CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

1 Univ of California at San Francisco, San Francisco, CA, USA, 2 Univ of South Carolina, Columbia, SC, USA, 3 SUNY Downstate Med Cntr, Brooklyn, NY, USA, 4 Stroger Hosp, Chicago, IL, USA, 5 The Johns Hopkins Univ, Baltimore, MD, USA, 6 Univ of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 7 Georgetown Univ, Washington, DC, USA, 8 Univ of Alabama at Birmingham, Birmingham, AL, USA Background: Food insecurity – or lack of access to sufficient quantity or quality of food – is associated with poor control of diabetes mellitus (DM) in the general United States (US) population. Women with HIV are at high risk for both food insecurity and type 2 DM, but no studies have examined the association between food insecurity and DM control among women or among people with HIV. We hypothesized that food insecurity would be associated with poor DM control, modified by HIV status. Methods: We analyzed longitudinal data (2013-2016) from the Women’s Interagency HIV Study (WIHS), a national study of US women with or at risk for HIV. We assessed associations between a validated measure of food insecurity and laboratory measures of DM control obtained via blood draw. Outcomes included a) fasting glucose (FG) (mg/dL) and optimal FG (70-130 mg/dL), to capture current DM control, and b) hemoglobin A1c (HbA1c) (%) and optimal HbA1c (<7%), to capture longer term DM control. We modeled the association between change in food insecurity and change in DM control using linear and logistic regression with random effects for continuous and dichotomous outcomes, respectively, controlling for age, race/ethnicity, income, health insurance, parity, and diabetes medication use. We also tested whether HIV status modified the association between food insecurity and DM control. Results: The analysis included 495 women with DM (67%with HIV). Marginal, low, and very low food security affected 13.5%, 13.3%, and 11.5% of women, respectively. Mean FG was 138 mg/dL and mean HbA1c was 7.2%. Almost two-thirds had optimal FG (61%) and optimal HbA1c (65%). In adjusted models, very low food security was associated with 18.5 mg/dL higher FG (p<0.01) and 60% lower odds of optimal FG (AOR: 0.40; 95% CI 0.20, 0.83; p<0.05), compared to food security. Furthermore, very low food security was associated with 0.33 percentage points higher HbA1c (p<0.01) and 68% lower odds of optimal HbA1c (AOR: 0.32; 95% CI 0.13, 0.75; p<0.01), compared to food security. We found no effect modification by HIV status. Conclusion: Food insecurity was longitudinally associated with multiple measures of poor DM control among women with or at risk for HIV. These results suggest food security should be addressed as part of optimal DMmanagement for women, including in the context of HIV care. Future studies should test the impact of food security interventions on DM health among women with or at risk for HIV.

Poster and Themed Discussion Abstracts

691 ADIPOSE MITOCHONDRIAL FUNCTION, ADIPONECTIN, AND INSULIN RESISTANCE IN ACTG A5224S Todd Hulgan 1 , Benjamin Ramsey 2 , John R. Koethe 1 , David C. Samuels 1 , Mariana Gerschenson 3 , Daniel Libutti 3 , Grace A. McComsey 4 , Paul E. Sax 5 , Todd Brown 6 , for the AIDS Clinical Trials Group Study A5224sTeam 1 Vanderbilt Univ, Nashville, TN, USA, 2 Univ of South Carolina, Greenville, SC, USA, 3 Univ. of Hawaii-Manoa, Honolulu, HI, USA, 4 Case Western Reserve Univ, Cleveland, OH, USA, 5 Brigham and Women’s Hosp, Boston, MA, USA, 6 The Johns Hopkins Univ, Baltimore, MD, USA Background: Some antiretroviral therapy (ART) and HIV itself confer a risk of metabolic effects which may be related to alterations in mitochondrial (mt) function and adipokine expression. ACTG study A5224s found that adipose mtDNA levels decreased in HIV+ persons starting ART, and electron transport chain complex I (CI) and IV (CIV) activity decreased in those starting tenofovir (vs. abacavir)-based regimens. A separate study found an association between a non-synonymous mtDNA mutation in CI (10398A>G encoding NADH dehydrogenase subunit 3) and decreased adiponectin on ART. We hypothesized that HIV+ persons with decreased adipocyte mt function on ART will have corresponding reductions in adiponectin and insulin sensitivity, and that these changes would be influenced by mtDNA mutation 10398G. Methods: Analyses included A5224s data on adipose mtDNA levels, CI and CIV activity by immunoassay, visceral abdominal tissue (VAT) by CT scan, and fasting serum glucose at week 0 and 96 of ART. The 10398G mtDNA variant was available from GWAS data. Fasting insulin and adiponectin were measured from cryopreserved serum using multiplex bead array. Insulin resistance and β-cell function were estimated by HOMA-IR and HOMA-B, respectively. Spearman correlation and single-covariate linear regression were performed. Results: 39 participants had week 0 and 96 adipose biopsies: median age was 39 years; body mass index (BMI) 25.7kg/m2; and adiponectin 7077ng/ml. Percent decreases in CIV activity and adiponectin over 96 weeks were correlated (Spearman rho 0.40; P=0.02; N=35). This association persisted after adjusting for age, sex, BMI, or VAT in separate regression analyses. Percent decrease in CIV activity correlated with increases in HOMA-IR (rho -0.44; P=0.01; N=33) and HOMA-B (rho -0.36; P=0.04; N=33). These relationships were less robust after adjusting as above (P=0.05-0.07). Among 12 non-Hispanic white participants, mtDNA 10398G was associated with change in adiponectin (P=0.048), but not HOMA; participants with the 10398G mutation had a median decrease in adiponectin over 96 weeks (-1552ng/mL) while those with 10398A had a median increase (+2555ng/mL). This difference remained statistically significant after adjusting for age, sex, BMI, or VAT. Conclusion: These analyses suggest that decreased adipose mt CIV activity after ART initiation is related to changes in adiponectin and glucose homeostasis, and support prior findings that a common mtDNA mutation in CI influences adiponectin levels on ART. 692 PLASMINOGEN ACTIVATOR INHIBITOR-1 PREDICTS REDUCED INSULIN SENSITIVITY IN HIV Kamonkiat Wirunsawanya 1 , Dominic Chow 1 , Loni Belyea 1 , Cecilia Shikuma 1 , Richard MWatanabe 2 , Lindsay Kohorn 1 , Bruce Shiramizu 1 , Brooks Mitchell 1 , Scott A. Souza 1 , Lishomwa Ndhlovu 1 1 Univ of Hawaii, Honolulu, HI, USA, 2 Univ of Southern California, Los Angeles, CA, USA Background: HIV-infected individuals despite long-term suppressive antiretroviral therapy (ART), remain at high risk for cardio-metabolic complications. None of studies have investigated plasma soluble biomarkers including plasminogen activator inhibitor type 1 (PAI-1) as a potential predictor of the development of insulin resistance (IR) in HIV. Here we assessed several soluble biomarkers to better document the development of IR among chronic HIV-infected adults on ART.

CROI 2017 302