CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

Conclusion: Prevalent OLD was associated with older age, current smoking and higher CRP levels; but not CD4 count, VL and ART; in HIV-infected South African adults. Even modest smoking impairs lung function; better understanding of the long term effects of TB, smoking and inflammation on lung function in HIV-infected populations is urgently needed.

Poster and Themed Discussion Abstracts

658

CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND MORTALITY IN HIV Matthew Triplette 1 , Sheldon T. Brown 2 , Matthew B. Goetz 3 , Joon W. Kim 4 , Maria Rodriguez-Barradas 5 , Guy W. Soo Hoo 3 , Cherry Wongtrakool 6 , Kathleen Akgün 7 , Amy Justice 8 , Kristina Crothers 1 1 Univ of Washington, Seattle, WA, USA, 2 James J. Peters VA Med Cntr, Bronx, NY, USA, 3 VA Greater Los Angeles Hlth Care System, Los Angeles, CA, USA, 4 James J. Peters VA Med Cntr, Bronx, NY, USA, 5 Baylor Coll of Med, Houston, TX, USA, 6 Emory Univ, Atlanta, GA, USA, 7 Yale Univ, New Haven, CT, USA, 8 VA Connecticut Hlthcare System, West Haven, CT, USA Background: Aging HIV-infected (HIV+) individuals face an increased burden of multimorbidity, including chronic obstructive pulmonary disease (COPD), which is associated with frailty and decreased physical function in those with HIV. However, the impact of COPD on mortality in HIV+ patients is unclear. We determined the association between COPD, defined by pulmonary function tests (PFTs) and chest CT scans, with mortality using data from the Examinations in HIV Associated Lung Emphysema (EXHALE) study, a substudy of the Veterans Aging Cohort Study (VACS). Methods: EXHALE enrolled 196 HIV+ and 165 uninfected smoking-matched subjects between 2009-2012. Subjects underwent baseline PFTs (spirometry and diffusing capacity [DLCO]) to define COPD and chest CT scans to define emphysema both by semi-quantitative ( ≤ or >10% lung involvement) and quantitative methods (% low attenuation areas), and were followed through 9/2015. We determined associations between PFT and CT markers of COPD and emphysema with mortality using multivariable Cox regression models, adjusting for smoking pack-years, demographics and the VACS Index, which predicts mortality and incorporates age, CD4 count, HIV RNA level, hepatitis C infection, and measures of organ dysfunction (hemoglobin, FIB-4, eGFR). Results: The mortality rate was 2.9 per 100-person-years among HIV+ subjects compared to 1.6 per 100-person-years among uninfected (p=0.07). The median follow-up time was 64 months (IQR 47-73), and was similar by HIV status. In multivariable models, lower forced expiratory volume in 1 second (FEV1), DLCO, and radiographic emphysema were associated with increased mortality in HIV+ subjects (Table). HIV+ subjects with airflow obstruction consistent with COPD had 2.9 times the risk of death (HR 2.9 [95% CI 1.1-7.6]), compared to those without; those with >10% emphysema had 3.0 times the risk of death (HR 3.0 [95% CI 1.1-8.0]) compared to those with ≤10% emphysema. While these markers were not associated with mortality in the uninfected, formal tests of interaction between HIV status and these markers did not reach significance. Conclusion: Markers of COPD were associated with greater mortality in HIV+ subjects, independent of the VACS Index. COPD may be an important contributor to mortality in HIV+ patients in the antiretroviral therapy era, and may have a different impact in HIV+ and uninfected patients. Further studies are needed to identify ways to improve outcomes of HIV+ patients with COPD and mitigate decline in pulmonary function.

CROI 2017 283