CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

686 PREVALENCE AND RISK FACTORS OF RENAL INJURY IN OPTION B+ DURING THE FIRST 6 MONTHS Caroline Melhado , Jacob Phulusa, Mathius John, Allan Jumbe, Bryna Harrington, Bryan Mthiko, Mina C. Hosseinipour, for the S4Team Univ of North Carolina Proj–Malawi, Lilongwe, Malawi

Poster and Themed Discussion Abstracts

Background: HIV-positive pregnant women in the Option B+ program are routinely initiated on Tenofovir/Lamivudine/Efavirenz (TDF/3TC/EFV) therapy without renal monitoring despite the potential for renal toxicity due to TDF. Physiological changes in kidney function during pregnancy might underestimate the prevalence of baseline kidney injury as measured by creatinine clearance (CrCl). We estimated the prevalence and risk factors for renal injury in the first 6 months of treatment to assess the need for monitoring renal function in the Option B+ population. Methods: We analyzed data from newly diagnosed HIV-positive pregnant women initiating TDF/3TC/EFV. Participants were recruited at a government antenatal clinic in Lilongwe, Malawi as part of a prospective observational cohort study on Option B+. Renal function was assessed by measuring serum creatinine with estimation of CrCl via the Cockroft-Gault equation and proteinuria by urine dipstick at first visit, 3 and 6 months. Demographics and baseline laboratory evaluations were used for a multivariable logistic regression of a priori identified risk factors for six month renal injury. Results: A total of 246 women were enrolled and 210 (85.4%) had evaluable data at 6 months (36 were lost to follow-up (17) or had no six month labs (19)). Participants had a median age of 30.0 years (IQR 27-35), a median BMI of 24.2 (IQR 22.4 -26.7), a median CD4 count of 356/uL (IQR 231-531) and a median hemoglobin of 11.1 g/dL (IQR 10.2-11.8). At enrollment 99.6% had a normal CrCl (>90ml/min), 13.9% had mild proteinuria (30-99 mg/dl) and 5.8% had moderate proteinuria (>100 mg/dl). Controlling for delivery status, the mean CrCl from enrollment to six months decreased by 42.4 ml/min (p <0.005, CI 36.4-49.0). Anemia, BMI, CD4 count and proteinuria were not significantly associated with a CrCl < 90 ml/min at six months. Conclusion: The low baseline prevalence of kidney injury in HIV positive pregnant women in Option B+ supports the public health approach of rapid initiation of TDF-based therapy in absence of monitoring. While CrCl might be falsely elevated during pregnancy and decline substantially after delivery, the vast majority of women remained with normal kidney function at six months. No asymptomatic woman experienced treatment limiting renal toxicity. No risk factors for renal injury were identified. Clinical monitoring is likely sufficient to ensure safety in this population.

687 PREDICTORS OF CKD AND UTILITY OF RISK-PREDICTION SCORES IN HIV-POSITIVE INDIVIDUALS Emily Woolnough 1 , Jennifer Hoy 1 , Allen Cheng 1 , Rowan G. Walker 1 , Anastasia Chrystostomou 1 , Ian Woolley 1 , Freya Langham 1 , Michael Moso 1 , Achini Weeraratne 2 , Janine M. Trevillyan 1 1 Alfred Hosp, Melbourne, Australia, 2 Monash Univ, Melbourne, Australia Background: Management of HIV-positive individuals with borderline estimated glomerular filtration rates (eGFR) is clinically challenging. This study aimed to identify factors associated with development of chronic kidney disease (CKD), and to validate existing risk prediction scores in individuals with eGFR >60ml/min at baseline. Methods: This retrospective cohort study included HIV-positive individuals managed at The Alfred Hospital, Melbourne Australia, with a baseline visit between June 30 2008 and December 31 2009 (n=749). Data was collected from an HIV database and a manual review of electronic records. Individuals with an eGFR <60ml/min at baseline or <5 eGFR results were excluded. CKD was defined as ≥2 consecutive eGFR results <60ml/min sustained for 90 days. Linear regression models were constructed for change in eGFR over time and the lowest and highest terciles of slope were compared. The performance of CKD scores proposed by the D:A:D Study Group (PLoS Med 2015) and Scherzer et al. (AIDS 2014) were estimated by the area under the ROC curve. Results: Participants were predominantly male (n=680, 91%) with a median age 46 (IQR 39, 53) years, time since HIV diagnosis 10 (4, 18) years, nadir CD4 count 153 (48, 261) cells/ µL, and current CD4 count 484 (297, 691) cells/µL. 63.4% had an HIV viral load <50 copies/µL, with 87.3% currently on antiretroviral therapy (55.9% on tenofovir DF). At baseline the median eGFR was 106ml/min (95, 116). Thirty-seven (4.9%) developed new CKD, at a median 4.7 (2.2, 6.2) years. Factors associated with development of CKD were baseline eGFR 60-90 (vs eGFR 90-120: HR 11.7, 95% CI: 5.7, 24.2), diabetes (HR 4.9, 95% CI: 2.1, 11.1), proteinuria (HR 3.2, 95% CI: 1.7, 6.3), and age >60 years (vs age 35-49, HR: 6.3, 95%

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