was considered elevated risk for CVD. Pearson’s correlations assessed the association between CVDRF / HIV factors and cIMT. Agreement in classification of participants as high risk for CVD by cIMT (≥75th percentile) and ASCVD risk score (≥7.5%) was assessed using McNemar`s Test; additionally, the cut point for cIMT that corresponded with ASCVD≥7.5%was assessed using Youden’s J statistic. Results: Among 208 HIV-infected patients (Female: 55%, mean age 39 years), multiple traditional CVD risk factors correlated with cIMT. Among HIV factors, longer duration of HIV disease was associated with increased cIMT (r=0.14, p=0.04). A higher proportion of patients were classified as high risk by cIMT versus ASCVD (42.3% versus 14.1% identified as high risk, respectively; McNemar`s exact p-value <0.001). An ASCVD score of ≥ 7.5%was equivalent the 88th percentile of cIMT. Conclusion: There was discordance in classification of high CVD risk when using the ASCVD risk score versus a cIMT threshold, with more patients classified as high risk using cIMT. More research is urgently needed to establish optimal CVD risk prediction strategies for HIV-infected patients in sub-Saharan Africa 641 HIV AND IMMUNE ACTIVATION ARE RISK FACTORS FOR ENDOTHELIAL DAMAGE IN ADULT MALAWIANS Christine Kelly 1 , Henry Mwandumba 2 , Rob Heyderman 3 , Raphael Kamng’ona 2 , Mishek Chammudzi 2 , Irene Sheha 2 , Jane E. Mallewa 4 , Sarah Walker 3 , Nigel Klein 3 , Saye Khoo 5 1 Univ Coll Dublin, Dublin, Ireland, 2 Malawi Liverpool Wellcome Clinical Rsr Prog, Blantyre, Malawi, 3 Univ Coll London, London, UK, 4 Univ of Malawi, Blantyre, Malawi, 5 Univ of Liverpool Inst of Translational Med, Liverpool, UK Background: Mortality from cardiovascular disease (CVD) is predicted to surpass that of infectious disease in subSaharan-Africa (SSA) by 2030. HIV doubles the risk of CVD in high resource settings, but the contribution of HIV and immune activation to the risk of CVD in SSA is unknown. Methods: HIV-1-infected adults with CD4<100 cells/ul were recruited 2 weeks following initiation of anti-retroviral therapy (ART) within the REALITY trial (NCT01825031), along with healthy HIV-uninfected adults and followed for 44-weeks. Acute infections (malaria, TB, cryptococcal meningitis, pneumonia, gastroenteritis) were recorded. Pulse wave velocity(PWV) was assessed using the Vicorder system. Flow cytometry identified T-cell activation(HLADR/CD38+), exhaustion(PD1+) and senescence(CD57+) in all participants, and circulating microparticles(CMPs) in 72 participants. Independent predictors of PWV were identified using linear regression with backwards elimination (exit p>0.1) of variables with univariable p<0.2 (spearman-rho or ranksum). Results: 279 HIV-infected adults had similar median(IQR) age [36(31-43) vs 35(3-41) years, p=0.4], but lower systolic BP [120(108-128) vs 128(114-134)mmHg, p<0.01], BMI [20(18-21) vs 22(20-25)kg/m2, p<0.01] and proportion of women [122(44%) vs 66(60%), p<0.01] than 110 HIV uninfected adults. Following adjustment for confounders, HIV was associated with a 12%-increase in PWV (p<0.01) at baseline, which remained at week 10 (14%-increase, p=0.02) but resolved by week 24 (Figure 1). %CD4-PD1 and %CD8-PD1 were independently associated with PWV at baseline (fold change 2% and 3% per 10%increase, p=0.06 and 0.05 respectively). A decrease in %CD4-PD1 was associated with improvement in PWV by week 44 (rho 0.20, p=0.02). At baseline, median (IQR) CMPs were increased in HIV infection [5.1(2.0-18.0)x106 versus 0.4(0.2-6.0)x106, p<0.00001) and high versus low immune activation [4.0(2.3-5.6)x106 versus 0.3(0.1-0.5)x106, p<0.0001)] and were strongly related to PWV (rho 0.42, p<0.001). An acute infection during the study carried a 51% adjusted increase in %CD8 activated Tcells at week 44 (p=0.02) and an increase in PWV at week 44 of 0.80m/s [versus -0.10m/s (p=0.01)]. Conclusion: These results strongly implicate HIV and immune activation in increased endothelial damage during the first 12 weeks of ART therapy. Improvement in PWV on ART and cotrimoxazole is associated with decreases in immune activation. HIV and co-infections may present modifiable CVD risk factors in low resource SSA setting.

Poster and Themed Discussion Abstracts

CROI 2017 274