CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

646 LONGITUDINAL HIV VIRAL TRAJECTORIES AND COMORBIDITIES IN THE WIHS Seble Kassaye 1 , Cuiwei Wang 2 , Jeff Collmann 3 , Tracey Wilson 4 , Kathryn Anastos 5 , Mardge H. Cohen 6 , Ruth Greenblatt 7 , Joel Milam 6 , Stephen J. Gange 7 , Michael Plankey 1 1 Georgetown Univ, Washington, DC, USA, 2 SUNY Downstate Med Cntr, Brooklyn, NY, USA, 3 Albert Einstein Coll of Med, Bronx, NY, USA, 4 John H.Stroger Jr. Hosp of Cook County, Chicago, IL, USA, 5 Univ of California San Francisco, San Francisco, CA, USA, 6 Univ of Southern California, Los Angeles, CA, USA, 7 The Johns Hopkins Univ, Baltimore, MD, USA Background: Current HIV treatment goal is universal long-term viral suppression. We studied the association between longitudinal HIV viral trajectories (LHT) and HIV-related and unrelated comorbidities among women enrolled in the Women’s Interagency HIV Study (WIHS).  Methods: Logistic trajectory modeling was performed to identify LHT among women enrolled in the WIHS to determine the probability of achieving HIV RNA <80 c/mL. The association between LHT and co-morbidities was determined using generalized linear models for repeated measures. Kaplan-Meyer survival analysis was conducted to explore the relationship between LHT and mortality (SASv9.2). Results: 2,440 women contributed 56,209 visits from 1994-2015. The baseline median age was 36.4 years, 58.2%were African American, with a median CD4+ T lymphocyte count of 464/µL and median HIV RNA of 7000 c/mL. Three distinct LHT were identified: sustained viremia (N=1010); intermittently viremic (N=719), and; non-viremic (N=711). Cumulative years of viral suppression were 20 years (non-viremic), 13 years (intermittent-viremia), and 5 years (non-viremic) across groups. Mortality differed significantly among the 3 LHT: 37.6% (sustained viremia), 31.0% (intermittent viremia), and 14.8% (non-viremic) (p<0.0001). On multivariate analysis adjusted by race, age, CD4, depression with CESD ≥16, illicit drug use, alcohol use >7 drinks/wk, antiretroviral therapy, self-reported adherence, HIV risk category, enrollment site and death (yes or no), individuals with AIDS defining conditions and AIDS-associated cancers were more likely to have sustained viremia, but no significant association was identified between LHT and non-AIDS related malignancies. Compared to women with sustained viremia, women with viral suppression were more likely (HR 1.4, p=0.0072) to report risk factors for cardiovascular (CV) disease (hypertension, hyperlipidemia, diabetes), without concurrent increased incidence in CV disease outcomes (OR 1.1, P=0.4116). Conclusion: Increasing cumulative duration of viral suppression was associated with lower mortality. However, we identified an unexpected increase in self-reported risk factors for CV disease among women with long-term viral suppression. Further analyses, continued follow up of participants, and CV risk and disease outcome ascertainment is critical to identify differences in CV disease risk and outcomes. 647 OXIDATIVE STRESS PREDICTS SERIOUS NON-AIDS EVENTS IN HIV-INFECTED PATIENTS Mar Masia 1 , Sergio Padilla 2 , Marta Fernández 2 , Xavier Barber 3 , Santiago Moreno 4 , Jose A. Iribarren 5 , Joaquin Portilla 6 , Alejandro Peña 7 , Francesc Vidal 7 , Félix Gutiérrez 2 1 Hosp General Univ de Elche, Elche, Spain, < 2 Univ Miguel Hernández, Elche, Spain, 3 Hosp Ramon y Cajal, Madrid, Spain, 4 Hosp Donostia, San Sebastián, Spain, 5 Hosp General Univ de Alicante, Alicante, Spain, 6 Hosp Univ San Cecilio, Granada, Spain, 7 Hosp Univ de Tarragona Joan XXIII, Tarragona, Spain Background: Non-AIDS events have become major causes of morbidity and mortality in people living with HIV. Recognition of potentially modifiable mechanisms implicated in their pathogenesis might help improve outcomes of the patients. HIV infection has been associated with increased oxidative stress, but its relationship with the development of non-AIDS events has not been explored. We assessed the association between F2-isoprostanes and serious non-AIDS events, and whether they improve the predictive performance of inflammation and coagulation biomarkers. Methods: Prospective cohort linked to a centralized BioBank where blood samples are archived at entry, and annually/biannually thereafter. The study population included all patients with available blood samples at the BioBank. Patients who had an incident serious non-AIDS event and a random group of patients with no events during the same period were selected. Measurement of F2-isoprostanes, highly-sensitive C-reactive protein (hsCRP), interleukin-6, D-dimer, sCD14, sCD40, sCD163 and neopterin levels was performed in successive plasma samples. Adjusted analyses controlled for age, sex, CD4 cell count, HIV RNA and HCV coinfection were carried out. Results: Biomarkers were measured in 78 patients developing serious non-AIDS events or death, and 388 patients with no events. Adjusted levels of F2-isoprostanes, and also of hsCRP, interleukin-6, sCD14 and D-dimer were higher in patients who developed serious non-AIDS events, including or not non-AIDS deaths. The same results were observed when only samples from patients with virological suppression were analyzed. The additive incorporation of each biomarker, ending with F2-isoprostanes, in an adjusted model was associated with a graded and significant increase in the quality of model fitting, and 95.27% sensitivity, 49.56% specificity and 0.86 accuracy to predict serious non-AIDS events. Conclusion: Oxidative stress is associated with a higher risk of serious non-AIDS events, including non-AIDS deaths. This effect is independent and additive to biomarkers of inflammation, monocyte activation and coagulation. Our results suggest that oxidative stress should be included among mechanisms to deal with to improve outcomes of HIV- infected patients.

Poster and Themed Discussion Abstracts

648 INFLAMMATION BIOMARKERS PREDICT CLINICAL TREATMENT FAILURE IN HIV-INFECTED ADULTS Rupak Shivakoti 1 , Nikhil Gupte 2 , Sandy Pillay 3 , Cynthia Riviere 4 , Sandra W. Cardoso 5 , Ashwin Balagopal 1 , Richard Semba 1 , Thomas Campbell 6 , Amita Gupta 1 , for the NWCS 319 and ACTG 5175 PEARLS StudyTeam

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