CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

Poster and Themed Discussion Abstracts

697 CHANGES IN LIVER STEATOSIS AFTER SWITCHING EFAVIRENZ TO RALTEGRAVIR: THE STERAL STUDY

Juan Macías 1 , Dolores Merino 2 , Francisco Téllez 3 , Federico Pulido 4 , Juan González-Garcia 5 , Manuel Márquez 6 , Antonio Rivero 7 , María Mancebo 1 , Juan A. Pineda 1 , for the RIS-HEP09 1 Hosp Univ de Valme, Sevilla, Spain, 2 Complejo Hospario Univ de Huelva, Huelva, Spain, 3 Hosp Univ de Puerto Real, Cádiz, Spain, 4 Hosp 12 de Octubre, Madrid, Spain, 5 Hosp Univ La Paz, Madrid, Spain, 6 Hosp Virgen de la Victoria, Málaga, Spain, 7 Hosp Univ Reina Sofia, Cordoba, Spain Background: Hepatic steatosis (HS) is a cause of liver disease. In addition, steatohepatitis can induce liver fibrosis and accelerate fibrosis progression associated with HCV. As a consequence, the effects of antiretroviral drugs less likely to induce increases in HS in HIV/HCV coinfection need to be investigated. Because of this, we aimed at comparing the impact of switching from efavirenz (EFV) plus two nucleoside analogs (nucs) to rategravir (RAL) plus two nucs versus continuing with EFV plus two nucs on HS among HIV/HCV- coinfected patients. Methods: This was a phase IV, open-label, randomized clinical trial (ClinicalTrials.gov: NCT01900015). HIV-infected patients, with or without detectable plasma HCV RNA, on current EFV plus two nucs were randomized 1:1 to switch EFV to RAL (400 mg BID), maintaining nucs unchanged, or to continue with EFV plus two nucs. At baseline (BL), eligible patients should show controlled attenuation parameter (CAP) values ≥238 dB/m, i.e. significant HS. Changes in HS were measured using CAP at BL, 24 and 48 weeks of follow-up. Results: In this interim analysis, 37 patients, 19 subjects randomized to RAL and 18 to EFV, have reached 48 weeks of follow-up. The proportion of men for RAL vs. EFV groups at BL were 90% vs. 83% (p=0.939). BL HCV RNA was detectable in 74% individuals switched to RAL vs. 67% subjects continuing on EFV (p=0.874). HIV viral load was undetectable at BL in 100% for the RAL group and 94% for the EFV group (p=0.515). The BL median (Q1-Q3) values for RAL vs. EFV group were: Age, 52 (45-55) vs. 48 (47-52) years (p=0.233); body mass index, 27 (23.9-29.5) vs. 25 (23.7-26.6) Kg/m2 (p=0.503); CD4 counts, 556 (342-856) vs. 582 (371-774) cells/mcL (p=0.684); HOMA, 2.4 (1.8-4) vs. 2.2 (1.8-5.4) (p=0.949); CAP, 273 (246-303) vs. 258 (247-287) dB/m (p=0.374); liver stiffness, 6.6 (5.3-10.9) vs. 6.7 (3.8-8.4) KPa (p=0.391). The median (Q1-Q3) of the difference in CAP values between baseline and 48 weeks (∆CAP) was -20 (-67, 15) dB/m for the RAL group and 28.5 (-18.8, 47.8) dB/m for the EFV group (p=0.019). The proportion of patients with CAP <238 dB/m at 48 weeks was 9 (47%) for the RAL arm vs. 3 (17%) for the EFV arm (p=0.049). Conclusion: After 48 weeks, HIV-infected individuals switching from EFV to RAL showed decreases in the degree of HS, as measured by CAP, compared with those continuing with EFV. In addition, the proportion of patients without significant HS after 48 weeks was greater for those who switched from EFV to RAL. 698 OBESITY IN ANTIRETROVIRAL-TREATED HIV-INFECTED ADULTS: PREDICTORS AND COMORBIDITIES Anchalee Avihingsanon 1 , Sivaporn Gatechompol 1 , Opass Putcharoen 2 , Jiratchaya Sophonphan 1 , Supalak Phonphithak 1 , Sasiwimol Ubolyam 1 , Stephen J. Kerr 1 , Kiat Ruxrungtham 2 , Praphan Phanunphak 1 , for the HIV-NAT 006 1 HIV-NAT, Thai Red Cross AIDS Rsr Cntr, Bangkok, Thailand, 2 Chulalongkorn Univ, Bangkok, Thailand Background: Obesity predisposes to cardiovascular disease, insulin resistance, and type 2 diabetes. At the same BMI as Caucasians, Asians have a higher percentage of visceral fat with proportionately higher obesity associated mortality. We therefore determined the prevalence, predictors and outcomes of obesity among 1412 HIV-infected patients on ART for a median of 11 years. Methods: A prospective cohort study was conducted between July 1996-August 2016 in Bangkok, Thailand. Asian criteria of obesity were used as follows: underweight (<18.5 kg/m2), normal (18.5-22.9 kg/m2), overweight (23-24.9 kg/m2) and obese (>25 kg/m2). Liver fibrosis was assessed by Fibroscan; 10 year cardiovascular risk was assessed by Framingham score. A multivariate GEE was used to calculate Odds Ratios (OR) and 95% confidence intervals (95% CI) for factors associated with developing obesity, adjusting for variables significant in univariate analysis at P <0.1. Results: The majority of participants (62.7%) were male. The prevalence of normal BMI, overweight and obesity at last visit was 49%, 22%, and 21%, respectively. Obesity increased from 12.9% before ART to 21.4% at last visit. Compared to normal BMI, the obese group had lower VL efficacy (<50 copies/mL) (87% vs 93%, p=0.03), higher diabetes mellitus (17% vs 7%, p=0.003), hypertension (43% vs 15%, p <0.001), advanced liver fibrosis ( >9.5 KPa; 24% vs 5%, P<0.001), metabolic syndrome (54% vs 16%, p<0.001), dyslipidemia (76% vs 68%, P=0.005), central obesity (98% vs 24%, p<0.001), higher Framingham scores (9.9 vs 5.4, <0.001) and higher 10 year cardiovascular risk (21% vs 14%, p<0.001). In multivariate analysis, higher baseline BMI, ever smoked, triglycerides >150 mg/dL, HDL<40 mg/dL, Age >40 years, fasting glucose >100 mg/dL, baseline CD4< 350 cells/mm3, lipodystrophy, ever taking lopinavir/r or atazanavir and abnormal waist circumference were significantly associated with developing obesity (Table). Conclusion: Obesity is highly prevalent among ART treated Thai patients and associated with higher rates of metabolic syndrome, cardiovascular risk and liver fibrosis. Relatively low VL efficacy in obesity requires further investigation. Traditional risk factors including older age, low baseline CD4, lipodystrophy and abnormal waist circumference were associated with developing of obesity. Given the strong relationships of obesity, chronic inflammation and high risk of cardiovascular disease, weight assessment and management programs should be a part of routine HIV care.

CROI 2017 305