CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

Methods: We studied HIV Outpatient Study (HOPS) patients at 8 US HIV clinics, seen during 1/1/1997 to 6/30/2015, who were followed for a minimum of 5.0 years with ≥75% of observation time having viral load (VL) <200 copies/mL and on ART. In stratified analysis (by age at last observation:18-40, 41-50, 51-60, >61 years), we assessed number and types of NACMs documented in medical records anytime during HOPS observation and evaluated for differences in NACM prevalence and type by age group, sex, race, insurance type, HIV risk and HIV clinical factors. NACMs included were cardiovascular disease, cancer, hypertension, diabetes, dyslipidemia, arthritis, chronic HBV or HCV infection, anemia, and psychiatric illness. Results: Of 1540 patients, there were 1247 (81%) men, 406 (26%) non-Hispanic black, 183 (12%) Hispanic/Latino, 846 (55%) with private insurance, 575 (37%) with public insurance, 939 (61%) men who have sex with men (MSM), 375 (24%) heterosexuals and 125 (8%) with injection drug use history. Patients numbered 180, 502, 560, and 298, respectively, in the age strata 18-40, 41-50, 51-60, >61 years, with HOPS observation of a median of 10.8 years (range: min-max = 5.0-18.5). Mean number of NACMs increased by age category; 1.8, 2.6, 3.5, 4.3, respectively, (P<0.001). Overall prevalence of all NACMs increased with older age categories (P<0.001) except HBV and HCV infection and psychiatric illness (Figure). Significant differences (all P< 0.05) in mean number of NACMs were apparent by sex (women >men, 3.5 vs 3.1), race (blacks > non-blacks, 3.4 vs 3.1), and by insurance status (public > private, 3.9 vs 2.6). These differences were especially apparent in older age groups (51-60 and > 61 years, 3.5 and 4.3 vs 2.3 for ≤ 50 years of age), and were driven primarily by differences in specific NACMs: anemia, HCV, and diabetes. Conclusion: We observed age-related increase in prevalence of NACMs and polymorbidity, with disproportionate burden most apparent among older women, blacks, and the publicly insured. These groups should be targeted for screening and prevention strategies aimed at risk reduction and disease intervention. 664 PSYCHIATRIC DISORDERS OBSERVED IN HIV+ PATIENTS USING 6 COMMON THIRD AGENTS IN OPERA Ricky Hsu 1 , Jennifer Fusco 2 , Cassidy Henegar 2 , Felix Carpio 3 , KaramMounzer 4 , Michael Wohlfeiler 5 , Vani Vannappagari 6 , Michael Aboud 7 , Lloyd Curtis 8 , Gregory Fusco 2 1 New York Univ, New York, NY, USA, 2 Epividian, Durham, NC, USA, 3 Altamed Hlth Services, Los Angeles, CA, USA, 4 Philadelphia FIGHT, Philadelphia, PA, USA, 5 AIDS Hlthcare Fndn, Los Angeles, CA, USA, 6 ViiV Hlthcare, Rsr Triangle Park, NC, USA, 7 ViiV Hlthcare, Brentford, UK, 8 GlaxoSmithKline, Uxbridge, UK Background: Psychiatric disorders (PD) are reported frequently in people living with HIV and may be associated with specific antiretroviral (ARV) use. We sought to evaluate PD in patients (pts) taking dolutegravir (DTG)-containing regimens compared to five other widely prescribed ARVs in an observational database. Methods: Pts prescribed DTG, efavirenz (EFV), raltegravir (RAL), darunavir (DRV), rilpivirine (RPV) or elvitegravir (EVG)-based regimens for the first time in the OPERA database between 1/1/2013 and 8/15/2015 were analyzed. Each was observed from the regimen start date until regimen discontinuation, loss to follow up, death, or data freeze (8/15/2016). Events were diagnoses of anxiety, depression, insomnia, or suicidality. PD diagnoses followed by 3rd agent discontinuation within 14 days were also evaluated. Time to each of these events was described. Pairwise comparisons were made using Pearson’s chi-square or Fisher’s exact tests; Kaplan-Meier curves were compared with log-rank tests. Results: Out of 70,106 HIV+ pts in the OPERA database, 11,539 qualified for the analysis of DTG (18.9%), EFV (14.1%), RAL (7.9%), DRV (15.2%), RPV (15.2%) or EVG (28.6%)-containing regimens. History of PDs was common and not evenly distributed across groups (DTG 39.2%; EFV 23.8%, RAL 39.9%, DRV 34.0%, RPV 28.4%, EVG 30.8%). Pts prescribed DTG were significantly (p<.05) more likely to have a history of anxiety, depression, or insomnia than EFV, DRV, RPV, and EVG. History of suicidality did not differ across groups. In analyses including pts with history of PDs, pts prescribed RAL regimens experienced more PDs over follow up (21.0%) than DTG (17.6%) regimens. The other four regimens did not differ significantly from DTG (EFV 18.1%, DRV 18.2%, RPV 16.6%, EVG 19.3%). When pts with PD history were excluded, incidence of new PDs was less frequent and similar across regimens (DTG 12.8%, EFV 14.3%, RAL 14.4%, DRV 11.7%, RPV 12.8%, EVG 13.9%). Incidence of PD associated discontinuation was significantly less frequent in pts treated with DTG (0.3%) vs EFV (2.2%), RAL (1.7%), DRV (1.7%), RPV (1.0%), and EVG (0.8%). Time to PD with discontinuation was longer for pts prescribed DTG.(Figure) Conclusion: In a large cohort of HIV+ patients in care, DTG use was not associated with an increased risk of PD despite a higher rate of pts with a history of PD prior to DTG treatment. Pts prescribed DTG were less likely than those prescribed five other ARVs to discontinue their ARV regimen due to PD.

Poster and Themed Discussion Abstracts

665 FRAILTY HAS A STRONGER ASSOCIATION THAN NEUROCOGNITIVE IMPAIRMENT WITH POOR OUTCOMES

Kristine Erlandson 1 , Mona Abdo 2 , Kevin Robertson 3 , Susan L. Koletar 4 , Robert Kalayjian 5 , Babafemi Taiwo 6 , Frank J. Palella 6 , Katherine Tassiopoulos 2 , for the A5322 StudyTeam 1 Univ of Colorado, Aurora, CO, USA, 2 Harvard Univ, Boston, USA, 3 Univ of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 4 Ohio State Univ, Columbus, OH, USA, 5 MetroHlth Med Cntr, Cleveland, OH, USA, 6 Northwestern Univ, Chicago, IL, USA Background: Frailty and neurocognitive impairment (NCI) are closely-related constructs of vulnerability in older adults. We previously found that NCI was one of the strongest predictors of frailty in HIV-infected adults; however, the overlap of frailty and NCI, and their impact on poor outcomes in HIV-infected persons is unknown. Methods: Participants in a longitudinal, observational study of aging in HIV (A5322, HAILO) completed entry evaluations for: 1) frailty, defined as presence of ≥3 criteria of slow gait, weak grip, unintentional weight loss, exhaustion, and low physical activity and: 2) NCI, defined by ≥1 normalized z-score >2 SD below 0 or ≥2 z-scores >1 SD below 0 on Trailmaking A and B and the Wechsler Adult Intelligence Scale-Revised Digit Symbol tests. Outcomes of falls (any), disability (increase in number of limitations in independent

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