CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

656 THE INFLUENCE OF HIV INFECTION ON PULMONARY FUNCTION IN A RURAL AFRICAN POPULATION Alinda Vos 1 , Meri Varkila 1 , Hugo Tempelman 2 , Walter Devillé 2 , Roos Barth 1 , Diederick Grobbee 1 , Roel Coutinho 1 , Kerstin Klipstein-Grobusch 1 , for the Ndlovu Research Group 1 Univ Med Cntr Utrecht, Utrecht, Netherlands, 2 Ndlovu Care Group, Groblersdal, South Africa Background: Epidemiological data about obstructive lung disease (OLD) in HIV from Sub-Saharan Africa (SSA) are scarce, and the association between HIV-infection and OLD in SSA remains unclear. This study aimed to investigate the prevalence of OLD in HIV infection, and to determine whether HIV infection affects pulmonary function in a South African population. Methods: As part of the Ndlovu Cohort study across-sectional study was conducted in a rural area in Limpopo, South Africa. HIV-positive and HIV-negative participants, aged 18 years and older without known cardiovascular disease who attended a baseline or follow-up visit at the cohort site were invited to participate. A respiratory questionnaire and pre- and post-bronchodilator spirometry were performed. Airflow obstruction was defined as a forced expiratory volume in one second / forced vital capacity (FEV1/FVC) ratio less than the lower limit of normal. Prevalence of airflow obstruction in HIV-positive and HIV-negative individuals was calculated. Multiple regression analysis was used to investigate if HIV was independently associated with a decrease in FEV1 and FEV1/FVC, adjusted for age, sex, history of pneumonia or tuberculosis, ever smoking, occupational exposure (mining, dusty job, work with chemicals) and exposure to solid fuels. Results: 201 consecutive participants were enrolled in the study from April to May 2016;84 were HIV-positive (82.1% on antiretroviral therapy). The median age (IQR) for the study population was 38 (29-51) years. 195 participants provided acceptable pre- and postbronchodilator spirometry. Both pre- and postbronchodilator FEV1 and FEV1/FVC-ratios were significantly lower in the HIV-positive group compared to the HIV-negative group (table 1). In sex and age adjusted analysis, the prevalence of airflow obstruction was significantly higher in the HIV-positive group (n=10, 12.2%) than the HIV-negative group (n=4, 3.5%), p-value 0.010. HIV was associated with a decrease in both FEV1 (B -0.148, p 0.048) and FEV1/FVC ratio (B -0.066, p 0.003) in multivariable regression analysis adjusted for respiratory risk factors and occupational exposure. Conclusion: The prevalence of airflow obstruction was observed to be significantly higher in HIV-infection than in HIV-negative controls and HIV-infection was associated with a decrease in lung function measured by FEV1 and FEV1/FVC ratio.

Poster and Themed Discussion Abstracts

657 FACTORS ASSOCIATED WITH PULMONARY IMPAIRMENT IN HIV-INFECTED SOUTH AFRICAN ADULTS

Akshay Gupte 1 , Michelle Wong 2 , Reginah Msandiwa 3 , Grace Barnes 1 , Jonathan Golub 1 , Richard Chaisson 1 , Chris Hoffmann 1 , Neil Martinson 3 1 The Johns Hopkins Univ, Baltimore, MD, USA, 2 Univ of the Witwatersrand, Soweto, South Africa, 3 Perinatal HIV Rsr Unit, Soweto, South Africa

Background: HIV-infected individuals have increased risk of developing obstructive lung disease (OLD). While studies from developed countries report high viral load (VL), low CD4 counts, and anti-retroviral therapy (ART) to be associated with OLD, these findings may not be generalizable to populations with different socio-economic and epidemiological profiles. Methods: We conducted a prospective cohort study in Soweto, South Africa from November 2008 to May 2011 to identify factors associated with OLD and lung function decline in 753 HIV-infected black African adults (>17 years). Spirometry without bronchodilators was performed according to ATS/ERS guidelines at enrollment and repeated annually thereafter. OLD was defined as FEV1/FVC<0.70. Logistic regression models were used to identify factors associated with OLD at enrollment. Excess annual declines in FEV1 and FVC were modelled as the product-term of follow-up time and exposures using random effects regression. Results: Median (IQR) age was 36 (31-41) years and 15%were males. 30% ever-smoked; median (IQR) exposure of 3 (2-7) pack-years; and none reported exposure to biomass fuels or having worked in a mine. Median (IQR) CD4 count and VL at enrollment were 374 (263-527) cells/mm3 and 2690 (87-13486) copies/mL respectively, and 25% received ART. At enrollment, 734 (97%) participants underwent spirometry and 35 (5%) had spirometry-defined OLD (Table). Age (aOR=1.07 per year increase [95%CI 1.01-1.13], p=0.01), current smoking (aOR=4.05 [95%CI 1.33-12.36], p=0.01), and CRP (aOR=1.01 per unit increase [95%CI 1.00-1.03], p=0.03) were independently associated with OLD at enrollment; while CD4 count (aOR=1.03 per 100 cells/mm3 increase [95%CI 0.86-1.24], p=0.67), VL (aOR=0.76 per log increase [95%CI 0.49-1.19], p=0.23), ART (aOR=0.57 [95%CI 0.18-1.84], p=0.35) and history of TB/PCP (aOR=0.35 [95%CI 0.05-2.10], p=0.25) were not. Median (IQR) participant follow-up was 12 (6-24) months. History of TB was independently associated with greater declines in FEV1 (45 mL/year excess loss [95%CI 7-83], p=0.01) and FVC (64 mL/year excess loss [95%CI 18-110], p=0.006); while smoking, CD4, VL, ART and CRP were not.

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