CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

642 INCREASING PREVALENCE OF HYPERTENSION AMONG HIV-POSITIVE ADULTS IN SENEGAL, 1994–2015 Noelle A. Benzekri 1 , Papa Salif Sow 2 , Moussa Seydi 2 , Stephen E. Hawes 1 , Geoffrey Gottlieb 1 1 Univ of Washington, Seattle, WA, 2 CHU de Fann, Dakar, Senegal

Background: Non-communicable diseases, including hypertension, are increasingly recognized as important causes of morbidity and mortality among people living with HIV (PLHIV) in resource limited settings. However, the prevalence and correlates of hypertension among HIV-positive individuals in Senegal are not well understood. The goals of this study were to determine the prevalence of hypertension among PLHIV in Senegal and to identify factors contributing to hypertension among HIV-positive versus HIV-negative adults. Methods: We conducted a retrospective study using data from individuals enrolled in previous studies in outpatient clinics in Senegal from 1994-2015. Blood pressure, height, and weight measurements taken during study visits were used for analysis. Hypertension (HTN) was defined as a systolic blood pressure ≥140 or a diastolic blood pressure ≥90. Data were analyzed using SPSS. Results: Data from 2848 adults were included in this study, of whom 1687 were HIV-positive and 1161 were HIV-negative. The prevalence of HTN among HIV-positive individuals was 12%, vs. 18% among those who were HIV-negative (p<0.01). During 1994-1999 the prevalence of HTN among HIV-positive individuals was 11%, vs. 22% during 2010-2015 (p=0.03) and the odds of HTN increased with time (OR 2.4 from 2010-2015 vs. 1994-1999, p=0.02). Among HIV-negative individuals, the prevalence of HTN during 1994-1999 was 16%, vs. 32% during 2010-2015 (p<0.01) with an increase in the odds of HTN with time (OR 2.6 from 2010-2015 vs. 1994-1999, p=0.02). Risk factors for HTN among both HIV-positive and HIV-negative individuals included increasing age, increasing BMI, and obesity (HIV-positive OR for obesity 4.4, p<0.01; HIV-negative OR 5.4, p<0.01). HTN was not associated with sex, education, or alcohol use in either group. Smoking was associated with HTN among HIV-negative, but not HIV-positive individuals. Among HIV-positive individuals, WHO stage 1 or 2 (OR 2.8, p<0.01) and CD4 counts ≥200 (OR 2.0, p<0.01) were associated with increased risk of HTN; there was no association with ART. Conclusion: This is the first study to document the increasing prevalence of hypertension among both HIV-positive and HIV-negative adults in Senegal, with an increase of 100% over the past 20 years. The strongest predictor of hypertension was obesity. Our findings highlight an urgent need for the integration of chronic disease management, including the prevention and treatment of hypertension and obesity, into HIV programs in Senegal. 643 MITOCHONDRIAL D-LOOP SNPS ASSOCIATED WITH AGE-RELATED COMORBIDITIES IN HIV PATIENTS Rumi Minami , Soichiro Takahama, Yasunori Koga, Masahiro Yamamoto Natl Hosp Org, Kyushu Med Cntr, Fukuoka, Japan Background: HIV-1-infected patients age prematurely and develop certain age-related diseases. The mitochondrial displacement loop (mt D-loop) accumulates mutations and single nucleotide polymorphisms (SNPs), which are associated with some age-related diseases. In this study, we analyzed the numbers and variations of SNPs in the mtDNA D-loop of combination antiretroviral therapy (cART) treated HIV patients and uninfected healthy controls. We also determined which clinical parameters were associated with SNPs in mtDNA D-loop in HIV patients. Methods: Three hundred and sixty-nine HIV patients on stable cART for > 6 months who achieved a viral load < 40 copies/ml, and 146 age-matched HIV-uninfected controls were enrolled. Peripheral blood mononuclear cells (PBMC) were obtained and a full sequence analysis of mtDNA D-loop was performed using direct sequencing. Linear regression analysis was used to analyze the factors associated with the numbers and variations of SNPs. We assessed several variables associated with HIV infection (CD4, HIV-RNA, HIV-DNA), cART (duration, regimen), and others (age, smoking, body mass index, hypertension). We also examined the relationship between SNPs and some age-related comorbidities. Variables found to be important in univariate analysis were multivariate model candidates. Results: We evaluated 33 SNPs with a frequency > 2%. The numbers of SNPs were larger in HIV patients than controls, but this was not significant. In HIV patients, HIV-DNA (r=0.129, p=0.0129) and nucleoside reverse transcriptase inhibitor (NRTI) use (r=0.115, p=0.0269) were independent factors to determine the numbers of SNPs. As for individual SNPs, T152C, C16261T, T310C, and T199C were independently associated with decreased mtDNA copy numbers in PBMC (r=−0.125, p=0.0171), GFR decreasing (r=−0.146, p=0.0249), high mean-intima-media thickness (r=0.203, p=0.0155), and bone mineral density T-score (r=−0.211, p=0.0361), when adjusting the covariates of important variables. The frequency of these SNPs was higher in HIV patients than controls. Conclusion: HIV-DNA and NRTI use were associated with the numbers of SNPs in the mtDNA D-loop, which was compatible with previous data showing that HIV-TAT and nucleotide analogues caused mitochondrial damage and mtDNA mutations. Furthermore, certain SNPs were linked with age-associated diseases. These findings suggest good virological control with decreased toxicity can help improve outcomes among HIV patients. 644 IMMUNOLOGIC AND VIROLOGIC MEASURES AND MORTALITY AFTER NCD IN HIV+ ADULTS Jessica L. Castilho , Megan M. Turner, Bryan E. Shepherd, John R. Koethe, Sally S. Bebawy, Carmen E. Bofill, Stephen P. Raffanti, Timothy R. Sterling Vanderbilt Univ, Nashville, TN, USA Background: In the setting of virologic suppression, occurrence of non-communicable diseases (NCD) including cardiovascular disease (CVD), cirrhosis, and non-AIDS-defining cancers (NADCs) has been associated with circulating CD4 and CD8 counts in HIV-infected adults on antiretroviral therapy. However, the importance of CD4/CD8 ratio and risk of short-termmortality following NCD has not been established. Methods: We used Cox proportional hazard models to assess the relationship between patient factors, immunologic (absolute CD4 count, nadir CD4, and CD4/CD8ratio) and virologic measures with mortality risk during the two years following incident CVD diagnosis (coronary artery disease, cerebrovascular disease, and peripheral vascular diseases), cirrhosis, or NADC diagnosis (excluding skin cancers) diagnoses among in a clinical cohort of HIV+ adults in Tennessee. Results: Between 1998-2013, 295 HIV+ patients had an incident NCD and were included in this study: 157 with CVD, 89 with NADC, and 49 with cirrhosis. Among all patients, the median age at NCD was 48 years, 117 (40%) were non-white race, and 54 (18%) were women. There were 80 patients who died within two years of NCD event, including 23 after CVD, 36 after NADC, and 21 after cirrhosis (see Figure). In multivariable analysis (which also included age, anemia, CD4 count, CD4/CD8 ratio, and year), female sex (aHR = 1.88 [95% CI 1.10-3.23]), undetectable HIV-1 RNA (aHR = 0.46 [0.27-0.79]), and NADC or cirrhosis diagnosis (compared to CVD, aHR = 3.37 [1.191-5.4] and aHR = 2.72 [1.40-5.27], respectively) were significantly associated with mortality risk in the two years after NCD. Among patients with undetectable viral load (n=197), only NCD diagnosis (NADC vs. CVD) was statistically associated with mortality risk in bivariate analyses. Conclusion: Virologic suppression, not CD4 or CD4/CD8 ratio, at the time of NCD diagnosis was associated with decreased risk of short-termmortality after CVD, NADC, and cirrhosis diagnosis. Female sex was also associated with increased risk of death in adjusted analyses. Detectable viral load may serve as a marker not only for HIV virologic activity but also social factors related to failure to achieve virologic suppression (such as adherence or other health-related behaviors) that increase risk of mortality after NCD. Further research is needed to understand disparities among HIV+ adults with NCDs for identification of those at high risk and development of interventions for poor outcomes following NCD diagnosis.

Poster and Themed Discussion Abstracts

CROI 2017 275